Pregnancy and maternal outcomes in women with prior or current gastrointestinal malignancies.

OBJECTIVES: To review the fetal and maternal outcomes of women with a diagnosis of gastrointestinal (GI) cancer before or during pregnancy. METHODS: We conducted a retrospective cohort study of pregnant women referred to a single tertiary care centre with a current or previous diagnosis of GI malignancy. Maternal, obstetric, and infant data were recorded. RESULTS: We identified 18 pregnancies in 13 women. Nine women were found to have a GI malignancy during pregnancy (group 1). There was an indirect maternal death in this group in a woman with advanced gastric adenocarcinoma. Nine unique pregnancies occurred in eight women with diagnosis and management of GI malignancies before their pregnancies (group 2). CONCLUSION: GI malignancies are difficult to diagnose and manage during pregnancy and are usually advanced at the time of diagnosis. Surgery can be performed during pregnancy if necessary, with chemotherapy and radiotherapy usually deferred to the postpartum period. Women who have had a prior GI malignancy have special circumstances related to the type of surgery performed and previous exposure to chemotherapy. These patients may benefit from a multidisciplinary team effort to optimize their care.

Objectifs : Analyser les issues fœtales et maternelles des femmes ayant reçu un diagnostic de cancer gastro-intestinal (GI) avant ou pendant la grossesse. Méthodes : Nous avons mené une étude de cohorte rétrospective portant sur des femmes enceintes orientées vers un seul centre de soins tertiaire en raison d'un diagnostic actuel ou précédent de tumeur maligne GI. Les données maternelles, obstétricales et infantiles ont été consignées. Résultats : Nous avons identifié 18 grossesses chez 13 femmes. Une tumeur maligne GI a été constatée chez neuf de ces femmes pendant la grossesse (groupe 1). Un décès maternel indirect a été signalé dans ce groupe chez une femme présentant un adénocarcinome gastrique avancé. Neuf grossesses uniques ont été constatées chez huit femmes ayant obtenu un diagnostic de tumeur maligne GI et ayant fait l'objet d'une prise en charge avant la grossesse (groupe 2). Conclusion : Les tumeurs malignes GI sont difficiles à diagnostiquer et à prendre en charge pendant la grossesse, et se trouvent habituellement à un stade avancé au moment du diagnostic. Une chirurgie peut être menée pendant la grossesse, au besoin, les traitements de chimiothérapie et de radiothérapie étant habituellement reportés à la période postpartum. Les femmes ayant déjà présenté une tumeur maligne GI comptent des circonstances particulières liées au type de la chirurgie dont elles ont fait l'objet et à leur exposition précédente à la chimiothérapie. Ces patientes pourraient tirer avantage d'une approche d'équipe multidisciplinaire pour optimiser les soins qu'elles reçoivent.

Differential synthesis of phosphate-starvation inducible purple acid phosphatase isozymes in tomato (Lycopersicon esculentum) suspension cells and seedlings.

This study compares the influence of phosphate (Pi) deprivation on the coordinate synthesis of the principle Pi-starvation inducible (PSI) acid phosphatase (AP) isozymes in a suspension cell culture with the homologous in planta system. Tomato suspension cells express three PSI purple AP isozymes: a heterodimeric intracellular AP (IAP) composed of 63 and 57 kDa subunits, and two monomeric secreted APs (SAPs) (84 kDa SAP1 and 57 kDa SAP2) localized in the culture media. Immunoblots probed with rabbit antibodies raised against purified SAP1 or IAP indicated the immunological distinctiveness of SAP1 relative to IAP and SAP2. Time-course studies of cells and seedlings undergoing a transition from Pi sufficiency to Pi deficiency revealed a close relationship between total IAP or SAP activity and relative amounts of antigenic IAP or SAP polypeptides. Upregulation of the pre-existing IAP in 6-day-old Pi-deficient (-Pi) suspension cells coincided with a 20-fold reduction in intracellular free Pi levels, which occurred 2 d prior to initial accumulation of SAP1 and SAP2 in the culture media. Similarly, root-specific SAP synthesis in -Pi seedlings occurred at least 7 d following IAP induction in roots or shoots. Preferential sequestration of limiting Pi to the leaves of the -Pi seedlings was suggested by the delayed induction of leaf versus root IAP. Our results confirm recent transcript profiling studies suggesting that PSI proteins are subject to both temporal and tissue-specific syntheses in- Pi plants.

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.