Cases Of Malignant Disease Research Articles

Main epidemiological data on cases of malignant neoplasms of the bladder in Saint Petersburg in 2012–2021

Background. Bladder cancer is the most common malignancy of the urinary tract and one of the most common neoplasias in this group. The incidence and mortality rates of the population from bladder cancer differ significantly in different geographical regions of Russia.Aim. To assess the main epidemiological indicators of malignant neoplasms of the bladder in residents of Saint Petersburg and the regions of Russia.Materials and methods. The main epidemiological indicators of malignant bladder neoplasms in Saint Petersburg, Russia and individual federal districts for the period 2012–2021 were studied: crude and standardized rates of morbidity, mortality, prevalence, age structure of patients, the number of cases of diagnosis of the disease at various stages, indicators of one-year mortality and 5-year survival, data on completed cases of treatment of bladder neoplasms. Sources of information: Form No. 7 “Information on cases of malignant diseases” and the database of the Medical Information and Analytical Center (Saint Petersburg).Results. During the period 2012–2021 in Russia, there was an increase in the incidence and prevalence of malignant neoplasms of the bladder. At the same time, mortality rates decreased, and 5-year survival rates increased. This fact indicates the effectiveness of the treatment of patients in this category. In more than 50 % of cases, the disease was detected at stage I of the pathological process, which is due to the proper level of diagnosis. The main medical and statistical indicators in patients with malignant bladder neoplasms in Saint Petersburg are comparable to the average Russian data, and in a number of parameters they exceed them.Conclusion. Oncourological assistance to the population with malignant neoplasms of the bladder in Saint Petersburg is provided properly. The study of medical and statistical indicators in dynamics can be used to improve the algorithms of medical and diagnostic care for cancer patients.

Tuberculosis screening among newly arrived asylum seekers in Denmark

Background Tuberculosis (TB) screening programmes among asylum seekers tend to focus on chest radiography (CXR) for early diagnosis, whereas knowledge on sputum examination is limited. We evaluated active TB screening using CXR and sputum culture among asylum seekers arriving in Denmark. In addition, we assessed the coverage of a voluntary health assessment. Methods Between 1 February 2017 and 31 March 2019, all newly arrived asylum seekers in Denmark ≥ 18 years from TB high-incidence countries or risk groups, who attended a voluntary general health assessment, were offered active TB screening with CXR and spot sputum examination. Sputum samples were examined by culture and smear microscopy. Results Coverage of the general health assessment was 65.1%. Among 1,154 referred for active TB screening, 923 (80.0%) attended. Of these, 854 were screened by CXR and one case of active TB was identified equivalent to a yield of 0.12%. Sputum samples were collected from 758 and one M. tuberculosis culture-positive TB case (also identified by CXR) was identified, equivalent to a yield of 0.13%. No cases were found by sputum culture screening only. In addition, screening found three cases of malignant disease. Conclusion We suggest that TB screening should focus on asylum seekers from TB high-incidence countries. Furthermore, early health assessments should be of high priority to ensure migrant health.

ВАКЦИНАЦИЯ ДЕТЕЙ СО ЗЛОКАЧЕСТВЕННЫМИ ЗАБОЛЕВАНИЯМИ: АКТУАЛЬНОСТЬ ПРОБЛЕМЫ

Currently, the number of cases of malignant diseases in children is increasing, but the number of children who have recovered is also increasing. In the past few years, the number of deaths has decreased thanks to the latest technologies for treating cancer patients, but there are still a number of problems in the lives of small patients after treatment. One of the important problems is the lack of continuation of the mandatory vaccination of children who have undergone a malignant disease, according to age and in accordance with the national calendar, despite the availability of clinical guidelines in domestic and foreign publications on preventive vaccination of this cohort. Many physicians make unjustified medical exclusions from vaccination based only on their own biases, which can be justified by the limited number of publications on this topic. In turn, vaccination can reduce the number of deaths from infectious complications and provide hope for further full life. Children with malignant diseases should be vaccinated against infectious diseases that can be prevented with vaccines after completion and sometimes during treatment. For such patients, there should be a vaccination schedule that takes into account the available therapy that may lead to the suppression of immunity. This article is devoted to the vaccination of children with malignant diseases.

Ultrasound evaluation of persistent cervical lymph nodes in young children

To review the ultrasonographic outcomes of persistent lymph nodes, in the absence of other concerning signs or symptoms, in patients <6 years of age. A retrospective analysis was undertaken of 98 patients <6 years old who had neck ultrasound for persistent lymph nodes at a single university hospital over a 3.5 year period between January 2016 and June 2019. There were no cases of malignant disease or serious systemic illness. Ninety-two of the 98 examinations showed normal or reactive lymph nodes. There were three sonographically indeterminate cases and two non-lymph-node structures: haemangioma and dermoid cyst. One examination reported an abnormal lymph node, which had resolved by the time of review in clinic. Persistently enlarged or abnormal lymph nodes should be investigated; however, a distinction should be made between lymph nodes that have regressed to <1 cm but are still palpable and persistently enlarged or abnormal lymph nodes. The findings of the present study indicate that persistence of non-enlarged lymph nodes is not a predictor for malignancy. It is advised that clear guidelines are used, which state the criteria for further investigation, to promote the best use of imaging.

Routine Histopathology for Resected Gallbladder Specimens: Outcomes and Cost-benefit Analysis at a District General Hospital, Retrospective Cohort Study

Routine histopathological assessment of resected gallbladder specimens is a common practice in the UK. However, the incidence of incidental gallbladder cancer is low and there is a debate over whether selective histopathology is more appropriate. Here we aim to identify the incidence of malignant and pre-malignant disease upon routine histological analysis of gallbladder specimens in Ealing hospital. We conducted a retrospective analysis of gallbladder histopathology reports was performed for all patients undergoing cholecystectomy at Ealing Hospital between June 2011 and December 2018. Demographic information, operative findings, pathology results, staging, treatment and outcome information were collected for each case of malignant or pre-malignant disease. The total financial cost of histopathological analysis of resected specimens was calculated. A total of 1,612 patients underwent cholecystectomy with histopathological assessment of the resected specimen. The majority of specimens showed chronic cholecystitis 71.3%. Acute cholecystitis 28.1%. Gall bladder polyps found in two patients 0.12%. Low grade dysplasia was identified in three patients 0.19% while high grade dysplasia was identified in two patients 0.12%, and malignant disease was reported in three patients 0.19%, two patients had stage 2 and one had stage 3 gall bladder cancer. All cases of malignant disease were identified by the surgeon intra-operatively on gross inspection. The cost of routine histopathological analysis was £128 per patient. The incidence of pre-malignant or malignant gallbladder disease after cholecystectomy is rare. A selective approach to histopathological assessment, based on patient age, clinical presentation and intra-operative findings, will provide a financial and labour cost saving.

STUDY OF CYTOKINE BIOMARKERS FOR EARLY DETECTION OF CHRONIC GRAFT VERSUS HOST DISEASE IN ALLOGENEIC STEM CELL TRANSPLANT PATIENTS

Allogeneic transplantation represents the most efficient consolidation treatment for most cases of malignant diseases. Some progression was made in the practice of transplantation but still, GvHD, relapse, and infection are the main obstacles. The cumulative incidence of cGvHD by 1 year after transplant ranged from 30-70 %. GvHD is the most common non-relapse mortality (NRM), and accounts of about 10–25 % of all transplanted patients.CGvHD is defined by the National Institutes of Health (NIH) Consensus depending on clinical manifestations, changing the classical and rather arbitrary chronological “beyond Day 100” definition. There are two types of cGvHD: Classic and overlap. The severity of cGvHD also assessed by the NIH global severity of cGvHD.Types of Hematopoietic stem-cell transplantation (HSCT) types: Allogeneic or autologous HSC.Chronic GvHD types: Classic chronic GvHD: occurs at any time after transplantation. Overlap syndrome: May occur at any time after transplantation, with a mixture of features of both cGvHD and aGvHD.Biomarker Panel for Chronic Graft-Versus-Host Disease:NIH Biomarker Working Group in 2006 meeting, declared cGvHD biomarkers utilization for clinical trials and disease management in the following conditions to (1) predict the risk of developing cGvHD; (2) diagnose cGvHD ; (3) measure disease activity or predict prognosis; (4) predict therapy response; and (5) serve as the surrogate endpoint for therapeutic response.

Detection of thyroiditis on PET/CT imaging: a systematic review.

The incidence and clinical significance of thyroiditis detected by molecular imaging methods is a clinical challenge that is not widely investigated in the literature. The aim of this systematic review was to analyze published data about the detection of thyroiditis on PET or PET/CT using different tracers. A comprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase, and Cochrane library databases was conducted up to November 2019 to find relevant papers on the detection of thyroiditis by PET/CT, the metabolic appearance, and the clinical significance. Twenty-six articles were selected and retrieved in full-text version. From the analyses of these studies, the following main findings have been found. Diffuse thyroid uptake of PET tracers is a relatively frequent event, ranging from 0.4 to 46.2%, and it is commonly related to benign disease. Thyroiditis is the most frequent reason for diffuse increased thyroid 18F-FDG uptake. Cases of malignant disease with a pattern of diffuse 18F-FDG thyroid uptake are less frequent. Preliminary studies show a possible role of thyroiditis detected by 18F-FDG PET/CT in evaluating treatment response and as a prognostic marker in oncological patients treated with immunotherapy. However, further studies are needed. Diffuse 18F-FDG thyroid uptake is a relatively rare event commonly due to benign diseases, among which thyroiditis is the most common. The rate of neoplastic disease with diffuse 18F-FDG thyroid uptake is very low. Diffuse 18F-FDG thyroid uptake requires further investigation and clinical evaluation for the correct diagnosis. Currently, cases of diffuse thyroid uptake with non-18F-FDG radiotracer are only anecdotal.

A prospective cohort study of 122 adult patients presenting to an otolaryngologist's office with globus pharyngeus.

To investigate the epidemiology of globus pharyngeus in adult patients presenting to the otolaryngologist's office. Also, the predictors of persisting symptoms, prevalence of anxiety and the effect of clinical assessment were analysed. This was a prospective cohort study. Follow-up was carried out using a postal questionnaire. One otolaryngologists' office comprising three medical doctors. A total of 122 consecutive globus patients presenting to one otolaryngology office in a 1-year period. Globus incidence, gender and age distribution, predictors of persisting symptoms and the patient's health-related concerns. 3.8% of first-time visits were regarding globus. The mean age was 48years [range 20-88years], and a female predominance was found (ratio 1.49). Eighty-four per cent experienced anxiety, mainly due to fear of cancer. The most common pathological findings were reflux (15.6%) and post-infectious inflammation (10.6%). 21.4% of questionnaire responders reported full remission of their symptoms. Three predictors regarding symptom persistence were identified: male gender (OR 1.52), smoking (OR 3.4) and difficulties in breathing (OR 8.7). Patients with concomitant foreign body sensation were less likely to have persisting symptoms (OR 0.42). No cases of malignant disease were encountered. 94.7% was reassured by the office visit. The incidence of globus is 3.8% in the otolaryngologist's office. Female gender and concomitant foreign body sensation were predictive for presenting to the clinic even if symptom remission had occurred. Male gender, smoking and self-perceived breathing difficulties were predictive for persisting symptoms. Globus is an anxiety-causing symptom, but reassurance is provided by clinical examination by the otolaryngologist.

The neutrophil-to-lymphocyte ratio (NLR) predicts adrenocortical carcinoma and is correlated with the prognosis

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) is reported as a biomarker for some solid malignant diseases. Thus far, however, no reports of the relationship between the NLR and adrenal tumors have been published. We analyzed the utility of the preoperative NLR as a biomarker for predicting the prognosis or diagnosis of malignant disease.MethodsA total of 59 patients with adrenal tumors (13 cases of malignant disease and 46 with benign disease) were analyzed in this study from February 2004 to June 2015 at our institute. The NLR was obtained just before adrenalectomy. The diagnosis of adrenal tumor was confirmed by a pathological examination of surgical specimens.ResultsThe NLR in malignant adrenal tumor specimens was significantly higher than in non-malignant specimens (p = 0.028). Adrenocortical carcinoma (ACC) showed the highest NLR among all adrenal tumors. In ACC, the higher NLR group (NLR ≥ 5) showed a significantly poorer overall survival than the lower NLR group (NLR < 5) (p = 0.032).ConclusionsIn adrenal tumors, a higher NLR indicates a higher incidence of malignancy. The NLR might be a new biomarker for predicting the prognosis of adrenal tumor patients.

Childhood malignant tumours in owerri

Tittle: Childhood Malignant Tumours in Owerri; A Histopathological Review.&#x0D; Aim: The aim of this study is to evaluate the demographic and pathologic characteristics of childhood tumours in Owerri.&#x0D; Methodology: The surgical day books, histology request and report forms were studied and the clinico-pathologic information were retrieved and analyzed using SPSS version 20.0&#x0D; Results: A total of 27 cases of malignant diseases of children were clinically diagnosed and histologically confirmed. The mean age of the patients were 10.17±4.33 years with age range of 1 to 18 years. The male to female ratio was 1:1.25. The peak age of incidence falls in the 6-10 age groups which accounted for 40.74%. Wilm’s tumor (Nephroblastoma) was the commonest 8 cases (29.63%), Embryonal Rhabdomyosarcoma 6 cases (22.22%), Neuroblastoma 4cases (14.81%), osteosarcoma 3cases (11.11%), yolk sac tumour of the ovary 2 cases (7.41%), one case “3.70%” each for retinoblastoma, soft tissue sarcoma and angiosarcoma&#x0D;

Abstract A82: Medicaid disenrollment in Tennessee and disparities in stage at diagnosis and surgery for female breast cancer

Abstract Purpose: To assess the effects of Medicaid disenrollment on stage at diagnosis and delay in surgery for female breast cancer among nonelderly women. Background: Although Medicaid expansions have received considerable attention in the literature, Medicaid contractions have received much less attention. Tennessee's Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults after implementing a new benefit policy in 2005. Despite the fact that this was the largest disenrollment in the history of Medicaid, little is known about the effects of this policy change on access to care and health outcomes. This is the first study, to our knowledge, to consider the effect of disenrollment on stage at diagnosis and delay in surgery for breast cancer. Methods: We use 2002-2008 data from Tennessee Cancer Registry which collects data on newly diagnosed cases of malignant disease that occur to Tennessee residents from all hospitals, laboratories, facilities and healthcare practitioners. The sample used for this study consists of women aged 21 to 64 who were diagnosed with breast cancer and living in Tennessee during the period of study. We merge data on zip code median income with the Tennessee Cancer Registry data and estimate a difference-in-differences model. We calculate the changes in stage at diagnosis, more than 60-days delay in surgery, and more than 90-days delay in surgery for female breast cancer among women who were diagnosed with breast cancer and had surgery as the first-line treatment. The difference-in-differences model compares women who were living in low-income zip codes (and thus more likely to be subject to disenrollment) with women who lived in high-income zip codes before and after Tennessee's 2005 Medicaid disenrollment. We control for age, race/ethnicity, marital status, insurance coverage, and year fixed effects. Results: Preliminary results suggest that nonelderly women who lived in low-income zip codes were 2.8 percentage points (p &amp;lt; 0.1) more likely to be diagnosed with late stage (regional or distant) breast cancer, compared to women living in high-income zip codes, after Tennessee's Medicaid disenrollment. In addition, nonelderly women who lived in low-income zip codes were 1.9 percentage points (p &amp;lt; 0.05) less likely to have more than 60-days delay in surgery than women living in high-income zip codes, after the disenrollment. Women who lived in low-income zip codes were also more likely to have more than 90-days delay in surgery, but this difference was not significant. Conclusions: While many states are expanding Medicaid eligibility under the Affordable Care Act, there has been discussion among policymakers in some states to reduce eligibility once full federal funding expires. This study provides evidence on the potential impact of Medicaid disenrollment on delays in diagnosis and performing urgent surgeries to treat late stages of breast cancer among low-income women in states that may consider future changes to Medicaid eligibility. Citation Format: Wafa W. Tarazi, Cathy J. Bradley, Harry D. Bear, David W. Harless, Lindsay M. Sabik. Medicaid disenrollment in Tennessee and disparities in stage at diagnosis and surgery for female breast cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A82.

The negative enrichment by immunomagnetic beads for tumor cells from malignant pleural effusions

To establish a method (negative enrichment by immunomagnetic beads) for detection of tumor cells in pleural effusions and to evaluate the sensitivity and specificity of the method for clinical application. Five, 10, 20, 50 and 100 A549 (lung adenocarcinoma) cells were labeled with DAPI and added into 20 ml pleural effusions [containing (1 - 10)×10(6)cells] from heart failure patients, followed by immunomagnetic negative enrichment method. Recovered cancer cells were enumerated using a fluorescent microscope. Tumor cells were enriched from pleural effusion samples by means of density gradient centrifugation and negative enrichment by immunomagnetic beads method, followed by identification with cytology analysis (Wright's Giemsa's staining), immunofluorescence staining (IF) and fluorescence in situ hybridization (FISH) using centromere DNA probes of chromosome 7 and 8. Cytology, IF and FISH evaluations were performed in 53 pleural effusion samples, including 36 cases of malignant disease (25 male and 11 female patients aging 40 to 78 years, mean age (63 ± 9) and 17 cases of benign disease (8 male and 9 female patients aging 25 to 81 years, mean age (53 ± 18). After DAPI staining and mixing with pleural effusions from heart failure patients, the cell recovery rates of A549 cells evaluated under fluorescence microscope were 75%, 78%, 82%, 85%, 88%, and the average recovery rate was 81.6%. Using negative enrichment method and density gradient centrifugation combined with cytology analysis, the positive rates of tumor cells in 36 malignant pleural effusion samples were 81% (29/36) and 61% (22/36), respectively (χ(2) = 4.00, P = 0.039). Using negative enrichment method combined with IF, the positive rate of CK18(+), DAPI(+), CD(45)(-) cells was 100%. Moreover, using negative enrichment method combined with FISH analysis, the positive rate of tumor cells was 86% (31/36), much higher than that using density gradient centrifugation combined with cytology analysis (χ(2) = 5.818, P = 0.012). In 17 cases of benign pleural effusions, using negative enrichment method combined with IF, the positive rate was 100%. But other methods didn't find cancer cells from benign pleural effusions. It was applicable to enrich tumor cells from pleural effusions using negative enrichment method by immunomagnetic beads. This method combined with cytology analysis or FISH significantly enhanced the sensitivity and specificity of tumor cell detection in pleural effusions. But it was difficult to distinguish cancer cells from mesothelial cells using immunofluorescence staining with CK18, DAPI and CD(45) label. More specific markers were needed to recognize tumor cells from pleural effusions.

The Predictors of Postoperative Laryngeal Nerve Paresis in Patients Undergoing Thyroid Surgery: A Pilot Study

The objective of this study was to evaluate the factors predictive of postoperative laryngeal nerve paresis (LNP) in patients undergoing thyroid surgery. We also assess the implications of preoperative LNP on postoperative vocal fold status. Case series with retrospective chart review. Charts of 17 patients who underwent thyroid surgery and had pre- and postoperative laryngeal electromyography (LEMG) were reviewed. LEMGs were ordered routinely in all patients undergoing thyroid surgery, not just in those with clinical findings suggestive of paresis. We collected data relating to pre- and postoperative laryngeal and thyroid evaluations and the details of the surgical procedure. We analyzed the prevalence of preoperative LNP and relationship of thyroid diagnoses, size of thyroid mass, and type of surgery performed with respect to the outcome of the LNP. All the 17 patients had a mild to moderate degree of unilateral or bilateral LNP preoperatively. However, only seven (41.2%) had vocal symptoms. After surgery, only five of these seven patients had voice complaints, and there were no patients with voice complaints among the group that had been asymptomatic preoperatively. Thyroid diagnoses included 11 cases of benign disease (64.7%) in which LNP improved in two, worsened in four, and remained the same in five; and six cases of malignant disease (35.3%) in which LNP improved in none, worsened in two, and remainedthe same in four. Predictors of worsening postoperative LNP on LEMG included the diagnosis of goiter (P=0.0005) and size of mass greater than 5cm (0.032). This study supports the notion that there is an intrinsic relationship between benign thyroid diseases and LNP that is probably related to local effects of the disease on the laryngeal nerves. All patients with the postoperative diagnosis of goiter worsened, and all patients with the postoperative diagnosis of adenoma showed no change on postoperative electromyography (EMG). Similarly, all patients with the diagnosis of thyroiditis alone improved, and there were no cases of improvement outside this group. Of the six cases of malignancy, four exhibited no change on EMG and only two worsened. The only reliable predictors of worsening paresis postoperatively are mass size greater than 5cm and diagnosis of goiter.

Millikan KW, Doolas A (2007) A long-term evaluation of the modified mesh-plug hernioplasty in over 2,000 patients

Dear Professor Schumpelick, We were glad to see that the results of this complete and thorough prospective audit are those that any general surgeon can attain. We too have had similar gratifying results with simple modiWcations of the original description of the “plug and patch” inguinal hernioplasty [1]. The important issue is that the dissection is “high” into the preperitoneal space, which is easily identiWed as having been reached by the glistening bright yellow preperitoneal fat, something that is rarely made enough fuss of. Indeed, we have often thought that the “PERFIX plug” would have been better named the “PREFIX plug” to remind surgeons that correct placement is the crucial step in this technique of repair. Furthermore, to attain a good preperitoneal placement of the plug, its outer petals are best stretched and Xattened, as illustrated in Fig. 1. Only then are the inner petals sutured to the margins of the hernial defect. This simple modiWcation allows the outer layer of the plug to sit astride the defect in the perperitoneal plane as a “sublay” patch. Since 1997, we have used this repair in 1,255 patients with very satisfying results and a paucity of complications in both the short and long term. We have had three cases of urinary retention and nine haematomas, of which, four needed draining. In the original description [1], it was suggested that the mesh patch was placed without sutures, as it was only there to augment the beneWt of the “plug.” Although we believe this still to be true, we now anchor the patch medially with one stitch just short of the pubic tubercle. This simple single suture keeps the patch in close proximity to the back wall of the canal. With these simple modiWcations, we have not seen a case of migration or sepsis, and have had to excise only one plug (in a butcher) at a median follow up of 7 years. Our recurrence rates are similar to that of these authors, but they do vary as to the aetiology of the hernial defect; primary indirect 2/789 (0.25%), primary direct 3/360 (0.83%) and 1/87 (1.1%) when a plug repair is used to manage a recurrence following a previously sutured repair. As stated some time ago, the “plug and patch approach” has caught on [2, 3], but its simplicity should not be an excuse for a poor anatomical dissection. At this point, it would be prudent to recall the words of Wakely, quoted by Glassow, well before the widespread use of mesh, who said “a surgeon can do more for his community by operating on hernia cases and seeing that his results are good, than by operating on cases of malignant disease” [4, 5]. In other words, if we do it well, we can all get good results and, with this technique, the anatomy is familiar to us all and the learning curve short.

Metastatic tumours of the diaphragm.

Abstract In a series of 151 autopsies on cases of malignant disease, 12 (7.9 per cent) were found to have involvement of the diaphragm as compared with 5 (3.4 per cent) which had metastases in the spleen. Secondary deposits from the bronchus and stomach were rarely seen in comparison with those from more distant organs and the surgical importance of this finding is discussed.

Occult bleeding in three different antithrombotic regimes after myocardial infarction: A WARIS-II subgroup analysis

Introduction Warfarin, aspirin, and the combination of these, have all proven to be efficacious in preventing future events after myocardial infarction. The accompanying bleeding tendency is a concern. The aim of the present study was to compare the occurrence of occult bleeding and iron deficiency during these treatment modalities. Methods The 267 patients who had survived a myocardial infarction were randomly assigned in the Warfarin Aspirin Reinfarction Study to treatment with aspirin 160 mg/day, or warfarin (INR 2.8–4.2), or aspirin 75 mg/day plus warfarin (INR 2.0–2.5). The patients were screened for the occurrence of occult bleeding in faeces and urine after 3 months. Haemoglobin and iron metabolism parameters were measured at baseline, after 3 months, and at the end of the 4 years follow-up. Results The number of occult bleeding in faeces was 19 (7.1%) and in urine 29 (10.9%). There were no intergroup differences ( p = 0.45 and 0.39, respectively). In the occult bleeders, a second test showed 3 (1.1%) positive samples in faeces and 9 (3.4%) in urine. Further investigation revealed 2 cases of malignant disease. Haemoglobin and iron status variables were all within normal limits after 3 months and after 4 years in all treatment groups. Conclusions Long-term treatment with aspirin, warfarin, or both, in the present doses and levels of anticoagulation did not lead to anemia or iron deficiency. The occurrence of occult bleeding in faeces and urine was a temporary phenomenon in most patients. Only macroscopic bleedings during these treatment modalities were of clinical importance, and screening for occult bleeding was of limit value.

Efficient screening for ovarian cancers using a combination of tumor markers CA602 and CA546

A new efficient screening for ovarian cancer based on a combination of two tumor markers, CA602 and CA546, is reported. These two tumor markers can be detected by a combination immunoenzymometric assay of these two antigens. This combination assay was initially performed in 1189 patients with clinically detected ovarian tumors (final pathological diagnosis: 645 cases of benign disease and 544 cases of malignant disease), and benign disease included 122 patients with endometriosis and 523 normal healthy women. The combination of CA602 and CA546 increased the detection rate of ovarian cancer from 77.8 to 85.8% compared with CA602 alone, demonstrating that the combination assay was effective at detecting ovarian cancers. The combination assay of CA602 and CA546 was then applied to 21,374 random subjects to screen for asymptomatic ovarian cancer. Ovarian cancer was detected in nine patients (detection rate: 0.04%), of which four cases were stage I disease. A retrospective analysis of these four patients revealed that a screening based on only a single assay would have been negative and further reiterates the effectiveness of this combination assay in detecting potential disease.

Efficient screening for ovarian cancers using a combination of tumor markers CA602 and CA546

A new efficient screening for ovarian cancer based on a combination of two tumor markers, CA602 and CA546, is reported. These two tumor markers can be detected by a combination immunoenzymometric assay of these two antigens. This combination assay was initially performed in 1189 patients with clinically detected ovarian tumors (final pathological diagnosis: 645 cases of benign disease and 544 cases of malignant disease), and benign disease included 122 patients with endometriosis and 523 normal healthy women. The combination of CA602 and CA546 increased the detection rate of ovarian cancer from 77.8 to 85.8% compared with CA602 alone, demonstrating that the combination assay was effective at detecting ovarian cancers. The combination assay of CA602 and CA546 was then applied to 21,374 random subjects to screen for asymptomatic ovarian cancer. Ovarian cancer was detected in nine patients (detection rate: 0.04%), of which four cases were stage I disease. A retrospective analysis of these four patients revealed that a screening based on only a single assay would have been negative and further reiterates the effectiveness of this combination assay in detecting potential disease.

Lobular neoplasia on core-needle biopsy--clinical significance.

Approximately 25% of all cases of atypical ductal hyperplasia (ADH) diagnosed on core biopsy of the breast are associated with ductal carcinoma in situ (DCIS) or invasive malignancy at the same site. As a result, surgical excision has become the standard of care for patients with ADH. In contrast, because data on the relation between breast malignancy and lobular neoplasia (LN) detected on core biopsy are limited, clinical management of patients with LN remains controversial. The goal of the current study was to determine the incidence of breast carcinoma at sites of core biopsy exhibiting LN compared with sites of core biopsy exhibiting ADH. The results of 2053 core biopsies were reviewed to identify cases of LN and cases of ADH. Follow-up findings on excisional biopsy were categorized as malignancy (DCIS or invasive malignancy) or no malignancy and were compared between the LN group and the ADH group. Mammograms and medical records were reviewed for patients with atypical findings on core biopsy. One hundred six (5.2%) of 2053 biopsy samples exhibited atypia on core biopsy. Among these 106 samples, ADH was found in 49 (46%), LN was found in 45 (42%), and both ADH and LN were found in 12 (12%). Malignant disease was detected on follow-up excisional biopsy in 22% of patients with ADH (9 of 41), 14% of patients with LN (3 of 21), and 33% of patients with both ADH and LN (4 of 12) on core biopsy. In the LN group, two cases of malignant disease were associated with lobular carcinoma in situ, and the third case was associated with atypical lobular hyperplasia. Mammographic and clinical features were unable to distinguish patients with malignant findings on excisional biopsy from patients without malignant findings. Malignant disease was found in a substantial percentage of excisional biopsy samples (14%) following the detection of LN on core biopsy. Thus, like patients with ADH, patients with LN on core biopsy could be considered candidates for surgical excision, which would allow full assessment of breast carcinoma risk and thereby facilitate the planning of prevention strategies.

Increasing incidence rates of childhood malignant diseases in Sweden during the period 1960–1998

We analysed the trends in incidence rates of childhood cancer in Sweden. All cases of malignant diseases and benign brain tumours in children, 0–14 years old, reported to the Swedish Cancer Registry 1960 to 1998 were included, n=9298. Cases were classified according to the International Classification of Childhood Cancer. Average annual change in incidence rate was calculated to +1.01%, (95% confidence interval CI=0.80, 1.22). An increase in incidence rate per year was found for leukaemia, +0.85% (95% CI=0.42, 1.28), lymphomas +1.87% (95% CI=1.17, 2.58), CNS (central nervous system) tumours +1.45% (95% CI=1.02, 1.88), sympathetic nervous system tumours +1.61% (95% CI=0.79, 2.44), hepatic tumours +2.62% (95% CI=2.02, 3.21), and germ cell and gonadal tumours +1.21% (95% CI=0.23, 2.19). Of the CNS tumours, significant changes were seen for low-grade glioma/astrocytoma +2.10% (95% CI=1.41, 2.80), benign brain tumours +3.77% (95% CI=2.47, 5.10), and PNET/medulloblastoma +1.96% (95% CI=0.48, 3.46). Changes in diagnostic criteria and better diagnostic tools may have contributed to these results.