Gastric ulcers after endoscopic sclerosis of esophageal varices

Two patients with bleeding esophageal varices underwent endoscopic sclerosis. Each developed a gastric ulcer of the fundic mucosa approximately 6-7 cm below the gastro-esophageal junction. It seems probable that these lesions were related to the retrograde flow of sclerosing solution into the venous system which drains the gastric mucosa.     

Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other

Purpose

The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads’ FOR.

Methods

We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors’ and caregivers’ FOR and determined the directionality of survivors’ and caregivers’ FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for.

Results

Caregivers’ FOR predicted survivors’ FOR, and sexual orientation had a significant effect on survivors’ FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors’ FOR included their medical characteristics, coresidence with caregivers, and caregivers’ social support and use of counseling. Caregivers’ FOR was related to their social support and survivors’ medical characteristics.

Conclusions

This study suggests a need for caregiver interventions. Because survivors’ FOR is affected by caregivers’ FOR, caregiver interventions will likely benefit survivors’ FOR.

Implications for cancer survivors

Both sexual minority and heterosexual breast cancer survivors’ FOR are affected by their caregivers’ FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors’ well-being and shall therefore be integrated into the care process.

     

Endoscopic Nd:YAG laser and radiation therapy for primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is rare. Reports on approximately 112 cases have appeared in the world literature. We report the 113th case in the eldest known patient at the time of diagnosis. Endoscopic neodymium-yttrium-aluminum-garnet laser coagulation, in conjunction with radiation therapy, was performed. This nonsurgical treatment combination appears to provide adequate palliative therapy for primary malignant melanoma of the esophagus.     

Three-dimensional patterns of lung tumor growth: association with tumor heterogeneity

Most histological Classifications of lung tumors assess information derived from 2-dimensional surfaces. However, tumors grow in 3 dimensions in a variety of architectural patterns that possibly reflect the histological type or progresssion status of the tumor. A new mathematically derived variable (Rratio) is presented, that assesses the overall 3-dimensional shape of a tumor and classifies tumors based on their sphericality. Analysis and comparison of groups of spherical and nonspherical tumors from mouse inbred strains and recombinant congenic strains with a strict set of predetermined histological criteria shows that Rratio is significantly associated with tumor heterogeneity and that histological differences exist between the spherical and nonspherical tumors. These results suggest that Rratio may be a valuable tool for the characterization of tumors and can be used to explore qualitative differences in tumors derived from segregating crosses.     

Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan

Background  

A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.