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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Nikšić M, Minicozzi P, Weir HK, Zimmerman H, Schymura MJ, Rees JR, Coleman MP, Allemani C. Pancreatic cancer survival trends in the US from 2001 to 2014: a CONCORD-3 study. Cancer Commun (Lond) 2022; 43:87-99. [PMID: 36353792 PMCID: PMC9859729 DOI: 10.1002/cac2.12375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survival from pancreatic cancer is low worldwide. In the US, the 5-year relative survival has been slightly higher for women, whites and younger patients than for their counterparts, and differences in age and stage at diagnosis [Corrections added Nov 16, 2022, after first online publication: a new affiliation is added to Maja Nikšić] may contribute to this pattern. We aimed to examine trends in survival by race, stage, age and sex for adults (15-99 years) diagnosed with pancreatic cancer in the US. METHODS This population-based study included 399,427 adults registered with pancreatic cancer in 41 US state cancer registries during 2001-2014, with follow-up to December 31, 2014. We estimated age-specific and age-standardized net survival at 1 and 5 years. RESULTS Overall, 12.3% of patients were blacks, and 84.2% were whites. About 9.5% of patients were diagnosed with localized disease, but 50.5% were diagnosed at an advanced stage; slightly more among blacks, mainly among men. No substantial changes were seen over time (2001-2003, 2004-2008, 2009-2014). In general, 1-year net survival was higher in whites than in blacks (26.1% vs. 22.1% during 2001-2003, 35.1% vs. 31.4% during 2009-2014). This difference was particularly evident among patients with localized disease (49.6% in whites vs. 44.6% in blacks during 2001-2003, 60.1% vs. 55.3% during 2009-2014). The survival gap between blacks and whites with localized disease was persistent at 5 years after diagnosis, and it widened over time (from 24.0% vs. 21.3% during 2001-2003 to 39.7% vs. 31.0% during 2009-2014). The survival gap was wider among men than among women. CONCLUSIONS Gaps in 1- and 5-year survival between blacks and whites were persistent throughout 2001-2014, especially for patients diagnosed with a localized tumor, for which surgery is currently the only treatment modality with the potential for cure.
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Affiliation(s)
- Maja Nikšić
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK,Centre for Health Services StudiesUniversity of KentCanterburyCT2 7NFUK
| | - Pamela Minicozzi
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Hannah K Weir
- Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaGA30333USA
| | - Heather Zimmerman
- Montana Central Tumor RegistryChronic Disease Prevention and Health Promotion BureauPO Box 202951, 1400 BroadwayHelenaMT59620‐2951USA
| | - Maria J Schymura
- Bureau of Cancer EpidemiologyNew York State Cancer RegistryNew York State Department of Health150 BroadwayAlbanyNY12204‐2719USA
| | - Judith R Rees
- New Hampshire State Cancer RegistryNorris Cotton Cancer Center, and Department of EpidemiologyGeisel School of MedicineDartmouth CollegeDartmouth‐Hitchcock Medical CenterOne Medical Center DriveLebanonNH03756USA
| | - Michel P Coleman
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK,Cancer DivisionUniversity College London Hospitals NHS Foundation Trust250 Euston RoadLondonNW1 2PGUK
| | - Claudia Allemani
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK
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Abstract
INTRODUCTION AND MOTIVATION Many health studies measure a continuous outcome and compare means between groups. Since means for biological data are often difficult to interpret clinically, it is common to dichotomise using a cut-point and present the 'percentage abnormal' alongside or in place of means. Examples include birthweight where 'abnormal' is defined as <2500 g (low birthweight), systolic blood pressure with abnormal defined as >140 mm Hg (high blood pressure) and lung function with varying definitions of the 'limit of normal'. In vulnerable populations with low means, for example, birthweight in a population of preterm babies, a given difference in means between two groups will represent a larger difference in the percentage with low birthweight than in a general population of babies where most will be full term. Thus, in general, the difference in percentage of patients with abnormal values for a given difference in means varies according to the reference population's mean value. This phenomenon leads to challenges in interpreting differences in means in vulnerable populations and in defining an outcome-specific minimal clinically important difference (MCID) in means since the proportion abnormal, which is useful in interpreting means, is not constant-it varies with the population mean. This has relevance for study power calculations and data analyses in vulnerable populations where a small observed difference in means may be difficult to interpret clinically and may be disregarded, even if associated with a relatively large difference in percentage abnormal which is clinically relevant. METHODS To address these issues, we suggest both difference in means and difference in percentage (proportion) abnormal are considered when choosing the MCID, and that both means and percentages abnormal are reported when analysing the data. CONCLUSIONS We describe a distributional approach to analyse proportions classified as abnormal that avoids the usual loss of precision and power associated with dichotomisation.
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Affiliation(s)
- Janet L Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Jessica Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Judith R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Odile Sauzet
- Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
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Di Carlo V, Estève J, Johnson C, Girardi F, Weir HK, Wilson RJ, Minicozzi P, Cress RD, Lynch CF, Pawlish KS, Rees JR, Coleman MP, Allemani C. Trends in short-term survival from distant-stage cutaneous melanoma in the United States, 2001-2013 (CONCORD-3). JNCI Cancer Spectr 2021; 4:pkaa078. [PMID: 33409455 PMCID: PMC7771008 DOI: 10.1093/jncics/pkaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. Methods Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. Results Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. Conclusions One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacques Estève
- Université Claude Bernard, Hospices Civils de Lyon, Service de Biostatistique, Lyon Cedex 03, France
| | | | - Fabio Girardi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reda J Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pamela Minicozzi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Judith R Rees
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Passarelli MN, Barry EL, Zhang D, Gangar P, Rees JR, Bresalier RS, McKeown-Eyssen G, Karagas MR, Baron JA. Risk of basal cell carcinoma in a randomized clinical trial of aspirin and folic acid for the prevention of colorectal adenomas. Br J Dermatol 2018; 179:337-344. [PMID: 29570772 DOI: 10.1111/bjd.16571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Aspirin may reduce the risk of several types of cancer. OBJECTIVES To evaluate if folic acid is associated with risk of basal cell carcinoma (BCC). METHODS BCC incidence was evaluated in a randomized, double-blind, placebo-controlled clinical trial of aspirin (81 mg daily or 325 mg daily for ~3 years) and/or folic acid (1 mg daily for ~6 years) for the prevention of colorectal adenomas among 1121 participants with a previous adenoma. BCC was confirmed by blinded review of pathology reports. RESULTS One hundred and four of 958 non-Hispanic white participants were diagnosed with BCC over a median follow-up of 13·5 years. Cumulative incidence of BCC was 12% [95% confidence interval (CI) 7-17] for placebo, 16% (95% CI 11-21) for 81 mg aspirin daily and 15% (95% CI 10-20) for 325 mg aspirin daily [hazard ratio (HR) for any aspirin 1·45 (95% CI 0·93-2·26); HR for 81 mg daily 1·57 (95% CI 0·96-2·56); HR for 325 mg daily 1·33 (95% CI 0·80-2·20)]. BCC risk was higher with aspirin use in those without previous skin cancer but lower with aspirin use in those with previous skin cancer (Pinteraction = 0·02 for 81 mg aspirin daily; Pinteraction = 0·03 for 325 mg aspirin daily). Folic acid supplementation was unrelated to BCC incidence (HR 0·85; 95% CI 0·57-1·27). CONCLUSIONS Neither aspirin nor folic acid treatment had a statistically significant effect on risk of BCC. Subgroup analysis suggested that chemopreventive effects of nonsteroidal anti-inflammatory drugs may be specific to those at high risk for BCC.
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Affiliation(s)
- M N Passarelli
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, U.S.A
| | - E L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, U.S.A
| | - D Zhang
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, U.S.A
| | - P Gangar
- Department of Pediatrics, University of Arizona, Tucson, AZ, U.S.A
| | - J R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, U.S.A
| | - R S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - G McKeown-Eyssen
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - M R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, U.S.A
| | - J A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, U.S.A.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, U.S.A
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Abstract
Thirty-six patients with angina were investigated by treadmill exercise testing and coronary angiography prior to coronary artery surgery. Severity of angina was judged by interview and self-assessment visual analogue scale and all patients were psychiatrically assessed. Further physical and psychiatric assessments were made at 3 and 6 months postoperatively. Eleven patients (31%) had significant psychiatric morbidity preoperatively and these had worse symptom scores and exercise tolerance compared with non-psychiatric cases, despite equivalent coronary angiographic findings and left ventricular function. Postoperatively, exercise tolerance improved equally in both groups but psychiatric cases remained significantly more symptomatic. Psychiatric morbidity remained unchanged throughout the study. We conclude that almost one third of patients with severe angina have psychiatric morbidity which is associated with a poor symptomatic response to coronary artery surgery, despite objective improvement in exercise tolerance. Ways of improving the symptomatic response to surgery in patients with coexisting psychiatric morbidity should be studied.
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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Stenehjem JS, Veierød MB, Nilsen LT, Ghiasvand R, Johnsen B, Grimsrud TK, Babigumira R, Rees JR, Robsahm TE. Anthropometric factors and cutaneous melanoma: Prospective data from the population-based Janus Cohort. Int J Cancer 2018; 142:681-690. [PMID: 28983909 DOI: 10.1002/ijc.31086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022]
Abstract
The aim of the present study was to prospectively examine risk of cutaneous melanoma (CM) according to measured anthropometric factors, adjusted for exposure to ultraviolet radiation (UVR), in a large population-based cohort in Norway. The Janus Cohort, including 292,851 Norwegians recruited 1972-2003, was linked to the Cancer Registry of Norway and followed for CM through 2014. Cox regression was used to estimate hazard ratios (HRs) of CM with 95% confidence intervals (CIs). Restricted cubic splines were incorporated into the Cox models to assess possible non-linear relationships. All analyses were adjusted for attained age, indicators of UVR exposure, education, and smoking status. During a mean follow-up of 27 years, 3,000 incident CM cases were identified. In men, CM risk was positively associated with body mass index, body surface area (BSA), height and weight (all ptrends < 0.001), and the exposure-response curves indicated an exponential increase in risk for all anthropometric factors. Weight loss of more than 2 kg in men was associated with a 53% lower risk (HR 0.47, 95% CI: 0.39, 0.57). In women, CM risk increased with increasing BSA (ptrend = 0.002) and height (ptrend < 0.001). The shape of the height-CM risk curve indicated an exponential increase. Our study suggests that large body size, in general, is a CM risk factor in men, and is the first to report that weight loss may reduce the risk of CM among men.
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Affiliation(s)
- Jo S Stenehjem
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Marit B Veierød
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | | | - Reza Ghiasvand
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Bjørn Johnsen
- Norwegian Radiation Protection Authority, Østerås, Norway
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | - Judith R Rees
- New Hampshire State Cancer Registry, Lebanon, NH
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Bernhardt EB, Caffrey AG, Celaya MO, Celaya V, Chamberlin MD, Rees JR. Abstract P6-08-18: Prognostic multigene testing in breast cancer: Patterns, disparities, and opportunities for advancing standardized patient care. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The decision to give adjuvant chemotherapy to patients with hormone receptor positive early stage breast cancer is controversial given the overall good prognosis with local therapy (surgery and radiation) plus hormonal therapy alone. In 2004, the 21-gene RT-PCR assay recurrence score (Oncotype) was developed to stratify early stage patients into categories of high, low, and intermediate recurrence rates considering treatment with local and hormonal therapy alone. This was incorporated into the NCCN guidelines in 2008. We sought to compare NCCN guidelines to actual practice patterns.
Methods: By retrospective review, data were examined from eight state registries participating in the National Program of Cancer Registries' Comparative Effectiveness Research program: Alaska, Colorado, Florida, Idaho, Louisiana, North Carolina, New Hampshire, and Rhode Island. These were then compared to NCCN guidelines for prognostic multigene testing.
Results: Of the 28,372 cases examined, 18.6% were classified as carcinoma in situ, 39.6% were stage I, 24.3% were stage II, 9.1% were stage III, 4.9% were stage IV, and 3.6% were unknown stage. The overwhelming majority of cases, 75.5%, were estrogen receptor (ER) or progesterone receptor (PR) positive, while 15.7% were ER and PR negative, and 8.8% were hormone receptor unknown. Approximately 40% of cases were human epidermal growth factor receptor 2 (HER2) positive, and the remaining 60% were HER2 negative or unknown. Approximately 72% of patients were node negative or had unknown nodal involvement, while the remaining 28% had at least micro-metastatic nodal disease. Invasive ductal carcinoma was the most common histology accounting for 71.4% of cases examined. Median age was 62. Data analysis for the use of prognostic multigene testing in relation to NCCN guidelines, race, age, and the above clinical factors is on-going and will be presented at SABCS 2017.
Conclusion: The purpose of this study is to examine the factors associated with the use of prognostic multigene testing according to the NCCN guidelines, including personal and clinical factors. By identifying practice patterns we can then address disparities and opportunities for advancing standardized quality patient care.
Citation Format: Bernhardt EB, Caffrey AG, Celaya MO, Celaya V, Chamberlin MD, Rees JR. Prognostic multigene testing in breast cancer: Patterns, disparities, and opportunities for advancing standardized patient care [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-18.
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Affiliation(s)
- EB Bernhardt
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
| | - AG Caffrey
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
| | - MO Celaya
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
| | - V Celaya
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
| | - MD Chamberlin
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
| | - JR Rees
- Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth College, Hanover, NH
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Stenehjem JS, Grimsrud TK, Rees JR, Vos L, Babigumira R, Veierød MB, Robsahm TE. A protocol for prospective studies of 25-hydroxyvitamin D, leptin and body mass index in relation to cutaneous melanoma incidence and survival. BMJ Open 2017; 7:e014829. [PMID: 28637727 PMCID: PMC5623373 DOI: 10.1136/bmjopen-2016-014829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The incidence and mortality rates of cutaneous melanoma (CM) are increasing among fair-skinned populations worldwide. Ultraviolet radiation (UVR) is the principal risk factor for CM, but is also the main source of 25-hydroxyvitamin D (25(OH)D), which has been associated with reduced risk and better prognosis of some cancer types. However, both low and high 25(OH)D levels have been associated with increased risk of CM. Obesity as measured by body mass index (BMI) is associated with risk of several cancers and has also been suggested as a risk factor for CM, and may also be related to insufficient 25(OH)D and/or high leptin levels. Moreover, contracting a CM diagnosis has been associated with increased risk of developing second cancer. We aim to study whether low prediagnostic serum levels of 25(OH)D, high prediagnostic levels of BMI and high serum leptin levels influence CM incidence, Breslow thickness and CM mortality, and risk of second cancer and survival after a CM diagnosis. METHODS AND ANALYSIS Cohort and nested case-control studies will be carried out using the population-based Janus Serum Bank Cohort (archival prediagnostic sera, BMI, smoking and physical activity), with follow-up from 1972 to 2014. Additional data will be received from the Cancer Registry of Norway, the national Cause of Death Registry, Statistics Norway (education and occupation) and exposure matrices of UVR. Time-to-event regression models will be used to analyse the cohort data, while the nested case-control studies will be analysed by conditional logistic regression. A multilevel approach will be applied when incorporating group-level data. ETHICS AND DISSEMINATION The project is approved by the Regional Committee for Medical Research Ethics and is funded by the Norwegian Cancer Society. Results will be published in peer-reviewed journals, at scientific conferences and in the news media.
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Affiliation(s)
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Judith R Rees
- New Hampshire State Cancer Registry, Lebanon, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Linda Vos
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | - Marit B Veierød
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
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10
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Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Goodall EC, Grant C, Janssens W, Laaksi I, Manaseki-Holland S, Murdoch D, Neale RE, Rees JR, Simpson S, Stelmach I, Kumar GT, Urashima M, Camargo CA. S102 Vitamin d supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Barry EL, Mott LA, Rees JR, Ahnen DJ, Bostick RM, Bresalier RS, Robertson DJ, Summers RW, Baron JA. Abstract 4584: VDR genotype modifies vitamin D efficacy for colorectal adenoma prevention in a randomized controlled trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Although epidemiological and pre-clinical research suggests that vitamin D and calcium supplementation reduce colorectal carcinogenesis, we found that they had no effect on risk of colorectal adenoma recurrence in a recently completed randomized controlled trial (Vitamin D/Calcium Polyp Prevention Study, NCT00153816). We now examine whether the effect of supplementation may be modified by common genetic variants in vitamin D and calcium pathway genes previously associated with 25-hydroxyvitamin D levels or other health outcomes.
Methods: 41 candidate single nucleotide polymorphisms (SNPs) in 7 genes (GC, DHCR7, CYP2R1, CYP27B1, CYP24A1, VDR and CASR) were genotyped in non-Hispanic white trial participants (N = 1,676). All had at least one adenoma at a baseline colonoscopy and were randomized to treatment with vitamin D3 (1000 IU/day), calcium (1200 mg/day), both or placebo in a modified 2×2 factorial design. Participants were followed until a subsequent colonoscopy 3 or 5 years later and assessed for the presence of at least one adenoma or advanced adenoma (adenoma ≥1 cm, or with >25% villous histology and/or high-grade dysplasia, or cancer). Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were used to estimate genotype effects, treatment effects and interactions. To account for multiple testing, based on the effective number of independent SNPs, statistical significance was defined as p<0.002.
Results: VDR SNP rs731236 (Taq1, minor allele frequency 0.39) statistically significantly modified the effect of vitamin D3 treatment on advanced adenomas (interaction RR = 0.49, 95% CI = 0.31-0.76, P = 0.001) but not on any adenoma (interaction RR = 0.94, 95% CI = 0.80-1.11, P = 0.48). Among participants (N = 249, 15%) with the homozygous variant genotype, the risk of an advanced adenoma was 15.2% among those randomized to placebo, and 3.2% among those randomized to vitamin D; a risk reduction of 78% for vitamin D supplementation (RR = 0.22, 95% CI = 0.08-0.63, P = 0.005). In contrast, among participants with one or more wild type allele (N = 1400, 85%), the risk of an advanced adenoma was 8.8% among those randomized to placebo, and 10.5% among those randomized to vitamin D; an apparent risk increase of 19% for vitamin D supplementation (RR = 1.19, 95% CI = 0.86-1.64, P = 0.3). Several other VDR SNPs in linkage disequilibrium with rs731236 had borderline statistically significant interactions. However, there were only nominally statistically significant (P<0.05) interactions of SNP genotypes with calcium treatment on adenoma outcomes.
Conclusions: Our results suggest that the effect of vitamin D3 supplementation on colorectal carcinogenesis depends on common genetic variants in VDR, with a 78% reduction in risk of advanced adenomas in individuals with the rs731236 homozygous variant genotype, and no benefit in individuals with one or more wild type alleles.
Note: This abstract was not presented at the meeting.
Citation Format: Elizabeth L. Barry, Leila A. Mott, Judith R. Rees, Dennis J. Ahnen, Roberd M. Bostick, Robert S. Bresalier, Douglas J. Robertson, Robert W. Summers, John A. Baron. VDR genotype modifies vitamin D efficacy for colorectal adenoma prevention in a randomized controlled trial. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4584. doi:10.1158/1538-7445.AM2015-4584
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Affiliation(s)
| | | | | | | | | | | | | | | | - John A. Baron
- 7University of North Carolina School of Medicine, Chapel Hill, NC
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12
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Barry EL, Mott LA, Melamed ML, Rees JR, Ivanova A, Sandler RS, Ahnen DJ, Bresalier RS, Summers RW, Bostick RM, Baron JA. Calcium supplementation increases blood creatinine concentration in a randomized controlled trial. PLoS One 2014; 9:e108094. [PMID: 25329821 PMCID: PMC4198086 DOI: 10.1371/journal.pone.0108094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 01/13/2023] Open
Abstract
Background Calcium supplements are widely used among older adults for osteoporosis prevention and treatment. However, their effect on creatinine levels and kidney function has not been well studied. Methods We investigated the effect of calcium supplementation on blood creatinine concentration in a randomized controlled trial of colorectal adenoma chemoprevention conducted between 2004–2013 at 11 clinical centers in the United States. Healthy participants (N = 1,675) aged 45–75 with a history of colorectal adenoma were assigned to daily supplementation with calcium (1200 mg, as carbonate), vitamin D3 (1000 IU), both, or placebo for three or five years. Changes in blood creatinine and total calcium concentration were measured after one year of treatment and multiple linear regression was used to estimate effects on creatinine concentrations. Results After one year of treatment, blood creatinine was 0.013±0.006 mg/dL higher on average among participants randomized to calcium compared to placebo after adjustment for other determinants of creatinine (P = 0.03). However, the effect of calcium treatment appeared to be larger among participants who consumed the most alcohol (2–6 drinks/day) or whose estimated glomerular filtration rate (eGFR) was less than 60 ml/min/1.73 m2 at baseline. The effect of calcium treatment on creatinine was only partially mediated by a concomitant increase in blood total calcium concentration and was independent of randomized vitamin D treatment. There did not appear to be further increases in creatinine after the first year of calcium treatment. Conclusions Among healthy adults participating in a randomized clinical trial, daily supplementation with 1200 mg of elemental calcium caused a small increase in blood creatinine. If confirmed, this finding may have implications for clinical and public health recommendations for calcium supplementation. Trial Registration ClinicalTrials.gov NCT00153816
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Affiliation(s)
- Elizabeth L Barry
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Leila A Mott
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Michal L Melamed
- Departments of Medicine and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Judith R Rees
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Anastasia Ivanova
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Robert S Sandler
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Dennis J Ahnen
- Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado, United States of America
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Robert W Summers
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - John A Baron
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America; Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Rees JR, Blazeby JM, Brookes ST, John T, Welsh FK, Rees M. Patient-reported outcomes in long-term survivors of metastatic colorectal cancer needing liver resection. Br J Surg 2014; 101:1468-74. [DOI: 10.1002/bjs.9620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 06/27/2014] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Five-year survival after hepatic resection for colorectal cancer (CRC) liver metastases is good, but data on patient-reported outcomes are lacking. This study describes the long-term impact of liver surgery for CRC metastases on patient-reported outcomes.
Methods
The study used the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and the disease-specific module, EORTC QLQ-LMC21. For functional scales, mean scores out of 100 with 95 per cent c.i. were calculated; differences of 10 points or more were considered clinically significant. Responses to symptom scales and items were categorized as ‘minimal’ or ‘severe’. Proportions and 95 per cent c.i. for symptoms were calculated.
Results
A total of 241 patients were recruited; nine (3·7 per cent) had unresectable disease and were excluded. Some 68 (42 men) of 80 long-term survivors participated; their mean age was 69·5 years and median follow-up was 8·0 (range 6·9–9·2) years. Values for baseline and 1-year patient-reported outcome data were similar. Scores for functional scales were excellent (emotional function: 92, 95 per cent c.i. 87 to 96; social function: 94, 89 to 99; role function: 94, 90 to 98), reflecting clinically significant improvements from baseline values of 17 (10 to 24), 12 (3 to 21) and 12 (3 to 20) respectively. Severe symptoms were uncommon (affected less than 5 per cent of patients) for most patient-reported outcome scales or items, but persistent severe symptoms were noted for sexual function (2 per cent increase from baseline), peripheral neuropathy (2 per cent increase), constipation (10 per cent increase) and diarrhoea (5 per cent increase).
Conclusion
Long-term survivors of metastatic colorectal cancer who have undergone liver surgery have excellent global quality of life, high levels of function and few symptoms.
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Affiliation(s)
- J R Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - S T Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
| | - T John
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - F K Welsh
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - M Rees
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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14
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Abstract
INTRODUCTION Hepatobiliary cystadenomas are rare cystic tumours that can arise from any portion of the biliary tract but most commonly develop intrahepatically. They typically cause non-specific symptoms and are often detected incidentally. Cystadenomas can be mistaken for simple hepatic cysts on radiological imaging, which leads to inadequate treatment. Hepatobiliary cystadenomas have a malignant predisposition and a high recurrence rate. Complete excision including hepatic resection is therefore generally recommended. METHODS Three cases of hepatobiliary cystadenoma were identified at one unit over a six-month period. Their clinical details and management are reported. RESULTS Three female patients are described aged 25, 37 and 73 years. One patient presented because of recurrent infection, one presented because of pressure related symptoms and one lesion was identified incidentally. All patients were investigated by ultrasonography and computed tomography (CT), two additionally had magnetic resonance imaging (MRI) and one had a liver biopsy. The tumours were 4-16cm in size and all lesions were excised by non-anatomical, parenchyma sparing resections. Histology revealed mixed epithelium with underlying ovarian-like stroma. CONCLUSIONS The management of hepatic cystadenomas as well as operative and pathological findings are discussed. Preoperative ultrasonography, CT and MRI is recommended, and early referral for specialist hepatobiliary review is advised. Operative resection is also recommended and complete excision was achieved in these cases. This strategy is supported by the current literature and recurrence has been shown to be unlikely.
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Barry EL, Mott LA, Peacock JL, Rees JR, Baron JA. Abstract 2196: Genetic correlates of serum 25-hydroxyvitamin D levels and response to vitamin D supplementation. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Epidemiological studies indicate that vitamin D has antineoplastic effects in the colorectum and suggest that vitamin D supplementation may be a promising chemopreventative approach to reduce risk of colorectal cancer. Thus, it is important to consider how genetic factors may modify vitamin D status and response to vitamin D supplementation. We investigated this question among 2,259 participants randomized in the Vitamin D/Calcium Polyp Prevention Study, an on-going, double-blind, placebo-controlled clinical trial of supplementation with vitamin D3 (1000 IU/day) and/or calcium carbonate (1200 mg elemental calcium/day) for the prevention of colorectal adenomas. Candidate single nucleotide polymorphisms (SNPs) were genotyped in or near seven genes involved in vitamin D or calcium metabolism, transport or signaling. Excluding SNPs with MAF<5% and r2>0.8, 23 SNPs were analyzed in vitamin D binding protein (GC), 25-hydroxylase (CYP2R1), 24-hydroxylase (CYP24A1), 1-hydroxylase (CYP27B1), 7-dehydrocholesterol reductase (DHCR7), vitamin D receptor (VDR), and calcium-sensing receptor (CaSR). These included 5 SNPs previously associated with circulating 25-hydroxyvitamin D levels in genome-wide association studies (GWAS): rs2282679, rs12785878, rs3829251, rs10741657 and rs6013897. Linear regression was used to estimate associations with baseline serum 25-hydroxyvitamin D levels and with levels of 25-hydroxyvitamin D achieved after approximately one year of vitamin D supplementation in the trial after adjusting for baseline levels. Analyses were restricted to non-Hispanic white participants (82%) to avoid population stratification and additive genetic models were used. Baseline 25-hydroxyvitamin D was statistically significantly associated with genotype at 3 GWAS hits in GC, DHCR7 and CYP2R1 and at 5 other SNPs in GC, CYP2R1 and CYP24A1. When response to supplementation was investigated, compliance with pill taking was taken into account by restricting analyses to optimally compliant subjects. Genotype at 3 SNPs in VDR, CYP2R1, and CYP24A1 statistically significantly modified the 25-hydroxyvitamin D level achieved with vitamin D supplementation. In conclusion, we have identified variation in or near key vitamin D and calcium pathway genes that modify serum 25-hydroxyvitamin D status and the response to supplementation with vitamin D. This research may identify individuals at risk for poor response to vitamin D supplementation. The public health significance of this work is substantial due to the prevalence of vitamin D insufficiency and the high incidence of colorectal cancer, osteoporosis, and other common diseases associated with poor vitamin D status.
Citation Format: Elizabeth L. Barry, Leila A. Mott, Janet L. Peacock, Judith R. Rees, John A. Baron. Genetic correlates of serum 25-hydroxyvitamin D levels and response to vitamin D supplementation. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2196. doi:10.1158/1538-7445.AM2013-2196
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Vaughan-Shaw PG, Rees JR, Bell E, Hamdan M, Platt T. Normal inflammatory markers in appendicitis: evidence from two independent cohort studies. JRSM Short Rep 2011; 2:43. [PMID: 21637404 PMCID: PMC3105453 DOI: 10.1258/shorts.2011.010114] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Acute appendicitis is a common surgical condition which can lead to severe complications. Recent work suggested that patients experiencing right lower abdominal pain, with normal white cell count (WCC) and C-reactive protein (CRP) are unlikely to have acute appendicitis and can be discharged. We present two independent data-sets that suggest that this strategy may not be risk-free. DESIGN Retrospective cohort study of consecutive patients from two district general hospitals. Sensitivity and specificity of CRP, WCC and neutrophil count (NC) in predicting appendicitis were calculated. Markers were analysed using Fisher's exact test and Kruskul-Wallace test. SETTING Two district general hospitals in the UK. PARTICIPANTS Patients undergoing appendicectomy for suspected appendicitis. MAIN OUTCOME MEASURES Inflammatory markers and appendix histology. RESULTS A total of 297 patients were included. Appendicitis occurred in four patients with normal CRP, WCC and NC in centre A and 13 patients in centre B. The sensitivity of all three markers combined was 94% (centre A) and 92% (centre B). The specificity was 60% (centre A) and 64% (centre B). No single marker could differentiate uncomplicated and complicated appendicitis, but a raised NC or a CRP >35.5 mg/l predicted complicated appendicitis. CRP, WCC and NC combined differentiated between patients with a normal appendix, uncomplicated appendicitis and complicated appendicitis. CONCLUSIONS Appendicitis in the presence of normal inflammatory markers is not uncommon. We disagree with the view of Sengupta et al. who suggest that patients with normal WCC and CRP are unlikely to have appendicitis, and recommend that clinicians be wary of normal inflammatory markers in patients with a high clinical suspicion of appendicitis.
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Affiliation(s)
- P G Vaughan-Shaw
- Department of Lower GI Surgery, Southampton University Hospitals Foundation Trust , Southampton , UK
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18
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Abstract
INTRODUCTION Resection, on-table lavage (OTL) and primary anastomosis is the treatment of choice for the obstructed left colon. OTL is time-consuming, requires considerable mobilisation/bowel handling, an enterotomy and potentially exposes the patient to mesenteric vascular injury, faecal contamination and a prolonged ileus. We have assessed outcome following primary resection and anastomosis without prior lavage. PATIENTS AND METHODS Twenty-four consecutive, obstructed patients underwent splenic flexure mobilisation and high anterior resection (concomitant small bowel resection in 2) with primary side-to-side colorectal anastomosis without either prior lavage or covering stoma. Outcome was audited. RESULTS Twenty-four patients, 17 female aged 48-92 years (median. 76 years) presented with left-sided obstruction due to carcinoma (Dukes' B [3], C [6], D [1]) or chronic diverticulitis (14). Median operative time was 85 min (range, 40-105 min). Colonic ileus resolved on day 2 (29%) and day 3 (58%). Median hospital stay was 7 days (range, 6-72 days); 92% discharged by day 10. There were no deaths or re-admissions. A return to theatre followed a reactionary haemorrhage in one. This latter patient's anastomosis leaked on day 4 (no faecal contamination) and was converted to an end stoma. Urinary and wound infections were seen in two. Late complications comprised two anastomotic strictures; both responded to balloon dilatation at 5 months. CONCLUSIONS Resection and primary anastomosis without on-table lavage is an easy, practical, predictable and safe treatment option for left-sided colonic obstruction with minimal complications.
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Affiliation(s)
- K L R Cross
- Department of Colorectal Surgery, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK
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Rees JR. Are we going OTT about ITT? Br J Dermatol 2002; 146:331; author reply 331-2. [PMID: 11903252 DOI: 10.1046/j.1365-2133.2002.4653_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998; 27:1138-47. [PMID: 9827260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Population-based active laboratory surveillance for invasive mycotic infections was conducted during 1992 and 1993 in three California counties: Alameda, Contra Costa, and San Francisco (population, 2.94 million). The cumulative incidence of invasive mycotic infections was 178.3 per million per year. Invasive mycoses were most commonly caused by Candida (72.8 per million per year), Cryptococcus (65.5), Coccidioides (15.3), Aspergillus (12.4), and Histoplasma (7.1). The clinical significance of other, less common fungi was determined by detailed chart review. The cumulative incidence was determined for zygomycosis (1.7 per million per year), hyalohyphomycosis (1.2), and phaeohyphomycosis (1.0). The most common underlying conditions were human immunodeficiency virus infection (47.4%), nonhematologic malignancy (14.7%), diabetes mellitus (9.9%), and chronic lung disease (9.3%). This represents the first population-based epidemiological assessment of invasive mycoses in the United States.
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Affiliation(s)
- J R Rees
- School of Public Health, University of California, Berkeley, USA
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21
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Abstract
1. The ideal drug treatment for atrial fibrillation will control resting heart rate, blunt exercise induced tachycardia whilst not exacerbating nocturnal bradycardia. Monotherapy with digoxin may not be ideal. We have compared the effect of combining digoxin (0.25 mg daily) with atenolol 50 mg and 100 mg or pindolol 5 mg twice daily and 15 mg twice daily in a cross-over randomised single-blind trial in eight symptomatic patients (six male; mean age 62 years) with poorly controlled atrial fibrillation. 2. Heart rate control was measured by 24 h ECG at baseline on digoxin therapy and after 2 weeks with each treatment. Symptom scores for breathlessness and palpitation were measured using visual analogue scales. 3. The addition of both beta-adrenoceptor blockers significantly reduced mean diurnal maximum heart rate from baseline (all P < 0.001 ANOVA). Atenolol at both doses caused a greater reduction than either dose of pindolol (P < 0.001 ANOVA). Nocturnal maximum heart rate was not significantly reduced from baseline by either beta-adrenoceptor blocker, but both doses of pindolol caused increases in nocturnal maximum heart rate compared with atenolol (P < 0.001 ANOVA). 4. Atenolol caused a reduction in diurnal minimum heart rate compared with baseline and caused a reduction in nocturnal minimum heart rate whereas pindolol caused an increase (P < 0.001 ANOVA). 5. Atenolol 100 mg caused longer nocturnal pauses compared with baseline but pindolol 15 mg twice daily reduced the number of nocturnal pauses > 1.5 s (P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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22
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Abstract
Transient visual loss lasting three days developed after transfemoral coronary angiography in a 62 year old man. Computed tomography (CT) showed bilateral leakage of contrast medium into the occipital cortex. A repeat CT scan after his sight recovered showed clearance of contrast with no underlying infarction. A breakdown of the blood-brain barrier with direct neurotoxicity of the contrast media seemed to be the cause of these neurological changes after coronary angiography which apparently have not been reported before.
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Affiliation(s)
- R Parry
- Department of Radiology, Bristol Royal Infirmary
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23
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Lillehei CW, Nakib A, Kaster RL, Kalke BR, Rees JR. The origin and development of three new mechanical valve designs: toroidal disc, pivoting disc, and rigid bileaflet cardiac prostheses. Ann Thorac Surg 1989; 48:S35-7. [PMID: 2673097 DOI: 10.1016/0003-4975(89)90630-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C W Lillehei
- Department of Surgery, University of Minnesota Medical School, Minneapolis 55104
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24
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Abstract
Of 1102 consecutive coronary angiograms 16 (1.4%) were found to have systolic narrowing typical of myocardial bridging on the left anterior coronary artery or its branches. Four cases of bridging had otherwise normal coronary arteriograms, four were associated with left ventricular hypertrophy (three in cases of aortic valve disease and one case of hypertrophic cardiomyopathy) and eight were found in association with fixed coronary artery stenoses. Bridging was seen more commonly than expected on normal angiograms. When bridging was associated with left ventricular hypertrophy it affected a longer segment and caused more severe compression. When bridging was found in patients with coronary artery disease, it was not associated with atheroma at its site. Evidence for a pathogenic role of myocardial bridging in ischaemic heart disease is discussed.
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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26
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Abstract
Eighteen adult patients presenting with breathlessness associated with bradycardia, and whose breathlessness was diminished or abolished by permanent pacing, were studied at least one month after this procedure in order to examine the relationship between symptoms and exercise performance. All were pacing-dependent at rest and were studied over successive two-weekly periods at set rates of 50, 70 and 90 beats min-1 in a double-blind, balanced and randomized trial. The degree of breathlessness was closely related to exercise capacity judged by 6-min walk testing, effort scores and weekly pedometer distance. Overall results were worse at 50 beats min-1 than the two faster rates. For a given individual, changing of ventricular rate caused parallel alterations in symptoms and performance. The 6-min walking test was a useful guide to disability in these patients, tightly linked to the symptoms of effort and breathlessness, and may be of clinical value in assessing mild heart failure. The pedometer readings were influenced more by the patients' walking habits than by fitness.
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Affiliation(s)
- A Rozkovec
- Cardiology Department, Bristol Royal Infirmary, U.K
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Abstract
This study has compared the effect on heart rate control of the addition of pindolol 15 mg bd or verapamil 40 mg tds to maintenance digoxin therapy in 12 patients with chronic atrial fibrillation. The study was performed in a randomized cross-over fashion. Treatment effects were assessed by 24-h ambulatory electrocardiography and symptomatic improvement by symptom scores. The results show that the combination of pindolol and digoxin provides better control of atrial fibrillation. With an attenuation of daytime tachycardia, prevention of nocturnal bradycardia and reduction in the length of nocturnal pauses in rhythm. Overall heart rate variability was significantly less with digoxin and pindolol (523 beats min-1 h-1) than with digoxin and verapamil (745 beats min-1 h-1). We conclude that, in the dosages employed, combined digoxin and pindolol therapy is superior to either digoxin and verapamil in combination or digoxin alone for the treatment of atrial fibrillation.
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Affiliation(s)
- M A James
- Cardiology Department, Bristol Royal Infirmary, U.K
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28
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Channer KS, Bolton R, Rees JR, Wilde P. Aneurysm of the interatrial septum and mitral valve prolapse--an aetiological association? Bristol Med Chir J 1988; 103:40-1. [PMID: 3256406 PMCID: PMC5113372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Mitral valve prolapse is common but aneurysm of the interatrial septum is rare. We report a case in which these two abnormalities of myocardial structure occurred and postulate a common aetiological mechanism.
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29
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30
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Abstract
The Kearns-Sayre syndrome is a mitochondrial myopathy characterised by ptosis, chronic progressive external ophthalmoplegia, abnormal retinal pigmentation, and cardiac conduction defects. A unique case is reported in which there was rapid development of progressive congestive cardiac failure that required cardiac transplantation. A review of published reports of mitochondrial myopathy shows that a minority of cases (less than 20%) have cardiac involvement. This had previously been limited to abnormalities of cardiac conduction with progressive heart block. Myocardial biopsy has, however, shown ultrastructural evidence of a generalised mitochondrial disorder which hitherto has not been associated with a functional deficit.
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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31
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Rees JR. The surgical treatment of complicated peptic esophagitis. Am Surg 1987; 53:497-500. [PMID: 3631761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Healing of stenosing peptic esophagitis was proved by endoscopy and biopsy in 22 of 27 patients treated by transthoracic Nissen fundoplication and esophageal dilation during a follow-up period extending to 14 years. Four additional patients did not have follow-up endoscopy because three expired from intercurrent disease before endoscopy could be carried out and one refused to have the procedure because of lack of symptoms. Postoperative reflux has not been demonstrated in any patient either endoscopically or by contrast studies. Dysphagia, requiring repeat dilation, occurred in two patients after operation. Transthoracic fundoplication with intraoperative stricture dilation is a reasonable alternative in treating complicated esophagitis.
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32
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Channer KS, James MA, Papouchado M, Rees JR. Failure of a negative exercise test to reassure patients with chest pain. Q J Med 1987; 63:315-22. [PMID: 3685244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Seventy-two patients with chest pain and negative exercise tests were observed. Twenty-one (29 per cent) became pain free but 51 (71 per cent) continued to complain of chest pain. Patients with persistent pain were significantly more anxious and depressed at presentation and later compared with those who had become pain free. Anxiety and particularly depression, at presentation and later, were significantly associated with severe symptoms. Patients with chest pain associated with neurosis and depression are not reassured by physiological stress testing because their physical symptoms are a feature of underlying psychiatric disease.
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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33
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Abstract
Patients with atrial fibrillation frequently show a wide variation in heart rate with digoxin therapy. We have compared the effect on heart rate variability, of doubling the digoxin dosage or adding verapamil 120 mg daily in a randomized cross-over study in 14 patients. Twenty-four hour ambulatory electrocardiographic recordings, six minute walking tests and palpitation and breathlessness scores were obtained on each regime. All patients exhibited a diurnal pattern in heart rate variability. Both treatments significantly lowered heart rate but high dose digoxin lowered minimum heart rate significantly more than digoxin and verapamil, causing more night time bradycardia. Overall, digoxin with verapamil produced significantly less heart rate variability than digoxin alone. Day time but not night time pauses were prolonged by digoxin and verapamil but were prolonged more by high dose digoxin. Five (36%) patients had serum digoxin levels in the toxic range when taking high dose digoxin. Palpitations were significantly reduced by both treatments but most improvement occurred with digoxin and verapamil. No significant effect was found on six minute walking distances or breathlessness scores. In conclusion, the addition of verapamil to digoxin was superior to increasing the dose of digoxin alone, producing significantly better control of heart rate variability with less night time bradycardia.
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Abstract
A 70-year-old woman presented with disabling breathlessness. She was found to have severe arterial hypoxaemia due to isolated right-to-left shunting through a patent foramen ovale. In the absence of pulmonary hypertension or evidence of right ventricular dysfunction this is attributed to reduced right atrial compliance. The phasic nature of the shunt, which occurred only during atrial filling, supports this view. Surgical closure of the foramen abolished the hypoxaemia and her symptoms.
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35
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Channer KS, Papouchado M, James MA, Rees JR. Treadmill tests for anxious or depressed patients. Lancet 1986; 1:909-10. [PMID: 2870375 DOI: 10.1016/s0140-6736(86)91011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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36
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Pitcher D, Fletcher P, Laszlo G, Keen G, Rees JR. Cyanosis attributable to right to left shunt in the carcinoid syndrome. Br Med J (Clin Res Ed) 1986; 292:1016. [PMID: 3083967 PMCID: PMC1339942 DOI: 10.1136/bmj.292.6526.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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37
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Abstract
A new stress test for thallium-201 myocardial imaging in which pharmacological coronary vasodilatation with dipyridamole is combined with dynamic exercise is described. In 38 patients with coronary artery disease the sensitivity, total number of defects, degree of redistribution, and visual quality of thallium-201 imaging were greater after dipyridamole with exercise testing than after exercise alone. When the data from these 38 patients were combined with the results of dipyridamole-exercise imaging in 49 patients in whom exercise electrocardiography had been inconclusive then the technique gave a sensitivity for coronary disease of 87% and a specificity of 92%. Dipyridamole also increased the sensitivity of the exercise electrocardiogram, so that no patient with coronary disease had a strictly negative dipyridamole-exercise stress test. Only five of 214 patients who have now undergone this test have had complications requiring reversal of vasodilatation with aminophylline. The combined use of dipyridamole and exercise in this simple technique is a reliable and safe improvement on standard thallium-201 imaging tests.
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38
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Pitcher D, Papouchado M, James MA, Rees JR. Twenty four hour ambulatory electrocardiography in patients with chronic atrial fibrillation. Br Med J (Clin Res Ed) 1986; 292:594. [PMID: 3081185 PMCID: PMC1339572 DOI: 10.1136/bmj.292.6520.594] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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39
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Abstract
Anxiety and depression were measured in 87 consecutive patients (65 males, 22 females) with chest pain before diagnostic exercise treadmill testing. Chest pain was assessed as typical or atypical of angina by an independent observer. Fifty exercise tests were positive; thirty-seven were negative (including nineteen submaximal). Patients with negative tests had significantly higher scores for anxiety and higher depression scores than those with positive tests. 12% of patients with positive tests were women compared with 43% with negative tests. 27 patients (73%) with negative tests had atypical pain compared with 6 (12%) with positive tests. Depressed patients walked for a significantly shorter time. The probability of a negative test in patients without anxiety or depression who had typical pain was 8% in males and 32% in females; the probability of a negative test in patients who were both anxious and depressed and had atypical pain was 97% in males and 99% in females. Diagnostic exercise testing in patients with both affective symptoms and atypical chest pain may be unhelpful, misleading, and uneconomical.
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Abstract
Exsanguinating hemoptysis accompanied removal of an endobronchial foreign body in a 12-year-old child. Preparations to treat this complication should be made prior to removal of any foreign body of prolonged sojourn in the tracheobronchial tree.
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41
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Pitcher DW, Wood P, Goddard PR, Rees JR. Fulminating Aspergillus pneumonia complicating radiation fibrosis. Bristol Med Chir J 1984; 99:84-7. [PMID: 6467067 PMCID: PMC5076941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jackson PC, Allen-Narker R, Davies ER, Rees JR, Wilde P, Watt I. The assessment of an edge detection algorithm in determining left ventricular ejection fraction using radio-nuclide multiple gated acquisition and contrast ventriculography. Eur J Nucl Med 1982; 7:62-5. [PMID: 6282592 DOI: 10.1007/bf00251644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The application of an edge detection algorithm (EDA) in defining the boundary of the left ventricle (LV) in multiple gated (MG) cardiac studies has been assessed by comparison of the left ventricular ejection fraction (LVEF) derived from X-ray contrast ventriculography (CV) in a series of patients. The results demonstrate good correlation between methods irrespective of the projection and LV status when an EDA is used, such that the correlation in anterior and left anterior oblique (45 degrees) views is 0.91 and 0.86 respectively.
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Abstract
Thallium-201 myocardial imaging is an important test in the assessment of patients with suspected coronary artery disease. Techniques differ in detail, reliability and in patient acceptability. Three techniques have been compared. Thirty-two-patients were studied in three groups. In the first group (15 patients) exercise thallium scans were compared with scans following an intravenous vasodilator (dipyridamole). In the second group (12 patients) intravenous dipyridamole and oral dipyridamole thallium scans were compared. In the third group (five patients) combined oral dipyridamole and exercise scans were assessed. There were no major differences in the first two groups but the combined test showed a marked increase in image quality and diagnostic yield. Thallium scanning is simplified considerably by the use of oral dipyridamole, without loss of diagnostic quality of safety. It promises to be the method of choice for stress scanning, and is ideal in patients unable to tolerate maximum exercise. The combined exercise--dipyridamole scan helps to evaluate complex problems, particularly those with less severe coronary insufficiency, and can be done without the use of a treadmill.
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Salmon P, Rees JR, Flanagan M, O'Moore R. Hypocalcaemia in a mother and rickets in an infant associated with a Zen macrobiotic diet. Ir J Med Sci 1981; 150:192-3. [PMID: 7275567 DOI: 10.1007/bf02938233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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47
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De Cock KM, Wakley EJ, Rees JR. Propranolol in thyroid storm with simultaneous Addisonian crisis. East Afr Med J 1981; 58:364-7. [PMID: 7285836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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48
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Abstract
A right ventricular endomyocardial biopsy specimen from a 30-year-old male with chromic progressive external ophthalmoplegia, retinal pigmentation and complete atrioventricular block (Kearns-Sayre syndrome) was examined in the electron microscope. There was a proliferation of mitochondria between the myofibrils and beneath the sarcolemma. Many of the mitochondria showed morphologic abnormalities not previously described in this condition. There were associated accumulations of glycogen. A similarly affected female with left anterior hemiblock developed complete atrioventricular block at age 26 years, Despite the ultrastructural changes, clinically detectable myocardial disease is not a feature of Kearns-Sayre syndrome. However, intraventricular conduction defects show an unusually rapid progression to potentially fatal complete atrioventricular block and are an indication for prophylactic cardiac pacing.
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50
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Abstract
Infective endocarditis can be complicated by the development of intra-cardiac shunts. A case of endocarditis secondary to staphylococcal septicaemia is reported where various conduction defects preceded the development of a fistula from the aortic root to the right atrium. Before emergency surgery there was marked worsening of heart failure with the appearance of a new loud murmur throughout diastole.
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