Increased CDK4 protein expression predicts a poor prognosis in mucosal melanoma associated with the p16INK4a-CDK4-pRb pathway

Mucosal melanoma (MM) occurs in non-cutaneous mucosal sites, e.g., the head and neck or the lower genital tract; it is a rare and aggressive neoplasm with a poor prognosis. To date, few prognostic markers of MM have been well-defined. The aim of this study is to clarify the prognostic value of the cell-cycle regulatory proteins (CDK4, pRb and CyclinD1, p16) which are associated with the p16^INK4a-CDK4-pRb pathway in MM. A total of 54 MM samples were obtained from biopsy specimens, and the expressions of the cell-cycle regulatory proteins (CDK4, pRb and CyclinD1, p16) were assessed by immunohistochemistry. A Mantel-Cox regression analysis was performed to investigate the association of these proteins with the overall survival of MM patients. Increased CDK4 expression was significantly associated with reduced survival at three years (P = 0.022). Increased CDK4 protein expression may be a helpful prognostic indicator for the management of these patients who infiltrate into the p16^INK4a-CDK4-pRb pathway. In addition, we found that those patients with low expression of CDK4 were significantly older (P < 0.05) compared to the patients with high expression of CDK4.

The arteriolar injury in hypertension

In 1937, Drs. Moritz and Oldt described arteriolar injuries in the kidneys (and other viscera) in hypertension, across the age range, in both sexes, and, in different races. This hypothesis proposes that injuries to vasomotor nerves cause the arteriolar injury in the kidney in hypertension, (as well as that in the uterus in preeclampsia). Different patterns of perivascular hyalinisation in different viscera are clues to the varying causes and consequences of arteriolar injury. In the uterus there is a symmetrical, perivascular "halo of hyalinisation" that marks the lines of extension of regenerating, injured nerves to the placental bed, whereas in the kidney there is a disordered and asymmetrical "halo of hyalinisation" where persistent, and recurrent, increases in intravascular pressures interrupt development of regenerating nerves. Consequences of injuries to vasomotor nerves include releasing a "soup" of cytokines that cause regeneration of "new" nerves expressing primitive, pain and stretch receptors including TRPV-1 and P2X3 purinergic "stretch" receptors that may be significant in the afferent mechanism in preeclampsia. There is also concurrent, "background" hyperplasia of denervated tunica media and intima leading to narrowing of the arterioles and a further drive to hypertension through renal ischaemia (Goldblatt, 1942). These observations require support from animal studies and other investigations to establish causation. This hypothesis may provide a number of potential mechanisms that reinforce, or accelerate, the physiological processes that contribute to hypertension.

Effects of dietary concentration of wet distillers grains on performance by newly received beef cattle, in vitro gas production and volatile fatty acid concentrations, and in vitro dry matter disappearance

Three studies were designed to evaluate effects of wet distillers grains with solubles (WDGS) on health and performance of newly received beef cattle, in vitro gas production, molar proportions and total concentrations of VFA, and IVDMD. In Exp. 1 and 2, 219 (BW = 209 kg, SE = 2.2 kg; Exp. 1) and 200 beef steers (BW = 186 kg, SE = 3.2 kg; Exp. 2) were used in randomized complete block design receiving studies. The 4 dietary treatments (DM basis) were a 65% concentrate, steam-flaked corn (SFC)-based receiving diet without WDGS (CON) or diets that contained 12.5, 25.0, or 37.5% WDGS. There were no differences among the 4 receiving diets in BW (P ≥ 0.61), ADG (P ≥ 0.75), DMI (P ≥ 0.27), and G:F (P ≥ 0.35), or in the proportion of cattle treated for morbidity from bovine respiratory disease in either of the 2 experiments. In Exp. 3, in vitro methods were used to determine the effects of WDGS on IVDMD, total gas production, and molar proportions and total concentrations of VFA. Substrates used for the incubations contained the same major components as the diets used in Exp. 1, with ruminal fluid obtained from steers fed a 60% concentrate diet. Total gas production was less (P = 0.03) for the average of the 3 WDGS substrates than for CON, with a linear decrease (P = 0.01) in total gas production as WDGS concentration increased in the substrates. In contrast to gas production, IVDMD was greater for the average of the 3 WDGS concentrations vs. CON (P ≤ 0.05) at 6 and 12 h and increased (P ≤ 0.02) with increasing WDGS concentration at 6 (linear and quadratic) and 12 h (linear) of incubation. At 48 h, there was a quadratic effect (P = 0.05) on IVDMD, with the greatest value for 25% WDGS. Molar proportion of butyrate increased linearly (P < 0.01) as the concentration of WDGS increased in the substrate, and the average of the 3 substrates containing WDGS had a greater proportion of butyrate (P = 0.03) than CON. Performance data from Exp. 1 and 2 indicate that including WDGS in the SFC-based diets for newly received cattle can be an effective at concentrations up to 37.5% of the DM. In vivo measurements are needed to corroborate the in vitro fermentation changes noted with addition of WDGS.

The management of cervical lymph nodes in patients with cutaneous melanoma

BACKGROUND

The aim of this study was to review the management of cervical lymph nodes in patients with cutaneous melanoma and to analyze factors influencing prognosis.

METHODS

This was a retrospective cohort study of patients who had cervical node surgery at the Sydney Melanoma Unit from 1990 to 2004.

RESULTS

Of 716 patients who met the study criteria, 339 had a sentinel node biopsy (SNB) and 396 had a neck dissection. Locoregional recurrence occurred in 27.6 % of those undergoing therapeutic neck dissection and 60 % eventually developed distant metastases. Radiotherapy was given as adjuvant treatment in 110 of the patients who had a therapeutic neck dissection (41 %), but this was not associated with improved regional control (p = .322). Multivariate analysis showed that nodal positivity (p < .001) and primary tumor ulceration (p = < .027) were the most important predictors of locoregional recurrence and that primary tumor Breslow thickness (p = .009) and node positivity (p = .046) were the most important factors predicting survival. SNB-positive patients who underwent immediate completion lymphadenectomy had a 5-year survival advantage over those who had a therapeutic neck dissection for macroscopic disease (54 % vs 47 %, p = .028).

CONCLUSIONS

Nodal status was the most important factor predicting disease-free and overall survival in patients with melanoma of the head and neck. Adjuvant radiotherapy was not associated with better locoregional control in the non-randomized cohorts of patients in this study.

Effects of roughage concentration in steam-flaked corn-based diets containing wet distillers grains with solubles on feedlot cattle performance, carcass characteristics, and in vitro fermentation

Two studies were conducted to evaluate effects of wet distillers grains with solubles (WDG) and dietary concentration of alfalfa hay (AH) on performance of finishing beef cattle and in vitro fermentation. In both studies, 7 treatments were arranged in a 2 × 3 + 1 factorial; factors were dietary concentrations (DM basis) of WDG (15 or 30%) and AH (7.5, 10, or 12.5%) plus a non-WDG control diet that contained 10% AH. In Exp. 1, 224 beef steers were used in a randomized complete block (initial BW 342 kg ± 9.03) finishing trial. No WDG × AH interactions were observed (P > 0.12). There were no differences among treatments in final shrunk BW or ADG (P > 0.15), and DMI did not differ with WDG concentration for the overall feeding period (P = 0.38). Increasing dietary AH concentration tended (P < 0.079) to linearly increase DMI, and linearly decreased (P < 0.05) G:F and calculated dietary NE(m) and NE(g) concentrations. Carcasses from cattle fed 15% WDG had greater yield grades (P = 0.014), with tendencies for greater 12th-rib fat (P = 0.054) and marbling score (P = 0.053) than those from cattle fed 30% WDG. There were no differences among treatments (P > 0.15) in HCW, dressing percent, LM area, KPH, proportions of cattle grading USDA Choice, and incidence of liver abscesses. In Exp. 2, ruminal fluid was collected from 2 ruminally cannulated Jersey steers adapted to a 60% concentrate diet to evaluate in vitro gas production kinetics, H(2)S production, IVDMD, and VFA. Relative to the control substrate, including WDG in substrates increased (P < 0.01) H(2)S production and decreased total gas production (P = 0.01) and rate of gas production (P = 0.03). Increasing substrate WDG from 15 to 30% increased (P < 0.05) H(2)S production and decreased (P < 0.001) total gas production, with a tendency (P = 0.073) to decrease IVDMD and fractional rate of gas production (P = 0.063). Treatments did not significantly affect (P > 0.09) molar proportions or total concentration of VFA. Results indicate that including 15 or 30% WDG in steam-flaked corn-based diets did not result in major changes in feedlot performance or carcass characteristics, but increasing AH concentration from 7.5 to 12.5% in diets containing WDG decreased G:F. Including WDG in substrates decreased rate and extent of gas production and increased H(2)S production. Changes in various measures of in vitro fermentation associated with AH concentrations were not large.

Corn or sorghum wet distillers grains with solubles in combination with steam-flaked corn: feedlot cattle performance, carcass characteristics, and apparent total tract digestibility

Two studies were conducted to evaluate the effects of corn (CDG) and sorghum (SDG) wet distillers grains with solubles on feedlot cattle performance, carcass characteristics, and apparent total tract digestion of nutrients. In Exp. 1, 224 steers were used in a randomized complete block design (initial BW 391.1 +/- 9.51 kg) and fed steam-flaked corn (SFC)-based diets consisting of (DM basis) 0% distillers grains (CON), 15% SDG, 30% SDG, 15% CDG, 30% CDG, 15% of a 50:50 blend of SDG and CDG, and 30% of a 50:50 blend of CDG and SDG. Decreased carcass-adjusted final BW and HCW (P < or = 0.05) were noted as the inclusion amount of distillers grains increased in the diet. Body weight gain efficiency did not differ among the CDG, 50:50 SDG and CDG blend, and CON treatments, but G:F was numerically less with either amount of SDG than for CON, and decreased (P < or = 0.05) as distillers grains were increased from 15 to 30%. Cattle fed CON had greater carcass yield grades than those fed the distillers grain diets (P < or = 0.05). In Exp. 2, crossbred beef steers (n = 36; initial BW 567.3 +/- 53.1 kg) were used in a generalized randomized block design and fed SFC-based diets with 0% distillers grains (CON) and 15% (DM basis) CDG or SDG. Digestibility was determined with a pulse dose of Cr(2)O(3). Feeding steers 15% CDG or SDG increased intakes of CP and NDF (P < or = 0.05), but intakes of DM, OM, and starch did not differ among treatments (P >o r = 0.07). Apparent total tract digestibilities of DM, OM, CP, NDF, and starch (P > or = 0.25) did not differ among the 3 treatments. Fecal pH averaged over all sampling times was not affected by treatment, nor were average fecal pH values for prefeeding samples (0, 24, 48, and 72 h after the pulse dose) or for samples taken after feeding (12, 36, and 60 h after the pulse dose; P > or = 0.11). Results suggest that with 15% distillers grains in the DM, G:F was similar for cattle fed the CDG, 50:50 SDG and CDG blend, and CON diets. Feeding 30 vs. 15% distillers grains decreased G:F, but including 15% CDG or SDG in SFC-based diets did not affect apparent total tract digestibilities in feedlot steers.

Corn or sorghum wet distillers grains with solubles in combination with steam-flaked corn: in vitro fermentation and hydrogen sulfide production

The effects of wet distillers grains with solubles (WDG) on in vitro rate of gas production, IVDMD, H(2)S production, and VFA were evaluated. Five substrate treatments that were balanced for ether extract content were arranged in a 2 x 2 + 1 factorial. Factors were concentration (15 or 30%; DM basis) and source of WDG (corn or sorghum WDG; CDG and SDG, respectively) plus a 0% WDG control in substrates with steam-flaked corn as the basal grain. Control substrates had greater (P < 0.01) IVDMD and total gas production per gram of substrate DM than WDG-based substrates, and IVDMD was greater (P = 0.03) for CDG than for SDG substrates. Increasing WDG inclusion from 15 to 30% decreased IVDMD and total gas production (P < 0.05), but H(2)S production (micromol/g of fermentable DM) increased (P = 0.01) as inclusion of WDG increased. There were no differences (P > or = 0.10) among treatments in proportions of major VFA, acetate:propionate ratio, and total VFA concentration. These results suggest that including WDG in the substrate decreased IVDMD and gas production, which was particularly evident as WDG increased from 15 to 30% of substrate DM. In addition, CDG seemed to be more digestible than SDG. Hydrogen sulfide production increased with increasing WDG in the substrate, reflecting greater S concentrations in WDG, but in vitro VFA profiles were not affected by WDG concentration or source.

Effects of dry-rolled or steam-flaked corn finishing diets with or without twenty-five percent dried distillers grains on ruminal fermentation and apparent total tract digestion

A metabolism study was conducted to evaluate ruminal fermentation and apparent total tract digestibilities of cattle finishing diets. Holstein steers (n = 16, 351 kg of BW) with ruminal cannulas were fed diets consisting of 0 or 25% dried corn distillers grains (DDG), using dry-rolled corn (DRC) or steam-flaked corn (SFC) as the principal energy source (2 x 2 factorial arrangement). The study was conducted in 2 periods, with 4 steers per treatment in each period. Periods consisted of a 12-d adaptation phase and a 3-d collection phase. Compared with DRC, feeding SFC decreased intakes of DM, OM, starch, NDF, and ether extract (P < 0.01), and steers fed SFC excreted less DM, OM, starch, NDF, and ether extract (P < 0.01). Compared with SFC, feeding DRC decreased ruminal concentrations of acetate, butyrate, isobutyrate, and isovalerate, and decreased the acetate-to-propionate ratio (P < 0.01). Compared with SFC, DRC decreased ruminal propionate, valerate, and lactate concentrations (P < 0.01). When compared with cattle fed SFC, ruminal pH of cattle fed DRC was less at 0 h and greater at 6 h postfeeding (P < 0.01). Ruminal ammonia concentrations were greater for DRC vs. SFC at h 0, 6, 10, 12, 14, 16, 18, 20, and 22 postfeeding (P < 0.05). Feeding DDG decreased consumption of starch and ether extract, but increased NDF intake (P < 0.01). Fecal excretion of ether extract was increased by adding DDG compared with diets without DDG (P < 0.05), resulting in less apparent total tract digestibility of ether extract for cattle fed DDG (P < 0.01). Ruminal lactate concentrations were increased with addition of DDG compared with diets without DDG (P = 0.01). Ruminal ammonia concentrations were less for steers fed 25 vs. 0% DDG at 2, 4, 6, 8, and 10 h postfeeding (P < 0.05). We conclude, based on these results, that ruminal fermentation and apparent total tract digestibility of DDG are affected by grain processing.

Perivascular nerve fibre proliferation: The consequence of prolonged straining

Four clinical cases are described in which a history of straining to achieve defaecation over many years, was associated with prolonged pelvic pain and the neuro-immunohistochemical observation of perivascular nerve fibre proliferation (PVNFP). Specimens of uterus, vagina, vulva and bladder have all demonstrated this novel histological feature. In three of the four cases, treatment with gonadotrophin releasing hormone agonists was associated with temporary improvement of the pain.

Effects of estradiol on the development of the bursa of Fabricius in Japanese quail

Effects of androgens on the development of the bursa of Fabricius are better understood than those of estradiol, despite the known sensitivity of the bursa to estradiol early in embryogenesis. The goal of this study was to determine the effects of one-time yolk injections of estradiol at day 4 of incubation on the development of the bursa and spleen as indices of treatment effects on the immune system. Follicle size and numbers in hatchling bursas were significantly reduced at 50 and 500 microg/egg, respectively. Additionally, distorted plicae and thicker epithelial layers surrounding the plicae were observed in day-old chicks at the same treatment levels. Adult bursas from birds embryonically exposed to estrogen were significantly larger than controls, suggesting an inhibition of natural bursal regression. Although estradiol altered the development of the bursa, the spleen appeared to be unaffected. The observed effects of estradiol on the development of the bursa indicate that this lymphoid organ may be a target for developmental disruption by estrogenic endocrine disrupting chemicals, though long-term consequences of embryonic exposure on immune function remain unknown.

Cancer survival in England and Wales at the end of the 20th century

Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the 'deprivation gap') became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986-1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement - an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable.

Effects of xenoestrogens on the differentiation of behaviorally-relevant neural circuits

It has become increasingly clear that environmental chemicals have the capability of impacting endocrine function. Moreover, these endocrine disrupting chemicals (EDCs) have long term consequences on adult reproductive function, especially if exposure occurs during embryonic development thereby affecting sexual differentiation. Of the EDCs, most of the research has been conducted on the effects of estrogen active compounds. Although androgen active compounds are also present in the environment, much less information is available about their action. However, in the case of xenoestrogens, there is mounting evidence for long-term consequences of early exposure at a range of doses. In this review, we present data relative to two widely used animal models: the mouse and the Japanese quail. These two species long have been used to understand neural, neuroendocrine, and behavioral components of reproduction and are therefore optimal models to understand how these components are altered by precocious exposure to EDCs. In particular we discuss effects of bisphenol A and methoxychlor on the dopaminergic and noradrenergic systems in rodents and the impact of these alterations. In addition, the effects of embryonic exposure to diethylstilbestrol, genistein or ethylene,1,1-dichloro-2,2-bis(p-chlorophenyl) is reviewed relative to behavioral impairment and associated alterations in the sexually dimorphic parvocellular vasotocin system in quail. We point out how sexually dimorphic behaviors are particularly useful to verify adverse developmental consequences produced by chemicals with endocrine disrupting properties, by examining either reproductive or non-reproductive behaviors.

Immunotoxicity of trenbolone acetate in Japanese quail

Trenbolone acetate is a synthetic androgen that is currently used as a growth promoter in many meat-exporting countries. Despite industry laboratories classifying trenbolone as nonteratogenic, data showed that embryonic exposure to this androgenic chemical altered development of the immune system in Japanese quail. Trenbolone is lipophilic, persistent, and released into the environment in manure used as soil fertilizer. This is the first study to date to assess this chemical's immunotoxic effects in an avian species. A one-time injection of trenbolone into yolks was administered to mimic maternal deposition, and subsequent effects on the development and function of the immune system were determined in chicks and adults. Development of the bursa of Fabricius, an organ responsible for development of the humoral arm of the immune system, was disrupted, as indicated by lower masse, and smaller and fewer follicles at day 1 of hatch. Morphological differences in the bursas persisted in adults, although no differences in either two measures of immune function were observed. Total numbers of circulating leukocytes were reduced and heterophil-lymphocyte ratios were elevated in chicks but not adults. This study shows that trenbolone acetate is teratogenic and immunotoxic in Japanese quail, and provides evidence that the quail immune system may be fairly resilient to embryonic endocrine-disrupting chemical-induced alterations following no further exposure posthatch.

Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival

BACKGROUND

Time trends in mortality from small intestinal cancer have not been studied for the 1990s.

OBJECTIVE

To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival).

METHODS

Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales.

RESULTS

Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival.

CONCLUSIONS

Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.

Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality

BACKGROUND

Rates and time trends in mortality from pancreatic cancer vary considerably between countries.

AIM

To examine trends and patterns in the incidence of, and the survival and mortality from, pancreatic cancer in England and Wales from 1975 to 2000; in particular, whether incidence and survival rates are related to socio-economic deprivation.

METHODS

We calculated annual age-specific and overall age-standardized incidence and mortality rates by sex for pancreatic cancer in total, and by subsite. We also estimated survival by sex and age group and by subsite.

RESULTS

In males, the age-standardized rate fluctuated in the late 1970s, to peak at 13.0 per 100,000 in 1979, declined steadily by an average of 1.3% per year to around 10.3 per 100,000 in the mid-1990s and then levelled off. For females, the rate peaked at 8.4 per 100,000 in the late 1980s before declining and fluctuating around 7.7 per 100,000 in the late 1990s. Patterns and trends in mortality rates were closely similar to those in incidence, due to the very low survival rates: only 2-3% at 5 years from diagnosis. Survival rates improved only minimally over the period 1971-99. Incidence and mortality rates were slightly higher in both males and females living in the most deprived areas, but survival was not consistently related to socio-economic deprivation.

CONCLUSIONS

The incidence of, and mortality from, pancreatic cancer in England and Wales have fallen from peak levels observed in the 1970s and 1980s, and levelled off in the 1990s for both sexes; survival rates remain very low.

Consequences of endocrine disrupting chemicals on reproductive endocrine function in birds: establishing reliable end points of exposure

It has been difficult to establish reliable indices of exposure to endocrine disrupting chemicals (EDCs) appropriate for a variety of avian species because of a vast array of reproductive strategies. Data from mammals, reptiles and fish provide insight on likely mechanisms of action for EDCs. However, many of the effects of EDCs are weaker than the actions of the native hormones, making it difficult to assess adverse effects in domestic and wild birds. It is clear that differential sensitivity to EDCs exists across species, due to the timing and mode of exposure, compound toxicity and age of the individual. Our studies on EDCs are conducted in the quail model system, with focus on reproductive endocrine, neuroendocrine and behavioral responses. Studies have included EDC exposure, either by egg injection or via diet. Results from egg injection studies showed the following: (1) estradiol administered by embryonic day 12 demasculinized male sexual behavior, altered hypothalamic neurotransmitters and reduced hen day production and fertility in a dose dependent fashion, (2) methoxychlor (MXC) or vinclozolin impaired male sexual behavior in adult quail and (3) DDE exposure impaired reproductive and immune related end points. Two-generation studies were conducted on Japanese and northern bobwhite quail with dietary methoxychlor (MXC) exposure (0, 5 and 10 ppm) beginning in adults (P1), continuing in their offspring (F1), with F2 offspring raised on control diet. MXC exposure impaired male sexual behavior, hypothalamic catecholamines and plasma steroid hormones. Moreover, MXC exposure had reproductive consequences observable at both the lower and higher doses of MXC in F1 and F2 generations. These data demonstrate that embryonic EDC exposure interferes with sexual differentiation of neural systems that direct reproduction.

CURRENT TRENDS IN BLADDER CANCER IN ENGLAND AND WALES

PURPOSE

We examined trends in bladder cancer (BC) incidence, mortality and survival in England and Wales during a 30-year period.

MATERIALS AND METHODS

Age standardized incidence and mortality rates for BC, cohort incidence ratios, and 1 and 5-year relative survival from BC were calculated, and current trends were assessed.

RESULTS

Between 1971 and 1998 the total number of cases of BC increased by 57% from around 7,200 to almost 11,400. Between 1971 and 1998 directly age standardized incidence increased by 16% in males and 37% in females. Directly age standardized mortality decreased by 26% in males and showed little change in females during the same period. Five-year relative survival improved by around 15% points in the 1970s and early 1980s. However, there was less improvement in survival thereafter in that 5-year relative survival for patients diagnosed in 1993 to 1995 was 67% in men and 58% in women.

CONCLUSIONS

With an almost 60% increased incidence during the last 3 decades, BC incidence remains much higher in men but has increased more rapidly in women. There have been steady decreases in mortality rates, more marked in men than in women. Unusually, women have a significantly lower survival rate than men. Reasons for these patterns and trends are unclear. The trends in bladder cancer incidence by birth cohort suggest that the relationship with smoking may not be that strong and that other factors may be involved. Further research should focus on reasons for the recent increase in bladder cancer incidence in younger female birth cohorts.

Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from 'affluent' to 'deprived') using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories ('deprivation gap') over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

Management and outcome of sight-threatening diabetic retinopathy in pregnancy

AIMS

To report the management and outcomes of sight-threatening diabetic retinopathy in pregnancy.

METHODS

A retrospective review of 8 diabetic females who developed pregnancy related sight-threatening diabetic retinopathy requiring treatment over a 12-year period.

RESULTS

In total, 16 eyes of eight patients were included in this series. The mean age of the patients at presentation was 30.75 years +/-3.8 SD and the mean duration of diabetes was 21.0 years +/-5.1 SD. The mean follow-up period was 46.75 months +/-47.2 SD. A total of 87.5% of patients showed progression of diabetic retinopathy during pregnancy, 71% of which were in the sight-threatening proliferative category. In the postpartum period, 81% of patients continued to progress to proliferative diabetic retinopathy, requiring panretinal photocoagulation and multiple other surgical procedures. In all, 69% of eyes retained visual acuity equal to or better than 0.3 logMAR units (6/12).

CONCLUSION

Sight-threatening diabetic retinopathy in pregnancy is a rare disease, but it can have devastating consequences for mother and child. Laser photocoagulation should be considered for pregnant women with severe preproliferative diabetic retinopathy. Proliferative diabetic retinopathy may not regress postpartum. Close followup should be extended in the postpartum period in this group of patients until the retinopathy is stabilised. The presence of combined rhegmatogenous and tractional retinal detachment and neovascular glaucoma were associated with the worst outcome.