Treatment Results of Nasopharyngeal Cancer a nationwide survey from Finland

The nationwide experience of treating nasopharyngeal cancer in Finland during the period 1980-1989 was reviewed. Of the 107 patients included in the present analysis, 13 were treated palliatively only, and three had metastatic disease at their first clinical presentation, whereas the rest (n = 91) were treated with radical radiotherapy, of whom, 8 patients received adjuvant chemotherapy after radiotherapy. The 5-year actuarial survival rates of these 91 patients was 52%, and by the UICC stage they were classified as follows: stage I 75% (n = 12), stage II 60% (n = 5), stage III 59% (n = 34), and stage IV 38% (n = 40). According to the Cox's stepwise proportional hazard model the most important factors influencing favourable survival were the total dose of radiotherapy expressed in terms of Biologically Effective Dose (BED) with a time factor, a small size of the primary tumour and a high performance status according to the WHO scale, whereas the most important factors influencing the local control analysis were the total dose of radiotherapy (expressed in BED) and the cervical lymph node status.     

In vitro response of cervical cancer cell lines CaSki, HeLa, and ME-180 to the antiestrogen tamoxifen

The effect of tamoxifen, a nonsteroidal antiestrogenic drug, on the in vitro growth of three cell lines derived from carcinoma of the uterine cervix (HeLa, CaSki, ME-180) was studied using the breast cancer cell line MCF-7 as a tamoxifen-sensitive control. Logarithmically growing cells were fed daily with medium containing 5% dextran-charcoal-treated fetal bovine serum (D5) and 0, 1, 2.5, 5, 7.5, or 10 microM tamoxifen. The cell number in replicate cultures was assessed every other day by cell counts. Growth inhibition was expressed as the percentage of the cell number in control cultures fed with D5. At a concentration of 5 microM tamoxifen, a clear decrease in cell proliferation, resulting in 66-74% inhibition of growth, was observed with MCF-7, HeLa, and ME-180 after 6 days of exposure to tamoxifen. Doses greater than 5 microM resulted in cytotoxicity and progressive cell loss. With the CaSki cell line, 2.5 microM tamoxifen induced more than 60% growth inhibition and 5 microM tamoxifen was cytotoxic. Tamoxifen-induced growth inhibition was reversed by removing tamoxifen from the cell cultures, and the cells resumed logarithmic growth after a lag period of 24-48 hr. MCF-7, but not the cervical carcinoma, lines required estradiol for complete and rapid recovery of logarithmic growth. Our results indicate that tamoxifen inhibits cell growth of these cervical carcinoma cell lines by a mechanism different from that in MCF-7.     

Evidence of benefit from centralised treatment of ovarian cancer: a nationwide population-based survival analysis in Finland

To assess the effect of different hospital types or surgical volume on the survival of ovarian cancer patients, a nationwide and population-based analysis was carried out in Finland. The study included all 3,851 ovarian cancer patients operated from 1983-94. The patients were classified according to the hospital of the first surgery. The hospitals were categorized by type (university, central or other hospital) and, separately, into quartiles by the number of operated patients (surgical volume). The patients operated at university hospitals had better survival than those operated in central hospitals, the 5-year relative survival rates (RSR) being 45% (95% CI = 42-48%) and 37% (34-40%), respectively. RSR in the 'other hospital' category was 45% (42-48%). The RSR for the patients operated in the highest volume hospitals was 47% (43-50%), and by decreasing volume (quartile) the RSR was 40% (36-43%), 40% (36-43%) and 42% (38-45%), respectively. After controlling for potential confounding by stage and age using regression models, the results remained practically the same. The results indicate that further centralizing of operative treatment of ovarian cancer may still improve survival rates on a population level in Finland.     

Familial dyslexia: neurocognitive and genetic correlation in a large Finnish family

Neuropsychological findings of individuals with dyslexia (n=24) from a large, three-generation Finnish family are presented. We have previously performed whole genome linkage scanning in this family and found that dyslexia in this kindred segregates with a single locus in the pericentromeric area of chromosome 3. Those included in the analyses were carefully evaluated for general cognitive ability, reading and spelling skills, and reading-related neurocognitive skills. The neurocognitive type of dyslexia segregating in this family consisted of deficits in phonological awareness, verbal short-term memory, and rapid naming. Severe dyslexia also seemed to be connected with a general language difficulty and was most common in the eldest generation.     

Epidemiology of child psychiatric disorder: Methodological issues and some substantive findings

Key conceptual and substantive issues in child psychiatric epidemiology are reviewed using mainly European studies in terms of methodological problems and causal mechanisms. Attention is paid to issues in the measurement and categorization of disorder, case definition, case identification and classification. Research into causal processes is discussed in relation to organic brain dysfunction, temperamental risk, parental mental disorder and stress associated with multiple hospital admission.Department of Child and Adolescent Psychiatry Institute of Psychiatry     

Sequence variation in the ATP8B1 gene and intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic condition that may affect women during the third trimester of pregnancy. Symptoms experienced by these women generally resolve spontaneously following delivery, but prior to delivery the fetus is at increased risk of intrauterine distress and sudden intrauterine death. The genetic etiology of most cases of ICP is unknown, although heterozygous carriers of mutations causing progressive familial intrahepatic cholestasis (PFIC) diseases may experience ICP. When examining linkage to known cholestasis genes, affected members of four Finnish ICP families shared haplotypes around ATP8B1, the gene responsible for PFIC1. This gene was subsequently screened in 176 familial and sporadic ICP patients. A total of 17 sequence changes were detected, five exonic and 12 intronic. No intronic change was associated with ICP in sporadic cases. Four intronic changes segregated with ICP in three families, a different change in each of two families and three changes in another family, although the significance of this is currently unknown. Three exonic changes were nonsynonymous, one (in exon 23) is probably a polymorphism while two predict novel amino-acid replacements (N45T and K203R). These changes, in exons 2 and 7, were detected in one individual each, and may have predisposed these individuals to ICP. In conclusion, although the exon 2 and 7 changes may have functioned as risk alleles, ATP8B1 is probably not a major gene contributing to the occurrence of ICP.     

Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients

OBJECTIVE: Many head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre. MATERIAL AND METHODS: A total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997-2001. RESULTS: Most of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment. CONCLUSIONS: A major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.     

Intraluminal radiotherapy in esophageal cancer. An update

Oesophageal cancer is severe illness leading usually to death. Radical surgery is the most successful treatment but most patients are not operable at the time of diagnosis. For these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. In patients with advanced oesophageal cancer, intraluminal brachytherapy has been proposed as an additional method to increase local control. Between 1989-2002, 49 patients with inoperable oesophageal cancer were treated with combined external and intraluminal radiation therapy in Turku University Central Hospital. The external radiation was performed with a median total dose of 40 Gy given in 20 fractions. On the average a week after the external radiation a median total dose of 10 Gy intraluminal radiation therapy was given in 4 fractions. The intraluminal brachytherapy could be performed without technical difficulties and no major complications were seen. In many cases (twenty out of 49 patients, 41%), the symptoms could be relieved immediately and in most cases the progression of the disease could be delayed. The one and two year survival rates were 30% and 18%, respectively. All patients alive at two years can be considered as long-time survivors. Median follow-up was 86 months. Intraluminal brachytherapy is a safe and efficient treatment modality which offers a potential means of cure for selected patients with oesophageal cancer.