Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types.

BACKGROUND: Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking. PATIENTS AND METHODS: Data on 818 902 Italian cancer patients diagnosed at age 15-74 years in 1985-2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds. RESULTS: The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon-rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%. CONCLUSIONS: A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

Lethal complications in a case of sigmoid diverticulitis. A case report.

A 61-year-old female complaining of arthralgia was repeatedly treated with antibiotics and also with prednisolone. A chronic polyarthritis was assumed. In hospital, leukocytosis of 21.000 was found one day before death as well as moderate anemia. Colonoscopy was rejected by the patient. A computer tomography revealed destructive arthritis of the symphysis, vertebral osteochondrosis L5/S1, and sigmoid diverticulosis. The patient died with clinical signs of central dysregulation. At autopsy, a covered perforation of a sigmoid diverticulum with purulent peridiverticulitis was found. The 5th lumbal vertebra and the symphysis showed hematogenic abscesses. Microabscedating pneumonia, purulent meningitis and hypophysitis, and mycotic aneurysm of the basilar artery with lethal rupture were further results of hematogenic spread. Death was caused by massive subarachnoidal hemorrhage. This history is not untypical for elder patients with complicated diverticular disease. The intestinal perforation is often clinically occult due to only few and unspecific symptoms which cannot be exactly attributed to the colon. In the last ten years, we have found lethal complications of sigmoid diverticulitis at a frequency of 0.32% (5 cases in 1.557 subsequent autopsies). The clinical differential diagnosis included diverticulitis in none of the cases. This underlines the importance of autopsies for quality control in medicine, because modern diagnostic methods such as computer tomography were not able to give the correct diagnosis in these cases.

Functional availability of sodium channels modulated by cytosolic free Ca2+ in cultured mammalian neurons (N1E-115).

1. Whole-cell sodium currents (INa) were measured in mouse neuroblastoma cells (N1E-115) at different [Ca2+]i values using appropriate Ca-EGTA buffers in the pipettes. 2. INa was found to be larger at pCa 7 than at pCa 8 or 9 with a ratio of 1:0.65 or 0.55, respectively. The steady-state inactivation (h infinity curve) was independent of [Ca2+]i, thus excluding surface charge effects as a cause of the Ca2+ effect. 3. Recovery of INa from slow inactivation after changing from resting (-30 to -40 mV) to holding potential (-70 mV) occurred in a similar way at all pCa values. The Ca2+ effect appears to be independent of slow inactivation and to occur within the first 2 min of pipette buffer-cytoplasm equilibration. 4. The cell membrane capacitance (Cm) was independent of [Ca2+]i, thus excluding exo- or endocytosis of sodium channel-containing membrane as a cause of the Ca2+ effect. 5. Non-stationary fluctuation analysis was used to determine simultaneously the single channel current (iNa) and the size of INa. At pCa values of 7 and 9, iNa was identical, i.e. 0.59 and 0.58 pA, while INa/Cm differed, i.e. 41.1 and 22.2 pA pF-1, respectively. The peak open probability at 0 mV was about 0.5 for both pCa values indicating that [Ca2+]i controls the fraction of channels available for activation. 6. Since [Ca2+]i in other neurons varies between 30 and 100 nM in the resting and active state, respectively, the present data suggest a modulatory role for [Ca2+]i in neuronal excitability.

Nucleolar and argyrophilic nucleolar organizer region counts in urothelial carcinomas with special emphasis on grade II tumors.

Prognostic assessment of bladder carcinomas of intermediate differentiation is difficult. This study therefore investigated the prognostic values of nucleolar status and silver staining of argyrophilic nucleolar organizer regions (AgNORs) in grade II bladder carcinomas. In biopsies from 34 grade II transitional cell carcinomas of the urinary bladder the number of nuclei with nucleoli, the location of nucleoli within the nucleus and the number of AgNORs were determined in 1000 or 200 nuclei per section respectively. Ten biopsies showing normal urothelium, 18 cases with mild to severe atypia, 27 grade I, 34 grade II and 12 grade III transitional cell carcinomas were also studied. Significantly differing nucleolar and AgNOR values were found comparing normal urothelium/grade I carcinomas with severe urothelial atypia/grade III carcinomas. Grade II carcinomas, however, were inhomogeneous. One subgroup had nucleolar and AgNOR values resembling grade I carcinomas while the second group had values similar to those of grade III carcinomas. This subdivision of grade II carcinomas correlates with results reported for DNA-cytometry. The results suggest a subdivision of patients with grade II transitional cell carcinomas into a low risk and high risk group.

Long-term cultivation of cryopreserved human fetal brain cells in a chemically defined medium.

Conditions for long-term cultivation of human fetal brain cells in a chemically defined medium were established using cryopreserved brain fragments obtained from legal abortions. Tissue of the same gestational age was pooled and the cells cultured in a fully defined medium containing insulin-like growth factors (IGF I and II). Primary cultures were kept for 2-4 weeks and secondary or tertiary cultures could be maintained for 3 months. The cultures were characterized by morphological, electrophysiological and biochemical methods. Glial cells were predominant during the first two weeks of culture. In later stages of cultivation, glial cells diminished in number and most cells were neuronal. Voltage-dependent Na+ channels were recorded from neurons. Biochemical studies indicated that the fetal brain cells contained and secreted immunoreactive somatostatin as well as the tachykinins, substance P and neurokinin A. Cultures grown in IGF II- or nerve growth factor-containing medium expressed increased choline acetyltransferase activity.