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PubMed2002

Spit tobacco prevention and cessation counseling: statewide survey of health-care professionals and educators.

The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment, etc.). Our findings have implications for community-based efforts aimed at controlling ST use among young people.

Adolescent↗
PubMedDate not supplied

NADPH oxidases in the gastrointestinal tract: a potential role of Nox1 in innate immune response and carcinogenesis.

The gastrointestinal epithelium functions as physical and innate immune barriers against commensal or pathogenic microbes. NADPH oxidase 1 (Nox1) and dual oxidase 2 (Duox2), highly expressed in the colon, are suggested to play a potential role in host defense. Guinea-pig gastric pit cells and human colonic epithelial cells (T84 cells) express Nox1. With regard to activation of Nox1, the gastric epithelial cells are primed with Helicobacter pylori lipopolysaccharide, whereas T84 cells preferentially use the Toll-like receptor (TLR) 5, rather than TLR4, against Salmonella enteritidis infection. Thus, gastric and colonic epithelial cells may use different TLR members to discern pathogenicities among bacteria, depending on their environments and to activate Nox1 appropriately for host defense. Nox1-derived reactive oxygen species (ROS) have been implicated in the pathogenesis of inflammation-associated tumor development. The human stomach does not express Nox1. Helicobacter pylori infection alone does not induce it, whereas Nox1 is specifically expressed in gastric adenocarcinomas. In the human colon, Nox1 is differentiation-dependently expressed, and its expression is upregulated in adenomas and well-differentiated adenocarcinomas. Although Nox1 expression may not be directly linked to mitogenic activity, Nox1-derived ROS may exert a cancer-promoting effect by increasing resistance to programmed cell death of tumor cells.

Animals↗
PubMed2004

Molecular analysis of GISTs: evaluation of sequencing and dHPLC.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and are characterized by mutations in the proto-oncogene KIT (c-kit). To date, the detection of genomic alterations of the c-kit gene has been based mostly on direct sequencing. However, sequencing is an expensive and time-consuming approach. Since the technology of WAVE DNA Fragment Analysis System (Transgenomic, Inc., Worcester, MA) (dHPLC) is available in our laboratory, we decided to evaluate its use. Sixteen patients with small/large intestine, stomach tumors were included in the study. Immunohistochemical evaluation was performed on formalin-fixed, paraffin-embedded specimens with the polyclonal antibody CD117 for the KIT protein. After DNA extraction and isolation from paraffin-embedded sections, a nested PCR approach was applied to amplify sequences of exon 11 of the c-kit gene. dHPLC and the ABI Prism 310 Genetic Analyzer (Applied Biosystems, Bedford, MA) were used respectively for screening and identification of genomic alterations. Immunohistochemical analysis revealed strong and diffuse KIT expression in each of the 16 paraffin-embedded sections examined. dHPLC analysis in two temperatures showed the presence of genomic alterations in 8 out of 16 (50%) samples examined. Subsequently, sequence analysis of exon 11 in those samples revealed c-kit alterations in only 8 out of 16 (50%) samples. These were five deletions, one of which was an in-frame deletion one-point mutation and one insertion. Furthermore, the sensitivity of both methods was compared by using different mixtures of a wild-type and a sample with a deletion in exon 11. dHPLC was shown to be able to detect genomic alterations in all four different sample mixtures, whereas with sequence analysis genomic alterations were detected only in the 1:2 and 1:4 sample mixtures. In conclusion, we showed that dHPLC is an efficient and accurate, as well as a more sensitive, method for screening of genomic alterations in exon 11 of the c-kit gene, compared to sequence analysis.

Aged↗
PubMed1995

Endoscopic biopsies and cytologic brushings of the esophagus are diagnostically complementary.

It is traditionally taught that concurrently obtained endoscopic tissue biopsies and cytologic brushings from the esophagus are diagnostically complementary. This contention is supported mostly by studies that involve only a small subset of patients (ie, those clinically thought to have an upper gastrointestinal neoplasm). Only a few investigations have examined the role of these paired specimens in the general patient population. Two hundred twenty-two consecutive esophageal biopsies and brushings obtained during the same endoscopic session were retrospectively reviewed. The same or a similar diagnosis was made for both specimen types in 166 (74.8%) of the specimen pairs. Among these pairs with diagnostic agreement, the most frequent diagnosis included Barrett's metaplasia (46), Candida esophagitis (37), and morphologically nonspecific inflammation (47). Nine squamous cell carcinomas and six adenocarcinomas were also detected in this subset. Diagnostic differences existed among 56 (25.2%) of the pairs. The most common diagnosis in this subset was Candida esophagitis. This fungus was present in 27 brushings, but not in the concurrently obtained biopsies. Two squamous cell carcinomas and one adenocarcinoma were diagnosed by cytology but not by biopsy. One squamous cell carcinoma was found only in the biopsy specimen. In the esophagus, brushings and biopsies are truly complementary for the detection of both neoplastic and inflammatory conditions.

Adenocarcinoma↗
PubMed2000

Extranodal lymphomas.

Explore the source record for details and available documents.

Central Nervous System Neoplasms↗
PubMed2006

Clinical outcome in gastrointestinal stromal tumor patients who interrupted imatinib after achieving stable disease or better response.

BACKGROUND: Imatinib has been found to be effective in the treatment of patients with gastrointestinal stromal tumors (GIST). We sought to evaluate the clinical outcome of imatinib interruption in GIST patients who had achieved stable disease (SD) or showed better response to imatinib therapy. METHODS: From July 2001 to December 2004, we prospectively collected clinical data from 62 consecutive patients with advanced GIST, of whom 58 (93.5%) achieved SD or better response to imatinib therapy and were included in this study. Imatinib therapy was interrupted in 14 of the 58 patients (interruption group, INT), after a median time of 11.9 months. Progression-free survival (PFS) after imatinib interruption was calculated and imatinib-refractory PFS and overall survival (OS) were compared between the INT group and the 44 patients who continued imatinib treatment (continuation group, CONT). RESULTS: After a median follow-up of 17.9 months following imatinib interruption, nine patients (64%) had progressive disease (PD) with a median PFS from the date of imatinib interruption of 10.0 months. Median PFS dated from the time of imatinib initiation in the INT group was 21.8 months (95% CI, 17.3-26.3 months), but was not reached in the CONT group (P=0.029). Following imatinib reintroduction in the INT group, 88% of patients achieved disease control. There were no statistically significant differences in imatinib-refractory PFS (P=0.405) and OS (P=0.498) between the groups. CONCLUSION: In GIST patients controlled with imatinib, treatment might be interrupted, at least temporarily, when clinically warranted.

Adult↗
PubMed1999

Surgical intervention and understanding of diseases of the stomach and duodenum.

The stomach and duodenum are organs of complex physiology and cell biology. Neoplastic disease of these organs represents a difficult surgical challenge, and gastric and duodenal cancer mortality rates remain high despite advances in surgical technique, perioperative care, and adjuvant therapy. True "cures" elude the surgeon all too often. Fortunately, our understanding of the genetics and molecular biology of upper gastrointestinal neoplasms is increasing and is now significantly affecting the clinical management of these tumors as surgical therapies continue to improve. The care of benign disease of the stomach and duodenum is also evolving as medical therapy and surgical technology improve to lessen the morbidity associated with peptic ulcer disease and other benign conditions. The event that may have the greatest effect on surgical intervention in peptic ulcer disease is the Centers for Disease Control and Prevention launching of an educational campaign to promote treatment of Helicobacter pylori. This article reviews the most significant advances published in the past year on surgical intervention of the stomach and duodenum.

Journal Article↗
PubMed2001

Adjuvant therapy for noncolorectal cancers.

Cancers of the esophagus, stomach, and pancreas account for 11% of American cancer deaths and have a high case fatality rate. For esophageal cancer, the superiority of chemoradiotherapy rather than radiotherapy alone as a nonsurgical management was reaffirmed by a large pattern-of-care study in the United States. The study of preoperative chemoradiotherapy followed by surgery continues, with the investigation of newer chemotherapeutic agents combined with radiotherapy in an attempt to improve the therapeutic index of therapy. Trials attempting to intensify chemoradiotherapy treatments have included the addition of postoperative chemotherapy, the addition of brachytherapy, and the escalation of radiotherapy dose above the standard dose of 50.4 Gy. Neither brachytherapy nor an increase in external beam radiotherapy dose has been proven to improve local tumor control or patient survival. Adjuvant chemotherapy alone may have an impact on patient survival in one preliminary report, despite the results of earlier trials that failed to show a benefit for adjuvant chemotherapy alone. In the adjuvant treatment of gastric cancer, a meta-analysis of adjuvant chemotherapy trials suggested a survival benefit for adjuvant chemotherapy compared with surgery alone; however, preliminary reports of two large adjuvant chemotherapy trials using cisplatin-based chemotherapy failed to improve survival compared with surgery alone. The large Intergroup Trial 116, comparing surgery alone to surgery followed by postoperative fluorouracil, leucovorin, and radiotherapy, indicated a significant survival benefit for postoperative chemoradiotherapy. Postoperative chemoradiotherapy is the new standard of care for high-risk resected gastric cancer. Ongoing and future trials will address the inclusion of newer chemotherapeutic agents, the use of preoperative chemotherapy and radiotherapy, and the use of intraperitoneal therapy. In the adjuvant treatment of pancreatic cancer, clinical trials continue to evaluate the role of fluorouracil and radiotherapy, the use of preoperative chemoradiotherapy, and the incorporation of new therapeutic agents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Carcinoma of the ampulla of Vater presenting as acute pancreatitis.

The presentation of ampullary carcinoma as acute pancreatitis has been documented only in scattered reports but may be more common than is generally appreciated. More typically this uncommon gastrointestinal neoplasm presents with obstructive jaundice, weight loss, anorexia, and nonspecific abdominal pain. A case of ampullary carcinoma is presented in which the clinical features and computed tomographic appearance were those of relapsing, acute pancreatitis. Only after various clinical and radiographic features indicated on ampullary lesion was the etiology of the pancreatitis finally established and a curative resection performed.

Adenocarcinoma↗
PubMedDate not supplied

Extrapelvic and extraperitoneal spread of recurrent stomach cancer: two case reports.

We report two cases of unusual combined extrapelvic and extraperitoneal extension of recurrent gastric adenocarcinoma and describe the imaging findings of the preferential anatomic pathway of disease spread. Extrapelvic and extraperitoneal extension of recurrent gastric adenocarcinoma is rare, and its symptoms may be vague and nonspecific. If patients with a surgical history of gastrointestinal neoplasm present with diffuse abdominal pain or painful swelling of the lower extremities, disease spread to the extrapelvic and extraperitoneal spaces should be suspected.

Adenocarcinoma↗
PubMed1984

Cancer cellulitis.

We have described a case of inflammatory carcinoma involving the skin of the inguinal region in a man with rectal carcinoma. This type of metastatic lesion is most often associated with carcinoma of the breast, but may also be a manifestation of lung, pancreatic, or gastrointestinal neoplasms. The diagnosis should be suspected when a patient with cellulitis is afebrile and has a normal white blood cell count. An additional clue is that the leading edge of the cellulitis may be raised as in erysipelas. Empiric antibiotic treatment is recommended until the diagnosis is confirmed by punch biopsy and the culture results are known.

Aged↗
PubMed1993

Recurrence of rectal carcinoma in the mediastinum.

Mediastinal metastases arising from a primary gastrointestinal neoplasm usually follow extensive subdiaphragmatic spread. However, we have reported the rare recurrence of rectal carcinoma in the mediastinum. In addition to emphasizing the systemic metastatic spread of rectal carcinoma, this case demonstrates the need to consider metastases arising from abdominal tumors as a cause of mediastinal masses.

Adenocarcinoma↗