The role of primary healthcare professionals in oral cancer prevention and detection

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities

IN-VITRO TRANSCRIPTION/TRANSLATION ASSAY FOR THE SCREENING OF HMLH1 AND HMSH2 MUTATIONS IN FAMILIAL COLON-CANCER

Background & Aims: Hereditary nonpolyposis colorectal cancer (HNPCC) has been linked recently to a defect in repairing mismatched nucleotides in DNA. The aim of this study was to screen for germline mutations that result in prematurely truncated proteins in two of the mismatch repair genes identified at this time, hMLH1 and hMSH2, in a consecutive series of patients belonging to familial aggregations of colorectal cancer. Methods: Nineteen individuals with colorectal cancer from 19 families were consecutively referred because of a strong positive family history of colorectal cancer. Premature truncation mutations in hMLH1 and hMSH2 were sought from lymphocyte RNA by using an in vitro transcription/translation (IVTT) assay. Results: Protein truncating mutations in the hMLH1 or hMSH2 genes were found in 50% of families with HNPCC (6 of 12) but were not observed in any of the remaining familial aggregations that did not fulfill the standard criteria for HNPCC. In some of the IVTT-positive samples, the mutations were characterized by genomic sequencing. Conclusions: IVTT may be a practical method to accomplish primary screening of germline mutations in DNA mismatch repair genes in HNPCC; however, a broader approach is necessary to obtain a more complete picture of the mutational spectrum in HNPCC and other familiar aggregations of colorectal cancer

Effect of lateralized epileptic discharges on the thought flow Efeito de descargas epilépticas lateralizadas no fluxo do pensamento

PURPOSE: Pauses in verbal expression of thought flow in patients with partial epilepsy was studied in order to achieve a best comprehension of brain interhemispheric influences. METHOD: We studied thirty nine patients with partial epileptic seizures and twenty four volunteers (control group). Free association of ideas was used as a method to stablish the thought flow, starting with a stimulus word (subject name) that must be followed by spontaneous and consecutive word-phrase. Patients were instructed to say any thought that came to their minds without any kind of censoring. Subject responses were recorded through a PC keyboard and time intervals (pauses) between each word-phrase were processed by a software developed for this purpose. RESULTS: Time intervals reduction among associations in right lesional group were compared to left lesional, right non-lesional and control groups. An increase of associative time intervals was observed in the right non-lesional group compared to left non-lesional group. CONCLUSIONS: We suggest a possible inhibitory inter-hemispheric function of the right hemisphere modulating verbal expression of the thought flow. Considering the hypothesis of the inter-hemispheric inhibition by the right hemisphere on left hemisphere, we admit that in epileptic patients with right hemispheric lesion there is an attenuation of the inter-hemispheric inhibition and an increase in thought flow, whereas in patients without a lesion but a paroxysmal epileptic activity in right temporal lobe there is an exacerbation of this inhibitory function and consequent reduction in the thought flow.<br>OBJETIVO: Foram estudadas as pausas na expressão verbal do pensamento em pacientes com epilepsia parcial a fim de estabelecer uma melhor compreensão das influências interhemisféricas cerebrais. MÉTODO: foram estudados 39 pacientes com crises epilépticas parciais e 24 voluntários (grupo controle). A associação livre de idéias foi usada como método para estabelecer o fluxo do pensamento, partindo de uma palavra-frase (nome do indivíduo) que devia ser seguida por palavras-frase espontâneas e consecutivas. Os pacientes foram orientados para dizer qualquer pensamento que viesse as suas mentes, sem qualquer tipo de censura. As respostas individuais foram registradas por meio de um teclado de computador (PC) e os intervalos de tempo (pausas) entre cada palavra-frase foram processadas por um software especialmente desenvolvido. RESULTADOS: Redução nos intervalos de tempo entre as associações encontrada no grupo lesional direito foi comparada aos grupos lesional esquerdo, não-lesional direito e controle. Um aumento nos intervalos de tempo das associações foi observado no grupo não lesional direito em relação ao grupo não-lesional esquerdo. CONCLUSÕES: Os resultado encontrados sugerem uma possível função inibitória do hemisfério direito modulando a expressão verbal do fluxo do pensamento. Considerando a hipótese da inibição inter-hemisférica pelo hemisfério direito sobre o hemisfério esquerdo, podemos admitir que em pacientes epilépticos com lesão hemisférica há uma atenuação da inibição inter-hemisférica e um aumento no fluxo do pensamento, enquanto que em pacientes sem lesão, porém com uma atividade epiléptica paroxística no lobo temporal direito há uma exacerbação desta função inibitória e consequente redução no fluxo do pensamento