1/5. Colorectal cancer: dilemmas regarding patient selection and toxicity prediction.Irinotecan (Campto, Rhone-Poulenc Rorer) is probably the most studied drug used as second-line treatment for colorectal cancer. Its main disadvantages are toxicity and cost. Delayed diarrhea and neutropenia are the most common toxic side effects, both of which can usually be predicted, by knowing the criteria for patients who are at increased risk for those side effects. These criteria include poor performance status (>2), bulky disease, previous abdominal-pelvic irradiation, hyperleukocytosis and increased bilirubin >1.5 x normal upper range. There are some other less common toxic effects of irinotecan, such as pneumonitis, cardiac arrhythmia, paralytic ileus, liver dysfunction, tumor lysis syndrome. While these side effects are very rare, physicians should be able to recognize them, because the number of patients being treated with irinotecan is increasing. The authors report four cases of probable irinotecan-related toxicity with fatal outcome in all 4 patients. Two of these 4 patients were not in the known risk categories for irinotecan toxicity. One patient died with signs of hepato-renal syndrome, the other with signs of rapid tumor lysis-like syndrome. Two other patients with bulky disease and performance status 2, had increased urea, creatinine and bilirubin serum levels after irinotecan administration, that could not be explained as manifestation of disease progression only. Data on all uncommon irinotecan toxic effects should be gathered and analyzed so that toxic effects, other than diarrhea and neutropenia, are better defined and predicted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases.Twelve patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) were analysed. Eight of them had typical RS3PE without underlying disease, and four presented associated neoplasia. The first patients experienced an excellent response to low doses of prednisone, and they all achieved complete and permanent remission. The mean treatment duration was 18 months and the mean follow-up was 4.4 years. During the follow-up, none of these patients relapsed, had fever or general health deterioration, and hand and foot radiographs did not show erosion. One of them developed a panarteritis nodosa 6 years later. Four RS3PE patients had associated neoplasia. Two were with solid malignancies, and the other two presented haematological malignancies. In one of them RS3PE preceded the diagnosis of malignancy. The diagnosis of RS3PE in the other patients was subsequent to cancer. The first patients presented clinical characteristics suggestive of paraneoplastic RS3PE, and they had a poor response to corticosteroid therapy. Two patients died, and the rest of them had a complete response to surgical resection of the tumour or to chemotherapy. In general, idiopathic RS3PE patients do not show either general health deterioration or fever and they do respond to low doses of steroids (10 mg/day). We observed strong contrasts with the results obtained when treating RS3PE patients with associated neoplasia. In patients with RS3PE the presence of systemic symptoms along with resistance to low doses of corticosteroid therapy should alert the physician to the possible presence of malignancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. The decision to suggest screening lower gastrointestinal endoscopy: the effect of training.Primary care residency directors in the Southeastern US were surveyed to obtain information on training in lower gastrointestinal endoscopy (LGIE). All residents in a sample of programs were asked to complete a similar questionnaire. Response was 77% for family practice residencies and 60% for internal medicine residencies. Significantly fewer (43%) internal medicine residents reported receiving training in either 35 cm or 60 cm LGIE than family practice residents (77%). When asked if they would suggest LGIE to screen an asymptomatic patient, 67% of family practice and 84% of internal medicine residents replied affirmatively. Those residents who had received training were significantly more likely to suggest screening LGIE. The screening decision was not influenced by the specialty of the physician who supervised the resident training. Out-of-pocket cost to the patient was expected to be a major consideration in the screening decision, but this was not supported statistically. Greater availability of residency training in LGIE will likely increase its use in screening.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Colorectal cancer in patients aged less than 40 years.Colorectal cancer is commonly found in adults aged greater than 50 years. The peak frequency occurs in the 6th to 7th decades and gradually declines in the 8th decade. This cancer is very unusual in young adults, the occurrence ranging from 1 to 17 percent of all cases of colon cancer. The prognosis for this disease in the young adult is reported to be unfavorable. This may be due to delayed diagnoses and a higher frequency of mucin-producing tumors and advanced stage of the disease. This article presents a case report and review of the literature and alerts the primary care physician to the possibility of serious disease in young adults who may present with protracted abdominal symptoms. Age should not be a barrier in the application of diagnostic tools. The duration and degree of symptoms should prompt early investigation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Detection and monitoring of serum p53 antibodies in patients with colorectal cancer.BACKGROUND: Detection of p53 antibodies in serum might be an effective indirect procedure to detect alterations of the p53 gene. AIMS: To assess the prevalence and the variation under treatment of p53 antibodies in patients with colorectal cancer. patients AND methods: Fifty four patients with colorectal cancer (26 men and 28 women, mean age 65, range 33-90 years) and 24 patients with non-malignant digestive disease were tested for p53 antibodies by enzyme linked immunosorbent assay (ELISA), and for the carcinoembryonic antigen and carbohydrate antigen 19.9. Immunohistochemical detection of p53 protein tumour overexpression was performed in 38 cases. RESULTS: Fourteen patients (26%) with colorectal cancer but none of those with non-malignant disease displayed p53 antibodies. Overexpression of p53 was shown by immunohistochemistry in 22 patients (58%), 10 of whom also had p53 antibodies. The antibodies were present in four patients with high carcinoembryonic antigen and three patients with high carbohydrate antigen 19.9 concentrations, but also in 10 patients (33.3%) with normal values of these markers. The ratio of p53 antibodies decreased in 11 of 13 patients after tumour resection. In two patients variations in p53 ratio strongly correlated with tumour relapse or progression. CONCLUSION: Testing for serum p53 antibodies constitutes a useful technique for assessing alterations in p53 and may help physicians to follow up patients with colorectal cancer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |