OBJECTIVE: To introduce and monitor a screening programme for first degree relatives of patients with colorectal cancer based on their calculated lifetime risk. DESIGN: Lifetime risks were calculated for first degree relatives of patients with colorectal cancer and used to offer screening based on estimated risk. SETTING: A family cancer clinic was set up as part of the North East Thames Regional Genetic Service for relatives of patients who had developed colorectal cancer before the age of 45 and members of families in which multiple cancer had occurred. PATIENTS: Self referrals as well as patients referred by general and hospital practitioners. INTERVENTION: Relatives with a lifetime risk of 1 in 10 or greater (high risk group) were offered screening five yearly by colonoscopy, and those whose risk was between 1 in 10 and 1 in 17 were offered yearly screening for faecal occult blood. Women with family histories compatible with Lynch type II cancer family syndrome were offered screening for breast and pelvic tumours. RESULTS: In four years 715 patients were seen. Acceptance of screening was 90% (644 patients). Of 151 patients screened for faecal occult blood, two were found to have polyps. This screening test was unsatisfactory for the high risk group, having a negative predictive value of 78% in 59 patients tested. Regular screening by colonoscopy was offered to 382 high risk patients; 62 patients with polyps and five with colonic cancer were found. One hundred and ten pedigrees were identified with the Lynch type II cancer family syndrome, and four of 35 women screened were found to have breast cancer. Of 14 relatives aged over 65 with a 1 in 2 risk of site specific colonic cancer or Lynch type II cancer family syndrome, seven were found to have polyps, one of whom had carcinoma in situ. CONCLUSIONS: Family history can be used to identify those at risk of colonic cancer and to target appropriate screening. Colonoscopy detected a high number of premalignant colonic polyps, but faecal occult blood testing was unsatisfactory for those at high risk of colorectal cancer.

Adenomatous Polyposis Coli↗

PubMedDate not supplied

Risk of ovarian cancer and genetic relationship to other cancers in families.

The risk of ovarian and other cancers was assessed in first-degree relatives of patients with ovarian cancer from an analysis of 391 pedigrees. Overall there was a significant increase in the risk of ovarian cancer (4.5-fold; p < 0.001). The risks were 14.2- (p < 0.001), 5.2- (p < 0.001) and 3.7-fold (p < 0.001) for relatives of patients diagnosed before 45, between 45 and 54 and after the age of 55, respectively. There was no significant increase in the risk of cancers of the uterus, stomach, lung, colorectum or prostate. There was, however, an overall increase in the risk of breast cancer (1.3-fold; p < 0.05). The risk was highest for those relatives of patients diagnosed with ovarian cancer before the age of 55 (2.2-fold; p < 0.01). These results support the role of genetic factors in the aetiology of ovarian cancer and provide further evidence for the existence of a breast-ovarian family cancer syndrome, which may result from the pleiotropic effects of the same gene in some families.

Adolescent↗

PubMedDate not supplied

ACE matters.

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Aged↗

PubMedDate not supplied

Rather a daunting exercise in the care of elderly people.

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Geriatric Nursing↗

PubMedDate not supplied

Application of the MultiScreen system to cytokine radioreceptor assays.

Radioreceptor assays are becoming increasingly valuable in the biotechnology community for a variety of basic and applied research applications. It is clear, for example, that assessing the potential spectrum of biological activities of a novel polypeptide regulatory factor can be greatly simplified by the development of a rapid radioreceptor assay, since a wide variety of cell types can be screened using a single type of assay. By contrast, searching for potentially diverse biological effects can be an extremely time-consuming process. In addition, screening for agonists/antagonists for hormones using radioreceptor assays has a marked advantage compared with biological assays, in that compounds or natural products that are toxic to cells will not read out as false positives in a binding assay. Our laboratory has developed a major program centered on the molecular characterization of receptors for polypeptide hormones involved in immune regulation, including a number of cytokines/interleukins and also several colony stimulating factors. We have developed a variety of radioreceptor- and fluorescence-based assay systems for ligand-receptor interactions, with applications in basic characterization, purification, cDNA cloning, and drug development screens for cytokine receptors. In this report we compare two assay formats, a standard phthalate oil centrifugation method and a novel plate filtration system, using the interaction between interleukin-1 alpha and its receptor as a test system.

Animals↗

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Pediatric nurses' experience with nurse extender position.

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Allied Health Personnel↗

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Effect of supplemental oxygen on cardiopulmonary changes during gastrointestinal endoscopy.

This prospective study evaluated supplemental oxygen as an effective means of preventing hypoxemia and electrocardiographic changes in sedated patients undergoing endoscopic procedures. Ninety-five patients with documented ischemic heart disease and 106 patients without heart or lung disease were studied. Patients within each group received either supplemental oxygen (2 L/minute) via nasal cannula or room air. Hypoxemia (oxygen saturation below 90%) and ST-segment deviations occurred in cardiac and control groups. The combination of midazolam and meperidine significantly increased the risk for hypoxemia as compared to midazolam alone (44% versus 8%). Supplemental oxygen significantly decreased, but did not entirely prevent, hypoxemia in cardiac and control groups. The incidence of ST-segment deviation in cardiac patients who were hypoxic was significantly lower in the group receiving oxygen (p = .0015). Supplemental oxygen did not affect the incidence of arrhythmias. Prophylactic supplemental oxygen should be administered to patients with ischemic heart disease who undergo conscious sedation for upper and lower gastrointestinal endoscopic procedures.

Adult↗