Why is colon cancer survival improving by time? A nationwide survival analysis spanning 35 years.

There is limited information present to explain temporal improvements in colon cancer survival. This nationwide study investigates the temporal changes in survival over a 35-year period (1970-2004) in Iceland and uses incidence, mortality, surgery rate, stage distribution, lymph node yield, tumor location and histological type to find explanations for these changes. Patients diagnosed with colon cancer in Iceland 1970-2004 were identified (n = 1962). All histopathology was reassessed. Proportions, age-standardized incidence and mortality, relative, cancer-specific and overall survival and conditional survival were calculated. When comparing first and last diagnostic periods (1970-1978 and 1997-2004), 5-year relative survival improved by 12% for men and 9% for women. At the same time surgery rate increased by 12% and the proportion of stage I increased by 9%. Stage-stratified, improved 5-year relative survival was mainly observed in stages II and III and coincided with higher lymph node yields, proportional reduction of stage II cancers and proportional increase of stage III cancers, indicating stage migration between these stages. Improvement in 1-year survival was mainly observed in stages III and IV. Five-year survival improvement for patients living beyond 1 year was minimum to none. There were no changes in histology that coincided with neither increased incidence nor possibly influencing improved survival. Concluding, as a novel finding, 1-year mortality, which previously has been identified as an important variable in explaining international survival differences, is in this study identified as also being important in explaining temporal improvements in colon cancer survival in Iceland.

Association of symptoms of colon cancer patients with tumor location and TNM tumor stage.

OBJECTIVE: Colon cancer is the second most common cause of cancer death in Iceland and accounts for 8% of malignancies. We related information on symptoms of colon cancer patients with information on tumor location and pTNM-stage. MATERIAL AND METHODS: The study is retrospective and population-based. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 was obtained. Information on symptoms of patients and blood hemoglobin was collected from patients' files. The pathological parameters were derived from a previously performed study. RESULTS: A total of 768 patients (422 males, 346 females) participated in this study. Median age was 73 years. Nearly 60% had anemia at the time of diagnosis, 53% had visible blood in stools, and 65% had changes in bowel habits. Around 84% had visible blood in stools and/or anemia. Of those with right-sided tumors, 75% had anemia and were more likely to be diagnosed incidentally (40%) than those with left-sided tumors (20%). Left-sided tumors were associated with blood in stools (68% compared to 41%, p < 0.05) and changes in bowel habits (74% compared to 57%, p < 0.05). Multivariate analysis indicated that blood in stools was strongly associated with a lower TNM-stage (OR = 0.75, p < 0.05). Anemia was strongly associated with a higher TNM-stage (OR = 1.84, p < 0.05). CONCLUSION: Right-sided tumors were associated with anemia and incidental diagnosis; left-sided tumors were associated with visible blood in stools and changes in bowel habits. Visible blood in stools was significantly associated with lower TNM-stage, whereas abdominal pain, general and acute symptoms were associated with higher TNM-stage.

Colon cancer in Iceland--a nationwide comparative study on various pathology parameters with respect to right and left tumor location and patients age.

Increasing evidence suggests genetic, biological and demographical difference between right and left colon cancer. Studies have also indicated age differences in the pathology of colon cancer. There is a scarcity of large-scale studies that closely examine the pathological differences regarding age and tumor location. The aim of our study was to do an extensive comparison of right- and left- sided colon cancers as well as comparing patients <50 years with older patients. A retrospective, population-based study was carried out on all patients with colon cancer in Iceland between 1955 and 2004. A total of 2293 cases were analyzed (1148 men, 1145 women). All histopathology material was re-evaluated. Differences in tumor characteristics between right and left location and younger (<50) and older (≥50) patients was evaluated in particular. Higher TNM-stage, larger tumors, vessel invasion, mucinous type, high grade and expanding tumor border occurred more frequently in right- versus left-sided lesions while annular and polypoid tumors were more common in left-sided tumors (p < 0.05). Young patients had more frequent lymph node metastases, vessel invasion, nonpolypoid lesions and infiltrating tumor border (p < 0.05). Right-sided lesions show more aggressive features, reflected in morphology and stage. Younger patients present more frequently with adverse features than do older patients. Frequency of right- and left-sided colon cancer differs by age with pronounced age-location differences in females. This supports the assumption of differences in etiology and carcinogenesis of right- and left-sided colon cancer, and between young and old patients.

Aldosterone and not plasminogen activator inhibitor-1 is a critical mediator of early angiotensin II/NG-nitro-L-arginine methyl ester-induced myocardial injury.

BACKGROUND: Angiotensin II (Ang II) increases levels of aldosterone and plasminogen activator inhibitor-1 (PAI-1). Both aldosterone and PAI-1 seem to promote cardiovascular (CV) injury. Our objective was to determine the roles of PAI-1 and aldosterone in the development of myocardial and renal damage in a model with high Ang II and low nitric oxide (NO) availability, a pattern seen in patients with heart failure, diabetes mellitus, and arteriosclerosis. METHODS AND RESULTS: Mice on a moderately high sodium diet were treated with the NO synthase inhibitor NG-nitro-l-arginine methyl ester (L-NAME) for 14 days plus Ang II during days 8 through 14. The roles of aldosterone and PAI-1 in the development of CV injury were assessed using the mineralocorticoid receptor antagonist spironolactone (0, 1.5, 15, and 50 mg x 100 g(-1) x day(-1)) and PAI-1-deficient mice (PAI-1-/-). Ang II/L-NAME-treated mice showed glomerular ischemia, proteinuria, and necrosis of myocytes and vascular smooth muscle cells with an associated mixed inflammatory response, deposition of loose collagen, and neovascularization. Compared with saline-drinking mice, Ang II/L-NAME-treated mice had significantly increased heart to body weight (HW/BW) ratios, cardiac and renal damage assessed by histological examination, PAI-1 immunoreactivity, and proteinuria. Spironolactone treatment decreased PAI-1 immunoreactivity and reduced in a dose-dependent fashion cardiac and renal damage. PAI-1-/- animals had a similar degree of CV injury as PAI-1+/+ animals. CONCLUSIONS: Mineralocorticoid receptor antagonism, but not PAI-1 deficiency, protected mice from developing Ang II/L-NAME-mediated myocardial and vascular injury and proteinuria, suggesting that aldosterone, but not PAI-1, plays a key role in the development of early Ang II/L-NAME-induced cardiovascular injury.

Colon cancer: association of histopathological parameters and patients' survival with clinical presentation.

Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.

[The many faces of Actinomycosis. Results from a retrospective study in Iceland, 1984-2007]. / Hin mörgu andlit geislagerlabólgu: Faraldsfraedileg rannsókn á Islandi 1984-2007.

INTRODUCTION: Actinomycosis is a rare infection caused by Actinomyces spp. which are part of the oral, intestinal and vaginal bacterial flora. It can invade tissue through mucosal disruption and form abscesses which tend to be difficult to treat and diagnose. This population-based study explores the epidemiology and manifestations of actinomycosis in Iceland. METHODOLOGY: All diagnosed cases of actinomycosis in Iceland 1984-2007 were identified by a computerised search using ICD and SNOMED codes. Clinical information was collected by chart review. The subjects were included in the study if they fulfilled two out of five diagnostic criteria. RESULTS: 41 women and 25 men (mean age 45 years) met the diagnostic criteria. The incidence rate during the first half of the period was 0.86/year/100.000 and 1.17 during the second half.The cervicofacial region (42%) was most commonly affected, then the pelvis (32%), lacrimal duct (14%), abdomen (11%) and thorax (2%). Diagnostic delay was common. The longest delay from first symptoms to diagnosis was 8-9 years (median 5 months) and it was significantly shorter among patients with abdominal or pelvic infections compared to infections of the lacrimal duct (p=0.012). No significant difference was noted in diagnostic delay between other groups and no patients died from the infection. CONCLUSION: This is the first population-based study of actinomycosis. The incidence rate increases with age and the time passing from first symptoms to diagnosis tends to be long.

Actinomycotic canaliculitis: resolution following surgery and short topical antibiotic treatment.

PURPOSE: This study aimed to study the incidence and clinical characteristics of patients diagnosed with actinomycotic canaliculitis in Iceland. METHODS: We present a nationwide, retrospective case series for which cases were identified by searches of hospital diagnostic registries and pathology databases. Case histories were reviewed and histopathological analysis repeated to confirm the diagnosis. RESULTS: Nine cases of actinomycotic canaliculitis were diagnosed in Iceland during 1988-2007. Subjects included six women and three men and represented 16% of all patients diagnosed with actinomycosis in the country. The incidence was 0.16 cases/100 000 inhabitants/year. Age-specific incidence rates were 0.59 cases/100 000 inhabitants/year for the 40-59-year-old age group and 1.37 cases/100 000 inhabitants/year for individuals aged 60-79 years. All patients underwent a three-way snip procedure and 1 week of topical antibacterial therapy. CONCLUSIONS: Actinomycotic canaliculitis is an uncommon condition which frequently eludes diagnosis. Topical antibiotics for 1 week may be sufficient following surgery, a finding which contrasts with previous reports.

[Colon cancer in Iceland 1955-2004. Study on epidemiology, histopathology and gender difference]. / Ristilkrabbamein á Islandi árin 1955-2004. Faraldsfraedileg og meinafraedileg athugun og samanburdur á kynjum.

OBJECTIVE: Colon cancer is the third most common cancer in Iceland. The aim of this study was to analyze the epidemiology and histopathology of colon cancer in Iceland, resection rate and the difference between men and women. MATERIAL AND METHODS: Pathology and autopsy reports for all patients diagnosed with colon cancer between 1955 and 2004 where reviewed. All the histopathology material was re-evaluated. Demographical information and pathological findings were registered. Age-standardized incidence was calculated for both men and women. Gender difference was evaluated. Time trend was evaluated by linear regression. RESULTS: After re-evaluation 2293 cases remained (1148 males and 1145 females). The incidence increased for men from 7.5, to 22.2/105 and for women from 8.6 to 15.1/105. Most tumors were located in the sigmoid colon (35%). Surgical rate increased from 50% to 85%. Adenocarcinomas where 84% and mucinous adenocarcinoma 7%. Altogether 7% of cases were TNM-stage I, 32% were stage II, 24% stage III, 21% in stage IV and stage was unknown in 16% of cases. Slight gender difference was observed regarding grade, vessel invasion, depth of invasion and anatomic subsite. CONCLUSION: Incidence of colon cancer increased considerably, mainly for men. Surgical rate and pathology of colon cancer is similar to that reported elsewhere except that there are somewhat fewer cases in TNM-stage I. Little gender difference was observed in the pathological parameters analysed.

[Actinomycosis in a 70 year old woman with a forgotten intrauterine contraceptive device]. / Geislagerlabólga í sjötugri konu med gleymda lykkju. Sjúkratilfelli og yfirlit um sjúkdóminn.

Actinomycosis is an infectious disease that has been known since the late nineteenth century. In the pre-antibiotic era it was thought to be rather common but with increased use of antimicrobial agents its incidence has decreased significantly. The causative agent, most commonly Actinomyces israelii, is part of the commensal bacterial flora. It can infect any tissue, respects no tissue boundaries and can spread throughout the body. The clinical presentation of this illness can be similar to malignant disease and definite diagnosis is sometimes not apparent until after surgery and histologic examination. We report the case of a 71 year old woman who suffered from actinomycosis of the uterus and ovaries due to a forgotten intrauterine contraceptive device that had been in place for over four decades. The disease presentation was consistent with malignant disease and tumor markers, CA 125, CA 19-9 and CEA, measured in blood were elevated. She was treated successfully with total hysterectomy and bilateral salphingo-oophorectomy, as well as penicillin for six months.

[Not all wheezing is asthma. Case report]. / Ekki er allt astmi sem hvaesir. Sjúkratilfelli.

UNLABELLED: A fifty six year old woman with history of asthma visited a respiratory specialist. She had been diagnosed with asthma more than a year previously in a primary care clinic. She was treated with inhaled medications without good response. A respiratory specialist diagnosed tracheal narrowing secondary to thyroid enlargement that was pushing the trachea together. She was cured with a thyroid operation. Discussed are differential diagnosis of asthma and causes of airway narrowing and the importance of spirometry in diagnosing asthma. KEYWORDS: case report, asthma, airway narrowing, spirometry.

[Carcinoma of the colon in Iceland 1955-1989. An investigation of survival according to various pathological parameters.].

OBJECTIVE: The purpose of this study was to estimate various pathological parameters of colon carcinoma over a 35 year time period and evaluate their effect on survival of the patients. MATERIAL AND METHODS: All pathological specimens from patients diagnosed with colon carcinoma in Iceland in the period 1955 to 1989 were re-evaluated in order to determine the following pathological parameters: Tumour size, gross appearance, tissue type, grade, Dukes stage, lymphatic and/or blood vessel invasion, lateral margin involvement, Jass-group of tumour, peritumoural lymphocytic infiltrate, limitation of tumour growth to bowel wall, lymph node metastases, invasive tumour margin and colloid component in adenocarcinoma. Also the following parameters were determined in every case: Age at diagnosis, sex, year of diagnosis and tumour location within the bowel. All these parameters were evaluated with respect to survival of the patients. RESULTS: According to the Icelandic Cancer Registry 1265 patients were diagnosed with colon cancer in Iceland in the period under investigation. After re-evaluation 1205 patients fulfilled the criteria of a primary colon cancer and of those we were able to re-evaluate specimens from 1109 patients to determine histopathological parameters. In a univariable analysis most of the parameters investigated proved significant with respect to survival, except sex, anatomical location of tumour within the bowel, and the proportion of colloid component of tumour. In a multivariable analysis the age at diagnosis proved important as well as the year/period of diagnosis. The following pathological parameters evaluated had a significant prognostic input with regard to survival: Tumour grade, Dukes stage, number of lymph nodes with metastases, peritumoral lymphocytic infiltrate, lateral margin involvement in the surgical specimen and invasive growth pattern of tumour margin. CONCLUSIONS: Many pathological parameters are important in regard with prognostic evaluation of patients diagnosed with colon cancer. We suggest that pathologists should include in their surgical pathology specimen reports of colon cancer, in addition to traditional parameters, an evaluation of peritumoral lymphocytic infiltrate, lateral margin involvement with tumour and the growth pattern of tumour at the invasive margin.