Cancer costs and gender: a snapshot of issues, trends, and opportunities to reduce inequities using Australia as an example.

As the cancer burden increases, so too does the cost, to health systems, economies, and individuals. There is increasing interest in productivity and out-of-pocket costs for individuals and their carers, but these remain poorly understood. The costs of cancer in women, often carers themselves, are less understood. This summary analysis explored data on the cancer burden in Australia (and health costs in comparable countries), including expenditure reports and literature on macroeconomic outcomes and out-of-pocket costs, to highlight the cost impacts of a cancer diagnosis in women, at a societal and an individual level. Data on productivity costs were skewed toward men, as men are over-represented in paid work compared with women. Data on societal and individual costs of cancer in women were scant, yet the predominance of women in unpaid work suggests the cost is significant. Evidence for the benefits of cancer prevention and early detection suggests that improved targeting of interventions to women would reduce costs at a societal and an individual level. More research is needed on the specific impacts of cancer on women and those they care for, to better target public health and support services to need.

Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors.

Hsp90 C-terminal modulation represents an attractive strategy for the development of potent and safer antitumor compounds. Continuing our investigation on DHPM type inhibitors here we report a new set of potent C-terminal ligands which allowed us to identify the key structural features crucial for the biological activity.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

AIM: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. METHODS: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. RESULTS: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. CONCLUSION: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

Aim: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. Methods: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. Results: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. Conclusion: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Hyperventilation-induced nystagmus in a large series of vestibular patients.

The Hyperventilation Test is widely used in the "bed-side examination" of vestibular patients. It can either activate a latent nystagmus in central or peripheral vestibular diseases or it can interact with a spontaneous nystagmus, by reducing it or increasing it. Aims of this study were to determine the incidence, patterns and temporal characteristics of Hyperventilation-induced nystagmus in patients suffering from vestibular diseases, as well as its contribution to the differential diagnosis between vestibular neuritis and neuroma of the 8(th) cranial nerve, and its behaviour in some central vestibular diseases. The present study includes 1202 patients featuring, at vestibular examination, at least one sign of vestibular system disorders or patients diagnosed with a "Migraine-related vertigo" or "Chronic subjective dizziness". The overall incidence of Hyperventilation-induced nystagmus was 21.9%. It was detected more frequently in retrocochlear vestibular diseases rather than in end-organ vestibular diseases: 5.3% in Paroxysmal Positional Vertigo, 37.1% in Menière's disease, 37.6% in compensated vestibular neuritis, 77.2% in acute vestibular neuritis and 91.7% in neuroma of the 8(th) cranial nerve. In acute vestibular neuritis, three HVIN patterns were observed: Paretic pattern: temporary enhancement of the spontaneous nystagmus; Excitatory pattern: temporary inhibition of the spontaneous nystagmus; Strong excitatory pattern: temporary inversion of the spontaneous nystagmus. Excitatory patterns proved to be time-dependent in that they disappeared and were replaced by the paretic pattern over a period of maximum 18 days since the beginning of the disorder. In acoustic neuroma, Hyperventilation-induced nystagmus was frequently observed (91.7%), either in the form of an excitatory pattern (fast phases towards the affected site) or in the form of a paretic pattern (fast phases towards the healthy side). The direction of the nystagmus is only partially related to tumour size, whereas other mechanisms, such as demyelination or a break in nerve fibres, might have an important role in triggering the situation. Hyperventilation-induced nystagmus has frequently been detected in cases of demyelinating diseases and in cerebellar diseases: in multiple sclerosis, hyperventilation inhibits a central type of spontaneous nystagmus or evokes nystagmus in 75% of patients; in cerebellar diseases, hyperventilation evokes or enhances a central spontaneous nystagmus in 72.7% of patients. In conclusion the Hyperventilation Test can provide patterns of oculomotor responses that indicate a diagnostic investigation through cerebral magnetic resonance imaging enhanced by gadolinium, upon suspicion of neuroma of the 8(th) cranial nerve or of a central disease. In our opinion, however, Hyperventilation-induced nystagmus always needs to be viewed within the more general context of a complete examination of the vestibular and acoustic system.

[Evaluation of bone scintigraphy and (18)F-FDG PET/CT in bone metastases of lung cancer patients]. / Evaluación de la gammagrafía ósea y la (18)F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón.

OBJECTIVE: To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. MATERIAL AND METHODS: We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. RESULTS: BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). CONCLUSIONS: In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients.

Submandibular gland myoepithelioma.

Benign myoepithelioma is a very rare form of salivary gland tumor, composed entirely of myoepithelial cells. It accounts for approximately 1% of all salivary gland tumors and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We describe herein the ninth reported case of myoepithelioma of the submandibular gland. Benign myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. Immunohistochemical staining can help differentiate between these conditions, but histopathology remains the gold standard for diagnosing this neoplastic process.

Stereotactic aspiration and drainage of brain abscesses. Experience with 9 cases.

The first-line treatment for brain abscesses is still a much-debated argument. Recently, stereotactic aspiration of these lesions has gained ground as a valid alternative to the traditional medical and/or surgical therapeutical treatments. From 1991 to 1995, 9 patients affected by intracranial abscesses were surgically treated by stereotactic puncture of the lesion and drainage of pus, using the Kelly-Goerss stereotactic system. Multiple abscesses were present in one case. Specific antibiotic therapy was used in the post-operative stage, when possible. One death occurred four weeks after surgery for acute ischemia of the brain stem. Follow-up CT demonstrated gradual resolution of the abscesses in all the cases and a successful return to normal daily life in all the surviving patients. In one case, recurrence of the abscess occurred two months after resolution: a successful result was obtained by steroids and broad-spectrum antibiotic therapy alone. Possible advantages of this technique are discussed and compared with the traditional routes. The literature concerning this argument is reviewed.

Circadian gastric acidity in Helicobacter pylori positive ulcer patients with and without gastric metaplasia in the duodenum.

BACKGROUND: The presence of gastric metaplasia allows helicobacter pylori to colonise the duodenum and this condition is thought to be acquired as a response to acid hypersecretion. This functional disorder, however, is present only in a subgroup of duodenal ulcer patients and, in addition, surface gastric metaplasia has been frequently found in the proximal duodenum of normal subjects and patients with non-ulcer dyspepsia, who cannot be certainly considered as acid hypersecretors. AIMS: To clarify the role of acid in inducing gastric type epithelium in the duodenum. This study aimed at assessing whether the pattern of circadian gastric acidity differs between H pylori positive duodenal ulcer patients with and without duodenal gastric metaplasia. PATIENTS: Seventy one patients with duodenal ulcer confirmed by endoscopy and who were found to be positive for H pylori infection by histology on antrum biopsy specimens were enrolled into this study. METHODS: Gastric type epithelium in the duodenum was found in 49 of 71 ulcer patients (69%). Continuous 24 hour gastric pH metry was performed in 50 healthy subjects and in the two subgroups of duodenal ulcer patients with and without gastric metaplasia in the duodenum. Gastric acidity was calculated for 24 hours (1700-1659), night (2000-0759) and day-time (0800-1959). RESULTS: Ulcer patients without gastric metaplasia showed a significantly higher gastric acidity (p < 0.001) than controls for every time interval considered, while the ulcer subgroup with gastric metaplasia was more acid than healthy subjects (p < 0.001) during the whole 24 hour period and the daytime. There was no difference between the two subgroups of duodenal ulcer patients with and without gastric metaplasia during the various time segments analysed. CONCLUSION: The findings confirm that the circadian gastric acidity of duodenal ulcer patients is higher than that of controls. As there is no difference in gastric pH between duodenal ulcer patients with and without gastric metaplasia, gastric hyperacidity is not specific to patients with duodenal gastric metaplasia. It is probable that this histological change is a non-specific response to mucosal injury resulting from various factors and not exclusively to acid.

[Infectious complications of diagnostic hysteroscopy]. / Complicanze infettive dopo isteroscopia diagnostica.

AIM: To evaluate whether diagnostic hysteroscopy may cause pelvic inflammatory disease; to evaluate whether there is a group of patients with a high risk of developing pelvic inflammatory disease. EXPERIMENTAL DESIGN: A prospective study of 300 non-consecutive hysteroscopies with a follow-up 20 days after the test. SETTING: The study was performed at Sanremo Hospital (Regione Liguria, USL 1 Imperiese, Sanremo Hospital Board) through the Hysteroscopy Clinic of the Gynecology Division (Head: Dott. G. Armentano) and Microbiology Service of the Test Laboratory. PATIENTS: A total of 300 non-consecutive patients undergoing hysteroscopy for any indication were enrolled during 1992 of whom 253 completed the study. The main criteria used for selection were the possibility of performing an atraumatic hysteroscopy and immediately prior to this a cervical smear for the direct and/or cultured assay of aerobic and anaerobic bacteria, fungi, microplasms, Chlamydia, protozoa. METHOD: Hysteroscopy was performed in all cases without cervical dilatation, following the disinfection of the cervix using povidone-iodine 10%, using a hysteroscope with a diameter of 5 mm (Microhysteroscope Hamou I-Storz); CO2 was used as the means of distending the uterine cavity and was supplied by an electronically controlled insufflator (Hysteroinsufflator acc. Hamou-Storz). RESULTS: Germs were identified in the cervical canal in 35 out of 253 women an the incidence of positivity decreased with age. A positive correlation was also found with the type of indication for hysteroscopy. Pelvic inflammatory disease developed in 2 cases out of 253 (0.79%) and both cases belonged to the group with germs in the cervical canal; in both cases the etiological agent was Chlamydia trachomatis. No case of pelvic inflammatory disease was observed in the group of patients without germs in the cervical canal. CONCLUSIONS: Patients under the age of 35, with hysteroscopic indications relating to sterility and painful pelvic syndrome, must be regarded as being at higher risk of developing posthysteriscopic pelvic inflammatory disease.

Volumetric reconstruction and stereotactic computer assisted resection in intracerebral lesions.

Since 1990 112 patients have undergone stereotactic resection of intra-axial tumoural lesions with volumetric reconstruction, using the Kelly-Goerss system. Stereotactic integration of CT, angiographic and particularly MRI information, together with three-dimensional information of the lesion, provide an innovative evaluation of the most appropriate surgical approach, even for each single patient. The main limitation of this surgical method is in cases where the infiltrating part of the tumour is pre-eminent, while it can allow "macroscopically complete resection" of well circumscribed lesions, almost independently of their location and volume. Some technical aspects of stereotactic resection of brain tumours are discussed in the light of our experience.

Urbanization gradients and cancer mortality in Uruguay, 1988-1992.

Cancer deaths occurring in Uruguay in the period 1988-1992 were classified by site, sex and residence according to the ninth version of the International Classification of Diseases (ICD-9), in order to analyze gradients of urbanization. For this purpose, Uruguayan counties were classified as rural, suburban and urban, using population density as an ordinal indicator of the degree of urbanization. Significant increasing trends with urban excess were observed for cancers of the colon, rectum, lung and female breast. In addition, this study showed significant urban deficits for esophageal, gastric and uterine cancers, contrasting with previous studies. These differences seem to be real rather than artifactual due to misclassification. The study thus provides interesting new findings concerning urban differences between developed communities and a partially developing country.

[Benzidamine in the topical treatment of vaginitis caused by Gardnerella vaginalis]. / La benzidamina nel trattamento topico della vaginite da Gardnerella vaginalis.

The present clinical trial has been carried out in order to evaluate the efficacy of benzydamine in treatment of vaginitis caused by Gardnerella vaginalis. Fifty women affected by this specific pathology have been submitted to topical treatment with 0.5% benzydamine vaginal cream. The treatment has been carried out for 9 consecutive days using a local application of benzydamine twice a day. The clinical result was evaluated after 12 and 60 days. The following parameters were taken into consideration: symptoms (leucorrhea, itching, burning), clinical signs (oedema, hyperemia, vaginal secretion), instrumental data (pH, colposcopy, sniff test) and microbiological findings (searching of clue cells, Lactobacillus and Gardnerella vaginalis). At the first check point after 12 days 84% of patients have been considered healed; at the second check the percentage of healing rose to 92%. Therefore benzydamine was considered highly effective in 92% of vaginitis caused by Gardnerella vaginalis.

Cancer in migrants to Uruguay.

Mortality rates from different cancers in the principal groups of migrants to Uruguay are compared with those in their countries of origin (Argentina, Brazil, Italy and Spain) and in the Uruguay-born population. Oesophageal cancer is very common in Uruguay and European-born populations, initially at low risk, appear to acquire rather higher rates after migration. For most migrants, the mortality from cancers of the breast, colon-rectum, corpus uteri and prostate is closer to the moderately elevated rates of Uruguay than those in their countries of origin. The results suggest that migrants to Uruguay undergo changes in some important environmental exposures, probably dietary, which give rise to substantial alterations in cancer risk within their lifespan.

Trends in mortality from major non-communicable diseases in the middle-aged population of Malta.

Trends in life expectancy and mortality from major non-communicable diseases in Malta were analyzed from the national vital statistics available. Most of the increased life expectancy during the 20th century in Malta took place between 1930 and 1960 and since then only a minor increase was observed. The peak in age standardized total mortality in men and women aged 40-69 years was during 1974-76. Total mortality in men was about 40% higher than that of women. The proportion of deaths from major non-communicable diseases (cardiovascular diseases, cancer and diabetes) of all deaths increased during 1968-82. In 1983-84 in the age group 45-64 cardiovascular diseases accounted for 54% of deaths in men and 43% in women, cancer 27% and 34%, and diabetes 3% and 11% in men and women, respectively. The international comparison of mortality data showed that mortality from both cardiovascular diseases, cancer and diabetes was clearly higher than in other European Mediterranean countries ranking among the highest in the whole Europe. Public health intervention programmes have initiated in Malta to reduce these high death rates in the future.

Esophageal cancer in Uruguay: a case-control study.

Esophageal cancer has constituted a major public health problem in Uruguay, with age-adjusted death rates of 14.5 X 10(5) for males and of 3.8 X 10(5) for females. A case-control study was undertaken to ascertain the possible association of the local custom of drinking infusions of Ilex paraguariensis ("maté") with cancer of the esophagus, after controlling for well-known risk factors, such as alcohol and tobacco consumption. Two hundred twenty-six patients with esophageal cancer and 469 controls (control:case = 2.1) were interviewed at the time of admission or consultation at the Oncology Institute of Montevideo from 1979 through 1984. Males showed elevated risks of esophageal cancer associated with heavy tobacco [relative risk (RR) = 10.8] and alcohol (RR = 10.3) exposures. Among females, the independent effects of tobacco and alcohol were nonsignificant. Maté consumption had an independent effect in both males and females, with odds ratios of 6.5 and 34.6, respectively, for heavy users. Moreover, a well-defined dose response was evident in both sexes.

Exposure to lead and cadmium of the general population of Malta.

The blood levels of lead (PbB), cadmium (CdB), and zinc protoporphyrin (ZPP) were determined in 538 Maltese adult subjects. A relatively high level exposure to both metals was discovered. For lead, the median value is 274 micrograms/l with percentile 90 and 98 respectively 564 and 863 micrograms/l. These values are to be compared with the reference values proposed by a directive of the European Community, respectively 200, 300 and 350 micrograms/l. For cadmium, the median value is 2.2 micrograms/l with percentile 90 and 98 respectively 3.8 and 5.7 micrograms/l. These values are compared with those of a Belgian population which are respectively 1.7, 2.6 and 4.3 micrograms/l. The causes of this relatively high exposure are not known. A few tentative hypotheses, which are to be investigated, are made.