Vascular endothelial growth factor is a strong predictor of early distant recurrences in a prospective study of premenopausal women with lymph-node negative breast cancer

We investigate the prognostic significance of the pro-angiogenic cytokine vascular endothelial growth factor (VEGF), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1), and S-phase fraction (SPF) for distant disease free survival (DDFS) in 219 premenopausal patients with node-negative breast cancer (NNBC). In univariate analysis significantly shorter DDFS was observed for patients with high VEGF (p=0.006), high uPA (p=0.001), and high SPF (p<0.001). The prognostic significance of VEGF varied over time being very strong for early relapses (0-2.25 years follow-up) (HR=7.9; p=0.006) while no difference was seen in the subsequent follow-up period (HR=1.3; p=0.62). In a series of bivariate analyses VEGF provided prognostic information during the whole observation period (0-72 months) in addition to age, tumour size, oestrogen receptor (ER), progesterone receptor (PgR), and uPA. Also this effect was more pronounced during the first follow-up period suggesting VEGF as a marker of early recurrences.     

Clinicians' views on clinical examination and treatment of children and adolescents with obsessive-compulsive disorder (OCD). A Danish national survey study

Obsessive-compulsive disorder (OCD) is a frequently encountered disorder in children and adolescents. Several characteristics make the disorder a challenge to diagnostic methods and treatment procedures including the diversity of symptoms, the delay of referral and the occurrence of comorbidity. The aim of the present study was to examine how recent progress in assessment and treatment has influenced the Danish clinicians in their work with children and adolescents with OCD. The study was conducted as a national survey addressing a total of 14 outpatient children and adolescent departments, and 25 medical specialists in private practice. The clinicians received a questionnaire including general and specific questions on assessment scales and treatment methods towards OCD and their view on treatment efficacy and prognosis. A total of 71.8% responded to the questionnaire. Most clinicians reported the use of a general medical and social history combined with the use of OCD-specific checklists. Treatment procedures included medication, cognitive therapy or cognitive-behavioural therapy and a family approach depending on the age of the patient. Eighty-one per cent of the clinicians reported a good or very good effect of treatment. Clinical Global Improvement ratings of the last treated patient indicated a treatment response of 68.8% and a response on general improvement of 59.4%. In conclusion, the present study shows that treatment methods employed towards children and adolescents with OCD are close to the clinical recommendations and comparable with those employed in other countries. Furthermore, the general opinion of clinicians towards OCD is comparable with that described in the literature. However, a discussion of the choice of recommended assessment methods including the use of both specific and general checklists is warranted.     

Recent developments in the understanding and management of functional somatic symptoms in primary care

PURPOSE OF REVIEW: Medically unexplained or functional somatic symptoms are prevalent in primary care, but general practitioners commonly find them difficult to treat. We focus on the conceptual issues and treatment from a primary care perspective, although the field is difficult to review because of the inconsistency and multiplicity of terminology used by different authors and specialties. RECENT FINDINGS: The training of general practitioners in management techniques has been hampered by an obsolete theoretical framework and outdated diagnostic systems. Epidemiological studies, however, indicate that valid, empirically based diagnostic criteria for functional disorders may be developed. Management studies in primary care have shown disappointing effects on patient outcome, but a lot may be gained by making the training programmes more sophisticated. Recently, stepped care approaches have been introduced but they need scientific evaluation. SUMMARY: There is an immediate need for a common language and a theoretical framework of understanding of functional symptoms and disorders across medical specialties, clinically and scientifically. Any names that presuppose a mind-body dualism (such as somatization, medically unexplained) ought to be abolished. The overall ambition for treatment is to offer patients with functional somatic symptoms the same quality of professional healthcare as we offer any other patient.