Intramuscular application of diclofenac--case report and critical consideration of a therapeutic measure

Diclofenac is a non-steroidal anti-inflammatory drug of the phenylacetic class. It is frequently given as an intramuscular injection. However several, sometimes severe, side effects have been described after an i.m. administration. Based on a short case report about a fatal complication in the context of the i.m. administration of diclofenac, the arguments for and against the intramuscular injection of the drug are critically discussed. As a result, the administration of diclofenac as an intramuscular injection should be critically reviewed and alternatives -- as suppositories are available -- should be taken into account.     

Infected aortic pseudoaneurysm at the site of a proximal mechanical anastomosic connector following off-pump coronary artery bypass grafting: case report

We describe a patient who underwent off-pump coronary artery bypass graft surgery performed with an aortic connector. The patient developed a malignant deep sternal wound infection that subsequently led to an aortic pseudoaneurysm at the site of proximal anastomosis.     

Is terminology used effectively to convey diagnostic certainty in radiology reports?

RATIONALE AND OBJECTIVES: This study was performed to assess the extent of agreement among radiologists and nonradiologists in perception of diagnostic certainty conveyed by words and phrases commonly used in radiology reports. MATERIALS AND METHODS: The study was performed in a large academic radiology department. To determine the commonly used terminology for conveying diagnostic certainty in radiology reports, 12 randomly selected radiologists from six different subspecialties were interviewed. The authors identified the 15 most commonly used words and phrases and included these in random order in a questionnaire sent to all staff radiologists (n = 45) and to 158 referring physicians. Physicians were asked to rank the 15 phrases in order of the diagnostic certainty conveyed by each, from 1 (most certain) to 15 (least certain), using each number only once. The kappa statistic was used to assess agreement in rank order among physicians. RESULTS: The questionnaire response rate was 76% (n = 34) for radiologists and 49% (n = 78) for nonradiologists. There was excellent agreement among radiologists (kappa = 0.95) and nonradiologists (kappa = 0.93) in the rank order for the phrase diagnostic of. Although there was good agreement (kappa = 0.45) among radiologists for the word unlikely, agreement among nonradiologists was poor (kappa = 0.27). There was very poor agreement among all physicians for the rank order of the other 13 phrases. CONCLUSION: Among radiologists and nonradiologists, concordance was poor regarding the diagnostic certainty associated with phrases commonly used in radiology reports. Because poor agreement could lead to suboptimal quality of care, the standardization of terminology would benefit all parties.     

New approaches to the endocrine prevention and treatment of breast cancer

All major endocrine prevention approaches act via the estrogen receptor (ER). A simple hypothesis concerning ER expression and breast cancer risk is outlined. We review breast cancer prevention trials with tamoxifen, raloxifene, aromatase inhibitors, and ovarian suppression. Current and planned endocrine prevention trials in populations of pre- and postmenopausal women at risk of breast cancer are summarized and endocrine therapy after primary surgery and for advanced disease discussed.     

ABL-kinase domain point mutation as a cause of imatinib (STI571) resistance in CML patient who progress to myeloid blast crisis

Imatinib mesylate (STI571) is a major therapeutic advance for the management of chronic myeloid leukaemia (CML), however, a proportion of patients are refractory to it, particularly those in more advanced phases of CML. Different mechanisms of resistance to imatinib are suggested, including point mutations within ABL-kinase domains. A point mutation leading to substitution at the ATP binding site of ABL-kinase and insensitivity to imatinib was detected in our patient treated with imatinib, who progressed to blast crisis. Additionally, clonal evolution could lead to BCR–ABL-independent proliferation. Early detection of ABL-kinase mutation could predict the progression of CML treated with imatinib.     

Alpha-methylacyl-CoA racemase as an androgen-independent growth modifier in prostate cancer

Alpha-methylacyl-CoA racemase (AMACR) is an enzyme involved in beta-oxidation of branched-chain fatty acids and bile acid intermediates. Recent work has identified AMACR as a new diagnostic marker for prostate cancer (PCa). The data from the present study suggest that AMACR is also functionally important for the growth of PCa cells. Overexpressed AMACR from both clinical tissues and PCa cell lines is wild type by sequence analysis and functionally active by enzymatic assay. Correspondingly, enzyme activity of AMACR increases approximately 4-fold in PCa in comparison with adjacent normal prostate. Small interference RNA (siRNA) against AMACR, but not the control inverted siRNA, reduced the expression of AMACR and significantly impaired proliferation of the androgen-responsive PCa cell line LAPC-4. No effect was observed in HeLaS3 cells, which express AMACR at a low level. Cell cycle analyses revealed a G(2)-M cell cycle arrest in LAPC-4 cells treated with siRNA compared with mock treatment or control inverted siRNA. Expression of a siRNA-resistant form of AMACR in LAPC-4 cells protects the cells from growth arrest after AMACR-specific siRNA treatment. Data from Western blotting and luciferase-based reporter assays suggest that the function and expression of AMACR are independent of androgen receptor-mediated signaling. Moreover, simultaneous inhibition of both the AMACR pathway by siRNA and androgen signaling by means of androgen withdrawal or antiandrogen suppressed the growth of LAPC-4 cells to a greater extent than either treatment alone. Taken together, these data suggest that AMACR is essential for optimal growth of PCa cells in vitro and that this enzyme has the potential to be a complementary target with androgen ablation in PCa treatment.     

Virtual integrated practice: integrating teams and technology to manage chronic disease in primary care

The use of teams in health care has generally relied on the notion that teams must physically meet and function in person in the same location, on a regular, scheduled basis, in order to maximize the value of the interdisciplinary process. This article examines the concept of creating a different kind of team in primary care, out-patient settings--one which relies upon communications technology to link together clinicians from different locations to coordinate and manage the care of patients, particularly those with chronic disease. This approach--referred to as Virtual Integrated Practice--is designed to overcome the barriers of traditional in-person teams by creating a "virtual team" with the potential to function more efficiently, productively, and satisfactorily for clinicians and patients alike.