4/30/2005 St. Simons Island, Ga. Kim J. Masters, M.D. Am J Psychiatry 162:1023, May 2005 Letter to the editor: Dry mouth (xerostomia) is a frequent complication of psychoactive medications with antimuscarinic and anticholinergic side effects. The lack of saliva is annoying to patients, impairs their ability to masticate and digest food, and is a potential source of dental morbidity, including increased risk for caries and oral infection. Pilocarpine is a cholinergic muscarinic agonist. It has been used to treat xerostomia induced in cancer patients by head and neck radiotherapy (1). It has recently been found to be effective in doses of 20 mg/day in a randomized, placebo-controlled dose-adjustment study in the treatment of dry mouth and dry eyes in patients with Sjogren’s syndrome (2). It has been used to treat dry mouth as a complication of opioid treatment (3). Toxicity has been infrequently reported (4). However, it is contraindicated in patients with angle-closure glaucoma. We have empirically used pilocarpine in doses of 10–30 mg/day, divided into dosing of two or three times a day. We have used it with our acute psychiatric inpatients, ages 20–69, who complained of dry mouth after they had been started on psychoactive medication. These included atypical antipsychotic agents, particularly clozapine and olanzapine; anticholinergic agents, primarily benztropine; and antidepressants, particularly tricyclic antidepressants and mirtazapine. Substantial relief of dry mouth was achieved in most patients. Side effects were mainly sweating and increased urination. We did not observe any adverse impact on psychiatric symptoms. The patients were generally [...]

4/30/2005 Schmieder AH et al. Magnetic Resonance in Medicine, 2005;53:621-627. as reported by Medical News Today (www.medicalnewstoday.com) Specially designed nanoparticles can reveal tiny cancerous tumors that are invisible by ordinary means of detection, according to a study by researchers at Washington University School of Medicine in St. Louis. The researchers demonstrated that very small human melanoma tumors growing in mice-indiscernible from the surrounding tissue by direct MRI scan-could be "lit up" and easily located as soon as 30 minutes after the mice were injected with the nanoparticles. Because nanoparticles can be engineered to carry a variety of substances, they also may be able to deliver cancer-fighting drugs to malignant tumors as effectively as they carry the imaging materials that spotlight cancerous growth. "One of the best advantages of the particles is that we designed them to detect tumors using the same MRI equipment that is in standard use for heart or brain scans," says senior author Gregory Lanza, M.D., Ph.D., associate professor of medicine. "We believe the technology is very close to being useful in a hospital setting." Lanza and his colleague Samuel Wickline, M.D., professor of medicine, are co-inventors of this nanoparticle technology. The effectiveness of the nanoparticles in diagnosis and therapy in humans will be tested in clinical trials in about one and a half to two years. The spherical nanoparticles are a few thousand times smaller than the dot above this "i," yet each can carry about 100,000 molecules of the metal used to provide contrast in [...]

4/30/2005 D. M. Tromp et al. Health Education Research, doi:10.1093/her/cyh031 Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors. Authors: D. M. Tromp 1, X. D. R. Brouha 2, G. J. Hordijk 2, J. A. M. Winnubst 1, W. A. Gebhardt 3, M. P. van der Doef 3, and J. R. J. De Leeuw 1 Authors Affiliations: 1 Julius Center for Health [...]

4/28/2005 Memphis, TN Hehr, T. et al. International Journal of Radiation Oncology, Biology and Physics. 2005; 61: 1423-1431 Reported by Cancer Consultants Oncology Resource Center (professional.cancerconsultants.com) Researchers from Germany have developed a tolerable regimen of alternated docetaxel (Taxotere®)-cisplatin (Platinol®) for the re-treatment of patients with recurrent head and neck cancer. The details of this report appeared in the April 1, 2005 issue of the International Journal of Radiation Oncology, Biology and Physics . Re-irradiation of patients who have failed radiation therapy for head and neck cancer can be associated with severe complications and high-doses can rarely be achieved. The study evaluated a regimen where chemotherapy was delivered on days 1-3 and radiation therapy on days 8-12 for a total of 3 cycles. Chemotherapy was Taxotere® and Platinol® and total radiation dose was 40 Gy. This trial included 27 patients with inoperable, recurrent head and neck cancer who had received prior radiation therapy. The overall response rate was 80%. The average time to cancer progression at or near the site of cancer was 10 months, the overall average duration of survival was 10 months, and survival at 3 years was 18%. Full doses of radiation therapy were delivered to 81% of patients, and between 73% and 83% of patients received full doses of the chemotherapy agents. The main side effects were leucopenia and mucositis. The researchers concluded that alternating chemotherapy and radiation therapy may improve tolerability of therapy in patients with recurrent head and neck cancer, potentially improving long-term outcomes in [...]

4/25/2005 as reported by www.pccoaltion.com Consumer Reports on Health Following the back and forth of medical news is enough to give you whiplash. Supplemental estrogen, portrayed in the media for decades as a veritable fountain of youth, ends up being anything but when definitive studies show it can increase the risk of breast cancer, heart attack, and stroke. Initially heralded as safer than existing drugs, the pain relievers rofecoxib (Vioxx) and celecoxib (Celebrex) make the front pages again when later studies show they increase heart-attack risk. After riding a long wave of good press, the reputation of the antidepressant paroxetine (Paxil) crashes amid reports that the drug may make some teenagers suicidal. Indeed, medical news often seems to follow an all-too-familiar pattern: New drugs or therapies are introduced with glowing reports, followed a few years later by headlines blaring their dangers. "That pattern leaves many people confused or even angry," says Steven Woloshin, M.D., a professor at the Dartmouth Medical School's Center for Evaluative Clinical Sciences. Some people react to that uncertainty by dismissing all medical news, while others overreact by adopting-or abandoning-medicines too soon. For example, in the 1990s many people stopped taking certain blood-pressure medications after a pair of studies linked them to increased heart-attack risk; subsequent research refuted that evidence, but only after some patients suffered adverse events because they stopped taking their medication. While some of the confusion stems from the natural unfolding of scientific knowledge, some comes from shortcomings in the way medical research is [...]

4/25/2005 Cuba Cubasi Cuba Travel Explorer TheraCIM h-R3, a humanized monoclonal antibody, received the certificate of first-category drug granted by the State Food and Drug Administration of China, for its production and commercialization in that Asian nation. According to Prensa Latina news agency, the drug is prescribed for the combined treatment of advanced head and neck epithelial cancer, of bad prognosis and resistant to the chemotherapy, explained PhD. Patricia Sierra, responsible on the Cuban side of this project. The h-R3 is a new type of drug obtained through biotechnology, with high effectiveness in the marking and specificity, and little side effect, that has been patented in other countries, including the United States. This drug will be produced and commercialized by Biotech Pharmaceutical, Chinese-Cuban Company constituted in 2000 by the CIMAB (representative of the Molecular Immunology Center) and three Chinese companies. Sierra, also general submanager of Biotech Pharmaceutical, pointed out that the industrial-scale cultivation of the recombinant antibody would kick off next September. To obtain that certificate, it was necessary to carry out clinical trials for more than one year with 120 patients affected by head and neck cancer in six hospitals of Beijing, capital of China, following strict protocols set for that aim. The studies wound up with very good results, with full response in 70% of the cases, without evidences of severe clinic toxicity, Prensa Latina assures in its note. That was the first time in which a humanized monoclonal antibody was subject to clinical test in China, country [...]

4/25/2005 Seattle, WA Bruce Taylor Seeman Seattle Times Chuck McDowell gave speeches. He sang with a band. But everything changed when his voice disappeared, leaving McDowell feeling frightened and isolated. "I was having to speak into an amplifier just to have a conversation at home," said the 46-year-old financial adviser from Duluth, Ga. "If I was in a restaurant, I could not be heard unless I put my amplifier on the table and turned it up." Eventually, McDowell had a growth removed from his vocal cords, a procedure he now jokingly recalls as easier than some haircuts. But in the 18 months it took to summon the courage for surgery, he experienced the unsettling questions familiar to nearly everyone at least once in a lifetime: Where did my voice go? How do I get it back? Experts believe that at any given time, more than 7 million Americans suffer from voice disorders, and that number is likely to grow. Longer lives may result in more voices muted by age-related fatigue. Meanwhile, the modern era — with so many service-sector jobs such as sales, and so much yapping on cellphones — is a recipe for voice strain. "Some people have a hypothesis, that the cellphone is the vocal endurance test for the new millennium," said voice-disorder specialist Dr. Michael Johns, director of the Emory Voice Center of Emory University in Atlanta. The key to effective voice production is healthy vocal cords, which experts call vocal folds. They lie horizontally in the [...]

4/25/2005 Lagos, Nigeria AI Ladehinde et al. Niger Postgrad Med J, March 1, 2005; 12(1): 18-22 Aims: This article reviews the present body of knowledge regarding the principle, transfer techniques, therapeutic strategies, clinical applications and limitations of gene therapy in the management of oral squamous cell carcinoma. Materials and Methods: Scientific publications on gene therapy between 1990 and 2003 were selected for the purpose of the review. These include clinical articles, experimental studies and review articles. Results: Viruses are the commonly used transfer system for the delivery of gene therapy. The viral vectors commonly used are: retroviruses, adenoviruses, herpesviruses, and adenoassociated viruses (AAV). Transfection of cancer cells in vivo with gene therapy is done by intralesional injection, and sometimes by topical application. Phase I and II clinical trials have established the safety and clinical efficacy of gene therapy in the treatment of oral squamous cell carcinomas in humans, especially in combination with chemotherapy or radiotherapy. Phase III clinical trials and studies of the use of gene therapy as an adjuvant following surgery are presently underway. Conclusions: Gene therapy represents a new and innovative approach to the treatment of oral cancer especially in recurrent disease and adjuvant treatment. Oral squamous cell carcinoma is especially an attractive tumour target due to its frequent genetic mutations and accessibility for intra-tumoural administration of gene therapy. However, gene therapy has not yet been shown to be suitable for systemic delivery in cancer patients, hence the control of regional and metastasis is presently difficult. Authors: AI [...]

4/25/2005 Bethesda, MD Cheryl A. Thompson Am. J. Health Syst. Pharm. 2005; 62(9): p. 890-894 While September 30, 2004, may be remembered as the day that clinicians and patients started reconsidering the available pain relievers, the negative news about rofecoxib sent a shock wave through the world of preventive oncology. December 17 brought bad news about celecoxib. Researchers had been exploring the potential of long-term therapy with rofecoxib or celecoxib, both cyclooxygenase-2 (COX-2) inhibitors, to reduce the risk of colorectal cancer. What the researchers found first was that the drugs apparently increased users’ risk for myocardial infarction, ischemic stroke, and other cardiovascular events. The ability of COX-2 inhibitors to obstruct the activity of the inflammation-promoting enzyme and also interfere with inflammatory mediators such as interleukin-1 and nuclear factor kappa B had made that type of drug a potential chemopreventive for cancer, according to Ernest T. Hawk of the National Cancer Institute (NCI). Buttressing this line of research was evidence that an excess of COX-2 played a role in the invasive and earlier stages of cancer at a large number of sites in the body, he explained. Hawk is a member of the steering committee for the NCI-sponsored Adenoma Prevention with Celecoxib study, which stopped administering the drug in December 2004 after an independent committee discovered an increased cardiovascular risk among drug recipients. He and an epidemiologist discussed the future for COX-2 inhibitors in cancer prevention at the American Society of Preventive Oncology annual meeting in San Francisco, held March 13–15. [...]

4/25/2005 T Minamikawa, M Umeda, and T Komori Oral Surg Oral Med Oral Pathol Oral Radiol Endod, May 1, 2005; 99(5): 532-8 Objectives: Although sentinel lymph node biopsy (SLNB) may reduce surgery-related complications related to unnecessary lymph node dissection and is now widely used for many patients with cutaneous melanoma and breast cancer, its use for oral cancer patients remains controversial. One of the main reasons for the reluctance to initiate SLNB for oral cancer is that the frequency of skip metastasis has not been clarified. The objectives of this study are to examine the frequency of skip metastasis and to evaluate SLNB for oral cancer. Study design: To shed light on these concerns, we first conducted a retrospective study of 296 patients with squamous cell carcinoma of the oral cavity who underwent neck dissection. Next, the accuracy of lymph node biopsy with and without detecting sentinel lymph node was examined. Results: Ten patients showed skip neck metastasis in the level III-V region without level I-II involvement. Of these patients, 7 underwent neck dissection when their initially N0 neck progressed to N+, 2 underwent neck dissection when local recurrence occurred, and only 1 underwent surgery as an initial therapy. Most patients who underwent neck dissection as the initial therapy showed skip metastasis. Intraoperative lymph node biopsy without any attempt to detect sentinel lymph nodes by means of blue dye or lymphoscintigraphy was performed on 68 patients with oral cancer. Sixty-one (90%) were diagnosed correctly, whereas 7 diagnosed as N- actually [...]