Incidence, Therapy and Prognosis of Colorectal Cancer in Different Age Groups

PURPOSE: Determination of frequency, treatment modalities used and prognoses of colorectal cancer in a population-specific analysis in relation to age. MATERIAL AND METHODS: In 1999 and 2000, 644/6,016 patients were documented as having colorectal carcinomas in the Cancer Registry of Rostock. 39 patients were excluded (16 cases: "in situ" carcinomas; 23 cases: insufficient data). Three age groups were formed: < 60 years, 60-74 years; > or = 75 years. RESULTS: The relative percentage of colorectal cancer increases with advanced age (< 60 years 7%; 60-74 years 12%, > or = 75 years 15%; p < 0.001).In older patients with stage III carcinomas, adjuvant treatment was done less frequently in accordance with the treatment recommendations (< 60 years 83-89%; 60-74 years 67-77%; > or = 75 years 29-36% according to stage and tumor localization); in stage IV, the use of chemotherapy was reduced (< 60 years 87.5-100%; 60-74 years 38-47%; > or = 75 years 33-37%).In the univariate analysis, age > or = 75 years (4-year survival rates: < 60 years 68 +/- 4.1%; 60-74 years 58 +/- 2.8%; > or = 75 years 38 +/- 3.7%), UICC stage and surgical treatment had a significant effect on prognosis. Adjuvant treatment had no significant effect on the whole population but on patients with UICC stage III and IV. In the multivariate analysis, however, the only independent prognostic parameters were age > or = 75 years (p = 0.001), performance of chemotherapy (colon cancer) or radiochemotherapy (rectal cancer; p = 0.004-0.001), and tumor stage (p = 0.045-0.001). Sex (p = 0.063) and age between 60 and 74 years (p = 0.067) had a borderline influence. CONCLUSION: With increasing age, there is a departure in daily practice from the treatment recommendations. The patient's prognosis is dependent upon age (especially > or = 75 years), tumor stage, and therapy.     

Transesophageal echocardiography as a guide for patient positioning before neurosurgical procedures in semi-sitting position

With an incidence of a patent foramen ovale in nearly one fourth of the normal population, neurosurgical procedures in the semi-sitting position are associated with the risk of paradoxical air embolism. The present study was undertaken to evaluate an anesthetic concept to detect a patent foramen ovale with the help of transesophageal echocardiography in anesthetized patients before neurosurgical procedures in the semi-sitting position. Transesophageal echocardiography was performed after induction of anesthesia before surgery to avoid additional physical and psychologic stress for the patients. Thirty-five neurosurgical patients scheduled for elective surgery in the semi-sitting position were examined with help of contrast transesophageal echocardiography. The data of the examined patients were analyzed with respect to efficiency, logistic efforts, and adverse events. Contrast transesophageal echocardiography was combined with a ventilation maneuver to increase right atrial pressure. A patent foramen ovale was detected in 3 of 35 patients. These patients were operated on in a supine position. Oral insertion of the echoprobe was possible in all patients without difficulties. A short-lasting hypertension was observed in 5 patients despite adequate analgesia and sedation. The average time of examination was 25 minutes. None of the patients showed paradoxical air embolism as judged by postoperative neurologic assessment. Contrast transesophageal echocardiography combined with a ventilation maneuver is an effective method in detecting a patent foramen ovale. Moreover, transesophageal echocardiography is a clinical guide to patient positioning. The method of anesthetic management presented to examine anesthetized patients immediately before surgery means less physical and psychologic stress for the patients and causes approximately a 30-minute delay of surgery.     

The usefulness of holotranscobalamin in predicting vitamin B12 status in different clinical settings

Serum concentrations of homocysteine (Hcy) and methylmalonic acid (MMA) become increased in B12-deficient subjects and are therefore, considered specific markers of B12 deficiency. Serum level of holotranscobalamin (holoTC) becomes decreased before the development of the metabolic dysfunction. We investigated the usefulness of holoTC in diagnosing B12 deficiency in some clinical settings. We measured serum concentrations of holoTC, MMA, Hcy and total B12 in omnivores, vegetarians, elderly people and haemodialysis patients. Our results indicated that the incidence of holoTC <35 pmol/L was highest in the vegans (76%). Low holoTC and elevated MMA were detected in 64% of the vegans and 43% of the lacto- and lacto-ovovegetarians. An elevated MMA and a low holoTC were found in subjects with total serum B12 as high as 300 pmol/L. The distribution of holoTC in elderly people was similar to that in younger adults (median holoTC 55 pmol/L in both groups). A low holoTC and an elevated MMA were found in 16% of the elderly group. An elevated MMA and a normal holoTC were found in 20% of the elderly group who had a relatively high median serum concentration of creatinine (106.1 micromol/L). Serum concentrations of holoTC in dialysis patients were considerably higher than all other groups (median 100 pmol/L). This was also associated with severely increased serum levels of MMA (median 987 nmol/L). From these results it can be concluded that serum concentration of holoTC is a much better predictor of B12 status than total B12. This was particularly evident in case of dietary B12 deficiency. Serum concentrations of holoTC as well as MMA can be affected by renal dysfunction. Elevated MMA and normal holoTC in patients with renal insufficiency may not exclude vitamin B12 deficiency. HoloTC seems not to be a promising marker in predicting B12 status in renal patients.     

Osteoarthritis - an untreatable disease?

Osteoarthritis is a painful and disabling disease that affects millions of patients. Its aetiology is largely unknown, but is most likely multi-factorial. Osteoarthritis poses a dilemma: it often begins attacking different joint tissues long before middle age, but cannot be diagnosed until it becomes symptomatic decades later, at which point structural alterations are already quite advanced. In this review, osteoarthritis is considered as a disease of the whole joint that may result from multiple pathophysiological mechanisms, one of which is the dysregulation of lipid homeostasis. No proven disease-modifying therapy exists for osteoarthritis and current treatment options for chronic osteoarthritic pain are insufficient, but new pharmacotherapeutic options are emerging.     

Lamellar keratotomy to correct astigmatism in cataract surgery

Background For the correction of astigmatism in cataract surgery, several incisional procedures have been developed. In this study, a modification of lamellar keratotomy was evaluated to correct astigmatism in cataract surgery.Methods Prospectively 32 eyes of 25 patients with a preoperative astigmatism greater than 1.5 D were studied. All patients were treated with lamellar keratotomy with an incision width of 6 mm and a radial length of 1.5 mm placed at the limbus in the steep meridian. Phacoemulsification and IOL implantation were then performed through a 3.2-mm corneal tunnel incision. After 4 weeks, mean astigmatism, mean corneal power changes, and mean surgically-induced astigmatism derived from vector analysis in the central 3-mm optical zone were determined.Results The mean astigmatism decreased from 2.75±0.80 D preoperatively to 1.58±0.91 D after 4 weeks (P<0.001). There were no significant changes (P=0.614) of the mean corneal power. The mean surgically-induced astigmatism was 2.59±1.50 D. The induced changes were more accentuated in superior incisions. In corneal topography, 78% of the treated eyes revealed a characteristic threefold pattern of the mid-peripheral cornea postoperatively, which impaired the corneal optical performance in ray-tracing analysis.Conclusions Lamellar keratotomy effectively reduced high preoperative astigmatism in cataract surgery. This surgical approach was combined with a superior, temporal, or oblique corneal incision.Presented in part at the Annual Meeting of the Deutsche Ophthalmologische Gesellschaft in Berlin, September 2003.     

Interventional study in 1,232 young German children to prevent the development of melanocytic nevi failed to change sun exposure and sun protective behavior

Sunscreens have been proposed as protective measures to inhibit the development of melanocytic nevi in childhood and to decrease the long term risk for cutaneous melanoma development. Our present study investigates the influence of sunscreen use and education on the number of incident melanocytic nevi. A total of 1,812 children in 78 public nursery schools in 2 German cities were randomized to 3 study arms: (i) parents were informed on study purpose and sun protection measures only at an initial educational meeting; (ii) parents received educational material 3 times yearly; and (iii) education and 800 ml free broad spectrum sunscreens with sun protection factor 25 provided on a yearly basis. Final assessment after 3 years follow-up included 1,232 children (68%). Changes of sun protection habits including sunscreen use were sparse, without any differences attributable to the intervention efforts. As a consequence, there were no significant differences between the 3 study arms for the main outcome measure, the number of incident melanocytic nevi. Analysis of the sunscreen use in the entire cohort irrespective of our study arms did not show any impact on incident nevus numbers in bivariate or multivariate analysis. In conclusion, intervention with educational letters and free sunscreens seemingly had no additional effect on sun-protection for German children. High prevalence of sunscreen use at study commencement, social desirability, and inadequate application of sunscreens might have partially covered their effect.     

Extended clinical phenotype, endocrine investigations and functional studies of a loss-of-function mutation A150V in the thyroid hormone specific transporter MCT8

OBJECTIVE: Thyroid hormones, besides having other functions, are known to be essential for the development of the human brain. Recently the monocarboxylate transporter 8 (MCT8) was identified as a thyroid hormone transporter which is expressed in different regions of the human brain. Here we describe in detail the clinical and biochemical features in response to thyroid hormone administration of a boy carrying an MCT8 mutation (A150V) in the second transmembrane domain. METHODS: To study the functional impact of the mutation we performed triiodothyronine (T3) uptake, immunofluorescence and dimerization studies. RESULTS: Thyroid hormone (l-thyroxine (LT4) and LT3) administration did not result in any significant clinical changes; however, with high doses of LT4, alone or in combination with T3, TSH suppression was achieved. We could show a robust uptake of (125)I-T3 for wild type (WT) MCT8, whereas no specific uptake could be detected for the mutant A150V. Subcellular localization of WT and mutant MCT8 revealed a strong cell surface expression for the WT MCT8, in contrast to A150V, which is mostly retained intracellularly with only weak cell surface expression. We could also demonstrate for the first time that WT MCT8 as well as the mutant are able to form multimers. CONCLUSION: Our findings open a wide field of possible interaction within the central nervous system and will help to understand the crucial role of MCT8 in early fetal brain development.