2012 President's Plenary International Psycho‐Oncology Society: future directions in psycho‐oncology

The inaugural President's Plenary was held at the 2012 International Psycho‐oncology Society's World Congress in Brisbane to provide a platform for dissemination of important initiatives and achievements of interest to cancer professionals globally. The vision of the International Psycho‐oncology Society – clarified and defined in 2004 – is that all cancer patients and their families throughout the world should receive optimal psychosocial care at all stages of disease and survivorship. Recent initiatives have been driven by the need to see psychosocial care available as a seamless part of holistic multidisciplinary quality cancer care and life‐extending lifestyle changes promoted and supported through the expertise of behavioural and social scientists. In keeping with World Health Organization targets that there is ‘no health without mental health’, cancer health must include mental health. This is in line with the patients' declaration to ‘See us – not our disease’. The aim is to ensure that within the next decade, psychosocial care is acknowledged as a vital part of the patient journey and accepted globally as good practice within cancer care. The President's Plenary session covered the need for the following:

• Behavioural and social scientists to be integral to the planned lifestyle changes that the United Nations agreed, at a high‐level meeting in 2011, to reduce world cancer incidence and morbidity over the next decade;
• An internationally agreed standard of quality cancer care that includes psychosocial care for patients and their families and carers;
• An endorsement to assess distress as the 6th vital sign;
• A declaration that mental health within cancer health is a human right;
• Psycho‐oncology professionals to integrate into a federation promoting better national and international outcomes; strength in numbers speaking with a unified voice.

The aim is to encourage dialogue between all cancer professionals and patient representatives to progress these targets; everyone has a voice. Copyright © 2013 John Wiley & Sons, Ltd.     

Evaluation of Waiting Times and Sonographic Findings in Patients with First Trimester Vaginal Bleeding at the University Hospital of the West Indies. Can Emergency Department Ultrasound Make a Difference?

Background:

Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department.

Objective:

This retrospective study was conducted to evaluate how long patients wait for a pelvic ultrasound. We also sought to establish how many patients had ultrasound findings that would have allowed safe discharge home.

Methods:

The records of 150 patients seen in the six-month period from January 1 to July 30, 2008 were examined. Data were extracted pertaining to age, time to see an emergency room doctor, time taken for ultrasound examination to be obtained from the radiology department and the ultrasound findings.

Result:

Fifty-four per cent presented to the Emergency Department with a complaint of vaginal bleeding and abdominal pain, 29% with bleeding only, 16% with abdominal pain only and one with syncope. One hundred and sixteen of the patients enrolled had an ultrasound performed at UHWI. The average waiting time for an ultrasound was 3.8 ± 2.5 hours. The majority (66/116) of the patients had an intrauterine pregnancy (IUP) demonstrated on ultrasound. Twenty-nine had no IUP, free fluid or adnexal mass. These 95 patients would likely have been discharged home. Ten patients had an adnexal mass with or without free fluid, and ten had free fluid only on ultrasound. One patient was found to have a definite ectopic pregnancy. These 21 patients would have been referred for evaluation by the obstetrician on call for further management.

Conclusion:

The majority of patients had sonographic findings that would have allowed safe and timely discharge from the Emergency Department had ultrasound been available at the point of care.     

Evaluation of serum ferritin as a marker for adult Still''s disease activity.

Extremely high serum ferritin values (greater than 10,000 micrograms/l) were detected in two patients with adult Still's disease. The ferritin concentrations decreased to normal after adequate treatment. During a one year follow up ferritin concentration was helpful in monitoring disease activity and guiding decisions about treatment. Raised concentrations of soluble interleukin 2 receptors (sCD25) were also found. Detection of ferritin values above 3000 micrograms/l should lead to the consideration of Still's disease when there is an acute febrile illness without evidence for bacterial or viral infections, serum ferritin being suitable for monitoring treatment.     

Discrimination between benign and malignant cells of melanocytic lineage by two novel antigens, a glycoprotein with a molecular weight of 113,000 and a protein with a molecular weight of 76,000

The present study describes two novel antigens, a glycoprotein with a molecular weight of 113,000 and a protein with a molecular weight of 76,000, which are associated with the transformed phenotype of melanocytes. The monoclonal antibodies (MoAb) MUC18 and MUC54, raised against human malignant melanoma, were selected for differential reactivity with normal and neoplastic cells of melanocyte lineage. The antigen defined by MoAb MUC18 is a membrane bound monomeric sialylated glycoprotein with an apparent molecular weight of 113,000. In contrast to the broad reactivity with melanomas, isolated nevus nests were stained in only 1 of 55 nevi investigated. No staining of MoAb MUC18 was observed in a large variety of surgically removed normal and tumor tissues except for smooth muscle cells of the blood vessel wall and hair follicles. MoAb MUC54 immunoprecipitated a cytoplasmic monomeric protein with an apparent molecular weight of 76,000. By immunoperoxidase staining, the antigen was demonstrated on a large number of melanomas and in addition on 1 of 36 nevocellular, 3 of 4 Spitz, and 5 of 14 dysplastic nevi. The Mr 76,000 protein was found in a number of epithelial tissues and various types of neoplasms. Both antibodies presented in this study define structural changes in the antigenic profile of melanocytes occurring during carcinogenesis.     

Model of Epstein-Barr virus infection of human thymocytes: expression of viral genome and impact on cellular receptor expression in the T- lymphoblastic cell line, HPB-ALL

Infection of B lymphocytes and epithelial tissue by Epstein-Barr virus (EBV) is associated with malignancy and autoimmunity. The cellular receptor for EBV has been identified as CD21 (CR2). A molecule, which is biochemically and immunologically similar to B-cell CD21, has been identified on a subpopulation of immature thymocytes, suggesting a role for this molecule in the regulation of T-cell development and further suggesting that immature T cells might be susceptible to EBV infection. A growing body of literature now documents the presence of EBV in tumors of T-cell origin. We have evaluated the susceptibility of the human immature T cell line, HPB-ALL, to infection by EBV. Electron microscopy studies showed a rapid internalization of virus by HPB cells. Southern blotting showed the intracellular presence of linear EBV genomes, and components of the virus replicative cycle were identified. Expression of the BamHI Z region of the genome, encoding the nuclear protein, ZEBRA, which is strictly associated with productive infection in B cells, was detected in HPB-ALL cells. A spliced variant of Z, RAZ, was also identified. Cell surface expression of EBV late antigens was observed to occur transiently. Infection of HPB cells was also accompanied by altered expression of T-cell surface molecules involved in antigen recognition, a process critical to normal development of the T-cell repertoire. Delineation of the outcome of T- cell infection by EBV may lead to a better understanding of the role of this virus in autoimmune processes and malignancy.