Clinical presentation of carcinoma of unknown primary: 14 years of experience

A carcinoma of unknown primary (CUP) is a histologically confirmed metastatic cancer without a definitive primary site after performing a detailed medical examination. The purpose of the study was to classify unfavorable CUPs into more reliable disease entities, which reflect the clinical course. We reviewed the medical records of patients diagnosed with a CUP between January 1995 and March 2008. Patients were classified into a conventional favorable-risk group and a newly proposed unfavorable-risk group according to the clinicopathologic features. Five hundred eighty-six patients were diagnosed with CUPs. Fifty-six (9.6%) patients were classified in the conventional favorable-risk group, and 486 (82.9%) patients were classified in the unfavorable-risk group. We further classified the 486 patients into six subgroups with an unfavorable risk, while excluding 29 patients (5.0%) who were not classifiable. The overall survival of the conventional favorable-risk group was 47.0 months (95% CI, 11.1~82.9 months), which was significantly longer than that of any subgroup of the newly proposed unfavorable-risk group (P?<?0.001). Patients with squamous cell carcinoma in the abdominopelvic cavity showed similar overall survival with unfavorable-risk group (P?=?0.484). Women with non-papillary malignant ascites had a survival in between the favorable and unfavorable groups (P?<?0.001). The newly proposed unfavorable-risk group may assist in classifying CUP patients with an unfavorable risk in a clinically more meaningful way. Squamous cell carcinoma in the abdominopelvic cavity should be considered in the unfavorable-risk group and women with non-papillary malignant ascites in an intermediate-risk group. Further studies with molecular profiling would help in classifying and treating patients with CUPs and an unfavorable risk.     

Implication of soluble and membrane HLA class I and serum IL-10 in liver graft acceptance.

Membrane HLA class-I expression (mHLA-I), soluble HLA class-I antigens (sHLA-I) and interleukin (IL)-10 are different factors implicated in the special acceptance of liver allograft. In this study, pre- and post-operative levels of mHLA-I in peripheral blood lymphocytes (PBL) and serum sHLA-I were analyzed in 86 liver transplants, immunosuppressed with Cyclosporine-A, methylprednisolone and azathioprine, and classified into acute-rejection (AR, n = 28) and non-acute-rejection (NAR, n = 58) groups. Serum IL-10 was studied in 47 recipients (AR-group, n = 16 and NAR-group, n = 31). Pre-transplant values of mHLA-I and sHLA-I showed a bimodal distribution (high/low) in NAR-recipients, but in AR-patients were mainly included in the low expression/secretion zone (mHLA-I, p < 0.02 and sHLA-I, p < 0.05). Consequently, average pre-transplant mHLA-I (868 +/- 109 versus 998 +/- 123, p < 0.05) and sHLA-I (1.3 +/- 0.4 versus 2.02 +/- 0.7 microg/ml, p < 0.01) was lower in the AR- than in the NAR-group. After transplant both parameters decreased in the NAR-group, but increased in AR-recipients previous to and on rejection diagnosis day. Additionally, serum IL-10 levels were significantly higher (p < 0.01) in the NAR than in the AR-group during the first 24 h post-transplant. In conclusion, low pre-transplant mHLA-I and sHLA-I levels pre-dispose liver recipients to acute rejection, whereas early post-transplant increases of serum IL-10 appear to be related to a good liver allograft acceptance.     

A structural equation model for predictors of mental and physical health in women]

OBJECTIVE: To measure the extent to which stress, social support, and self-esteem are predictors of an individual's mental and physical health. Structural equations were integrated with previously-estimated partial models, which simplify the relationships among variables. METHODS: The study sample included 283 women with children. All of the participants resided in the municipality of General Escobedo, state of Nuevo León, Mexico. The surveys were carried out in the second semester of 2003, in the participants homes, using self-evaluation questionnaires to measure each of the variables included in the model. Each participant completed the questionnaire in one sitting. Results were analyzed with AMOS 5.0, employing the maximum likelihood method, often utilized in structural equation models. RESULTS: The results indicate an acceptable adjustment in the proposed model: (chi2/gl=3.03, goodness of fit (GFI)=0.894, adjusted goodness of fit (AGFI)=0.848, root mean square error of approximation (RMSEA)=0.08, incremental fit index (IFI)=0.910). Variances were 31.9% with regard to stress, 27.4% with regard to physical health, and 72.1% with regard to mental health. CONCLUSIONS: Social support and self-esteem are predictors of stress; age and stress are predictors of physical health; and stress, self-esteem, and physical health are predictors of mental health.     

Participación del paciente en la toma de decisiones en atención primaria: una herramienta para su medición

ObjectivesThis work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings.DesignCross-sectional, development of a measurement tool.SettingPrimary care clinics.ParticipantsFamily doctors and residents.InterventionsBased on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement.Main measurementsThe involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process.ResultsSome degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96.ConclusionsThe levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care.     

Chick kainate binding protein lacks GTPase activity.

Chick kainate binding protein was solubilized from cerebellar membranes and purified (x19) by use of two chromatographic steps. Measurements of [3H]kainate binding and GTPase activity in the different fractions reveal a consistent decrease of GTPase activity as the purification proceeds so that no GTPase is detectable after the final purification step. This fact, in the context of the differential involvement in nucleotide recognition of some critical amino acid residues in the p-loop motif of GTPases and in the guanine nucleotide-binding sequence of ionotropic glutamate receptors, together with significant discrepancies concerning the activity of individual nucleotides, suggests that both guanine nucleotide-recognizing sequences are unlikely to be alternative expressions of the same functional domain.     

Tratamiento radioterápico exclusivo en el carcinoma del pabellón auricular. Análisis de una serie de 104 casos

We assessed the role of the radiation therapy as the exclusive treatment of the epithelial tumours of the pinna, evaluating the control disease, the rate of late complications and the cosmetic results. One hundred and four patients with epidermoid carcinoma of the pinna and radical treatment with radiotherapy were analyzed retrospectively. 53 (51%) were squamous cell carcinoma and 51 (49%) basocelular carcinoma. Classification according to tumours size was as follows: ≤1 cm, 22 (21.2%); 1–2 cm, 47 (45.2%); 2–3 cm, 19 (18.3%), and >3 cm, 11 (10.6%). Eighty eight patients (84.6%) were treated with⁶⁰Co, 15 (14.4%) with ortovoltage and one patient with 9 MeV electron. The median follow up is 55 month (14–257). The local control, complication like condritis, condronecrosis and audition damage, and the cosmetic result were the factors analyzed. The 5 and 10 years actuarial local control rate is 89.8% and 87.6%, respectively. In an univariate analysis including variables like size, localization, histologic type, differentiation grade, energy type, irradiation technique, doses and response to treatment, the bad prognostic factors regarding to local control, were found to be the size (>3 cm) (p=0.013), localization (posterior sulcus) (p=0.012) and response to treatment (not complete) (p=0.046). In a multivariate analysis only the size showed this tendency (p=0.05). After the intent of rescue in the 11 patients that failed locally, the final local control rate was 95.19% (99/104). Four patients with squamous cell carcinoma had nodal regional recurrence, which didn't occur in the patients with basocelular carcinoma. Eight (7.7%) patients presented some degree of condritis, which was resolved medically in all the cases except one patient that evolved to condronecrosis. The cosmetic results in the 76 patients evaluated was excellent in 53 (69.7%) and acceptable in 12 (22.6%). Radiotherapy is recommended for treatment of the epithelial tumour of the pinna, mainly in tumors less than 3 cm, getting local control rate similar to surgery but avoiding its cosmetic and functional sequelae.