Collaborating to conquer cancer: a comprehensive approach to cancer control

Despite substantial contributions on the part of public, non-profit, and private sector organizations, the burden of cancer in the United States remains high. As public health organizations, particularly county, state, tribal, and territorial health departments, try to reduce the significant burden of cancer, they face additional issues that make it difficult to address cancer in a comprehensive way. These challenges along with the need to accelerate progress in reducing the U.S. cancer burden, prompted the Centers for Disease Control and Prevention (CDC) and its national partners to begin to work together to further define and describe comprehensive cancer control (CCC) as an approach to reducing the burden of cancer. CCC is defined as "an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation." This article describes the national effort to support comprehensive cancer control, outlines national and state level success in comprehensive cancer control, and provides a call to action to public, private, and non-profit organizations, governments of all levels, and individuals to renew their commitments to reducing the burden of cancer.     

Intracranial arteriovenous malformations in childhood

During the 13-year period 1964 through 1976, 37 patients less than 20 years old with an intracranial, parenchymal arteriovenous fistula were seen at the Mayo Clinic. The most frequent mode of presentation was hemorrhage or seizure. Other than angiography, computed tomography with contrast enhancement was the most helpful diagnostic test. Surgery was restricted to patients with intraparenchymal hematomas, intractable seizures, or subarachnoid hemorrhage with accessible lesions and to 1 infant with a massive, symptomatic malformation. Surgery generally was tolerated well, with reversal of most acute focal neurological deficits related to hematomas. In the nonsurgical group, follow-up revealed a fairly stable neurological status during the period of the study.     

A feasibility study of contrast enhancement of acute myocardial infarction in multislice computed tomography: comparison with magnetic resonance imaging and gross morphology in pigs

INTRODUCTION: Late enhancement magnetic resonance imaging (MRI) of myocardial infarction (MI) is clinically established. There are no reports on MI assessment using state-of-the-art multislice CT technology. For this reason, animal experiments were conducted to examine the applicability of contrast-enhanced ECG-gated multislice computed tomography (MSCT) for the detection of acute MI. The results were correlated with MRI and postmortem tissue staining. MATERIAL AND METHODS: Acute MI was induced in 14 pigs by balloon occlusion of the LAD. In 8 animals, the LAD was reperfused after 45 minutes. In 6 animals, the LAD was permanently blocked. MR imaging was performed 15 minutes after the administration of 0.2 mmol Gd-DTPA/kg/bodyweight. Subsequently, 16-slice MSCT was performed at various timepoints after injecting 120 mL of iodinated contrast medium. 2,3,5-Triphenyltetrazolin-chloride (TTC) staining was acquired for all hearts investigated. Correlation analysis was applied to compare the area of MI derived from MRI, MSCT, and TTC. The reperfused infarcts were compared with the nonreperfused infarcts using an unpaired t test. RESULTS:: Mean infarct area as measured by TTC staining was 18.3% +/- 7.8% of the left ventricular area. Good correlation of the spatial extent of the infarcted area was found for TTC and MRI as well as for TTC and MSCT data obtained 5 minutes postcontrast injection. MSCT imaging demonstrated a significant difference in density (P < 0.001) between nonreperfused (47.0 +/- 6.6 HU) and reperfused (116.4 +/- 19.8 HU) infarction. CONCLUSION: In our pilot study, contrast-enhanced MSCT was feasible to assess myocardial viability in pigs. MSCT also affords differentiation of nonreperfused and reperfused acute MI. MI sizes derived from MSCT imaging correlate well to those obtained with MRI and TTC.     

Role of intraoperative transesophageal echocardiography in patients having coronary artery bypass graft surgery

Background

Previous studies have shown that intraoperative transesophageal echocardiography provides important preoperative and postoperative information in various cardiac and noncardiac surgeries that may alter patient management and outcome. The role of intraoperative transesophageal echocardiography in patients in whom isolated coronary artery bypass graft surgery is anticipated has been reported only in small selected groups. This study was designed to prospectively evaluate the role of intraoperative transesophageal echocardiography in a large, nonselected group of patients undergoing primarily coronary artery bypass graft surgery.

Methods

From January 2001 to December 2003, 474 consecutive patients (76% men, 24% women) aged 30 to 89 years (mean age of 70 ± 10 years) who were undergoing coronary artery bypass graft surgery had prebypass and postbypass intraoperative transesophageal echocardiography. New findings and alterations in the surgical plan were documented prospectively.

Results

New prebypass findings were found in 10% of patients, and the surgical plan was altered in 3.4% of patients. New postbypass findings were found in 3.2% of patients, altering the surgical plan in 2% of patients.

Conclusions

This large consecutive, nonselected, prospective study reveals the significant impact of intraoperative transesophageal echocardiography in patients having coronary artery bypass graft surgery as a primary procedure. New findings (prebypass and postbypass) were found in 13% of patients overall, and the surgical plan was altered in 5.5% of patients. This study supports the use of intraoperative transesophageal echocardiography in patients undergoing primarily coronary artery bypass graft surgery.     

Ganzkörperhyperthermie bei Keimzellentumoren

Durch multimodale Therapiekonzepte k?nnen 70–80 % der Patienten mit fortgeschrittenen Hodentumoren geheilt werden. Die Prognose ist allerdings infaust, wenn kein Ansprechen auf die Prim?r- oder Salvagetherapie erfolgt oder nach Hochdosischemotherapie (HDCT) ein Rezidiv auftritt. Um auch diesen Patienten noch eine – m?glicherweise l?ngerfristig palliative – Behandlungsoption zu er?ffnen, sind weiterhin neue Therapiemodalit?ten zu prüfen. Wir haben daher an unserer Klinik 2 Patienten mit einer Kombination aus Polychemotherapie (Carboplatin, Ifosfamid, Etoposid) und Ganzk?rperhyperthermie (“systemische Krebsmehrschritttherapie”) behandelt, und konnten in beiden F?llen ein gutes Ansprechen der Erkrankung bei guter Vertr?glichkeit beobachten. Ausgehend von der Pr?sentation dieser beiden F?lle wird der von uns initiierte “Multizentrische Behandlungsplan zur Therapieoptimierung des refrakt?ren oder rezidivierten Keimzelltumores mittels Chemotherapie (Carboplatin, Etoposid, Ifosfamid) und Ganzk?rperhyperthermie bzw. systemischer Krebsmehrschritttherapie (sKMT)” vorgestellt.     

A study of phosphorylated ERK1/2 and COX‐2 in early stage (T1–T2) oral squamous cell carcinomas

Background: Histomorphological grading at the invasive front of oral squamous cell carcinomas (OSCCs) may provide useful prognostic information. In the present study, we investigated the presence and prognostic value of activated phosphorylated extracellular signal‐regulated kinases 1 and 2 (p‐ERK1/2) and cyclo‐oxygenase‐2 (COX‐2) both at the invasive front and in central/superficial parts of OSCCs. Methods: Using immunohistochemistry, we assessed the presence of p‐ERK1/2 and COX‐2 in 53 early stage OSCCs. Clinical data were recorded prospectively. The end point was disease‐free survival. Results: p‐ERK1/2 staining was present in almost all tumours. The staining was mostly nuclear in the cells of the invasive front and either nuclear or nuclear/cytoplasmic in central/superficial tumour parts. COX‐2 was observed in almost all tumours (98%) and the staining was often restricted to focal areas. Most tumours were COX‐2 negative at the invasive front. The lowest P‐value in survival analyses was P = 0.06 for p‐ERK1/2 at the invasive front. COX‐2, the histomorphological grading systems and TNM stage were of no prognostic value. Conclusion: p‐ERK1/2 was present in almost all tumours and p‐ERK1/2 may be a prognostic marker at the invasive front of OSCCs. In early stage OSCCs, most tumours did not express COX‐2 at the invasive front.     

Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type

Previous studies of the relationship between cancer stage, age, and race have not controlled for social class and health care setting. Logistic regression analyses, using information from the New York State Tumor Registry and area-level social class indicators, demonstrated that, in New York City, older Black, lower class women in public hospitals were 3.75 and 2.54 times more likely to have late stage breast or cervical cancer, respectively, than were younger White, high social class women in non-public hospitals.