To improve prognosis and treatment of patients with colon and rectal cancer

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkin

The effect of pregnancy on the survival of women diagnosed with breast cancer

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To answer the question whether the prognosis of women with breast cancer is affected by pregnancy after diagnosis. Material and methods: We used information from the Icelandic Cancer Registry, the Birth Registry and the Genetic Committee. We identified all women who were diagnosed with breast cancer in the years 1927-1992 and who later became pregnant. Controls were women without a history of childbirth after diagnosis of breast cancer. They were matched on tumour size, axillary lymph node status and years of birth and diagnosis, with four year deviation. Results: In the years 1927-1992, 838 women at ages below 50 were diagnosed with breast cancer in Iceland. Of those, 29 gave birth to a child after the diagnosis. Fourteen cases and 33 matched controls fulfilled the inclusion criteria of the study. Survival was better in the group of women who became pregnant after diagnosis, but the difference was not statistically significant (P=0.06). Discussion: Our results do not indicate that the prognosis of women who become pregnant after the diagnosis of breast cancer is worse than of those who do not become pregnant. The group was too small to make definite conclusions. However, the results are in concordance with results from other studies.Tilgangur: Að leita svara við þeirri spurningu hvort horfur kvenna með brjóstakrabbamein versni við að eignast börn eftir greiningu. Efniviður og aðferðir: Notaðar voru upplýsingar frá Krabbameinsskrá, Fæðingaskráningu og Erfðafræðinefnd. Í rannsóknarhópnum voru konur sem greindust yngri en 50 ára með brjóstakrabbamein á árunum 1927-1992 og eignuðust síðar börn. Fundin voru viðmið sem einnig höfðu greinst með brjóstakrabbamein en höfðu ekki eignast börn eftir greiningu. Þessi viðmið voru sambærileg við sjúklingana varðandi stærð æxlis og eitlaíferð auk greiningar- og fæðingarára með fjögurra ára fráviki. Niðurstöður: Á árunum 1927-1992 greindust 838 konur yngri en 50 ára með brjóstakrabbamein, þar af eignuðust 29 konur börn í kjölfarið. Fjórtán þessara kvenna uppfylltu aðgangsskilyrði rannsóknarinnar. Fyrir þær fundust 33 viðmið. Lífshorfur reyndust vera betri í hópi þeirra kvenna sem áttu börn eftir greiningu brjóstakrabbameinsins, en munurinn var ekki tölfræðilega marktækur (P=0,06). Umræður: Niðurstöður okkar gefa ekki til kynna að barnsfæðing í kjölfar greiningar brjóstakrabbameins hafi slæm áhrif á horfur. Hópurinn er of lítill til þess að draga megi almennar ályktanir á grundvelli hans, en niðurstöðurnar eru í samræmi við erlendar rannsóknir

Emphysematous Pancreatitis. A case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSjúkratilfelli Fimmtíu ára gamall karlmaður var lagður inn á Landspítala Hringbraut með átta tíma sögu um kviðverki, ógleði og uppköst sem fóru stöðugt versnandi. Sjúklingur var með þekkta sykursýki, kransæðastíflu, háþrýsting, of hátt kólesteról og blóðtappa í heila með minnkuðum krafti í vinstri hendi. Það var engin saga um aðgerðir á kvið, áfengismisnotkun eða gallsteinasjúkdóm. Við innlögn hafði sjúklingur slæma kviðverki sem leiddu aftur í bak, ógleði og uppköst. Við skoðun var hitinn 38,3°C, blóðþrýstingur 175/100mm Hg og púls 85 slög/mín. Kviður var þaninn, aumur og vöðvavörn var til staðar í efri hluta. Garnahljóð voru eðlileg

Kingella kingae ostemyelitis and septic arthritis in paediatric patients. Six cases from the Department of Pediatrics, National University Hospital of Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenKingella kingae (K. kingae) is a gram negative rod most often associated with septic arthritis and osteomyelitis in children. Infections caused by K. kingae had not been reported in Iceland when six cases were diagnosed at the Pediatric Department at the National University Hospital of Iceland. In this report we describe those cases and review the literature.Bakterían Kingella kingae (K. kingae) er gram neikvæður stafur sem getur valdið liða- og beinasýkingum í börnum. Árið 1995 greindist fyrsta sýkingin af völdum K. kingae hér á landi og í kjölfarið greindust fimm tilfelli á rúmu einu ári og eitt tilfelli fjórum árum síðar. Öll tilfellin greindust á Barnaspítala Hringsins. Í þessari grein munum við lýsa tilfellunum og gera grein fyrir sýkingavaldinum

Acute pancreatitis. Prospective study of incidence, aetiology, severity, and mortality in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To evaluate the aetiology, severity and mortality of patients with acute pancreatitis at Landspítali - University Hospital (LSH) and to estimate the incidence in Iceland. Material and methods: A prospective study of all patients diagnosed with acute pancreatitis LSH during the one-year period October 1998 - September 1999 inclusive. The main outcome measures were APACHE II, Ranson, and Imrie scores, and C-reactive protein (CRP) concentrations. The Balthazar - Ranson criteria were used for scoring of computed tomograms (CT). Results: Twenty seven of the 50 patients were male. The median age of the whole series was 60 years (range 19-85). The estimated incidence was 32/100000 for the first attack of acute pancreatitis. The causes were; gallstones 42%, alcohol 32%, miscellaneous 24%, and idiopathic 2%. Thirty three percentage of the patients had APACHE II scores 9, 38% had Ranson scores of 3, 50% had Imrie scores of 3, and 34% had CRP concentrations >210 mg/L during the first 4 days or >120 mg/L during the first week. Seven patients had severe pancreatitis. Two patients in the whole group died, and both had clinically severe pancreatitis. Conclusions: Incidence and aetiology of acute pancreatitis in Iceland is in concordance to that described in other studies. Prospective assessment makes it possible to evaluate the aetiological factors more accurately. Measurement of the CRP concentration is an attractive and simple alternative to the severity scoring systems currently in use

Gallstone disease during pregnancy at Landspitali University Hospital 1990-2010

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Gallblöðrutaka um kviðsjá er talin örugg aðgerð á meðgöngu, óháð meðgöngulengd. Ekki er vitað hver kjörmeðferð er við gallsteinasjúkdómum hjá þunguðum konum. Talið hefur verið að meðferð án aðgerðar skili bestum árangri á fyrsta og þriðja þriðjungi meðgöngu en skurðmeðferð sé öruggust á öðrum þriðjungi. Tilgangur rannsóknarinnar var að kanna tíðni, orsakir, greiningu og árangur gallblöðrutöku hjá þunguðum konum á Landspítala á tímabilinu 1990-2010. Efniviður og aðferðir: Rannsóknin var afturskyggn og tók til allra kvenna er lögðust inn á Landspítala með gallsteinasjúkdóm meðan á þungun stóð og allt að 6 vikum eftir fæðingu. Skráðar voru meðal annars upplýsingar um aldur, einkenni, vefjagreiningu og þyngdarstuðul ásamt ASA-flokkun og fylgikvillum aðgerða hjá þeim konum sem gengust undir gallblöðrutöku á tímabili rannsóknarinnar. Niðurstöður: Á rannsóknartímabilinu voru 77 konur lagðar inn með gallsteinasjúkdóma í samtals 139 innlögnum og nýgengi því 0,09%. Gallsteinagreiningar voru gallkveisa (n=59), brisbólga (n=1), gallgangasteinar (n=10) og bráð gallblöðrubólga (n=7). Algengasta ástæða innlagnar var verkur í efri hægri fjórðungi kviðar (n=63). Fylgikvillar gallsteinasjúkdóma tengdir meðgöngu voru fyrirburafæðingar (n=2). Fimmtán konur gengust undir aðgerð á meðgöngu og 17 á 6 vikna tímabili eftir fæðingu en fylgikvillar aðgerða voru helst steinar í gallgangi (n=2). Meðal þyngdarstuðull sjúklinga var 31,1 og algengasta ASA-flokkun var 1 (bil: 1-3). Flest vefjasvör sýndu langvinna bólgu (n=24) og bráða bólgu (n=5) í gallblöðru. Ályktun: Gallsteinasjúkdómar þungaðra kvenna eru fátíðir, hafa í för með sér endurteknar innlagnir en tíðni fylgikvilla er lág. Gallblöðrutaka með kviðsjá hjá þunguðum konum á Landspítala er örugg aðgerð, sem er í samræmi við erlendar niðurstöður.Introduction: Gallstone disease in pregnant patients and their management in Iceland has not been studied. Management of these patients changed after the introduction of laparoscopic cholecystectomy. The aim of this study was to investigate the incidence, symptoms, diagnostic methods and management of gallstone disease during pregnancy at the National University Hospital of Iceland during the years 1990-2010. Material and methods: This was a retrospective study and included all pregnant women admitted with gallstone diseases to the National University Hospital of Iceland which is the only tertiary hospital in Iceland. Information regarding age, symptoms and diagnostic methods for all women with gallstone disease along with BMI, ASA scores, pathology results and pregnancy related outcomes for women who underwent cholecystectomy were gathered. Results: During the twenty year time period 77 women were admitted with gallstone disease in 139 admissions which makes incidence 0,1% amongst pregnant women. Diagnoses incuded biliary colic (n=59), common bile duct stones (n=10), acute cholecystitis (n=7) and gallstone pancreatitis (n=1). The most common symptom was RUQ pain (n=63). Two preterm births were a direct consequence of gallstone disease. Fifteen women underwent cholecystectomy during pregnancy and 17 during the six week period after birth. Mean BMI was 31,1 and median ASA score was 1. Pathology reports showed chronic inflammation (n=24) and acute inflammation (n=5), one case included gallstones without inflammation Adverse outcomes of surgeries were two cases of gallstones left in the common bile duct. No stillbirths or preterm births resulted from cholecystectomies during pregnancy. Conclusion: Gallstone disease during pregnancy is rare and readmissions are frequent. Pregnancy related complications are rare. Laparoscopic cholecystectomy is safe during pregnancy

Allele-specific copy number analysis of tumor samples with aneuploidy and tumor heterogeneity

We describe a bioinformatic tool, Tumor Aberration Prediction Suite (TAPS), for the identification of allele-specific copy numbers in tumor samples using data from Affymetrix SNP arrays. It includes detailed visualization of genomic segment characteristics and iterative pattern recognition for copy number identification, and does not require patient-matched normal samples. TAPS can be used to identify chromosomal aberrations with high sensitivity even when the proportion of tumor cells is as low as 30%. Analysis of cancer samples indicates that TAPS is well suited to investigate samples with aneuploidy and tumor heterogeneity, which is commonly found in many types of solid tumors

Validation of podocalyxin-like protein as a biomarker of poor prognosis in colorectal cancer

Background: Podocalyxin-like 1 (PODXL) is a cell-adhesion glycoprotein and stem cell marker that has been associated with an aggressive tumour phenotype and adverse outcome in several cancer types. We recently demonstrated that overexpression of PODXL is an independent factor of poor prognosis in colorectal cancer (CRC). The aim of this study was to validate these results in two additional independent patient cohorts and to examine the correlation between PODXL mRNA and protein levels in a subset of tumours. Method: PODXL protein expression was analyzed by immunohistochemistry in tissue microarrays with tumour samples from a consecutive, retrospective cohort of 270 CRC patients (cohort 1) and a prospective cohort of 337 CRC patients (cohort 2). The expression of PODXL mRNA was measured by real-time quantitative PCR in a subgroup of 62 patients from cohort 2. Spearman's Rho and Chi-Square tests were used for analysis of correlations between PODXL expression and clinicopathological parameters. Kaplan Meier analysis and Cox proportional hazards modelling were applied to assess the relationship between PODXL expression and time to recurrence (TTR), disease free survival (DFS) and overall survival (OS). Results: High PODXL protein expression was significantly associated with unfavourable clinicopathological characteristics in both cohorts. In cohort 1, high PODXL expression was associated with a significantly shorter 5-year OS in both univariable (HR = 2.28; 95% CI 1.43-3.63, p = 0.001) and multivariable analysis (HR = 2.07; 95% CI 1.25-3.43, p = 0.005). In cohort 2, high PODXL expression was associated with a shorter TTR (HR = 2.93; 95% CI 1.26-6.82, p = 0.013) and DFS (HR = 2.44; 95% CI 1.32-4.54, p = 0.005), remaining significant in multivariable analysis, HR = 2.50; 95% CI 1.05-5.96, p = 0.038 for TTR and HR = 2.11; 95% CI 1.13-3.94, p = 0.019 for DFS. No significant correlation could be found between mRNA levels and protein expression of PODXL and there was no association between mRNA levels and clinicopathological parameters or survival. Conclusions: Here, we have validated the previously demonstrated association between immunohistochemical expression of PODXL and poor prognosis in CRC in two additional independent patient cohorts. The results further underline the potential utility of PODXL as a biomarker for more precise prognostication and treatment stratification of CRC patients

Survival endpoints in colorectal cancer and the effect of second primary other cancer on disease free survival

<p>Abstract</p> <p>Background</p> <p>In cancer research the selection and definitions of survival endpoints are important and yet they are not used consistently. The aim of this study was to compare different survival endpoints in patients with primary colorectal cancer (CRC) and to understand the effect of second primary other cancer on disease-free survival (DFS) calculations.</p> <p>Methods</p> <p>A population-based cohort of 415 patients with CRC, 332 of whom were treated with curative intention between the years 2000-2003, was analysed. Events such as locoregional recurrence, distant metastases, second primary cancers, death, cause of death and loss to follow-up were recorded. Different survival endpoints, including DFS, overall survival, cancer-specific survival, relapse-free survival, time to treatment failure and time to recurrence were compared and DFS was calculated with and without inclusion of second primary other cancers.</p> <p>Results</p> <p>The events that occurred most often in patients treated with curative intention were non-cancer-related death (n = 74), distant metastases (n = 66) and death from CRC (n = 59). DFS was the survival endpoint with most events (n = 170) followed by overall survival (n = 144) and relapse-free survival (n = 139). Fewer events were seen for time to treatment failure (n = 80), time to recurrence (n = 68) and cancer-specific survival (n = 59). Second primary other cancer occurred in 26 patients and its inclusion as an event in DFS calculations had a detrimental effect on the survival. The DFS for patients with stage I-III disease was 62% after 5 years if second primary other cancer was not included as an event, compared with 58% if it was. However, the difference was larger for stage II (68 vs 60%) than for stage III (49 vs 47%).</p> <p>Conclusions</p> <p>The inclusion of second primary other cancer as an endpoint in DFS analyses significantly alters the DFS for patients with CRC. Researchers and journals must clearly define survival endpoints in all trial protocols and published manuscripts.</p