Main Category: Hypertension
Also Included In: GastroIntestinal / Gastroenterology;  Immune System / Vaccines;  Radiology / Nuclear Medicine
Article Date: 21 Jun 2011 – 5:00 PDT

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1. For Hypertension Patients, Single Reading Not Enough to Assess Blood Pressure Control

Using Multiple Readings Increases Measurement Accuracy

For patients with hypertension, physicians typically use a single in-office blood pressure (BP) reading to assess how well medical interventions are working and then adjust hypertension medications accordingly. However, some patients may experience a phenomenon known as “white coat” hypertension, meaning they have a higher than normal BP due to the anxiety associated with the office visit. Researchers sought to determine how many readings would be needed to accurately determine whether a patient’s BP was under control. They followed 444 veterans with hypertension for 18 months to compare three different strategies for BP measurement: standardized research BP measurement every six months; in-office BP measurements taken during outpatient visits; and home BP measurements using a monitor that transmitted results electronically. The researchers found that taking an average BP reading from several measurements resulted in substantially greater accuracy in diagnosis. The authors recommend that home monitoring could improve the quality of blood pressure care.

2. Experts Recommend Multidetector Computed Tomography as Standard Preoperative Care for Suspected Appendicitis

Acute appendicitis can be difficult to diagnose, as the symptoms of appendicitis mirror those of other illnesses. Accurate diagnosis is important because patients with appendicitis go to surgery, while those that do not have appendicitis do not. Computed tomography is often used to help diagnose appendicitis, but high quality studies of its effectiveness in this situation have been lacking. Researchers reviewed hospital records for 2,871 adult patients with suspected appendicitis between 2000 and 2009 to determine if multidetector computed tomography (MDCT) could accurately rule in or rule out appendicitis. The researchers found that MDCT was sensitive and specific enough to identify the approximately one quarter of patients with actual appendicitis who needed urgent surgery, and it identified a probable alternative cause of symptoms in those who did not have appendicitis. In addition, preoperative MDCT can reduce rates of perforation and negative findings at appendectomy. The researchers recommend MDCT as the standard of care for suspected appendicitis in adults.

3. Insufficient Evidence to Support Preemptive Assessment of Thiopurine S-Methyltransferase Activity in Patients Prescribed Thiopurines

Thiopurine-based drugs are sometimes used to treat patients with chronic inflammatory autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease. Because thiopurine-based drugs can lead to severe lowering of blood counts in patients with reduced or absent thioputine S-methyltransferase (TPMT) enzyme, some experts recommend routine measurement of TPMT activity before prescribing these drugs. Another approach is to start the drugs, monitor blood counts, and stopping the drug if blood counts fall. Researchers reviewed 55 published studies to examine the sensitivity and specificity of TPMT genotyping for several purposes: measuring TPMT enzymatic activity; reducing harm from thiopurine; and to determine the association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases. The researchers found insufficient evidence that TPMT pretesting guides appropriate prescribing or improves patient outcomes (such as by limiting toxicity) compared with routine blood count monitoring in patients receiving thiopurine therapy. The authors of this study and the author of an accompanying editorial call for more research about biological testing to preempt prescribing mediations with potentially harsh side-effects in particular patients.

Source:
Angela collom

American College of Physicians

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Main Category: Colorectal Cancer
Also Included In: Genetics;  Clinical Trials / Drug Trials;  GastroIntestinal / Gastroenterology
Article Date: 19 Jun 2011 – 2:00 PDT

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A compound that for about 60 years has been used as a drug against tapeworm infection is also apparently effective against colon cancer metastasis, as studies using mice have now shown. The compound silences a gene that triggers the formation of metastases in colon cancer. Professor Ulrike Stein (Experimental and Clinical Research Center, a joint cooperation between the Charite Medical Faculty and the Max Delbrück Center for Molecular Medicine, (MDC)) and her research group made this discovery in collaboration with Professor Robert H. Shoemaker of the National Cancer Institute (NCI) in Frederick, Maryland, USA (Journal of the National Cancer Institute, Vol. 103, No. 12, June 17, 2011)*. Plans are already underway with Professor Peter M. Schlag (Charite Comprehensive Cancer Center) to conduct a clinical trial.

Colon cancer is one of the most common tumor diseases in Western countries. In Germany alone, there are approximated 73 000 new cases of the disease every year. Despite surgery, chemotherapy and radiation therapy, only about half of the affected patients are cured.

The reason is that around 20 percent of the colon cancer patients already have metastases at diagnosis and in about one third of the patients, metastasis occurs despite successful initial treatment. Of these patients with metastatic colon cancer, the five-year survival rate is only about 10 percent. By contrast, for nonmetastatic colon cancer patients the survival rate is 90 percent.

Scientists have known for several years that the gene S100A4/metastasin can initiate colon cancer metastasis. Five years ago Professor Stein, working together with Professor Schlag and Professor Walter Birchmeier (MDC), showed how this gene is regulated. They found that the beta-catenin gene, when mutant, activates this S100A4/metastasin gene, thus triggering colon cancer metastasis. Beta-catenin normally regulates cellular adhesion.

The scientists looked for compounds that block the expression of the metastasin gene. They screened 1280 compounds and found what they were looking for: niclosamide, a drug until now approved for use to treat intestinal parasite infections from tapeworms.

Surprisingly, the researchers discovered that niclosamide inhibits the beta catenin-driven expression of the S100A4/metastasin gene, both in the cell culture and in mice. The animals had fewer metastases. Next, the researchers want to conduct clinical trials to find out whether the compound is also effective in patients with metastasizing colon cancer.

*Novel Effect of Antihelminthic Niclosamide on S100A4-Mediated Metastatic Progression in Colon Cancer Ulrike Sack, Wolfgang Walther, Dominic Scuiero, Mike Selby, Dennis Kobelt, Margit Lemm, Iduna Fichtner, Peter M. Schlag, Robert H. Shoemaker, Ulrike Stein.

Source:
Barbara Bachtler

Helmholtz Association of German Research Centres

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Main Category: Colorectal Cancer
Also Included In: GastroIntestinal / Gastroenterology;  Cancer / Oncology
Article Date: 17 Jun 2011 – 9:00 PDT

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Results from a nationwide research poll released today by the Colon Cancer Alliance and Quest Diagnostics (NYSE: DGX) show that 31 percent of men and women age 50 years and over have never been screened for colon cancer by standard screening methods such as a colonoscopy, fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT). The poll also shows that among men and women age 50 and older who have not been screened for colon cancer, more than 1 in 4 (28 percent) said their healthcare provider, such as a doctor or nurse, did not recommend they be screened.

Among those age 50 and older who have not been screened for colon cancer, the top reasons they were not screened were (respondents were asked to select options that applied):

– 28 percent — healthcare provider, such a doctor or nurse, didn’t recommend I get screened

– 18 percent — too busy or time constraints

– 16 percent — fear

– 16 percent — didn’t know I needed to be screened

– 15 percent — can’t afford the health insurance co-payment

– 10 percent — no insurance

– 9 percent — modesty or embarrassment

American Cancer Society guidelines recommend that men and women of average risk for developing colon cancer begin screening at age 50 by colonoscopy or other tests. The Colon Cancer Alliance and Quest Diagnostics’ survey supports earlier research that a large percentage of men and women age 50 and older are not adhering to the screening guidelines. In addition, among the 69 percent who reported in the survey that they have been screened for colon cancer, 87 percent said they have been screened with a colonoscopy.

“Our survey suggests that while more men and women of screening age are being tested than in the past, a significant screening gap remains,” said Andrew Spiegel, CEO of the Colon Cancer Alliance. “Health care professionals have a tremendous opportunity to educate patients about screening options.”

DNA blood tests for aiding the detection of colon cancer have recently been introduced in the U.S., although they have yet to be reviewed for inclusion in medical guidelines. When respondents were polled on their attitudes about a blood test, 78 percent said they were likely to take a blood test for colon cancer screening compared to 18 percent who said they were unlikely to take a blood test and 4 percent who didn’t know. Three out of four people (75 percent) said they were more likely to get screened more frequently for colon cancer if a blood test were available.

“With technological advances, physicians and patients have a range of options to choose from for colon cancer screening, from colonoscopy to FITs. But as options increase, so does the risk that patients will be confused about how, when and under which circumstances to be screened,” said Dr. Jon R. Cohen, senior vice president and chief medical officer, Quest Diagnostics. “It is vital that physicians engage their patients in a dialogue about their options and help them resolve the fears or misinformation that prevents testing.”

When those who said they had never been screened due to fear were asked the specific source of their fear, the number one reason cited (61 percent) was having to undergo unpleasant bowel preparation (including laxatives and fasting). Some tests, most notably a colonoscopy, involve bowel preparation, but others, such as FITs, do not. Other reasons were: afraid of test results (36 percent), side effects, such as pain discomfort and gas (35 percent), afraid of medical tests (28 percent) and fear of being sedated by anesthesia (17 percent).

Colon cancer is the second leading cause of cancer death in the United States, but is often treatable when caught in early stages. Sixty percent of colon cancer deaths could be prevented if people were screened as indicated by guidelines, according to the U.S. Centers for Disease Control and Prevention.

Polling Methodology

The Colon Cancer Alliance and Quest Diagnostics engaged national survey firm ORC International, an infoGroup company, to conduct a national probability phone study among 1,304 men and women 50 years of age and over to gauge their level of awareness about colon cancer screening, adherence to American Cancer Society guidelines and barriers to screening. A total of 614 men and 690 women were surveyed in May 2011. The survey was funded through an educational grant from Quest Diagnostics.

Source:

Colon Cancer Alliance

Quest Diagnostics

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
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