Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder. Methods: The annual equivalent costs and consequences of a biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99-400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05)

Background and purpose: Despite numerous randomized trials investigating radiotherapy (RT) fractionation schedules for painful bone metastases, there are very few data on RT for bone metastases causing pain with a neuropathic component. The Trans-Tasman Radiation Oncology Group undertook a randomized trial comparing the efficacy of a single 8 Gy (8/1) with 20 Gy in 5 fractions (20/5) for this type of pain. Materials and methods: Eligible patients had radiological evidence of bone metastases from a known malignancy with no change in systemic therapy within 6 weeks before or anticipated within 4 weeks after RT, no other metastases along the distribution of the neuropathic pain and no clinical or radiological evidence of cord/cauda equina compression. All patients gave written informed consent. Primary endpoints were pain response within 2 months of commencement of RT and time to treatment failure (TTF). The hypothesis was that 8/1 is at least as effective as 20/5 and the planned sample size was 270 patients. Results: Between February 1996 and December 2002, 272 patients were randomized (8/1:20/5 = 137:135) from 15 centres (Australia 11, New Zealand 3, UK 1). The commonest primary cancers were lung (31%), prostate (29%) and breast (8%); index sites were spine (89%), rib (9%), other (2%); 72% of patients were males and the median age was 67 (range 2989). The median overall survival (95% CI) for all randomized patients was 4.8 mo (4.2-5.7 mo). The intention-to-treat overall response rates (95% Cl) for 8/1 vs 20/5 were 53% (45-62%) vs 61% (53-70%), P = 0.18. Corresponding figures for complete response were 26% (18-34%) vs 27% (19-35%), P = 0.89. The estimated median TTFs (95% CI) were 2.4 mo (2.0-3.3 mo) vs 3.7 mo (3.1-5.9 mo) respectively. The hazard ratio (95% Cl) for the comparison of TTF curves was 1.35 (0.99-1.85), log-rank P = 0.056. There were no statistically significant differences in the rates of re-treatment, cord compression or pathological fracture by arm. Conclusions: 8/1 was not shown to be as effective as 20/5, nor was it statistically significantly worse. Outcomes were generally poorer for 8/1, although the quantitative differences were relatively small. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Parapsychology on the couch: The psychology of occult belief in Germany, c. 1870-1939

This article considers the attempts of academic psychologists and critical occultists in Germany during the late nineteenth and early twentieth centuries to construct a psychology of occult belief. While they claimed that the purpose of this new subdiscipline was to help evaluate the work of occult researchers, the emergence of a psychology of occult belief in Germany served primarily to pathologize parapsychology and its practitioners. Not to be outdone, however, parapsychologists argued that their adversaries suffered from a morbid inability to accept the reality of the paranormal. Unable to resolve through experimental means the dispute over who should be allowed to mold the public's understanding of the occult, both sides resorted to defaming their opponent. (c) 2006 Wiley Periodicals, Inc.

Whole brain irradiation following surgery or radiosurgery for solitary brain metastases: Mature results of a prematurely closed randomized Trans-Tasman Radiation Oncology Group trial (TROG 98.05)

We evaluated the effect of adjuvant whole brain irradiation (WBI) after surgery or radiosurgery for solitary brain metastases in a Phase III multicentre trial with randomization to 30-36 Gy WBI or observation. The study was closed early due to slow accrual after 19 patients (WBI 10, observation 9). There was no difference in CNS failure-free survival or overall survival between the arms. There was a trend to reduced CNS relapse with WBI (30% versus 78%, P = 0.12). Limited analysis of quality of life and neurocognitive function data revealed no evidence of difference between the arms. Our results are not inconsistent with two larger randomized trials and support the use of upfront WBI to decrease brain recurrence in this setting. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

‘Why are there always three?’: The Gothic Occult in Dario Argento’s Three Mothers Trilogy

Thomas De Quincey’s essay ‘Levana and Our Ladies of Sorrow’ provided Dario Argento with the spark of an idea, which was further ignited by tales from his then wife, Daria Nicolodi, who told him of her grandmother’s stay at a music school which was run by a coven of witches. From these sources Argento came up with the mythology of The Three Mothers, which were to feature in three of his films: Suspiria (1977), Inferno (1980) and La terza madre/The Mother of Tears (2007). This article will examine the occult and esoteric sources of The Three Mothers trilogy, and explore how these references work to create a series of films that may superficially appear to use the supernatural and occult to create scares, but actually incorporate elements of Western Esotericism rather than traditional Christian images of evil. By doing this, these films transcend their apparent flaws (in terms of shallow plot and character development, a common complaint directed toward many Italian horror films) and instead imbue the mise-enscene itself with meaning, character and narrative. Although the films are situated within the Gothic genre, and in many respects follow traditional Gothic lines with witchcraft and the occult becoming synonymous with evil, I will argue that the films actually belong to the long tradition of art forms that have attempted to investigate the allure and the danger of occult exploration.

Delayed and occult splenic rupture: a diagnostic puzzle

Splenic rupture is a common complaint encountered in emergency surgery. Trauma is the most common cause of splenic rupture, while non-traumatic or occult splenic rupture (OSR) is a rare condition. The differential diagnosis weighs on treatment that ranges between close monitoring, splenorrhaphy, splenic conservation and splenectomy. We report a case of an 63-year-old man presenting with acute atraumatic left upper quadrant pain. Preliminary diagnosis was subsequently determined to be a hematoma secondary to OSR. More accurate detailed history revealed a previous trauma, which occurred more than one year before and mimicked an OSR. Delayed and occult splenic rupture are as different diagnosis as different treatment. Even in emergency surgery, the key for a target therapeutic strategy should consider an accurate diagnostic time.

Safe lipid nanocapsule-based gel technology to target lymph nodes and combat mediastinal metastases from an orthotopic non-small-cell lung cancer model in SCID-CB17 mice

International audience

Differentiated thyroid cancer with liver metastases: lessons learned from managing a series of 14 patients

International audience

Molecular and serological detection of occult hepatitis B virus among healthy hepatitis B surface antigen-negative blood donors in Malaysia.

Background: Occult hepatitis B infections are becoming a major global threat, but the available data on its prevalence in various parts of the world are often divergent. Objective: This study aimed to detect occult hepatitis B virus in hepatitis B surface antigen-negative serum using anti-HBc as a marker of previous infection. Patient and Methods: A total of 1000 randomly selected hepatitis B surface antigen-negative sera from blood donors were tested for hepatitis B core antibody and hepatitis B surface antibody using an ELISA and nested polymerase chain reaction was done using primers specific to the surface gene (S-gene). Results: Of the 1000 samples 55 (5.5%) were found to be reactive, of which 87.3% (48/55) were positive for hepatitis B surface antibody, indicating immunity as a result of previous infection however, that does not exclude active infection with escaped mutant HBV. Nested PCR results showed the presence of hepatitis B viral DNA in all the 55 samples that were positive for core protein, which is in agreement with the hepatitis B surface antibody result. Conclusion: This study reveals the 5.5% prevalence of occult hepatitis B among Malaysian blood donors as well as the reliability of using hepatitis B core antibody in screening for occult hepatitis B infection in low endemic, low socioeconomic settings.

Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma

Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.

In vitro characterization of the three-dimensional strain pattern in human vertebrae affected by metastases

La colonna vertebrale è la principale sede di metastasi, le quali possono alterare la normale distribuzione dei tessuti ossei e ridurre la capacità della vertebra di sostenere carichi. L’instabilità spinale causata dalle metastasi, tuttavia, è di difficile determinazione. La caratterizzazione meccanica delle vertebre metastatiche permetterebbe di identificare e, di conseguenza trattare, quelle ad alto rischio di frattura. In questo studio, ho valutato il comportamento meccanico a rottura di vertebre umane affette da metastasi misurando in vitro il campo di deformazione. Undici provini, costituiti da due vertebre centrali, una metastatica e una sana, sono stati preparati e scansionati applicando carichi graduali di compressione in una micro-tomografia computerizzata (μCT). Le deformazioni principali sono state misurate attraverso un algoritmo globale di Digital Volume Correlation (DVC) e successivamente sono state analizzate. Lo studio ha rivelato che le vertebre con metastasi litiche raggiungono deformazioni maggiori delle vertebre sane. Invece, le metastasi miste non assicurano un comportamento univoco in quanto combinano gli effetti antagonisti delle lesioni litiche e blastiche. Dunque la valutazione è stata estesa a possibili correlazioni tra il campo di deformazione e la microstruttura della vertebra. L'analisi ha identificato le regioni in cui parte la frattura (a più alta deformazione), senza identificare, in termini microstrutturali, una zona preferenziale di rottura a priori. Infatti, alcune zone con un pattern trabecolare denso, presunte più rigide, hanno mostrato deformazioni maggiori di quelle dei tessuti sani, sottolineando l’importanza della valutazione della qualità del tessuto osseo. Questi risultati, generalizzati su un campione più ampio, potrebbero essere utilizzati per implementare nuovi criteri negli attuali sistemi di valutazione dell'instabilità spinale.