Variation in the staging of colorectal carcinomas: a survey of current practice.

Dukes' staging is the most common means of staging and grouping colorectal carcinomas and is also used to determine which patients will be offered adjuvant therapies or entered into clinical trials. This study was performed to assess the degree of variation in the staging of colorectal carcinomas in normal clinical practice. Seven consultant surgeons and two consultant pathologists returned questionnaires asking them to stage 14 carcinomas on the basis of their pathology reports alone. The results show agreement among all nine in only six out of the 14 cases. In two cases there was a close to 50:50 split in perceived stage. Between them, the nine consultants produced eight different sets of staging results. These results indicate difficulties in the application of Dukes' staging system for several possible reasons. There may be misinterpretation of the written report, misapplication of the staging system because of unfamiliarity or confusion between the various modifications of Dukes' system which have been published. A more precisely defined staging system based on a standard proforma may be more appropriate in modern clinical practice.     

Tropical pyomyositis

A 22 year old male presented with symptoms of diffuse muscle pain and multiple abnormal laboratory findings that were eventually attributed to tropical myositis. Computed tomography scan was more reliable than ultrasound and served as a guide to needle aspiration and pathologic diagnosis.     

Alpha-thalassemia in two Mediterranean populations

We used restriction endonuclease analysis to determine the incidence of alpha-thalassemia in two Mediterranean islands. In a random population sample, the gene frequency of deletion-type alpha-thalassemia-2 (- alpha) was 0.18 in Sardinians and 0.07 in Greek Cypriots. All cases were the rightward crossover type. From these frequencies and the known incidence of hemoglobin-H disease in these populations, we calculated the frequency of the alpha-thalassemia-1 genotype (--) and determined that it was low. We also found that beta-thalassemia homozygotes in sardinia have a higher incidence of alpha-thalassemia than normals and beta thalassemia heterozygotes because a significantly greater number of these homozygotes are also homozygous for the alpha-thalassemia-2 lesion. These findings support the theory that coinheritance of alpha- thalassemia mitigates the severity of beta-thalassemia and suggest that the protection is most pronounced when two alpha-globin genes are deleted.     

A Preoperative Prognostic Score for Resected Pancreatic and Periampullary Neuroendocrine Tumours

Background/Aims: To identify potential preoperative prognostic factors in resected pancreatic and periampullary neuroendocrine tumours. Methods: Clinico-pathological data for 54 consecutive patients with pancreatic or periampullary neuroendocrine tumours referred to our institution over a 10-year period were identified from a prospective database. Results: 34 patients underwent pancreatic resection (12 males, 22 females; median age 54 (IQR 44–71) years). There was a single 30-day mortality (3%). Nodal status (log rank, p = 0.652), microscopic resection margin involvement (p = 0.549) and tumour size (p = 0.122) failed to exhibit any prognostic value. Only the presence of malignant tumour characteristics was associated with poorer overall survival (p = 0.008). Analysis of preoperative parameters showed that age >60 years (p = 0.056), platelet-lymphocyte ratio 1300 (p = 0.008), alkaline phosphatase levels 1125 U/l (p = 0.042) and alanine aminotransferase >35 U/l (p = 0.016) were adverse prognostic factors. A risk stratification score was generated where each adverse preoperative parameter was allocated a score of 1. A cumulative score of ≤1 was defined as low risk, while a score of ≥2 was defined as high risk. Median overall survival in the high-risk group was 10.4 months, while the median survival in the low-risk group was 160 months (p > 0.001). Conclusion: Significant prognostic information can be gained from routine preoperative biochemistry and haematology results in resected pancreatic and periampullary neuroendocrine tumours. These findings merit further evaluation in a larger patient cohort.     

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

Background

Access to pediatric antiretroviral formulations is increasing in resource-limited countries, however adult FDCs are still commonly used by antiretroviral therapy (ART) programs.

Objective

To describe long-term effectiveness of using adult FDC of d4T+3TC+NVP (Triomune) in children for HIV treatment.

Methods

Clinical, immunologic, and virologic outcomes of HIV-infected ART-naïve children aged six months to 12 years, were evaluated up to 96 weeks post-ART initiation.

Results

From March 2004 to June 2006, 104 children were followed with a median age of 5.4 years, median CD4 cell percent and HIV-1 RNA were 11.0% (IQR 6.7–13.9) and 348,846copies/mL (IQR 160,941–681,313) respectively at baseline. Using Kaplan-Meir estimates, 75% of children had undetectable viral loads (<400copies/mL) at 96weeks of ART. Children with a baseline CD4 cell percent >15% were 3 times more likely to achieve viral load <400copies/mL than those with baseline CD4 cell percent <5% after adjusting for baseline age {aHR = 3.03 (1.10–8.32), p=0.03}; no difference was found among those with CD4 cell percent >5–14.9% and <5%.

Conclusion

Treatment with generic adult FDC for HIV-infected Ugandan children led to sustained clinical, immunologic and virologic response during 96 weeks of ART. Early initiation of ART is key to achieving virological success.