Detection of cytokeratins 19/20 and guanylyl cyclase C in peripheral blood of colorectal cancer patients

The clinical significance of detecting supposed tumour cell-derived mRNA transcripts in blood using the polymerase chain reaction (PCR) remains unclear. We have used a fully quantitative 5′-nuclease RT-PCR assay to screen for the expression of cytokeratins (ck) 19 and 20 and guanylyl cyclase C (GCC) in the peripheral blood of 21 healthy controls and 27 colorectal cancer patients. Expression of cytokeratin 19 and 20 mRNA was detected in 30% and 100% of samples, respectively, taken from healthy volunteers. There was no apparent difference in ck19 and ck20 mRNA transcription levels between controls and patients, or between patients with different Dukes' stages. While GCC mRNA was detected in only 1/21 control samples, it was expressed in approximately 80% of patients, although again there was no correlation between GCC levels and disease stage. Transcription levels of all three markers varied considerably between samples, even between samples taken from the same person at different times. We conclude that neither ck19 nor ck20 are reliable markers for the detection of colon epithelial cells in peripheral blood and that an evaluation of the usefulness of GCC awaits further longitudinal studies. © 1999 Cancer Research Campaig

Surgical resection for locoregional esophageal cancer is underutilized in the United States

Background Although esophagectomy provides the highest probability of cure in patients with esophageal cancer, many candidates are never referred for surgery. We hypothesized that esophagectomy for esophageal cancer is underused, and we assessed the prevalence of resection in national, state, and local cancer data registries. Study Design Clinical stage, surgical and nonsurgical treatments, age, and race of patients with cancer of the esophagus were identified from the Surveillance, Epidemiology and End Results (SEER) registry (1988 to 2004), the Healthcare Association of NY State registry (HANYS 2007), and a single referral center (2000 to 2007). SEER identified a total of 25,306 patients with esophageal cancer (average age 65.0 years, male-to-female ratio 3:1). HANYS identified 1,012 cases of esophageal cancer (average age 67 years, M:F ratio 3:1); stage was not available from NY State registry data. A single referral center identified 385 patients (48 per year; average age 67 years, M:F 3:1). For SEER data, logistic regression was used to examine determinants of esophageal resection; variables tested included age, race, and gender. Results Surgical exploration was performed in 29% of the total and only 44.2% of potentially resectable patients. Esophageal resection was performed in 44% of estimated cancer patients in NY State. By comparison, 64% of patients at a specialized referral center underwent surgical exploration, 96% of whom had resection. SEER resection rates for esophageal cancer did not change between 1988 and 2004. Males were more likely to receive operative treatment. Nonwhites were less likely to undergo surgery than whites (odds ratio 0.45, p < 0.001). Conclusions Surgical therapy for locoregional esophageal cancer is likely underused. Racial variations in esophagectomy are significant. Referral to specialized centers may result in an increase in patients considered for surgical therapy. \ua9 2010 American College of Surgeons

Reflux-Associated Oxygen Desaturations: Usefulness in Diagnosing Reflux-Related Respiratory Symptoms

Background: Current diagnostic techniques establishing gastroesophageal reflux disease as the underlying cause in patients with respiratory symptoms are poor. Our aim was to provide additional support to our prior studies suggesting that the association between reflux events and oxygen desaturations may be a useful discriminatory test in patients presenting with primary respiratory symptoms suspected of having gastroesophageal reflux as the etiology. Methods: Thirty-seven patients with respiratory symptoms, 26 with typical symptoms, and 40 control subjects underwent simultaneous 24-h impedance-pH and pulse oximetry monitoring. Eight patients returned for post-fundoplication studies. Results: The median number (interquartile range) of distal reflux events associated with oxygen desaturation was greater in patients with respiratory symptoms (17 (9-23)) than those with typical symptoms (7 (4-11, p < 0. 001)) or control subjects (3 (2-6, p < 0. 001)). A similar relationship was found for the number of proximal reflux-associated desaturations. Repeat study in seven post-fundoplication patients showed marked improvement, with reflux-associated desaturations approaching those of control subjects in five patients; 20 (9-20) distal preoperative versus 3 (0-5, p = 0. 06) postoperative; similar results were identified proximally. Conclusions: These data provide further proof that reflux-associated oxygen desaturations may discriminate patients presenting with primary respiratory symptoms as being due to reflux and may respond to antireflux surgery. \ua9 2012 The Society for Surgery of the Alimentary Tract

Inventário de Arnett de Busca de Sensações (AISS): testando diferentes modelos fatoriais Arnett Inventory of Sensation Seeking (AISS): testing different factorial models

O estudo do traço de busca de sensações permite explicar diversos comportamentos de risco. Considerando sua relevância e a ausência de medida específica no Brasil, decidiu-se adaptar o Inventário de Arnett de Busca de Sensações. Este é formado por 20 itens, medindo dois fatores: novidade e intensidade. Participaram da pesquisa 279 estudantes do ensino médio de escolas particulares e públicas, com idade média de 17 anos, igualmente distribuídos quanto ao sexo, provenientes de João Pessoa (n=108) e Teresina (n=171). Por meio de análises fatoriais confirmatórias, testaram-se quatro modelos, segundo o número de fatores (um ou dois) e itens (12 ou 20). Os resultados mostraram que o modelo bifatorial reduzido apresentou melhores índices de ajuste. Os fatores e a pontuação total desse instrumento apresentaram consistência interna aceitável, estando correlacionados com sexo e idade dos participantes. Tais resultados justificam a utilização dessa medida em estudos futuros.<br>The study of sensation seeking trait is able to explain several risky behaviors. Considering its relevance and the lack of specific instruments to measure it in Brazil, it was decided to adapt the Arnett Inventory of Sensation. It is composed by 20 items, measuring two factors: novelty and intensity. Participants were 279 high school students of private and public schools from João Pessoa (n=108) and Teresina (n=171). They had mean age of 17 years old, being equally distributed for sex. Using confirmatory factor analysis, four models were tested according to the number of factors (one or two) and items (12 or 20). Results showed that the reduced bifactorial model presented the best fit indices. The factors and the total score of this instrument presented acceptable internal consistency, being correlated with sex and age. These results justify the use of this instrument in subsequent studies