Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002.

BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. METHODS: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed and compared to similar data from 2002 (n=211) and 1992 (n=168). RESULTS: The median time to diagnosis was 13 days (2010) versus 17 days (2002; p<0.001) and 20 days (1992; p<0.001). Median days from diagnosis to treatment start were 25 (2010) versus 47 (2002; p<0.001) and 31 (1992; p<0.001). Total pre-treatment time was median 41 days in 2010 versus 69 days (2002) (p<0.001) and 50 days (1992; p<0.001). Significantly more diagnostic imaging was done in 2010 compared to 2002 and 1992. When compared to current fast track standards the adherence to diagnosis improved slightly from 47% (1992) to 51% (2002) and 64% (2010); waiting time for radiotherapy was within standards for 7%, 1% and 22% of cases, respectively; waiting time for surgery was within standards for 17%, 22% and 48%, respectively. CONCLUSION: The study showed a significant reduction in delay of diagnosis and treatment of head and neck cancer in 2010, but still less than half of all patients start treatment within the current standards.

Comparison of lower extremity motor score parameters for patients with motor incomplete spinal cord injury using gait parameters.

STUDY DESIGN: Retrospective investigation using gait analysis and medical records. OBJECTIVE: To evaluate the relationship between ambulatory function improvement and an increase in lower-limb motor scores in persons with motor incomplete spinal cord injury (SCI) and to compare the efficiency of lower extremity motor score (LEMS) and ambulatory motor index (AMI) in representation of ambulatory function improvement using gait analysis. SETTING: SCI Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: The gait analysis from 43 patients with SCI (paraplegic, n=22, tetraplegic n=21) were reviewed. The gait analysis data were obtained with Vicon 370 system. The LEMS and AMI were assessed before the gait analysis and the influence of an increase in lower-limb motor scores were investigated with linear parameters of gait analysis. RESULTS: For group including both tetraplegic and paraplegic patients, both AMI and LEMS were statistically correlated with gait speed, step length and negative correlation with double-limb support. However, only LEMS was correlated with cadence. For the paraplegic group, with AMI and LEMS, there were correlation with gait speed, step length and right single-limb support and negative correlation with right double-limb support. However, only LEMS was correlated with left cadence and negative correlation with double-limb support. For the tetraplegic group, only left cadence was statistically correlated with AMI. CONCLUSION: Both AMI and LEMS were useful in terms of providing information for capability of ambulatory function for the paraplegic group. However, for the tetraplegic group, both AMI and LEMS do not provide sufficient information for ambulatory function of the incomplete SCI patients.

The clinical course of respiratory tuberculosis in lung cancer patients.

OBJECTIVE: To determine the clinical features of lung cancer patients with respiratory tuberculosis (TB), thereby elucidating the clinical course. SETTING: A tertiary referral hospital in Korea, with intermediate TB prevalence. DESIGN: A retrospective case-control study involving lung cancer patients in whom respiratory TB was diagnosed concurrently or sequentially. RESULTS: Of 36 lung cancer patients, 10 (27.8%) were diagnosed with TB concurrently with the diagnosis of lung cancer, while 26 (72.2%) were diagnosed with TB after the diagnosis of lung cancer. The median time from the diagnosis of lung cancer to the diagnosis of TB was 4 months (range -1-47). Five lung cancer patients presented with incidental microbiological or pathological findings. Of the 36 lung cancer patients, eight (22%) had no remarkable changes on chest radiography, while all control group patients had identifiable abnormalities (P < 0.001). In both groups, most patients completed the initially prescribed anti-tuberculosis medications, with some modest modifications. The most common cause of death in the lung cancer group was progression of lung cancer (89.5%). CONCLUSION: The clinical course of respiratory TB in lung cancer patients does not differ from that in patients without malignancy, suggesting that respiratory TB may not influence the clinical course of lung cancer patients if properly treated.

Polymorphisms in the type IV collagen alpha3 gene and the risk of COPD.

A number of genome-wide linkage analyses have identified the 2q33.3-2q37.2 region as the most likely to contain the genes that contribute to the susceptibility to chronic obstructive pulmonary disease (COPD). It was hypothesised that the type IV collagen alpha3 (COL4A3) gene, which is one of the genes located in the 2q33.3-2q37.2 region, may act as a low-penetrance susceptibility gene for COPD. To test this hypothesis, the association of COL4A3 -1162T>C, IVS2+12C>A, P141L, G162E, H451R, P574L and *315C>A polymorphisms with the risk of COPD was investigated in a case-control study of 311 COPD patients and 386 controls. The presence of at least one 451R allele was associated with a significantly higher risk of COPD compared with the 451 H/H genotype (adjusted odds ratio 1.48, 95% confidence interval (1.03-2.14)). When the subjects were stratified according to age and COPD severity, the 451R allele was associated with a significantly higher risk of COPD only in younger individuals with severe COPD (3.02 (1.37-6.67)). In conclusion, these findings suggest that the type IV collagen alpha3 gene contributes to the genetic susceptibility to chronic obstructive pulmonary disease.

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11.

STUDY DESIGN: Retrospective investigation using urodynamic studies and medical records. OBJECTIVE: To evaluate the safety of sensation-dependent bladder emptying in complete spinal cord injury (SCI) patients, based on the preservation of the desire to void. SETTING: Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: This study was performed retrospectively on 79 complete SCI patients with lesions above T11, who had preserved the desire to void during conventional urodynamic studies. Patients were classified according to detrusor compliance and maximal bladder capacity. The clinical and urodynamic characteristics of each group were analyzed. RESULTS: Forty-five (57.0%) patients were classified as group A and 34 (43.0%) patients were classified as group B. There were no significant differences in clinical features, such as voiding methods and the presence of autonomic dysreflexia between the two groups. Compared with group B, there were significantly more areflexic neurogenic bladder cases in group A (P<0.05). There were significantly higher maximal detrusor pressures in group B (P<0.05). There were significantly more cases with the preservation of the strong desire to void in group B (P<0.05). CONCLUSION: Not all patients with discomplete SCIs accepted the use of sensation-dependent bladder emptying. The safe use of sensation-dependent bladder emptying will be determined based on the results of urodynamic studies.

Properties of cholesterol-reduced butter made with beta-cyclodextrin and added evening primrose oil and phytosterols.

The present study was carried out to examine changes in the chemical and sensory properties of butter in which the cholesterol was reduced and to which evening primrose oil (EPO) and phytosterols were added. Crosslinked beta-cyclodextrin (beta-CD) made from adipic acid was used, and approximately 90% of the cholesterol was removed. The color measurement values "L" and "a" were significantly different between the control (butter with no beta-CD treatment and no added EPO and phytosterols) and treatment A (butter treated with 10% crosslinked beta-CD); however, the color values for "L" and "a" were similar. The color value "b" in treatment B (butter treated with 10% crosslinked beta-CD and 5% phytosterols and 3% EPO added) was significantly higher than in the other treatments. The thiobarbituric acid value of treatment B was significantly higher than that of the control and treatment A. Scores for hardness, elasticity, and cohesiveness were significantly lower in the control than in treatment A. Differences in sensory characteristics did not result from the beta-CD treatment but from the addition of EPO and phytosterols. In microscopic examinations, no noticeable differences were found among the treatments, and a smooth texture and a fine, uniform crystalline structure were observed. Results indicated that about 90% of the cholesterol was reduced by crosslinked beta-CD and that the beta-CD treatment itself did not adversely influence the chemical and sensory properties of the butter. However, the addition of EPO and phytosterols to the butter appeared to impair its sensory properties, especially in terms of rancidity and overall acceptability.

Microsatellite alteration in histologically normal lung tissue of patients with non-small cell lung cancer.

Microsatellite alteration (MSA) has been observed in a fraction of non-small cell lung cancer (NSCLC). Most prior studies regarding MSA in lung cancer have usually used adjacent non-malignant lung tissues as a source of constitutional DNA. However, these normal tissues might have genetic alterations because the entire field of bronchial tree is exposed to the same carcinogenic insult. The aim of this study was to search if MSA is present in the histologically normal lung tissue of patients with NSCLC. Tumor and corresponding normal lung tissue specimens were obtained from 20 patients with NSCLC. Normal lung tissue specimens were obtained from either the opposite end of resected surgical samples or as distant from the tumor as possible. They were examined histopathologically and confirmed as normal by H-E stain. Patients' peripheral lymphocytes were used as the source for the normal DNA. Sixteen markers on 3p and 9p (nine and seven markers, respectively) were used. MSA was detected in seven of 20 (35%) histologically normal lung tissue specimens at a frequency similar to that observed in tumor tissue (eight of 20, 40%). Five cases showed MSA in both normal lung tissue and the corresponding tumor. In these five cases, MSA in normal lung tissue was detected at the same microsatellite markers which MSA was detected in the corresponding tumor. The number and size of novel bands in normal lung tissue was identical to that in tumor tissue except in one case. In which case, the same pattern of MSA was found in both normal lung tissue and corresponding tumor tissue at two markers. However, at one marker, while one identical novel band was detected in normal lung tissue and corresponding tumor tissue, another novel band was found only in tumor tissue. In two of 12 patients whose tumor was negative for the presence of MSA, MSA was detected in normal lung tissue. These results indicate that genetic alterations are widely distributed in the lung tissue of patients with lung cancer and provide considerable support for the field cancerization theory. Screening for MSA in resected normal lung tissue might be a new method to identify patients at high risk for developing second primary lung cancers.

Impact of abnormal uptakes in bone scan on the prognosis of patients with lung cancer.

The detection of bone metastases is important in the management of patients with lung cancer because bone metastasis has a major impact on the prognosis and choice of treatment modality. Bone scan has been widely used for early detection of bone metastases but its low specificity complicates confirmation of bone scan findings. To evaluate the effects of abnormal bone scan findings on the prognosis of patients with lung cancer, we retrospectively analyzed the effect of abnormal uptakes on the prognosis of patients with primary lung cancer. The overall survival of patients with abnormal bone uptake was not significantly different from those without abnormal uptake. However, the patients with more than two abnormal bone uptakes had significantly shorter survival than those with no abnormal uptake (P<0.05). To confirm the effect of abnormal bone uptakes on survival, we compared the survival curves of three patient groups without knowledge of bone scan findings: group A, stage I-IIIB with more than two abnormal bone uptakes (potential stage IV); group B, stage IIIB with no abnormal bone uptake (true stage IIIB); and group C, stage IV with no abnormal bone uptake. Group A revealed shorter survival than group B (P<0.05). But, there was no significant difference in survival times between group A and group C. In the Cox regression analysis, the presence of more than two abnormal bone uptakes was a significant prognostic factor (P=0.0277), together with performance status, stage, and albumin. These results suggest that one or two abnormal bone uptake at diagnosis did not affect overall survival of the patients, and that the patients with more than two abnormal bone uptakes are considered as clinical stage IV because of high probability of bone metastases.

Plastic bronchitis.

Plastic bronchitis is generally associated with some type of pulmonary disease and improves either spontaneously or with medical therapy. We present a case of plastic bronchitis with no known cause. The patients' symptoms were not responsive to medical therapy but were relieved after right middle lobectomy.

Effects of corticosteroid and chlorambucil on multiple pulmonary artery aneurysms in Behcet's syndrome. A case report.

A patient with Behcet's syndrome in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroid and chlorambucil is reported.