Prevalence of vitamin B12 deficiency in patients with plasma cell dyscrasias: a retrospective review

BACKGROUND: To the authors' knowledge, the prevalence of vitamin B12 deficiency among patients with plasma cell dyscrasias (PCD) is largely unknown. Identifying this vitamin deficiency in such patients could help improve their anemia and increase their tolerance to potentially neurotoxic agents. METHODS: The authors retrospectively reviewed the charts and laboratory results of 664 consecutive patients diagnosed with PCD who had their vitamin B12 and folate status evaluated between 1997 and 2001 at the Cleveland Clinic Multiple Myeloma Research Program. The patients were screened for vitamin B12 deficiency using serum vitamin B12 and methylmalonic acid. RESULTS: Of the 664 patients whose medical charts were reviewed, information on vitamin B12 status was available for 522 patients (78%). Among these 522 patients, 71 (13.6%) had laboratory-defined vitamin B12 deficiency and the remaining 451 patients (86.4%) did not. On univariate analysis, vitamin B12 deficiency correlated with immunoglobulin A (IgA) PCD (P = 0.04), higher mean corpuscular volume (P = 0.008), and longer follow-up (P = 0.048). In a covariate adjusted model, only the presence of IgA PCD was associated with an increased prevalence of vitamin B12 deficiency (P = 0.003). CONCLUSIONS: Vitamin B12 deficiency was prevalent in patients with PCD, especially in patients with the IgA subtype. Serum vitamin B12 measurements should be part of the initial evaluation and subsequent workups for anemia in patients with PCD.     

Celecoxib: a novel treatment for lung cancer

Lung cancer is by far the leading cause of cancer-related deaths. Overall survival is poor and has not improved substantially over the last 50 years. Therefore, it is clear that novel and more effective treatments are needed to improve the outcome of therapy. Recent attention has been drawn to the role of cyclooxygenase (COX)-2 in the pathogenesis of cancer, and it has been considered as an attractive target for therapeutic and chemopreventive strategies in lung cancer patients. Celecoxib (Celebrex), Pfizer), a selective COX-2 inhibitor and potent anti-inflammatory agent, has been approved for the treatment of osteoarthritis and rheumatoid arthritis. This orally administered agent is generally well tolerated and has almost no gastrointestinal or renal toxicity. Phase II clinical trials suggest that COX-2 inhibition by celecoxib would enhance response to cytotoxic chemotherapy or radiation therapy through interference with cellular proliferation and tumor angiogenic processes, promotion of apoptosis and immune surveillance, or other possible mechanisms. Celecoxib has shown promising antitumor efficacy in lung cancer and a large variety of solid tumors that rely on COX-2-related mechanisms for growth and survival. This article reviews the profile of celecoxib and evidence supporting its role in the therapy of lung cancer.     

Microscopic Tumor Cell Dissemination in Gastric Cancer

Purpose There is still much controversy surrounding the prognostic significance of microscopic tumor cell dissemination in gastric cancer and its correlation with histopathologic parameters. We herein investigate such dissemination, predominantly restricted to the subserosa, in patients with gastric cancer.Methods Intraoperative bone marrow aspiration was done in 26 patients undergoing resection of gastric carcinoma. Peritoneal lavage could not be done in 8 of these 26 patients. The R0-resection rate was 84% (n = 22). A cytokeratin-directed antibody and an antibody directed against carcinoembryonic antigen served for the immunocytochemical detection of tumor cells, and the alkaline phosphatase antialkaline phosphatase method was used for visualization.Results The bone marrow aspirate and peritoneal lavage fluid were immunocytochemically positive in 31% and 56% of the patients, respectively. There was a trend (P = 0.10) towards higher overall survival rates in patients with negative bone marrow samples than in those with tumor cells detected in bone marrow samples. Analyzing the results of peritoneal lavage did not reveal any significant differences. In the group of T1/2 cancers, survival was significantly worse if the bone marrow was positive for tumor cells, with 3-year survival rates of 25% vs 77%, respectively (P < 0.05).Conclusion The rates of tumor cell dissemination into the bone marrow or into the peritoneal cavity were within the scope of previous reports. Dissemination into the bone marrow resulted in significantly impaired survival in patients with T1 and T2 gastric carcinoma, and it did not correlate with known prognostic parameters.     

Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana

Background  

This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana.     

The global breast cancer burden: variations in epidemiology and survival

Breast cancer is the most common type of cancer and the most common cause of cancer-related mortality among women worldwide. However, the burden is not evenly distributed, and, according to the best available data, there are large variations in the incidence, mortality, and survival between different countries and regions and within specific regions. Many complex factors underlie these variations, including population structure (eg, age, race, and ethnicity), lifestyle, environment, socioeconomic status, risk factor prevalence, mammography use, disease stage at diagnosis, and access to high-quality care. We review recent breast cancer incidence and mortality statistics and explore why these vary so greatly across the world. Further research is needed to fully understand the reasons for variations in breast cancer outcomes. This will aid the development of tailored strategies to improve outcomes in general as well as the standard of care for underserved populations and reduce the burden of breast cancer worldwide.     

Skin cancer in Egypt: a word in your ear

BACKGROUND AND OBJECTIVES: In Egypt, the clinicopathologic features of skin cancer are still unknown. MATERIALS AND METHODS: To define these features, registries of the Pathology Departments, Assiut and South Valley University Hospitals were reviewed. The lesions included 21 melanomas, 39 squamous cell carcinomas (SCCs), and 202 basal cell carcinomas (BCCs). RESULTS: Skin cancer represented 5% of the malignant tumors of the entire body. BCC (77%) was the most common skin cancer followed by SCC (15%) and melanomas (8%). The mean age was 54 +/- 3 (melanomas), 66 +/- 10 (BCC), and 60 +/- 5.18 (SCC). The most common sites were the face (BCCs), face and extremities (SCCs), and face and lower limbs (melanomas). The average size (mm) was 21 +/- 0.3 (melanomas), 28 +/- 0.3 (BCC) and 30 +/- 1.1 (SCC). Melanomas, BCCs and SCCs were of nodular, keratotic invasive and nodular infiltrative types, respectively. CONCLUSIONS: In Egypt, skin cancer is uncommon malignancy. As compared to Western societies, the incidence rate of melanoma is very low and its topographic distribution is different. Alternatively, the rates for SCCs/BCCs are comparably high and their topographic distribution is similar. This is the first investigation that reports the clinicopathologic features of skin cancer in Egypt and compares it to other parts of Africa and Western societies.     

Implementing a full-feature PACS solution in accordance with the IHE technical framework: the CHILI approach

RATIONALE AND OBJECTIVES: During the last 4 years, Integrating the Healthcare Enterprise (IHE) has worked in establishing a reliable integrated environment for medical imaging devices and other clinical information systems by using existing industry standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7). Because IHE is organized and driven by professional organizations representing both buyers and vendors, it was able to define a common language for the various health care parties who are involved in the integration process. Thus IHE offers a rigorously organized technical framework that provides a comprehensive guide for a coordinated implementation of information standards. MATERIALS AND METHODS: A multistage plan for incorporating the IHE elements while scaling up general-purpose workstations with teleradiology functionalities to a full-feature picture archiving and communication system (PACS) solution was created. To introduce a pragmatic example, the plan approach was applied to the CHILI workstations (CHILI, Heidelberg, Germany). To implement the proposed plan in making various legacy systems comply with IHE, the effects of available resources and market needs on the plan are discussed. Most implementation challenges and problems were overcome using generic design approaches and well-designed DICOM utilities. RESULTS: On completion of the first stage, the PACS viewer and reporting workstations were IHE-compliant. In addition, the plan facilitates the conformance process while maintaining the planned software development cycle. CONCLUSION: Based on these positive results and the practical experience acquired during the first stage, further stages will be completed to provide the system with the required plug-and-play interoperability among systems from different vendors.