bluuebunny/crossref_metadata_2025 huggingface dataset:
Sialyl Tn Is a Frequently Expressed Antigen in Colorectal Cancer: No Correlation with Patient Prognosis
Authors: Lundin M. , Nordling S. , Roberts P.J. , Lundin J. , Carpelan-Holmström M. , von Boguslawsky K. , Haglund C.
Published: April 2003

Immunohistochemical expression of sialyl Tn antigen (STn), previously claimed to be a prognostic factor in colorectal cancer, was evaluated in 239 patients with colorectal adenocarcinoma. Formalin-fixed, paraffin-embedded specimens were stained with the monoclonal antibody C1282. STn immunoreactivity was seen in 189 of 239 tumors (79%). There was no significant correlation between STn immunoreactivity and Dukes stage, tumor location, histological type or gender. However, STn was significantly more often expressed in younger patients. There was so significant difference in survival between STn-negative patients (median survival 68 months) and STn-positive patients (median survival 79 months). In a Cox multivariate analysis, Dukes stage was the strongest predictor of outcome, followed by the age of the patient, whereas STn did not provide any prognostic information.
Dose Intensification of Platinum Compounds with Glutathione Protection as Induction Chemotherapy for Advanced Ovarian Carcinoma
Authors: Böhm Silvia , Oriana Saro , Spatti Gianbattista , Di Re Francesco , Breasciani Gianluigi , Pirovano Carlo , Grosso Ilaria , Martini Cinzia , Caraceni Augusto , Pilotti Silvana , Zunino Franco
Published: April 2003

Based on previous clinical experience indicating the tolerability and efficacy of high-dose cisplatin with glutathione protection in the treatment of advanced ovarian cancer, this study was undertaken to explore the efficacy and feasibility of an alternative high-dose, platinum-based approach including a combination of high-dose cisplatin plus carboplatin as induction chemotherapy of advanced ovarian carcinoma and intervention surgery. Fifty consecutive eligible patients with untreated stage III or IV epithelial ovarian cancer received 40 mg/m2 cisplatin daily on days 1–4 and 160 mg/m2 carboplatin on day 5. The cycle was repeated after 28 days. Patients received glutathione (2,500 mg) before each cisplatin or carboplatin administration and standard intravenous hydration. After 2 courses of induction chemotherapy, the patients underwent surgical reevaluation with debulking, when possible, followed by a further 3 cycles of 120 mg/m2 cisplatin (i.e. 40 mg/m2 daily for 3 consecutive days plus 600 mg/m2 cyclophosphamide on day 3) except in instances of lack of response. All eligible patients were assessed for response and toxicity. The toxicity was moderate with lack of significant nephrotoxicity. Neurotoxicity and ototoxicity were acceptable and in no patient was treatment discontinued for those toxic effects. Myelotoxicity was somewhat more severe than that observed with our previous study with high-dose cisplatin and probably related to the addition of carboplatin. Of the 40 responsive patients, 23 (46%) had a pathological complete response and 4 (8%) had a clinical complete response (without second-look laparotomy). The efficacy of the present protocol was also documented by overall survival (median survival >48 months), which appeared to be better than expected with the current therapy in this group with advanced/bulky disease. The impressive efficacy suggests a possible contribution of reduced glutathione itself in improving the outcome, as supported by preclinical studies. The results of this study should be placed in context with current platinum-based therapy including paclitaxel.
Breast Cancer in Women following Supradiaphragmatic Irradiation for Hodgkin’s Disease
Authors: Gervais-Fagnou Danielle D. , Girouard Caroline , Laperriere Normand , Pintillie Melania , Goss Paul E.
Published: April 2003

Purpose: In women treated with supradiaphragmatic irradiation for Hodgkin’s disease (HD) the relative risk (RR) of breast cancer (BC) has been reported to be elevated, particularly in younger women. A retrospective chart review was conducted to investigate the incidence of BC and to describe the characteristics of these cases. Based on these results, predictions were made regarding the future incidence of breast cancer in this patient population, and surveillance strategies are outlined. Patients and Methods: Charts from 1965 through 1990 were reviewed at the Princess Margaret Hospital to include women ≤30 years who were treated with supradiaphragmatic irradiation for HD. Results: Of the 427 women with a mean follow-up of 12.3 years, 15 subsequently developed BC. The median age at BC diagnosis was 41 years (range: 30–52) and the median interval from irradiation was 17 years (9–25). Laterality was equally divided, and 50% of the tumors were located in the inner quadrant of the breast. Two women developed bilateral metachronous tumors. In this cohort, the RR of BC is 10.6 (95% confidence interval 5.8–17). It is predicted that in our patient population there will be a total of 22, 32, and 39 cases of BC by the years 2000, 2005, and 2010, respectively. Conclusion: Compared to women in the general population, young women irradiated for HD have a 10-fold higher risk of developing BC. In this specific patient group, we are able to predict the number of BC cases expected in the forthcoming years. Hopefully, improved surveillance will enable early detection, timely treatment, and improved prognosis for these at-risk women.
A Phase II Evaluation of Clofazimine plus Doxorubicin in Advanced, Unresectable Primary Hepatocellular Carcinoma
Authors: Falkson Carla I. , Falkson Geoffrey
Published: April 2003

The riminophenazine compound clofazimine has been shown to be a potent inhibitor of hepatocellular carcinoma (HCC) in vitro. Therapeutic benefit was claimed for patients with HCC treated with clofazimine in a recent clinical trial. The current trial was initiated to evaluate response and survival of patients with HCC receiving clofazimine plus doxorubicin. Twenty-eight patients were entered into the study, of whom 27 were evaluable for response and survival. No patients had a complete or partial response, and 9 had stable disease. The median survival time was 7 weeks. Toxicity was mild with yellow pigmentation of the skin resulting from the clofazimine, and leukopenia, nausea, vomiting and mucositis as expected from doxorubicin. Further studies using other riminophenazine compounds are warranted.
Plasma Insulin-Like Growth Factor-I and Serum IGF-Binding Protein 3 Can Be Associated with the Progression of Breast Cancer, and Predict the Risk of Recurrence and the Probability of Survival in African-American and Hispanic Women
Authors: Vadgama Jaydutt V. , Wu Yanyuan , Datta Geetanjali , Khan Huma , Chillar Ram
Published: April 2003

In vitro studies have shown that insulin-like growth factor (IGF) is a mitogen for breast cancer cells. However, the associations of plasma IGF-I with tumor histopathology in high-risk groups need further investigation. We hypothesize that plasma IGF-I and serum IGFBP3 concentrations in breast cancer patients may provide useful information on the progression of their disease, and determine the probability of recurrence and survival. We have carried out a retrospective study on 130 minority breast cancer patients. Plasma IGF-I and serum IGFBP3 were correlated with tumor histopathology, menopausal status, treatment modality, recurrence rates, and probability of survival. Plasma IGF-I and serum IGFBP3 were measured by radioimmunoassay. Our studies show that breast cancer patients have elevated plasma IGF-I and serum IGFBP3 levels. In addition we observed the following: IGF-I did not correlate with age and nodal stage. IGF-I and IGFBP3 increased with tumor size (T4). IGF-I did not correlate with estrogen receptor status, but did increase in progesterone-receptor-positive patients. IGF-I levels were higher in premenopausal patients and in women with cancer recurrence. Tamoxifen reduced IGF-I levels significantly and reduced the risk of recurrence. The survival probability was greater in patients with plasma IGF-I levels <120 ng/ml. In conclusion, lowering of plasma IGF-I may offer the following benefits: (a) reduce the risk of developing breast cancer in high-risk groups; (b) slow the progression of breast cancer in patients at early stages of cancer; (c) lower the risk of recurrence, and (d) increase the probability of survival.
Initial Experience with Healthport miniMax® and Other Peripheral Arm Ports in Patients with Advanced Gastrointestinal Malignancy
Authors: Lersch C. , Eckel F. , Sader R. , Paschalidis M. , Zeilhofer F. , Schulte-Frohlinde E. , Theiss W.
Published: April 2003

While central ports are located at the chest, peripheral ports (PP) are inserted at the patients’ forearms. Two new PPs (Healthport miniMax® and Bard Titan Low Profile Port) and two well-established types (Port-A-Cath® P.A.S. Port and PeriPortTM peripheral access system) were tested. 125 patients were given the choice between PP and chest ports, and 100 of them chose PP. PP were inserted in patients suffering from gastrointestinal malignancies (n = 95), AIDS (n = 3) or Crohn’s disease (n = 2). The first 30 patients were prospectively monitored by repeated color-coded duplex sonography examinations in order to evaluate clinically inapparent thromboses. Easy percutaneous needle puncture as early as 1 day after surgery was possible using innovative ports with large septa. The following complications arose during 12,688 catheter placement days: difficult implantation (n = 5), intolerable pain at the insertion site (n = 1), port erosion of the skin (n = 1), catheter leaks (n = 4), disconnection of the catheter from the port (n = 1), systemic infections (n = 4), local infections (n = 6) and symptomatic deep vein thrombosis (n = 8) despite anticoagulation in 1 of these. Only systemic infections and intolerable pain resulted in PP explantation (n = 5); other complications were easily dealt with. No serious or life-threatening complications occurred.
Treatment Resistant Small Cell Carcinoma of the Cervix
Authors: McGarry Ronald C. , Smith Charles , Seemayer Thomas A.
Published: April 2003

Background: Small cell undifferentiated carcinoma of the cervix is an uncommon malignancy with a poor prognosis. Treatment of localized disease has an approximate 40% 5-year survival with multimodality therapies. Case Report: We describe the case of a 24-year-old woman with small cell carcinoma of the cervix that recurred locally despite intensive chemotherapy and radiotherapy. Hysterectomy was performed and the patient is now 18 months disease free. Following treatment, the pathological appearance of the tumor had changed from a typical small cell neuroendocrine malignancy to a more intermediate neuroendocrine cell type. Conclusion: Small cell carcinoma of the cervix is a rare aggressive malignancy that may require cytostatic multimodality therapy including chemotherapy, radiotherapy and surgery, even in early stage disease.
Psychological Distress in Cancer Patients Attending the European Institute of Oncology in Milan
Authors: Brédart A. , Didier F. , Robertson C. , Scaffidi E. , Fonzo D. , Costa A. , Goldhirsch A. , Autier P.
Published: April 2003

Background: The determination of the extent and specific features of the psychological distress to be expected in a cancer centre may influence the choice of interventions to be implemented for addressing these problems. This study was aimed at estimating the prevalence of psychological distress in patients attending a second reference cancer centre in Milan (Italy), and at identifying associated factors. Patients and Methods: 190 consecutive patients were assessed within 3 days of hospital discharge using the Hospital Anxiety and Depression Scale. Results: Major depressive disorders or generalised anxiety disorders were estimated in 16% of the patients. Only 2 of these patients were referred to the psycho-oncology unit, hence the psychological distress of many patients was not considered during their hospital stay. In the multiple regression analysis, independent predictors of psychological distress were female gender, experience of disturbance in family and social life due to illness, nausea and vomiting, and perception of being in a poor state of health (R2 = 0.31, p value < 0.001), while physical functioning, fatigue and pain, significant factors in univariate analysis (p < 0.05), sociodemographic and clinical factors were not predictors. Conclusion: The psycho-oncology team should focus on helping doctors and nurses identify the patients’ psychological problems, dealing with them or making a referral.
Prognostic Value of p27Kip1 and CyclinD1 Expression in Esophageal Cancer
Authors: Itami Atsushi , Shimada Yutaka , Watanabe Go , Imamura Masayuki
Published: April 2003

It has recently been reported that the reduced expression of p27Kip1 is a negative prognostic marker in several carcinomas. In this study, we examined the expression of p27Kip1 in esophageal squamous cell carcinomas in order to understand its prognostic role. We also examined the expression of cyclinD1, which is believed to be correlated with the prognosis. Of the 128 cases, 64 cases (50.0%) showed low grade p27Kip1 immunostaining and 64 cases (50.0%) high grade immunostaining; there was no significant difference in survival (p = 0.0915) between the two groups. On the other hand, 51 of the 156 cases (32.7%) were classified as the high cyclinD1 group, and 105 of the 156 cases (67.3%) as the low group, thus representing prognostic significance with regard to survival (p = 0.0161). Multivariate analysis indicated that gender, lymph node metastasis and positive cyclinD1 were independent prognostic factors. Our results revealed that cyclinD1 was a significant prognostic predictor of esophageal squamous cell carcinomas, whereas p27Kip1 was not a significant prognostic factor.
Expression of p53 and Glutathione S-Transferase-π Relates to Clinical Drug Resistance in Non-Small Cell Lung Cancer
Authors: Nakanishi Yoichi , Kawasaki Masayuki , Bai Fen , Takayama Koichi , Pei Xin-Hai , Takano Koichi , Inoue Koji , Osaki Sin-ichi , Hara Nobuyuki , Kiyohara Chikako
Published: April 2003

To determine the predictive value of the expression of p53 and glutathione S-transferase-π (GST-π) with respect to chemotherapy response, immunostaining was performed on transbronchial biopsy specimens from previously untreated patients with non-small cell lung cancer. Of the 54 patients, 34 patients (63%) and 37 patients (69%) were positive for p53 and GST-π, respectively. The response rates in the p53-positive and p53-negative group were 15 and 45%, and those in GST-π-positive and GST-π-negative groups were 16 and 47%, respectively. A multiple logistic regression analysis revealed that positive immunostaining for GST-π was a significant risk factor for clinical chemotherapy resistance. The combination of these two markers was the most important independent factor in predicting a response to chemotherapy in multiple logistic regression analysis. Immunohistochemical expression of p53 and GST-π was independently related to clinical chemoresistance in patients with non-small cell lung cancer. Combined use of these two biomarkers may be a useful predictor of clinical chemoresistance.
Vinorelbine + Mitomycin C as Second-Line Treatment of Metastatic Breast Cancer: A Two-Stage Phase 2 Study
Authors: De Placido S. , Lauria R. , Perrone F. , Vernaglia Lombardi A. , Carlomagno C. , Varriale E. , Costanzo R. , Leo L. , De Laurentiis M. , Bianco A.R.
Published: April 2003

Second-line treatment of patients with metastatic breast cancer resistant to anthracyclines is an important clinical issue. The aim of the present two-stage phase II study was to evaluate activity and toxicity of vinorelbine + mitomycin C (VM) in such patients. Fifty-five patients were entered and received vinorelbine 30 mg/m2 on days 1 and 8 + mitomycin C 10 mg/m2 on day 1, every 4 weeks, up to 9 cycles. Two complete and 23 partial responses were observed for an overall response rate of 45.4% (95% CI 32.0–59.4). Median survival was 13 months and probability of surviving after a 1-year follow-up was 58%. Toxicity was never life-threatening, but G-CSF was used in 45% of cycles to contrast neutropenia that was the most frequent side effect. These results are consistent with previous studies and strongly support VM being considered among the optimal polychemotherapy regimens for second-line treatment of metastatic breast cancer in clinical practice; for clinical research aims, VM should be used as control arm for randomized trials evaluating the activity of new drugs against breast cancer.
Prognostic Significance of p27kip1 Protein Expression and Spontaneous Apoptosis in Patients with Colorectal Adenocarcinomas
Authors: Tenjo Toshiyuki , Toyoda Masao , Okuda Junji , Watanabe Ichizo , Yamamoto Tetsuhisa , Tanaka Keitaro , Ohtani Masahiro , Nohara Takehiro , Kawasaki Hiroshi , Tanigawa Nobuhiko
Published: April 2003

Tumor cell apoptosis, proliferation and p27 expression using an in situ apoptosis detection kit, anti-Ki67 antibody and anti-p27 antibody were investigated in 171 colorectal adenocarcinoma specimens, together with the assessment of mutated p53 expression. No apparent association was observed among p27 expression, mutated p53 accumulation, the Ki67 labeling index and the apoptotic index (AI). In the multivariate analysis using the median values as the cut-off points (46.8% for p27 expression and 0.89% for AI), p27 expression was identified as an independent and significant predictor for overall survival. When the present series of patients were dichotomized by these cut-off points to categorize the cases into 4 subgroups, the patients in the group with low p27 expression and a low AI had the poorest prognosis. The assessment of p27 expression and AI therefore may prove valuable in identifying patients with colorectal adenocarcinoma who may have a poor prognosis.
Risk Factors of Metastasis in Oral Squamous Cell Carcinomas
Authors: Osaki Tokio , Kimura Tsuyoshi , Tatemoto Yukihiro , Yamamoto Tetsuya , Yoneda Kazunori
Published: April 2003

Lymph node and distant metastasis were comparatively studied in 225 oral carcinomas, and factors predisposing toward metastasis were investigated using clinical and immunohistopathological approaches. Neither the sites of tumors nor T-stage was correlated with either type of metastasis. Tumor cell differentiation was weakly correlated with lymph node metastasis, and stromal reaction (the degree of cell infiltration) did not differ greatly between metastasis-positive and negative tumors, although natural killer (NK) activities were correlated with lymph node metastasis. However, the mode of tumor cell invasion was closely associated with both lymphnode and distant metastases. In grade 4C and 4D tumors, distant and lymph node metastases were observed in 8 (16%) and 31 (62%) cases, respectively, while of 68 grade 1 and 2 tumors, distant metastasis was not observed in any, and lymph node metastasis occurred in only 15 (22.1%). In addition, the expression of p53 protein was correlated with lymph node metastasis; of 70 tumors without p53 protein expression, 23 (32.9%) revealed lymph node metastasis, while it occurred in 54 out of 96 tumors positive for p53 protein. However, p53 protein expression was not associated with distant metastasis, and p24 protein, a cyclin-dependent kinase inhibitor, did not show any relationship with either type of metastasis. These results indicate that lymph node metastasis is correlated with multiple factors in the host and tumor cells, but distant metastasis is only correlated with the mode of tumor cell invasion, suggesting that the former can be highly accurately predicted by invasion mode, p53 protein expression and NK activity.
Bcl-2, Bax, Bcl-xL and Bcl-xS Expression in Neoplastic and Normal Endometrium
Authors: Marone Maria , Ferrandina Gabriella , Macchia Gabriella , Mozzetti Simona , de Pasqua Anna , Benedetti-Panici Pierluigi , Mancuso Salvatore , Scambia Giovanni
Published: April 2003

The two anti-apoptotic proteins Bcl-2 and Bcl-xL, and the two pro-apoptotic proteins Bax and Bcl-xS were measured by Western blotting in 51 neoplastic and 8 normal endometrial samples. The corresponding mRNA levels were analyzed by semiquantitative reverse transcriptase-polymerase chain reaction in a subgroup of 19 endometrial carcinomas. Neoplastic tissues had higher amounts of Bcl-2 protein than normal tissues (p < 0.051). Bcl-xL followed the same trend since its levels were higher in tumor than in normal samples (p < 0.048). Interestingly, Bcl-2 and Bcl-xL protein content showed a trend towards an inverse correlation (r = 0.27, p < 0.052). mRNA and protein levels directly correlated only with Bcl-2 (r = 0.63, p < 0.0032). Despite the fact that the amounts of Bcl-2, Bax and Bcl-xL proteins in the neoplastic population were not significantly differently distributed according to the clinicopathological features of the patients, the differences observed between normal and neoplastic samples suggest that these proteins may play a role in endometrial carcinoma: long-term follow-up studies will be required to confirm this hypothesis.
Consolidation Radiotherapy to Bulky or Semibulky Lesions in the Management of Stage III–IV Diffuse Large B Cell Lymphomas
Authors: Ferreri Andrés J.M. , Dell’Oro Stefania , Reni Michele , Ceresoli Giovanni L. , Cozzarini Cesare , Ponzoni Maurilio , Villa Eugenio
Published: April 2003

Background: To assess the impact on survival of consolidation radiotherapy to bulky or semibulky lesions in patients with advanced diffuse large B cell lymphoma (DLCL) in complete remission after primary chemotherapy. Patients and Methods: Ninety-four patients with stage III–IV DLCL and bulky (≥10 cm) or semibulky lesions (6–9 cm) in complete remission after primary chemotherapy were reviewed. Forty patients received consolidation radiotherapy to bulky (n = 20) or semibulky lesions (n = 20), while 54 (18 with bulky disease) did not. Twenty-eight patients were irradiated to the involved field and 12 to the extended field with a dose of 30–46 Gy. Results: In patients with bulky disease, consolidation radiotherapy prevented relapses involving exclusively the bulky area, prolonged time to relapse (TTR) (median 41+ vs. 18 months; p = 0.05) and improved 5-year overall survival (OS) (73 vs. 57%; p = 0.05). Consolidation radiotherapy reduced relapses within the semibulky area, prolonged TTR (median 26+ vs. 20 months; p = 0.01) and improved 5-year OS (59 vs. 41%; p = 0.09) also in patients with semibulky lesions. Multivariate analyses confirmed the independent association between consolidation radiotherapy and survival, and showed that a dose ≥36 Gy was related to a longer OS, while the extension of the radiotherapy field did not modify outcome. No treatment-related deaths were observed. Four patients developed a second malignancy, none of whom had undergone consolidation radiotherapy. Conclusions: Consolidation radiotherapy to bulky or semibulky lesions significantly improved the outcome in patients with advanced DLCL in complete remission after primary chemotherapy. Involved-field irradiation with 36–45 Gy made a prolonged disease control possible without either lethal toxicity or a higher incidence of second malignancies.
Fluorouracil and Leucovorin with or without Interferon Alfa-2a as Adjuvant Treatment, in Patients with High-Risk Colon Cancer
Authors: Fountzilas George , Zisiadis Alkis , Dafni Urania , Konstantaras Christos , Hatzitheoharis George , Papavramidis Spyros , Bousoulegas Aris , Basdanis George , Giannoulis Eleftherios , Dokmetzioglou John , Katsohis Constantine , Nenopoulou Eleni , Karvounis Nicholaos , Briassoulis Evangelos , Aravantinos Gerassimos , Kosmidis Paris , Skarlos Dimosthenis , Pavlidis Nicholas
Published: April 2003

Background: It has been shown in randomized studies that adjuvant treatment with the combination of fluorouracil (FU) and levamisole reduced the risk of recurrence and deaths of patients with stage III colon cancer. Pharmacological studies of FU led to its use in combination with a number of modulating agents including interferon-α and leucovorin (LV) that appear to enhance its activity in vitro. Furthermore, a meta-analysis suggested that the combination of FU with LV increased the response rate as compared to FU monotherapy in patients with advanced colorectal cancer. Purpose: To evaluate the impact of adjuvant treatment with the combination of FU and LV with or without interferon alfa-2a (IFN) on disease-free survival (DFS) and overall survival (OS) for patients with stage II or III colon cancer. Patients and Methods: From August 1989 to July 1997, 280 patients with stage II and III colon cancer entered the study and were randomly assigned to receive either the combination of FU (600 mg/m2/week × 6, followed by a 2-week rest) and LV (500 mg/m2/week × 6 as a 2-hour infusion, followed by a 2-week rest) for 4 cycles (group A, 139 patients), or the same chemotherapy plus recombinant IFN (3 MU subcutaneously 3 times a week) for 1 year (group B, 141 patients). Results: A total of 109 patients (78.9%) of group A and 119 (84.4%) of group B completed four cycles of chemotherapy. Also, 51.4% of patients of group A and 53.9% of group B received ≥80% of the planned dose of FU. One patient (group A) was found to be ineligible and was not included in the analysis. The median relative dose intensity of FU in the two groups was 0.90 and 0.85, respectively. As of August 1998, after a median follow up of 4 years, there was no significant difference in either 3-year DFS (group A, 83.1%; group B, 75.9%, p = 0.14) or OS (group A, 84.5%; group B, 80.0%, p = 0.27). In the Cox model, stage of disease, number of infiltrated nodes, tumor grade and presence of regional implants were identified as significant prognostic factors for OS. Grade 3–4 toxicities, mainly diarrhea, were observed in 26.1% of patients of group A and in 24.8% of group B. There were no treatment-related deaths. Conclusions: The addition of IFN to the combination of FU with LV postoperatively does not improve DFS and OS of patients with stage II or III colon cancer.
Trends in the Clinical Characteristics of Patients with Papillary Thyroid Carcinoma in Taiwan
Authors: Lin Jen-Der , Chao Tzu-Chieh , Sun Jui-Hung , Ho Cheng , Weng Hsiao-Fen
Published: April 2003

The incidence of thyroid cancer is influenced by many factors including socioeconomic status. As economic conditions have improved in Taiwan, the increased frequency of medical examinations in the general population has led to earlier diagnosis of this indolent malignancy. The purpose of this retrospective study was to compare the clinical characteristics of cases of papillary thyroid cancer diagnosed over a 6-year period from 1993 to 1998 with those patients diagnosed from 1977 to 1992 at a single medical center. Of the 1,485 pathologically verified cases of thyroid cancer from 1977 to 1998, 1,093 had papillary thyroid carcinoma. The mean age of these patients was 40.4 ± 14.6 years. In order to identify trends in the characteristics of patients with thyroid cancer, patients were divided into those diagnosed before and those diagnosed after 1993. Patients diagnosed in these two time periods were also categorized into disease-free or non-disease-free groups depending on their status at the end of 1998. Actuarial survival rates were calculated using the Kaplan-Meier method. Multivariate analysis was performed to assess the independent effect of these variables using the Cox model. By December 1998, 61 (5.6%) of the 1,093 patients with papillary thyroid carcinoma had died. Among them, only 35 (3.2%) patients had died of thyroid cancer. The 5-year Greenwood survival probabilities for the groups diagnosed before and after 1993 were 0.9412 and 0.9817, respectively. The patients diagnosed after 1993 received more aggressive surgical procedures, had smaller tumor size, lower postoperative thyroglobulin levels, less advanced clinical stage at the time of diagnosis, showed more disease-free survival, and a lower mortality rate. In conclusion, the results of this study show that patients with a diagnosis of papillary thyroid cancer after 1993 had a smaller tumor size and a better prognosis than those diagnosed before 1993. This finding emphasizes the importance of early detection in thyroid cancer.
Primary Small Cell Neuroendocrine Carcinoma of the Vagina
Authors: Hayashi Masatoshi , Mori Yoshiomi , Takagi Yoshitake , Hoshimoto Kazunori , Ohkura Takeyoshi
Published: April 2003

Primary small cell neuroendocrine carcinoma of the vagina is extremely rare and very aggressive. Nineteen patients with this cancer have been reported in the English-language literature to date. We report a 51-year-old woman with this cancer. Punch biopsy specimens of the vaginal tumor were studied. Electron microscopy demonstrated neuroendocrine granules in the cytoplasm. Tumor cells were strongly stained for cytokeratin, neuron-specific enolase, chromogranin A and serotonin. These findings were consistent with small cell neuroendocrine carcinoma. The patient was treated with combination chemotherapy. The cancer mass completely disappeared after five cycles of the therapy. The patient is still alive without metastasis 41 months after diagnosis. This is the first report of such a remarkable effect of combination chemotherapy on small cell neuroendocrine carcinoma of the vagina.
Effects of Three Cytokine Regimens on Hematologic Recovery and Progenitor Cell Mobilization after High-Dose Cyclophosphamide, Etoposide, and Cisplatin
Authors: Ballestrero A. , Ferrando F. , Garuti A. , Gonella R. , Stura P. , Sessarego M. , Amoroso D. , Boccardo F. , Patrone F.
Published: April 2003

The aim of this study was to compare both the effects on hematologic recovery and circulating progenitor cell mobilization and the toxicity of three cytokine regimens administered after high-dose non-myeloablative chemotherapy with cyclophosphamide 5 g/m2, etoposide 1.5 g/m2 and cisplatin 150 mg/m2. Thirty-five consecutive patients were non-random sequentially allocated to one of three treatment groups: (1) granulocyte colony-stimulating factor alone (n = 15); (2) granulocyte-macrophage colony-stimulating factor alone (n = 10), and (3) sequential interleukin-3 and granulocyte-macrophage colony-stimulating factor (n = 10). Neutrophil recovery in group 1 was significantly hastened as compared to the two other groups (median 2 days, p < 0.005), while no significant differences were observed between groups 2 and 3. CD34+ cells peaked about 2 days earlier in group 1 compared to the other groups (p = 0.0001), whereas the median peak value of CD34+ cells was similar in the three groups. In all patients, the toxicity related to cytokine administration was low and easily manageable with nonsteroidal anti-inflammatory drugs.
Body Mass Index Determines the Success of Lymph Node Dissection and Predicts the Outcome of Gastric Carcinoma Patients
Authors: Dhar Dipok Kumar , Kubota Hirofumi , Tachibana Mitsuo , Kotoh Tsukasa , Tabara Hideki , Masunaga Reiko , Kohno Hitoshi , Nagasue Naofumi
Published: April 2003

We tried to determine the role of the body mass index (BMI) on the extent of lymph node dissection in gastric cancer surgery. Seven hundred and eighty-seven patients with gastric carcinoma were reviewed. Ninety-two (11%) patients exceeded the upper limit of the optimum BMI. Significantly fewer lymph nodes were removed following D2 (p = 0.002) and ≥D3 (p = 0.023) dissections, and the lymph node ratio was significantly (p = 0.0383) higher in overweight patients. The recurrence-free survival was significantly (p = 0.0297) shorter in T2/T3 cases with high BMI, and BMI (relative risk 1.85) became an independent prognostic factor in multivariate analysis. Higher BMI hampers regional lymph node dissection in gastric cancer patients and became an independent predictor of disease recurrences in T2/T3 gastric cancers.
Frequency of Microsatellite Instability inBreast Cancer Determined by High-Resolution Fluorescent Microsatellite Analysis
Authors: Tokunaga Eriko , Oki Eiji , Oda Shinya , Kataoka Akemi , Kitamura Kaoru , Ohno Shinji , Maehara Yoshihiko , Sugimachi Keizo
Published: April 2003

In breast cancer, the rates of positivity for microsatellite instability (MSI), vary greatly in the literature. Using high-resolution fluorescent microsatellite analysis (HFRMA), we studied microsatellite alterations in 75 patients with sporadic breast cancer. In this system, several devices were prepared to improve reproducibility of polymerase chain reaction products, migration accuracy of electrophoresis, and characteristics of the detection system. Precise and objective analyses of microsatellite alterations are made feasible using HRFMA. Seven of the 75 cases were judged to be positive for MSI, the rate of positivity being 9.3%. This rate is relatively low compared to the data in the literature. All the microsatellite changes observed in this system can be classified into two types: type A with relatively small changes in microsatellite sequences observed in limited loci and type B with drastic and widely dispersed changes. The former was thought to be connected to abnormal activity in DNA mismatch repair (MMR). Among the 7 cases, 6 (8.0%) had type A alterations, which means that the tumors may have an abnormal MMR activity. Application of precise and objective systems for microsatellite analysis is expected to be clinically useful to detect patients at high risk for cancers.
Splenic Hemangiosarcoma
Authors: Manco M. , Buononato M. , Equitani F.
Published: April 2003

Splenic hemangiosarcoma is a rare and aggressive tumor. Up to now, less than 150 cases have been reported. We describe a patient with a rapide course. The diagnosis of hemangiosarcoma was based on immunohistochemical tests (factor-VIII-associated antigen, CD31, CD34). Despite the improvement of diagnostic techniques, pathological examination and immunohistochemistry remain the only methods available for the diagnosis.
Demonstration and Diagnostic Significance of Pro-Gastrin-Releasing Peptide in Medullary Thyroid Carcinoma
Authors: Inaji Hideo , Komoike Yoshifumi , Motomura Kazuyoshi , Higashiyama Masahiko , Ohtsuru Minoru , Funai Hiroko , Kasugai Tsutomu , Koyama Hiroki
Published: April 2003

The expression of pro-gastrin-releasing peptide (proGRP) in medullary thyroid carcinoma (MTC) and other histological types of thyroid carcinoma was studied by an immunohistochemical technique, using polyclonal anti-proGRP antiserum. Immunoreactivity for proGRP was detected exclusively in MTC (n = 7); other histological types (n = 12) were all negative for proGRP. In addition, serum proGRP levels were elevated in patients with primary or recurrent MTC (n = 3), and they changed in parallel with serum calcitonin (CT), and carcinoembryonic antigen (CEA). These results show that proGRP, which is considered to be a specific marker for small-cell lung carcinoma, may be also a potential tumor marker for MTC, in addition to CT and CEA.
Treatment of Patients with Chronic Somatic Symptoms by Means of Art Psychotherapy: A Process Description
Authors: Theorell Töres , Konarski Kristoffer , Westerlund Hugo , Burell Ann-Margret , Engström Robert , Lagercrantz Ann-Mari , Teszary Judith , Thulin Karin
Published: April 2003

Background: Inability to express emotions is common in patients with long-lasting somatic symptoms associated with incapacitation and impaired quality of life. One method for treating this inability is art psychotherapy. In this study the typical course in such treatments is described. Patients were followed longitudinally before therapy and every 4th to 6th month during the treatment. Methods: Patients with long-lasting psychosomatic conditions resulting in partial or total loss of working capacity for at least 1 year have been treated in the programme. All of them had chronic pain. The majority of the patients that were referred to us were offered treatment. Three-fourths of those who started treatment stayed in treatment as long as the therapist considered it optimal. Twenty-four patients (22 women and 2 men) in the present study had their treatment started on average 2 years (range 13–42 months) before the end of the treatment period. In addition these 24 patients were contacted 6–48 months after the end of the therapy (average 23 months) and a short post-evaluation was made by telephone. Results: The first year of treatment was characterized by emotional turmoil paralleled by increased energy level reflected in temporary elevation of serum uric acid. Significant improvement was observed with regard to anxiety-depression after one year of treatment. A tendency towards decreased levels of psychosomatic symptoms in general was observed after two years of treatment. One-fourth of the 20 non-working or parttime working patients increased their working activity. Conclusions: A slow partial recovery was observed. Art psychotherapy may have contributed to this.
Perceived Parental Attitude, Alexithymia and Defense Style in Psychiatric Outpatients
Authors: Kooiman C.G. , Spinhoven Ph. , Trijsburg R.W. , Rooijmans H.G.M.
Published: April 2003

Background: Although it is the clinical impression that alexithymia may be due to disturbances in the early parent-child relationship and that it is associated with primitive defense mechanisms, a possible association with neurotic defense mechanisms, such as repression and reaction formation, has also been mentioned. However, empirical studies on these and related issues are scarce. The aim of this study was to determine the association between perceived parental attitude, defense mechanisms and alexithymia. Methods: In a cross-sectional study we obtained data from 78 psychiatric outpatients. Alexithymia, defense mechanisms and perceived parental attitude were measured with the Toronto Alexithymia Scale, the Defense Style Questionnaire and the Parental Bonding Instrument. Results: We found only weak associations between perceived parental attitude and alexithymic features. Primitive and adaptive defenses were associated with alexithymic features in a clinically sensible way. The strongest association was found between primitive defense mechanisms and alexithymic features. There was hardly any association between neurotic defense mechanisms and alexithymic features. Conclusions: The results of our study support the hypothesis that alexithymia is associated with a primitive defense style, whereas a relation to disturbances in early parent-child relationship could not be confirmed. It is argued that possibly more severe traumatic experiences, such as physical and sexual abuse, than merely a negatively perceived parental attitude, are necessary to develop alexithymic features.
Illness Behavior, Emotional Stress and Psychosocial Factors among Asymptomatic HIV-Infected Patients
Authors: Grassi Luigi , Righi Roberto , Makoui Shariar , Sighinolfi Laura , Ferri Stefano , Ghinelli Florio
Published: April 2003

Background: Over the last years the way in which patients with chronic physical illness respond to their illness (illness behavior) has been explored by several studies. This study sought to examine characteristics of illness behavior and to investigate the association between illness behavior and psychosocial and clinical variables among asymptomatic HIV-infected subjects. Methods: Seventy-three asymptomatic HIV+ outpatients completed self-report questionnaires to evaluate illness behavior (Illness Behavior Questionnaire), psychological stress symptoms (Brief Symptom Inventory), personality variables (External Locus of Control and Courtauld Emotional Control Scales) and social support (Social Provision Scale). Results: Psychological morbidity (‘caseness’ = 34%) was associated with a pattern of illness behavior characterized by conviction of disease progression, irritability, dysphoria, psychological perception of illness and low denial. Individual capacity to express emotions, adequate levels of social support and low levels of depression, as well as clinical variables (high number of CD4+ cells, recent notification of HIV infection and nonintravenous drug use category) influenced a more adaptive illness behavior. Psychological stress and low CD4+ cell count were the main predictors of the affective dimension of illness behavior. Conclusions: Psychosocial variables resulted to influence the tendency to interpret illness in a nonadaptive way in asymptomatic HIV-infected subjects. Such variables merit to be routinely examined within the doctor-patient relationship in AIDS clinics.
Power Spectral Analysis of Heart Rate Variability in Psychiatry
Authors: Cohen Hagit , Matar Michael A. , Kaplan Zeev , Kotler Moshe
Published: April 2003

Power spectrum analysis of heart rate variability (PSA of HRV) is a promising method, which can be used as an index of cardiac autonomic balance. PSA of HRV is a noninvasive technique, based on ECG sampling of RR interval variation, thus providing a dynamic assessment of sympathetic and parasympathetic tone, reflecting the interactions between the two. It has been shown to have potential value in various laboratory and clinical conditions. It is influenced by many factors such as age, sex, position, breathing, smoking, hour of the day and medications. Different methods of data processing by various authors have often elicited conflicting results. Standard values are not yet available to be used or compared in different settings. From the interest it has raised, it may be expected that this method will be in widespread use in clinical practice in the future, providing a useful tool, both for diagnostic and prognostic purposes, as well as serving as a further aid towards monitoring therapeutic interventions. This review highlights techniques of dynamic assessment of HRV and studies of its clinical applications in psychiatry in particular. It raises the potentially important prognostic implications of protracted autonomic dysfunction in psychiatric patient populations, especially for cardiovascular morbidity and mortality.
Psychological Stress and Neuroendocrine Function in Humans: The Last Two Decades of Research
Authors: Biondi M. , Picardi A.
Published: April 2003

This paper reviews experimental contributions published in the last two decades and exploring the effect of emotional stress on neuroendocrine function in healthy humans. Laboratory studies allow standardization of the stressor and better control for known confounding factors. Commonly used stressors are mental arithmetics, speech tasks, the Stroop test, videogame playing, films or videotapes and interviews. Little is known about the generalizability of laboratory results, with some studies suggesting great caution in extrapolating data to real-life stress conditions. Another strategy is studying the psychoendocrine reaction to real-life stressors, such as bereavement or anticipated loss, academic examinations, everyday work and parachute jumping. The effects of different stressors on neuroendocrine axes are reviewed, as well as the influence of gender, age, personality, coping style, social support, biological and nonbiological interventions. The subjective perception of the situation is probably a main determinant of the psychoendocrine response pattern. In fact, marked variability in individual responses to a variety of stressors has frequently been observed. Evidently, the ‘objective’ characteristics of a given event are not the only determinants of reaction to the event itself. According to a constructivistic perspective, every given stressor has a strictly personal and idiosyncratic meaning and loses its ‘objective’ characteristics. Of course, biological factors may also play a part. In any case, it is mandatory to overcome a rigid dichotomy between psychological and biological processes. Dualistic conceptions which imply a determination of the physical by the psychological or vice versa should give place to a systemic conception, which implies mutual, circular interactions.
Optimism and Coping Styles: A Comparison of Candidates for Liver Transplantation with Candidates for Lung Transplantation
Authors: Stilley Carol S. , Miller David J. , Manzetti Jan D. , Marino Ignazio R. , Keenan Robert J.
Published: April 2003

Background: Dispositional optimism and adaptive coping styles have been shown to correlate with each other and with physical and psychological well-being in a number of studies with medical patients. Few studies in the transplant literature evaluate psychological characteristics of patients across medical diagnoses. A comparison of optimism and coping styles among candidates for liver and lung transplantation is presented. Method: Subjects were 73 candidates for lung transplantation at the University of Pittsburgh Medical Center and 76 candidates for liver transplantation at the Pittsburgh VA Healthcare System. All candidates were classified according to medical diagnosis and history of substance abuse (alcohol/drugs or smoking). There were no significant between- or within-group differences on optimism. Results: There was a significant difference within both groups, according to history of substance abuse on the coping style ‘acceptance’. There were also significant between-group differences on a number of coping styles. Conclusions: This preliminary study is intended to suggest direction for future research; studying psychological variables known to impact on health apart from medical diagnosis may provide data pertinent to selection criteria and the design of interventions to more effectively maximize the benefit of transplantation for all concerned.
Associations between Body Weight, Psychiatric Disorders and Body Image in Female Adolescents
Authors: Buddeberg-Fischer Barbara , Klaghofer Richard , Reed Victoria
Published: April 2003

Objectives: The study explored associations between body weight, psychiatric disorders and body image in a nonclinical sample of female adolescents. It was also investigated whether complaints of negative body image could be an indicator of psychiatric morbidity. Methods: A sample of 136 Swiss female high school students, 15–20 years of age, initially had weight, height and body image (FBeK questionnaire) assessed and were screened for psychiatric morbidity (SSQ). Subsequently, they were assessed using the DIA-X psychiatric interview which generates DSM-IV diagnoses. Univariate, multivariate, regressive and canonical correlation analyses were performed. Results: Being overweight was significantly correlated with a more negative body image (attractiveness/self-confidence). There were also significant correlations between psychiatric diagnoses and unfavorable body image (3 of the 4 FBeK scales). Besides having a more disturbed body image, overweight subjects also evidenced more psychiatric morbidity. The multiple regression analysis revealed that psychiatric disorders had the greatest association with negative body image, followed by age and weight. The canonical correlation indicated that body image, psychiatric disorder, age and weight clearly correlated with one another (Rxy = 0.43). Conclusion: Psychosomatic research should be more concerned about issues of obesity and concurrent psychiatric morbidity and aim to develop preventative as well as therapeutic treatment methods. Physicians should be aware of the associations between obesity, negative body image and psychiatric morbidity.