Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study.

BACKGROUND: The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS: Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS: Of the 5584 cases of thyroid carcinoma, 81% were papillary, 10% follicular, 3.6% Hürthle cell, 0.5% familial medullary, 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS: In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes.

Clinical highlights from the National Cancer Data Base, 1998.

The National Cancer Data Base is a community-oriented cancer management and outcomes database that is the joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. This article provides a first look at highlights from the 1998 summary.

The growth and maturation of the National Cancer Data Base.

BACKGROUND: The National Cancer Data Base (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, is a cancer management and outcomes data base for health care organizations. It provides a comparative summary of patient care that is used by communities and participating hospitals for self-assessment. The most current (1994) data are described here. METHODS: Six calls for data have yielded a total of 4,580,000 cases for the years 1985-1994. A total of 1735 hospital cancer registries have each participated in at least one of the calls for data. RESULTS: Summing the last year's report from each of the 1227 hospitals that participated in 1994, the cases represent the equivalent of 57% of the estimated 1994 U.S. cancer cases. These data were received from all six regions of the country, including all 50 states. Ninety-seven percent of patients received all or part of their treatment at the reporting hospital. The four most common cancers are carcinomas of the breast (15.7%), lung (14.3%), prostate (13.1%), and colon (7.7%), and collectively they comprise a majority of new cases. CONCLUSIONS: The NCDB is a cancer management and outcomes data base for health care organizations that currently provides data on 57% of the estimated new cases in the U.S. Past data have been used extensively to assess patterns of care and outcomes.

The National Cancer Data Base report on race, age, and region variations in prostate cancer treatment.

BACKGROUND: Patterns of care for prostate cancer patients in the United States have changed as early detection has improved. The National Cancer Data Base of the American College of Surgeons Commission on Cancer provides information about the treatment of patients in all age, race, and regional groups from institutions that represent cancer care at the community level as well as in medical centers. METHODS: Data on 251,416 prostate cancer patients diagnosed between 1992 and 1994 were studied. Patient and disease characteristics, including age, race, the geographic region from which a case was reported, American Joint Committee on Cancer stage, and tumor grade were related to the primary pattern of treatment. Stage-standardized comparisons were made among different age groups, race groups, and regional groups. RESULTS: Stage and tumor grade varied little across age, race, and regional classifications. African American patients were more likely than white patients to have Stage IV prostate cancer at the time of diagnosis. Men older than 75 years had greater proportions than younger men of both the earliest and the most advanced stages of cancer. Overall, 24.6% of patients received no cancer-directed therapy, 11.6% were treated with hormones or endocrine surgery, 28.6% received radiation therapy, 28.3% underwent radical prostatectomy, and 6.9% were treated by other modalities or combinations of modalities. Treatment patterns varied markedly by age. The selection of radical prostatectomy relative to no treatment and radiation therapy varied by race and region. CONCLUSIONS: The results of this study showed that prostate cancer treatment varies by patient age, race, and geographic region. The reasons for some of these variations are not well understood and deserve further investigation.

The effect of dentin disinfectants on shear bond strength of resin-modified glass-ionomer materials.

The purpose of this study was to investigate the effect of dentinal disinfection with a 2% chlorhexidine or a 0.11% I2-KI/CuSO4 solution on the shear bond strength of three resin-modified glass-ionomer cements: Fuji II LC, Photac-Fil, and Vitremer. The occlusal surfaces of extracted human teeth were flattened to dentin. Specimens were randomly assigned to one of nine treatment groups (n = 12). For each glass-ionomer material, there was a control group and two treatment groups in which the dentin was treated with either a 2% chlorhexidine or a 0.11% I2-KI/CuSO4 solution before the dentin was treated with the recommended dentin conditioner prior to glass-ionomer bonding. Specimens were stored for 1 day in water, thermocycled, and tested in shear until failure. The chlorhexidine solution did not significantly affect the shear bond strengths of any of the cements, but the I2-KI/CuSO4 solution significantly lowered the bond strengths of Vitremer and Fuji II LC compared to the controls.

The Breast Cancer Detection Demonstration Project 25 years later.

The Breast Cancer Detection Demonstration Project was initiated 25 years ago to demonstrate the feasibility of large-scale screening for breast cancer. A retrospective view shows that it has more than fulfilled its mission; among other important accomplishments it has significantly advanced both the notion and science of population-based breast cancer screening and provided a huge data base for epidemiologic research.

Clinical highlights from the National Cancer Data Base: 1997.

The following highlights summarize the principle findings of the NCDB, which are presented in more detail in other reports, some of which have been published and others of which are in press or submitted awaiting review. Collectively, these findings present a broad pattern of NCDB assessment of cancer patterns of care. In addition to the resulting journal publications, 1,600 NCDB participating hospitals receive a customized summary of similar patterns of care and outcome at their facility compared with national norms, which is then used for quality assurance purposes.

Giving life to numbers.

The yearly cancer statistics article represents a snapshot of the evolving trends in cancer events, providing a reference point for evaluating the successes and failures of cancer control in the United States. Dr. Cunningham, President of the American Cancer Society and a Surgical Oncologist at St. Francis Hospital in Evanston, Illinois, provides an overview of important observations from this year's data, including the observation that for the first time overall cancer mortality is following a downward trend in the United States.

Plight of children of street.

PIP: UNICEF Senior Urban Advisor, Ximena de la Barra, spoke at the conference, "Women and Children in Urban Poverty - What Way Out?," on the need to fight the social and economic circumstances which are conducive to poor health. She also discussed how the promotion of productivity, rather than well-being, often results in the exploitation of the poor, including children. Economic growth within the framework of the current development model is failing to reduce poverty. Rather, society has simply become more polarized. It is inexcusable that half of child mortality in Southeast Asia is due to malnutrition, especially when the US and some European countries block other countries from producing food which could otherwise be consumed abroad by people in need. Countries need to invest in their women and children. Field Director for PLAN International and the President of Dunn Nutrition Group also spoke at the UNICEF workshop.^ieng

Scanning electron microscopy of cyclosporine-induced gingival overgrowth.

Overgrown human gingival specimens were examined histologically and by scanning electron microscopy (SEM) to study structural changes caused by cyclosporine. The biopsy specimens were from organ transplant recipients receiving cyclosporine to suppress the rejection of the transplanted organ. The epithelium of the overgrown gingiva was thickened, acanthotic and parakeratotic. Retepegs were anastomosing and extending into connective tissue. The SEM examination of the outer surface of the attached gingival showed loss of cellular attachments and cells were exfoliating. The normal honeycomb structure formed by interconnecting microvilli surrounding the pits was distorted. Outer gingival cell surface showed numerous round, ovoid and dome-like structures instead of parallel, reticular or fingerprint-like microridges. It was concluded that cyclosporine not only caused hyperplasia but also changed the structure of the outer epithelial cell surface.

Patient characteristics, methods of diagnosis and treatment of melanoma in the United States.

The American College of Surgeons performed a patient care and evaluation study of melanoma for 1981 and 1987 to determine the presenting symptoms, methods of evaluation, clinical management and resulting outcome. Melanomas of the skin, eye, mucous membrane, metastases with unknown primary site and miscellaneous sites were included. Details concerning 5,004 patients from 681 hospitals in the study in 1981 and 6,900 patients from 844 hospitals in the study in 1987 were obtained--most melanomas were located in the skin; a decline in symptoms occurred at initial diagnosis; an increase in age at first diagnosis was reported; most melanomas were in Caucasian patients; slightly more melanomas occurred in men than women; more melanomas occurred in men on the head and neck and trunk, and more in the lower extremity in women; most tumors were not large in diameter; a significant shift was reported to lower levels of Clark's invasion, and a significant amount of unknowns existed in the Breslow's thickness of invasion. The large number of unknowns makes analysis difficult, but there seems to be some shift toward thinner levels of Breslow's in tumors in which it was known, from 1981 to 1987. Only a small proportion of patients in the current series was known to have node involvement or known distant metastases. An overall decline in diagnostic studies occurred between 1981 and 1987.

Survival discriminants for differentiated thyroid cancer.

Since 1975, the American Cancer Society, Illinois Division, has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state. The current study was undertaken, in part, to apprehend information regarding contested areas in the management of patients having differentiated (papillary/follicular) thyroid cancer. A total of 2,282 patients with either papillary or follicular carcinoma of the thyroid from 76 different Illinois hospitals and providing 10 years of follow-up information (life-table analysis) were retrospectively analyzed for demographic, disease, and treatment-related predictors of survival. Multivariate analysis using the Cox proportional hazards method was made for stage, age, race, sex, morphology, history of radiation exposure, presence of positive lymph nodes, initial surgical treatment, postoperative iodine 131 therapy, and replacement/suppressive thyroid hormone treatment. Statistically significant (p less than or equal to 0.05) predictors of favorable survival after thyroid cancer were low stage (I and II), young age (less than 50 years), white race, female sex, and the administration, postoperatively, of either thyroid hormone or radioactive iodine. Factors that had no influence on survival were lymph node status, choice of initial surgical treatment, and a history of prior irradiation. We suggest that where a prospective clinical trial is impracticable, a retrospective analysis of a large and detailed database, such as that available from cooperating hospital-based tumor registries, may yet provide useful insights to solutions of cancer management problems.

Theileria parva: the immune status of calves born of dams immunised against East Coast fever.

Eight Friesian cross cows three months pregnant to a single Friesian bull were immunised against East Coast fever by infection with Theileria parva (Muguga) sporozoite stabilate and treatment with pyrrolidino-methyl tetracycline. They were challenged with the homologous stock four times before calving and a fifth time after calving, and resisted all five challenges which killed all of the five groups of five susceptible controls. Calves born to these hyperimmunised dams were fully susceptible on challenge with the same stabilate, as were susceptible cows from the same farm and their calves. In both instances the calves died three to seven days earlier than the cows which were approximately 10 times heavier. These results show that one- to two-month-old taurine calves from artificially immunised dams are not protected from experimental T parva sporozoite challenge and that there is no inherent calfhood resistance to East Coast fever.

We went to Mississippi.

This is a combined version of two very similar articles: "Holmes County Clinic, an experiment in rural health care" by Helene Richardson and Patricia Weatherly, Health Rights, Vol. 2, No. 2 (Spring 1966), pp. 10, 11, 19-23; "We Went to Mississippi" by M. Phyllis Cunningham,, Helen Richardson Sanders and Patricia Weatherly, American Journal of Nursing, Vol. 67, No. 4 (April 1967), pp. 801-4. Only minor editorial changes have been made.

Maintenance of Theileria parva parva infection in an endemic area of Kenya.

The maintenance of Theileria parva parva infection in an endemic area of Kenya on the shore of Lake Victoria was studied in the field and laboratory. High prevalences of antibodies against T. parva and T. mutans and intra-erythrocytic piroplasms were detected in local zebu (Bos indicus) cattle. The mean infection rate of Theileria parasites in the tick, Rhipicephalus appendiculatus, in field collections was 1.1%. Most of the infection was attributed to T. parva parva by application of field ticks to susceptible cattle. Five cattle, all about 1.5 years old, were purchased from local owners and transported to the laboratory. All five had oscillating antibody titres against T. parva and T. mutans and had patent theilerial infections during the subsequent 13 months. Uninfected R. appendiculatus nymphs were applied to cattle at 0, 3, 6, 9 and 13 months after transport to Muguga, and 18 out of 23 batches transmitted T. parva parva infection to cattle when 100 resultant R. appendiculatus adults were applied. Infection rates in the tick batches were usually low, with 1 salivary gland acinus infected/tick. Hence, a frequent carrier state of naturally infected cattle has been demonstrated for T. parva parva for the first time, and it is likely that this carrier state is of great importance in maintenance of T. parva parva infection in the field.

Effects of tick infestation on Boran (Bos indicus) cattle immunised against theileriosis in an endemic area of Kenya.

Boran (Bos indicus) heifers were immunised by infection with local Theileria parva parva, T p lawrencei and T mutans stocks and treated with parvaquone and later exposed to natural tick and tick-borne disease challenge in the Trans-Mara Division of Kenya. The Theileria species parasites in the challenge were maintained in African buffalo and cattle and the tick vectors were supported by several species of wild Bovidae and domestic livestock present in the area. Thirty immune cattle were observed for 30 weeks while grazing on a ranch in the Trans-Mara Division. Of these, 15 were immersed in toxaphene at weekly or twice-weekly intervals while 15 cattle remained without acaricide application. Cattle which became pregnant were withdrawn from the experiment. There was no evidence of any clinical tick-borne disease in either group of cattle during the experiment. Five species of ixodid ticks infested the cattle during the experiment and cattle which were not treated with acaricide had far more ticks. Rhipicephalus appendiculatus was the most abundant tick species, with a mean infestation of 46 adults per animal in the undipped cattle. This tick also appeared to be the cause of the observed reduction in weight gains. Major haematological parameters did not differ significantly between the groups. Behavioural studies showed that the undipped cattle spent less time grazing and ruminating. This study has shown that, at the expense of some loss in productivity, zebu cattle, immunised against ticks and theileriosis, can be kept despite tick infestation.