Recent trends in breast cancer incidence in US white women by county-level urban/rural and poverty status

Background  

Unprecedented declines in invasive breast cancer rates occurred in the United States between 2001 and 2004, particularly for estrogen receptor-positive tumors among non-Hispanic white women over 50 years. To understand the broader public health import of these reductions among previously unstudied populations, we utilized the largest available US cancer registry resource to describe age-adjusted invasive and in situ breast cancer incidence trends for non-Hispanic white women aged 50 to 74 years overall and by county-level rural/urban and poverty status.     

Age-specific administration of chemotherapy and long-term quality of life in stage II and III colorectal cancer patients: a population-based prospective cohort

Purpose.

To investigate the age-specific pattern of administration of chemotherapy and its association with long-term survival and quality of life (QoL) in stage II and III colorectal cancer patients.

Methods.

Chemotherapy allocation according to disease and patient characteristics was investigated in a population-based cohort of 562 stage II and III colorectal cancer patients. Five years after diagnosis, survival was determined and QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and a tumor specific module. The association among chemotherapy, survival, and QoL was examined while controlling for potential confounders.

Results.

Chemotherapy was administered in 71% of patients aged <60 years and in only 20% of patients aged ≥80 years. A significant association between chemotherapy and longer survival time was found for stage III cancer only. Chemotherapy was associated with higher symptom levels for trouble with taste, anxiety, and hair loss. In age-specific analyses, younger survivors (<70 years at time of follow-up) with a history of chemotherapy reported significantly lower physical, role, and cognitive functioning and higher pain, appetite loss, hair loss, and trouble with taste symptom levels. In contrast, for older survivors (≥70 years), only two (hair loss and dry mouth) out of 38 QoL scores were significantly associated with chemotherapy.

Discussion.

Chemotherapy is associated with lower long-term QoL, especially in younger survivors. In cases of uncertain survival benefits of chemotherapy, consideration of its long-term effects on QoL should be incorporated into final decisions on treatment.     

Recipient bed perfusion as a predictor for postoperative complications in irradiated patients with microvascular free tissue transfer of the head and neck area: a clinical analysis of 191 microvascular free flaps

Purpose

Despite microvascular free tissue transfer being the mainstay of care in the reconstruction of larger maxillofacial defects, a significant number of patients experience postoperative complications due to impaired blood supply of the flap. In this context, the early influence of recipient bed perfusion remains unclear, but there is evidence that it is associated with free flap viability immediately after surgery.

Methods

We analyzed flap and recipient bed perfusion within the first 2 weeks after surgery by using the oxygen-to-see device. One hundred ninety-one patients who underwent free flap surgery in our department were included.

Results

Flow parameters were higher and postoperative complications were less frequent in radial forearm free flaps compared to any other type of flap. Flow parameters of the recipient bed were higher than transferred tissue at all times, implicating flap autonomization is not completed within 2 weeks. Previous radiotherapy significantly decreased flow parameters of the recipient bed but not of the flaps. Furthermore, irradiated patients with postoperative complications were found to have reduced flow parameters of their recipient bed compared to non-irradiated patients with postoperative complications.

Conclusion

We conclude that monitoring of recipient bed perfusion is useful for detecting flap compromise of irradiated patients in the early postoperative period.

     

Hormone replacement therapy, body mass, and the risk of colorectal cancer among postmenopausal women from Germany

Previous studies have reported inconsistent results regarding the modifying effect of hormone replacement therapy (HRT) on the association of body mass index (BMI) and the risk of colorectal cancer (CRC) among postmenopausal women. We assessed the use of HRT and BMI in 208 postmenopausal women with histologically confirmed incident CRC and 246 controls in a population-based case-control study in Germany (DACHS study). Ever use of HRT was strongly associated with reduction of CRC risk (adjusted odds ratio 0.41, 95% confidence interval 0.25-0.67). Among nonusers of HRT, risk of CRC was strongly increased in women with BMI 27 to <30 kg m(-2) (2.76, 1.07-7.12) and obese women (3.30, 1.25-8.72), when compared with women with BMI <23 kg m(-2) (P for trend <0.01). BMI was not associated with risk of CRC among HRT users (P for interaction <0.01). In contrast to most other studies, a positive association of BMI and CRC risk was found among nonusers of HRT, but not among users of HRT. The reasons for the inconsistency of results regarding the potential risk modifying effect of postmenopausal hormones in the association of BMI with CRC remain inconclusive and require further study.     

Welche Voraussetzungen sind für ein Screening notwendig?

Screening can be a very powerful tool for prevention or more effective treatment of diseases. However, a number of prerequisites have to be met. Only diseases with a preclinical phase, during which the disease or its precursors can be detected by a suited test, are amenable to screening. Early detection of the disease must enable either prevention or more effective management of the disease and not just prolong the “patient career”. The benefits of screening must encompass potential harms, which may include, for example, complications, false positive diagnoses or over-diagnoses (i.e. the diagnosis of clinically irrelevant disease). Benefits from screening must be achieved at acceptable costs. Implementation of screening has to be based on scientific evidence and accompanied by scientific evaluation.     

高效液相色谱法测定消痰咳片的含量

目的：采用反相色谱法同时测定消痰咳片中两种主要成分甲氧苄啶和磺胺体的含量。方法：以乙腈：0.1%H3PO4(15:85)为流动相，检测波长254nm，HPLC法测定含量。结果：试验表明，甲氧苄啶和磺胺林在0.8-8ug范围内呈良好的线性关系，回归方程分别为Y＝－1127.1＋110.2x(r=0.9994),Y=-1852.3 256.2x(r=0.9996),相对标准偏差分别为2.1%和0.8%。结论：该方法简便、准确、可靠。     

Modification of hemodynamics by intravenous administration of flecainide

We investigated the influence of the new class-I antiarrhythmic drug flecainide on myocardial performance and hemodynamic parameters in Wistar rats (2 mg, 4 mg, 8 mg flecainide/kg). Left ventricular and aortic pressures, dp/dt max, cardiac output and additionally isovolumic left ventricular maxima curves were registered 5 min and 15 min after flecainide (n = 28) or saline (controls; n = 12) i.v. infusion (7 min). 2 mg and 4 mg flecainide/kg had no significant effect on isovolumic indices. 5 min after infusion of 8 mg flecainide/kg peak isovolumic left ventricular pressure was reduced by 84.9 +/- 2.6% vs. 95.6 +/- 1.1% (NaCl), mean +/- SEM (p less than 0.01) and peak isovolumic dp/dt max by 44.5 +/- 4.5% vs. 91.5 +/- 3.6% (NaCl), mean +/- SEM (p less than 0.01). Flecainide caused a significant reduction of heart rate (81.9 +/- 4.7%, 2 mg flecainide/kg vs. 95.4 + 2.5% (NaCl), an AV-block occurred only after administration of 8 mg/kg. Mean aortic pressure was decreased after 4 mg and 8 mg flecainide/kg. 8 mg flecainide/kg significantly reduced the cardiac output (73.1 +/- 7.7%, p less than 0.05). 15 min after 2 mg and 4 mg flecainide/kg infusion the determined parameters were normalized, only a dose of 8 mg/kg caused a prolonged hemodynamic depression. Our results demonstrate that in clinically used dosages no hemodynamic side-effects are detectable. A significant reduction of isovolumic indices of myocardial performance occurs only after infusion of 8 mg flecainide/kg. A transfer of laboratory experiments to the clinical situation is only possible with limitations, but our data might indicate that the myocardial and hemodynamic side-effects of flecainide are relatively small at therapeutic dosages.     

Primary thinning and de-epithelialization of microsurgical transplants from the lateral thigh]

To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, we performed extreme, primary thinning of the fat and muscle component of this microsurgical transplant in 14 patients. After subfascial localization of the 0.5- to 1.0-mm-thick perforating vessel, it is exposed through the fascia and muscles up to its exit from the descending branch of the lateral circumflex femoral artery. After isolating the perforating vessel, it is no longer necessary to include parts of the vastus lateralis muscle in the flap. The fatty tissue of the remaining epifascial fat component is completely removed except for a ca. 1- to 2-cm-wide cuff of fatty tissue and fascia around the perforating vessel. When performing this primary radical removal of the subcutaneous fatty tissue, care should be taken not to injure the deep subdermal vascular plexus. In addition to the thinning procedure, de-epithelialization of the skin was performed using scalpel blade dissection (five patients) or carbon dioxide laser (6 W, five patients). This thinning technique was used for covering ten intraoral and four extraoral defects and enabled the raising of skin flaps with a thickness of 3-5 mm even in obese patients. The vessel pedicle length of thinned flaps was between 12 and 16 cm; flap size varied between 4 x 5 and 9 x 15 cm, and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the remaining flaps healed without complications. On the intraoral flaps, a thin, smooth and pliable surface developed after re-epithelialization within 3-6 weeks. The described method expands the application possibilities of the myocutaneous vastus lateralis flap for a large number of intraoral and flat defects with minimal donor-site morbidity.