Racial disparity in incidence patterns and outcome of kidney cancer

OBJECTIVES

To identify the subgroups that primarily contribute to the greater incidence and mortality of renal cancer in black Americans compared with white Americans.

METHODS

We analyzed age, stage, and race-related differences in the incidence and survival among patients with renal cancer using the national Surveillance, Epidemiology, and End Results (SEER) registry database. White and black patients with renal cell carcinoma who were older than 19 years of age and had been diagnosed between 1975 and 1998 were included. Incidence trends were analyzed by joinpoint regression with the statistical significance level at P <0.05. The Cox proportional hazards model was used to determine the overall survival of patients with renal cell carcinoma by race (white versus black), age (20 to 59 versus 60+ years), and stage (local versus regional/distant).

RESULTS

Localized disease predominantly accounted for the rise in incidence. Both black age groups with localized disease had a greater estimated annual percentage of incidence increase (4.46% for 20 to 59 years and 4.35% for 60+ years) compared with their white counterparts (2.87% and 3.06%, respectively). The magnitude of survival difference was largest between black versus white patients younger than 60 years of age who had local stage disease, with a median survival time of 190 and 259 months, respectively (P <0.0001).

CONCLUSIONS

Young black patients with localized renal cancer appear to have had a greater rise in incidence and a poorer outcome than white patients of the same age and disease stage. Additional investigation is warranted to define the role of these race, stage, and age-related disparities in the etiology, prognosis, treatment, and follow-up of kidney cancer.

Cotton leaf curl disease is associated with multiple monopartite begomoviruses supported by single DNA beta

For bipartite begomoviruses (family Geminiviridae) trans-replication of the DNA B component by the DNA A-encoded replication-associated protein (Rep) is achieved by virtue of a shared sequence, the "common region", which contains repeated motifs (iterons) which are sequence-specific Rep binding sites and form part of the origin of replication. Recently cotton leaf curl disease (CLCuD), a major constraint to cotton production on the Indian subcontinent, has been shown to be caused by a monopartite begomovirus ( Cotton leaf curl Multan virus [CLCuMV]) and a novel single-stranded DNA satellite molecule termed CLCuD DNA beta. The satellite molecule is trans-replicated by CLCuMV but does not possess the iteron sequences of this virus. We have investigated the ability of CLCuD DNA beta to interact with three further clones of monopartite begomoviruses, isolated from cotton, that have distinct Rep binding specificities. All three cloned viruses were capable of trans-replicating the satellite molecule and inducing CLCuD symptoms in cotton, indicating that the interaction between begomovirus and DNA beta is relaxed in comparison to the interaction between DNA A and DNA B components. Field surveys across all the cotton growing regions of Pakistan indicate that dual and multiple infections are the norm for CLCuD with no evidence of synergism. Despite the diversity of begomoviruses associated with CLCuD, only a single class of DNA beta has been detected, suggesting that this satellite has the capacity to be recruited by unrelated begomoviruses.

Lipoma of the finger--a case report

A rare case of a lipoma occurring in the little finger of a 48-year-old woman is described. The presentation and clinical relevance of this and other lipomas occurring in the fingers are discussed.

Management of colonic injury following percutaneous nephrolithotomy

Injury to the colon during percutaneous nephrolithotomy is rare. There are no definitive management guidelines for this injury. We report a case of left-sided colonic injury diagnosed following percutaneous nephrolithotomy and suggest a treatment algorithm.

Novel approaches with targeted therapies in bladder cancer. Therapy of bladder cancer by blockade of the epidermal growth factor receptor family

The improved understanding of the molecular biology of urothelial malignancies is helping to define the role of new targets and prognostic indices that can direct the most appropriate choice of treatment for advanced disease. Many human tumors express high levels of growth factors and their receptors that can be used as potential therapeutical targets. Tyrosine-kinase receptors, including many growth factor receptors such the receptors for epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and Her2/neu, have been found overexpressed in urothelial tumors. For many of these growth factor receptors, the degree of expression has been associated with the progression of cancer and a poor prognosis. Among the best studied growth factor receptors are the two members of EGF receptor familiy EGFr (ErbB-1), and Her2/neu (ErbB-2). Several preclinical studies in bladder cancer models, have confirmed that systemic administration of growth factor inhibitors inhibits the growth and metastasis of human transitional cell carcinoma established in the bladder wall of athymic nude mice. Additional studies indicate that therapy with EGFR inhibitors enhances the activity of conventional cytoreductive chemotherapeutic agents, in part by inhibiting tumor cell proliferation, angiogenesis, and inducing apoptosis. Novel targeted therapy hold promise to improve the current results of bladder cancer treatment. Based on the success seen with anti-HER2 monoclonal antibodies (Herceptin) and the promising results with EGFR targeted agents (IMC-C225 Cetuximab, ZD1389 Iressa, OSI-774 Tarceva, GW 57016) in other tumor types, and based on the results obtained in preclinical models, there is a great interest in assessing these agents in patients with bladder cancer. Several trials are now ongoing testing these new agents alone or in combination with chemotherapy in bladder cancer patients. The integration of these newer biologic agents, probably to supplement rather than to supplant chemotherapeutic drugs, should be a primary direction of research with the objective to interfere with multiple aspects of bladder cancer progression. However, the value of integration of biologically targeted agents into combined modality treatment for patients with bladder cancer has still to be proven.

Synthesis and antimicrobial activities of some isocoumarin and dihydroisocoumarin derivatives

A new series of the isocoumarin derivatives of ibuprofen, fluribiprofen, naproxen, valproic acid and 1-naphthoic acid have been synthesized via condensation of homophthalic acid with their respective acid chlorides. The conversion of the latter two isocoumarins into (dl)-3,4-dihydroisocoumarins has also been achieved. Most of the synthesized compounds showed antifungal and antibacterial activities.

Management of pediatric urolithiasis in Pakistan: experience with 1,440 children

PURPOSE

We evaluated the efficacy and safety of different modalities for pediatric urolithiasis in a developing country in 2 eras, namely before and after the advent of minimally invasive surgery.

MATERIALS AND METHODS

We retrospectively reviewed the records of 1,440 children younger than 14 years treated with various modalities during a 14-year period. From 1987 to 1995, 486 and 50 patients were treated with open surgery, and extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) and minimally invasive methods, respectively. Between 1996 and 2000, 518 and 386 children were treated with surgery and minimally invasive methods, respectively.

RESULTS

Of the 1,440 children 795 (55.2%) had renal, 198 (13.8%) had ureteral and 447 (31%) had bladder calculi. Of the renal stones 556 (70%), 177 (22%) and 62 (7.8%) were treated with open surgery, ESWL and percutaneous nephrolithotomy, respectively. Of the ureteral calculi 85 (43%), 37 (18.6%) and 76 (38%) were managed by ESWL, ureterorenoscopy and open surgery, respectively. Of the bladder calculi 307 (68%), 77 (17.2%) and 63 (14%) were treated with open vesicolithotomy, transurethral pneumatic cystolithotripsy and ESWL, respectively. The renal stone clearance rate was 98% after open surgery, 84% after ESWL and 68% after percutaneous nephrolithotomy monotherapy at 3 months of followup. Similarly the ureteral stone-free rate was 54% after ESWL and 86.9% after ureterorenoscopy. Of the patients with bladder calculi 48% and 93% become stone-free after ESWL and transurethral pneumatic cystolithotripsy, respectively.

CONCLUSIONS

The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.

The incidence of incomplete excision in surgically treated basal cell carcinoma: a retrospective clinical audit

BCC is the commonest of the malignant skin tumours and the complete resection is the key to successful outcome with the cure rate of the order of 95%. Incomplete excisions are associated with high rate of recurrence. We designed our study to quantify the incidence of incomplete excision and its association with the subsequent recurrence of the tumour and also to identify any variables that might affect it. Case notes of 118 patients who had 126 BCCs excised between January 1995 and December 1995 in the Mater Hospital were studied retrospectively. 10 lesions showed incomplete excision on histology.

Breast-feeding counselling and its effect on the prevalence of exclusive breast-feeding

This prospective intervention study was undertaken to assess the impact of repeated breast-feeding counselling on the rate of exclusive breast-feeding up to five months. The study was carried out in two breast-feeding counselling sub-centres, established at the community level in the vicinity of two maternity facilities and one main centre established in an urban children hospital. Eighty-four pregnant mothers who attended the maternity facilities for delivery of babies were randomly selected and repeatedly counselled regarding breast-feeding--once just before delivery and subsequently at the completion of 1, 2, 3, 4, 5, 6, 9, and 12 month(s) of age of the child. These child-mother pairs comprised the intervention group. Another group of 90 child-mother pairs was selected from the maternity facilities. Mothers in this group (comparison group) received a single session of breast-feeding counselling just before delivery of babies. Fifty-nine and 55 child-mother pairs in the intervention and the comparison groups respectively completed the one-year follow-up. In the intervention group, 54.2% and in the comparison group 36.4% of the babies were exclusively breastfed up to five months of age. Forty-two (88%) children in the intervention group and 29 (53%) in the comparison group were given complementary foods at the optimum time, e.g. after completion of five months, and 81% of the children in the intervention group and 100% of the children in the comparison group were given complementary foods in the first year of life. It was observed that repeated organized breast-feeding counselling significantly improved the prevalence of exclusive breast-feeding to 54% which is much above the existing national prevalence (12.7%) in Bangladesh.

Pediatric urolithiasis: developing nation perspectives

PURPOSE

We evaluated epidemiology, etiology, dietary and urinary risk factors, and the composition of calculi in pediatric stone formers in Pakistan.

MATERIALS AND METHODS

This retrospective study includes 1,440 children treated between 1987 and 2000. Case records were reviewed for demographics, etiology and clinical symptoms. Dietary and urinary risk factors were analyzed prospectively in idiopathic stone formers. Stone composition was analyzed by infrared spectroscopy.

RESULTS

There were 1,075 males and 365 females for a male-to-female ratio of 3:1. The peak age for renal and bladder stones was 6 to 10 and 1 to 5 years, respectively. Overall 795 stones (55%) were renal, 198 (14%) were ureteral and 447 (31%) were vesical. Bladder stones were present in 60% of cases in the mid 1980s but decreased to 15% in the mid 1990s. The clinical symptoms were abdominal pain in 511 patients (51%) and fever in 193 (19.5%). There were anatomical abnormalities in 96 patients (12%), metabolic abnormalities in 206 (25%), infection stones in 60 (7%) and idiopathic stones in 444 (55%). Urinary analysis in idiopathic stone formers revealed hypercalciuria in 17 (11%), hyperoxaluria in 62 (40%), hyperuricosuria in 41 (27%) and hypocitruria in 97 (63%). Diet involved a low intake of protein in 60 cases (44%), calcium in 45 (33%), potassium in 105 (77%) and high oxalate in 75 (55%). The composition was calcium oxalate in 362 stones (47%), ammonium hydrogen urate in 210 (27%) and struvite in 49 (6.4%). Stones recurred in 30 patients (2%).

CONCLUSIONS

The pattern of calculous disease changed from a predominantly lower tract site in the mid 1980s to the upper tract in the mid 1990s. Stone composition, urinary risk factors and dietary analysis suggest that diet, dehydration and poor nutrition are the main causative factors of stone disease.

Pediatric urolithiasis: developing nation perspectives

PURPOSE

We evaluated epidemiology, etiology, dietary and urinary risk factors, and the composition of calculi in pediatric stone formers in Pakistan.

MATERIALS AND METHODS

This retrospective study includes 1,440 children treated between 1987 and 2000. Case records were reviewed for demographics, etiology and clinical symptoms. Dietary and urinary risk factors were analyzed prospectively in idiopathic stone formers. Stone composition was analyzed by infrared spectroscopy.

RESULTS

There were 1,075 males and 365 females for a male-to-female ratio of 3:1. The peak age for renal and bladder stones was 6 to 10 and 1 to 5 years, respectively. Overall 795 stones (55%) were renal, 198 (14%) were ureteral and 447 (31%) were vesical. Bladder stones were present in 60% of cases in the mid 1980s but decreased to 15% in the mid 1990s. The clinical symptoms were abdominal pain in 511 patients (51%) and fever in 193 (19.5%). There were anatomical abnormalities in 96 patients (12%), metabolic abnormalities in 206 (25%), infection stones in 60 (7%) and idiopathic stones in 444 (55%). Urinary analysis in idiopathic stone formers revealed hypercalciuria in 17 (11%), hyperoxaluria in 62 (40%), hyperuricosuria in 41 (27%) and hypocitruria in 97 (63%). Diet involved a low intake of protein in 60 cases (44%), calcium in 45 (33%), potassium in 105 (77%) and high oxalate in 75 (55%). The composition was calcium oxalate in 362 stones (47%), ammonium hydrogen urate in 210 (27%) and struvite in 49 (6.4%). Stones recurred in 30 patients (2%).

CONCLUSIONS

The pattern of calculous disease changed from a predominantly lower tract site in the mid 1980s to the upper tract in the mid 1990s. Stone composition, urinary risk factors and dietary analysis suggest that diet, dehydration and poor nutrition are the main causative factors of stone disease.

Experience with sentinel node localisation in a district general hospital breast unit

Intraoperative lymphatic mapping with identification of the first draining lymph node (sentinel node) is under investigation as a possible sole axillary staging procedure in breast cancer patients. The role of sentinel node biopsy in the district general hospital breast unit is currently unclear. We report a series of 122 patients undergoing sentinel node biopsy, using a blue dye technique. The sentinel node was identified in 113 patients, and accurately predicted the status of the axilla in 108 patients (96%). Of 39 patients who were node positive, the sentinel node was the only positive node in 11 cases (26%). There were five false negatives in patients who had a node-positive axilla. We therefore suggest that sentinel node biopsy may be a feasible alternative to formal axillary dissection in certain patients, and that lack of access to radioisotope facilities in a district general hospital need not preclude such an approach.

Correlation of fine needle aspiration cytology and its histopathology in diagnosis of breast lumps

This study was carried out to evaluate the accuracy of FNAC and the role of FNAC in palpable breast lumps for the early surgical management in out patient and inpatient basis. The study was carried out in Dhaka Medical College during the period of January-December, 2000. FNAC was performed on 310 patients presented with palpable breast lumps. Histopathology was available for 122 cases. Of them, cytologically diagnosed benign cases were 106, histologically 105 cases were proved so. There was false negative diagnosis in one case. All 14 cases diagnosed as malignant cytologically proved as such histologically. Two cases reported as suspicious for malignancy one of which were proved malignant histologically. False positive diagnosis was made in one case. FNAC of breast lump was found to be associated with increased diagnostic yields. It can be carried out safely as a preoperative diagnostic method in-patients with breast lumps mostly in out-patient department.