Detection Of High-risk Patients Research Articles

Use of Breast MRI Surveillance in Women at High Risk for Breast Cancer: A Single-Institutional Experience

The study aim is to investigate indications for breast magnetic resonance imaging (MRI) screening for high-risk women and to determine outcomes, correlation with routine imaging, and adherence to current guidelines for use. We identified 200 patients undergoing 275 breast MRIs for high-risk surveillance from 2005 to 2008. Data collected included patient characteristics, need for additional imaging and/or biopsy, correlation with routine imaging, and outcomes. Gail scores were calculated for patients without hereditary breast cancer syndromes or previous chest radiation. Descriptive statistics were utilized for data summary. Two hundred patients underwent 275 breast MRIs for high-risk surveillance (mean age 45 years, range 18-76 years). Indications included BRCA mutation (n =21), history of chest radiation (n = 10), and perceived high risk (n =169). The mean Gail score for the latter group was 25% (range 10-46%); 32 (16%) patients had Gail score <20%. Of 275 MRIs, 49 (18%) required additional imaging and 21 (8%) prompted biopsy. Of 21 biopsies, 4 were malignant; 2 were also visible on routine imaging performed concurrently with breast MRI. The false-positive rate for breast MRI screening in our cohort of high-risk patients was 23%. The rate of cancer detection in high-risk patients undergoing breast MRI at our institution is similar to that of large, multicenter trials. Sixteen percent of patients undergoing breast MRI did not meet high-risk criteria. Because the need for additional imaging and biopsy remains high, further investigation is necessary to determine if this strategy is cost effective.

1080b: Narrow Band Imaging (NBI) for Adenoma Detection in High Risk Patients: A Randomised, Controlled Trial

Randomised data so far suggest that NBI provides limited or no benefit for adenoma detection at colonoscopy in patients at standard risk of adenomas[1]; however a back-to-back study in high risk patients with hereditary non-polyposis colorectal cancer (HNPCC) did show improved adenoma detection[2]. No randomised data exist for other higher risk groups where NBI might be more effective.

Current strategies for the management of children with sickle cell disease

Children with sickle cell disease may present to doctors anywhere in the world. In developed countries, neonatal screening allows early identification and management of the disease, mostly through daily antibioprophylaxis, immunizations and education of the parents. Stroke prevention relies on the detection of high-risk patients by annual transcranial Doppler ultrasonography from 2 to 16 years of age. Annual check-ups aim to detect early organ deficiencies. The most frequent complications are pain, infections and acute anemia; they may occur in combination. Approximately 10% of children have severe sickle cell disease that may require chronic blood transfusion, hydroxyurea or hematopoietic stem cell transplantation. Comprehensive management programs have dramatically increased survival, and most patients now reach adulthood.

L’hyperméthylation des gènes suppresseurs de tumeur comme marqueur en cancérologie

Summary During malignant transformation, cells accumulate epigenetic abnormalities like DNA methylation that do not alter the DNA sequence but are transmissible during divisions. The methylation of CpG islands in the promoter region of tumour suppressor genes is a mechanism of gene inactivation and the methylation profile (or panel of methylated genes in a tumour) varies with the tumour type and histology. The methods of DNA methylation analysis, based on a bisulfite treatment followed by a PCR amplification or a sequencing, are sensitive and specific to allow the detection of these abnormalities not only in tumour tissues but also in biological fluids that drain the tumour or in circulating DNA. This is a very promising approach for early cancer detection in high risk patients or rapid diagnosis of relapse as well as to define tumour prognosis or response to chemotherapy. Finally, DNA methylation is reversible with demethylating agents, a new avenue for cancer therapy in association with conventional chemotherapy.

Pulmonary preneoplasia – sequential molecular carcinogenetic events

Bronchial and bronchioloalveolar carcinogenesis is a multicentric and multistep process, leading to a sequential accumulation of molecular and genetic abnormalities, mainly due to exposure to tobacco carcinogens. Concomitantly, a series of morphological alterations of normal bronchial or bronchioloalveolar epithelium occur, resulting in preneoplastic and then neoplastic lesions. The three pulmonary preneoplastic changes recognized to date in the lung include bronchial squamous dysplasia and in situ carcinoma, preceding invasive squamous cell carcinoma and basaloid carcinoma, atypical adenomatous hyperplasia, a preneoplastic condition of bronchioloalveolar carcinoma, and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, a proposed precursor for carcinoid tumours. Although the gradual accumulation of molecular alterations has been widely investigated in bronchial carcinogenesis, with the aim of determining new biomarkers for early lung cancer detection in high-risk patients and targeted chemoprevention, lung adenocarcinoma pathogenesis has been only recently highlighted, with the recent discovery of epidermal growth factor receptor mutation pathway in non-smokers. This review focuses on the current status of molecular pathology in lung cancer and pulmonary preneoplastic conditions.

Inpatient Monitoring and Prognostic Importance of B‐Type Natriuretic Peptide

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in many industrialized countries. Despite a consistent body of data demonstrating the benefits of drug therapy, the prognosis of patients admitted with ADHF remains dismal, as it is associated with high readmission and mortality rates within 6 months of admission. ADHF is a largely hemodynamic disorder; 90% of hospitalized patients present with volume overload. Neurohormonal activation characterizes the disease; the B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide are natriuretic and vasodilating peptides released from the cardiac ventricles as a response to ventricular volume expansion and relate to outcome. While BNP levels obtained on admission provide independent prognostic information of in-hospital mortality, BNP levels during and at the completion of hospitalization can help to achieve euvolemia and may reflect adequacy of treatment. Once euvolemia is reached, BNP level correlated with functional class and prognosis. Studies using natriuretic peptides have suggested that predischarge BNP level appeared to be the strongest predictor for identifying subsequent death or hospital admission at 6 months. The addition of predischarge BNP levels to a clinical/instrumental decisional score for discharge decision should make possible the detection of high-risk patients who need reinforced treatment or follow-up.

Use of intensified early cancer detection in high-risk patients with familial breast and ovarian cancer

A prospective follow-up study was carried out to evaluate the influence of risk and genetic counselling on use of early cancer detection. Five hundred and fifty-six subjects who fulfilled inclusion criteria for a genetic analysis of the BRCA1/2 genes (the high-risk group A) and 205 who did not fulfil the inclusion criteria (the lower risk group B) attended primary consultation in the interdisciplinary cancer genetic clinic. Information about participation in the early cancer detection programme was documented. Information about changes in use after consultation could be evaluated from 349 women (94 group B and 255 group A). Methods such as monthly self-palpation, breast palpation by gynaecologist, ultrasound of the breast, transvaginal ultrasound and pelvic examination had all been commonly used. Consultees at higher risk used mammography less often than women at lower risk. Magnetic resonance imaging of the breast was used rarely. Most methods were used more often at the recommended interval by women at higher risk during the follow-up period. In conclusion, at present intensified early cancer detection programmes for women at risk provide a less invasive option than chemoprevention or prophylactic surgery. Although the methods are used at high frequency it seems feasible to motivate women at risk to participate. This can be done by providing information and counselling in the cancer genetic clinic.

P-237 Lung cancer detection in high risk patients with airflow obstruction; An ongoing study

P-237 Lung cancer detection in high risk patients with airflow obstruction; An ongoing study

B-Raf specific antibody responses in melanoma patients.

BackgroundMutations of the BRAF gene are the most common genetic alteration in melanoma. Moreover, BRAF mutations are already present in benign nevi. Being overexpressed and mutated, B-Raf is a potential target for the immune system and as this mutation seems to be an early event, a humoral immune response against this antigen might serve as a diagnostic tool for detection of high risk patients.Methods372 sera of 148 stage IV melanoma patients and 119 sera of non-melanoma patients were screened for B-Raf, B-Raf V599E and C-Raf specific antibodies by an ELISA assay. Sera were screened for specific total Ig and for IgG. Serum titers were compared with a two tailed Mann-Whitney U test. Sera with titers of 1:300 or higher were termed positive and groups were compared with a two tailed Fisher's exact test.ResultsB-Raf specific antibodies recognizing both B-Raf and B-Raf V599E were detected in 8.9% of the sera of melanoma patients and in 2,5% of the control group. Raf specific IgG was detected in some patients at very low levels. B-Raf specific antibody responses did not correlate with clinical parameters but in some cases, B-Raf antibodies emerged during disease progression.ConclusionThese findings imply that B-Raf is immunogenic in melanoma patients and that it might serve as a potential target for immunotherapy. However, B-Raf specific antibodies emerge at rather late stages of melanoma progression and are present only with a low frequency indicating that spontaneous B-Raf specific antibodies are not an early marker for melanoma, but rather may serve as a therapeutic target.

Nuclear neuroimaging in the 21st century

Functional neuroimaging methods have been used widely to elucidate normal brain physiology as well as impaired function in diseased brain. The combination of various approaches, such as electromagnetic signals, signal changes in blood flow, metabolism and the kinetic behavior of radioligands bound to the specific recognition site, will answer the question how each neuron communicates with others. Another key technique is molecular imaging, which aims to visualize the functional changes at a molecular level involving the expression of specific genes. The important advances will be recognized in the next century for the treatment of brain disease by cell biology technique. Radionuclide approach will continue to play an important role in detection of high-risk patients toward the prevention of the disease as well as in planning and monitoring the treatment including cell transplantation.

The fate of the ischaemic limb in diabetes: it is neuropathy that makes the difference

Evidence is presented of the deleterious effects of sensory and autonomic polyneuropathy on coexisting peripheral arterial occlusive disease (PAOD) in diabetes mellitus. Autonomic neuropathy triggers medial arterial calcification in the lower leg, which affects arterial haemodynamics, and aggravates preexisting PAOD. Calcificated arteries are incompressible and give false blood pressure readings by sphygmomanometry, with subsequent underestimation of PAOD. Sensory neuropathy leads to loss of protective pain sensation, and precludes the timely diagnosis and treatment of limb ischaemia (no claudication, no rest pain). Absent pain perception is also critical for the outcome of surgical interventions, as wound infections and other complications will occur unnoticed. These features have consequences for the detection of high-risk patients, and for the safety of surgery as well.

Allergie au latex : pertinence des mesures d’éviction

Complete latex avoidance is the most effective approach for treatment of latex allergy. Alternatives to latex gloves and other articles include chemical processes as well as synthetic rubber or other synthetic materials. These may be suited for certain uses only, depending on their respective physical properties. Global preventive strategies are based on current knowledge and a common-sense approach to minimizing latex allergy. Undue latex exposure should be reduced by the use of non-latex materials when there is little potential for contact with infectious agents. When latex is required, reduced-protein, powder-free latex gloves must be chosen. Education and information programs, improvement of ventilation procedures, frequent cleaning of contaminated areas, and training devices about latex allergy are usually recommended. However, detection of high-risk patients or workers must be discussed in relation to the background.

Comparison of Culture and Rapid Enzyme Immunoassay for the Detection of Group B Streptococcus inHigh‐Risk Pregnancies

Objective: The purpose of this study was to evaluate the Equate Strep B® test for clinical use in patients at high risk for complications from group B streptococcus (GBS) disease. Methods: Vaginoperineal swabs were obtained from patients with preterm premature rupture of the membranes and/or preterm labor and semiquantitative GBS cultures and Equate® assay were performed. Results: From May 14, 1990, to April 30, 1992, 650 patients were enrolled; 626 had both culture and Equate® results available, of whom 24% were colonized with GBS. The sensitivity, specificity, positive predictive value, and negative predictive value of the rapid assay were 28%, 84%, 35%, and 79%, respectively. Although the prevalence of GBS was higher in patients with ruptured membranes compared with those with intact membranes, rupture of membranes did not affect test sensitivity or specificity. Conclusions: We conclude that the Equate® rapid assay is not a sensitive method of GBS detection in high-risk patients.

Detection of high-risk patients for sustained monomorphic ventricular tachycardia in patients with late potentials by signal-averaged ECGs

Detection of high-risk patients for sustained monomorphic ventricular tachycardia in patients with late potentials by signal-averaged ECGs

Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging.

To determine whether magnetic resonance (MR) imaging can demonstrate the early stages of osteonecrosis that are not detectable radiographically, the authors compared radiologic findings with histologic results in seven patients at high risk for osteonecrosis of the femoral head. Radiography and MR imaging were performed, and proximal femoral intramedullary pressures were measured in all patients, even if results from imaging studies were normal. If the pressures were elevated, core decompression with biopsy was performed. Seven patients had elevated pressures in 11 hips. Of 11 hips from which biopsy specimens were taken, all had histologic evidence of osteonecrosis. However, in only five were the MR imaging findings consistent with osteonecrosis. In the remaining six hips with osteonecrosis, MR imaging findings were normal. Sensitivity of MR imaging in detection of osteonecrosis was 46%. The authors conclude that normal MR imaging results in high-risk patients do not rule out the presence of osteonecrosis.

Arrêt cardiaque pendant l'anesthésie et la période de réveil. Données de l'enquête INSERM 1978–1982

This report analyses rate, predisposing factors, causes and outcome of 458 cardiac arrests occurring during anaesthesia and the following 24 hours and collected in France by a national prospective survey between 1978 and 1982. The overall rate of cardiac arrests was 1 per 433 anaesthetics, resulting in death before the 24th postoperative hour in 79 % of cases, i.e. 1 per 547 anaesthetics. Cardiac arrests not related to anaesthesia were three times more frequent than those related to anaesthesia. Among these, one half is partially related to anaesthesia and the other totally. The prognosis of cardiac arrests totally related to anaesthesia is six times better than that of not related arrests (64 % of recoveries without sequelae vs 10 %). The cardiac arrests not related to anaesthesia occur mainly at the end of surgery and the following 24 hours. The main causes are hypovolaemia, sepsis and severity of surgical illness. Among cardiac arrests related to anaesthesia, a quarter occurred during induction, another during maintenance and a half during recovery from anaesthesia. The first were mainly related to histamine release and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. The authors underline the necessity of better preoperative detection of high risk patients, smooth induction of anaesthesia, continuous clinical monitoring of the patient during surgery and the recovery period.