An Experimental Drug Eases Poisonous Scorpion Stings in Children, a Study Finds

By RONI CARYN RABIN
Published: May 13, 2009

Scorpion stings rarely leave a trace, so when 10-year-old Michael Moerdler-Green woke up at 3 a.m. during a recent family trip to Phoenix, all he knew was that his leg hurt. But as the scorpion’s poison began to spread, his body started to tingle, his eyes rolled around in his head and his legs and arms began to flail.

At the emergency room of Phoenix Children’s Hospital, doctors offered Michael’s parents a choice of treatments: heavy sedation to quell the boy’s symptoms, or an experimental scorpion antivenom made in Mexico but not approved by the Food and Drug Administration for use in the United States.

The boy’s father, Dr. David Moerdler-Green, chose the antivenom. A new study suggests he made the right decision.


No other antivenom specifically for scorpion stings is available in the United States, and a small clinical trial of young children stung by bark scorpions has found that most of those given the investigational drug recovered within two hours, while children given a placebo had symptoms that lasted four hours or more and required heavy sedation and hospitalization.

The study is to be published on Thursday in The New England Journal of Medicine.

“It was like a miracle,” said Dr. Moerdler-Green, who is head of radiology at St. Barnabas Hospital in the Bronx. His son was able to leave the hospital just an hour after receiving the medication. “How many people go into the emergency room around the world and are able to get medication and be cured in the course of one hour?”

Dr. Leslie V. Boyer, principal investigator of the new study, said the trial, though small, demonstrated that the effects of bark scorpion venom could be quickly reversed.

“Using this antivenom in the emergency room will make intensive care treatment unnecessary for most patients,” said Dr. Boyer, who is director of a venom research institute at the University of Arizona College of Medicine in Tucson.

Although 8,000 Arizona residents are stung by poisonous scorpions each year, most adults recover without needing medical treatment. Each year about 200 young children, however, suffer severe neurotoxic symptoms, including trouble breathing, after being stung.

Wider use of the scorpion antivenom, called Anascorp, could make treatment much easier in rural areas and small towns in the state that do not have pediatric intensive care units and usually have to helicopter children to hospitals for care, Dr. Boyer said.

A professor at Arizona State University used to make her own scorpion antivenom. She retired in 1999, leaving behind her recipe and enough of the drug to last about five years. Ever since, the state has been using up its inventory.

In the new study, children from ages 6 months to 18 years who were admitted to a pediatric intensive care unit in Tucson after being stung by scorpions were randomly assigned to receive either Anascorp or a placebo. Eight received the antivenom, and seven received a placebo.

Within two hours, children who had received Anascorp recovered from most of their symptoms; within four hours, the children recovered completely, the researchers found. None of the children who received the drug had detectable levels of scorpion venom in their blood an hour after infusion.

By contrast, children who received the placebo treatment required sedation at levels 65 times higher than did the children who received antivenom. Symptoms persisted for more than four hours in all but one of the children receiving the placebo, the researchers found, and some were hospitalized for up to 48 hours.

--NYTimes--

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Hope of new prostate cancer test

Scientists have found a potential new way to assess whether prostate cancer is aggressive.
They have found tiny bubbles of fat in the urine may hold the key information needed to decide what type of treatment the patient needs.
If prostate cancer is aggressive it requires urgent treatment, but this is not appropriate for patients with slow-growing forms of the disease.
The study appears in Cancer Research UK's British Journal of Cancer.

"This approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future"

John Neate
Prostate Cancer Charity

Prostate cancer is the most common cancer in men in the UK.
Each year around 34,000 men are diagnosed with the disease, and around 10,000 die from it.

But while the disease can be a killer, in its more benign form it often requires nothing other than close monitoring and the patient often eventually dies from another, unrelated condition.
Until now, researchers have used levels of proteins, like prostate specific antigen (PSA), produced by cancer cells to try to spot the aggressive tumours.
But this can throw up inaccurate results, and lead to people unnecessarily undergoing treatment which can have long-term side effects, such as incontinence and impotence.

Direct from tumour

The latest work focused on fatty capsules called exosomes that are flushed out of the body in the urine.
Scientists found that in patients with prostate cancer exosomes contain molecules that come directly from the tumour itself.
These molecules, which contain a type of genetic material called RNA, can be used to figure out which genes are turned on and off in the cancer - and thus whether it is aggressive or not.
The researchers, led by Dr Jonas Nilsson, from the VU University Medical Centre in Amsterdam, hope the discovery will enable them eventually to develop a more effective test for aggressive tumours.
John Neate, of the Prostate Cancer Charity, said the study was a step towards finding a reliable way to identify aggressive forms of the disease.
But he warned it was a small study, and scientists would need to examine exosomes from a larger number of men before they could assess the reliability of the technique.

Acceptability?

He also said the need to massage the prostate to increase the likelihood that the relevant molecules were released into the urine might reduce its acceptability as a mass screening tool.
Mr Neate added: "Nevertheless, this approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future.
"Possibly the most significant research question in prostate cancer is how to distinguish early, and with confidence, the potentially life-threatening prostate tumours from the slow growing form of the disease.
"Then treatments could be refined and concentrated on the aggressive cancers where the benefits of treatment far outweigh the risk of side-effects, which can seriously affect a man's quality of life.

---BBC---

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WHO Avoids Assigning Severity Scale to H1N1 Flu

The World Health Organization (WHO) said today it is unable to assign a severity scale to the influenza A (H1N1) epidemic for the reason that disease characteristics and responses of countries vary.

Dr. Sylvie Briand, with the WHO Global Influenza Programme, spoke today at a media briefing in Geneva. As of 1:00 am EDT, 33 countries had reported 5728 confirmed cases of influenza A (H1N1) infection.

According to Dr. Briand, the WHO pandemic alert level phases are mainly based on the transmission of the virus and its geographical spread, while "the severity itself is assessed by other means." Currently, the pandemic alert level has remained at level 5 out of 6, indicating community-based outbreaks in a single WHO region.


The severity of a potential pandemic is based on 3 factors: "the [characteristics of the] virus, the vulnerability of the population, and the intervention we can put in place to reduce the impact of severe disease," Dr. Briand said.

Assessing severity is important for helping countries determine their response to an outbreak, but at a global level, a severity index is "not very helpful" because "severity will vary from place to place," she said.

Dr. Briand pointed out that while wealthier countries may have the resources to mount a more effective response to an outbreak, some developing parts of the world such as West Africa are already used to coping with epidemics and may be at an advantage due to having healthcare systems in place. This is referred to as the "resilience" of a country, she said.

Dr. Briand also emphasized that oseltamivir and zanamivir are effective against this novel H1N1 strain, which is in contrast to the seasonal influenza strain, which is resistant to these antiviral drugs.

News reports are circulating regarding a claim by an eminent Australian influenza researcher that human error may have been involved in creating this strain. Adrian Gibbs, 75, said in an interview that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs that scientists use to grow viruses and drugmakers use to make vaccines.

WHO spokesperson Gregory Hartl said the WHO is looking into evidence regarding these claims, but "it is way too soon to say anything." He added that the WHO's main task is to assess the current risk level and to "help member states to be prepared to respond."

The US Centers for Disease Control and Prevention (CDC) today is reporting 3009 laboratory-confirmed cases in 44 states and Washington, DC.

Yesterday the CDC issued a dispatch in the Morbidity and Mortality Weekly Report on novel influenza A (H1N1) virus infections in pregnant women. As of May 10, 20 probable or confirmed cases had been reported in pregnant women. Of the women, 3 have been hospitalized and 1 woman died.

The CDC is recommending that pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) virus infection should receive antiviral treatment for 5 days.

---MedScape--

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Human error behind H1N1? WHO probes

The World Health Organization is investigating a claim by an Australian researcher that the swine flu virus circling the globe may have been
created as a result of human error.

Adrian Gibbs, 75, who collaborated on research that led to the development of Tamiflu drug, said that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs scientists use to grow viruses and drugmakers use to make vaccines. Gibbs said he came to his conclusion as part of an effort to trace the virus’s origins by analyzing its genetic
blueprint.

“One of the simplest explanations is that it’s a laboratory escape,” Gibbs said on Wednesday. “But there are lots of others.”

The World health Organization received the study last weekend and is reviewing it, Keiji Fukuda, the agency’s assistant director-general of health security and environment, said in an interview on May 11.

Gibbs, who has studied germ evolution for four decades, is one of the first scientists to analyze the genetic makeup of the virus that was identified three weeks ago in Mexico and threatens to touch off the first flu pandemic since 1968.

---The Times of India---

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Influenza A(H1N1) - update 27

As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728 cases of influenza A(H1N1) infection.

Mexico has reported 2059 laboratory confirmed human cases of infection, including 56 deaths. The United States has reported 3009 laboratory confirmed human cases, including three deaths. Canada has reported 358 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68). WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.
---WHO---

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Cisplatin

Cisplatin is a chemotherapy drug that was approved by the Federal Drug Administration (FDA) in 1978 and is used to treat patients suffering from malignant pleural mesothelioma. Cisplatin is administered when surgical procedures are not an option, and it is often used in combination with other chemotherapy drugs, including Alimta. Manufactured by Bristol Myers Squibb, Cisplatin is also used to treat ovarian and lung cancer and is a highly effective method of mesothelioma treatment that is often recommended by oncologists.

Cisplatin is administered intravenously and may be given along with other drugs, such as anti-nausea medication and antibiotics that prevent buildup of Cisplatin within the kidneys. Your doctor will determine how often you receive Cisplatin and for how long, but patients who receive Cisplatin in tandem with Alimta will follow a 21-day treatment cycle.

Because Cisplatin was developed three decades ago, the side effects associated with this drug are often much more severe. Side effects include damage to the kidneys, (which is often prevented by administering other drugs, such as a diuretic or sodium polystyrene sulfonate, during Cisplatin treatment) serious nausea, depleted levels of calcium, potassium and other nutrients, loss of appetite, tiredness, hair loss, and an increased risk of infection. Because cancer treatment in general has become so advanced since Cisplatin was first developed, doctors are generally able to control the unpleasant side effects associated with Cisplatin treatment in an effort to make the patient more comfortable.

Other drugs similar to Cisplatin include Carboplatin, generally used to treat cancer of the lung, head and neck, and Oxaliplatin, which is most often used to treat colorectal cancer.

As with any mesothelioma cancer drug, your doctor will decide whether or not Cisplatin is a beneficial option for treating your cancer.
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Cancer Centers

National

National Cancer Institute
National Institutes of Health
Bethesda, MD 20892
301-496-4000
800-4-CANCER
800-422-6237

Alabama

University of Alabama at Birmingham
Comprehensive Cancer Center
Basic Health Sciences Building
1824 Sixth Avenue South
237 T.I.
Birmingham, AL 35294-3300
205-934-5077

Arizona

University of Arizona Cancer Center
1501 North Campbell Avenue
Tucson, AZ 85724
520-626-7383

California

Jonsson Comprehensive Cancer Center at UCLA
Box 951781
Los Angeles, CA 90095-1781
800-825-2631
310-825-5268

USC/Norris Comprehensive Cancer Center
1441 Eastlake Avenue MS #83
Los Angeles, CA 90033-0800
323-865-0816

City of Hope National Medical Center
Beckman Research Institute
1500 East Duarte Road
East Duarte, CA 91010-3000
626-359-8111
Comprehensive Cancer Center

Salk Institute
Cancer Center
10010 North Torrey Pines Road
La Jolla, CA 92037
619-453-4100 x1386
Cancer Center

The Burnham Institute
10901 North Torrey Pines Road
La Jolla, CA 92037
619-455-6480 x3209
Cancer Center

University of California at Irvine
Cancer Center
Building #23 4th Floor
101 The City Drive
Orange, CA 92868
714-456-6310
Clinical Cancer Center

UCSF Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
650-723-4000

University of California at San
Diego Cancer Center
9500 Gilman Drive
La Jolla, CA 92093-0658
619-534-7600
Clinical Cancer Center

Colorado

University of Colorado Cancer Center
4200 East 9th Avenue
Denver, CO 80262
Clinical Cancer Center

Connecticut

Yale Comprehensive Cancer Center
Yale University School of Medicine
333 Cedar Street
New Haven, CT 06520-8028
203-785-4095

Florida

Sylvester Comprehensive Cancer Center
University of Miami Medical School
1475 Northwest 12th Avenue, Room 4023
Miami, FL 33136

H. Lee Moffitt Cancer Center
12902 Magnolia Drive
Tampa, FL 33612-9497
813-979-3050

Hawaii

Cancer Research Center of Hawaii
University of Hawaii at Manoa
1236 Lauhala Street
Honolulu, HI 96813
808-586-3013
Clinical Cancer Center

Illinois

Robert H. Lurie Cancer Center
Northwestern University
303 East Chicago Avenue
Olson Pavilion, Room 8250
Chicago, IL 60611
312-908-5250
Clinical Cancer Center

University of Chicago Cancer
Research Center
5841 South Maryland Avenue
Chicago, IL 60637
Clinical Cancer Center

Indiana

Purdue University Cancer Center
Hansen Life Sciences Research Building
South University Street
West Lafayette, IN 47907-1524
765-494-9129 Cancer Center

Maine

The Jackson Laboratory
600 Main Street
Bar Harbor, ME 04609-0800
207-288-6041
Cancer Center

Maryland

The Johns Hopkins Oncology Center
600 North Wolfe Street
Baltimore, MD 21287-8943
410-955-8822

Massachusetts

Center for Cancer Research
Massachusetts Institute of Technology
77 Massachusetts Avenue, Room E17-110
Cambridge, MA 02139-4307
617-253-6422
Cancer Center

Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
617-632-3000

Michigan

University of Michigan
Comprehensive Cancer Center
102 Observatory
Ann Arbor, MI 48109-0724
313-936-1831

Barbara Ann Karmanos
Cancer Institute
110 East Warren Avenue
Detroit, MI 48201
1-800-KARMANOS

Minnesota

University of Minnesota
Cancer Center
Box 806, 420 Delaware Street, S.E.
Minneapolis, MN 55455
612-624-8484
Comprehensive Cancer Center

Mayo Cancer Center
Mayo Foundation
200 First Street SW
Rochester, MN 55905
507-284-3753
Clinical Cancer Center

Nebraska

University of Nebraska Medical Center
Eppley Cancer Center
600 South 42nd Street
Omaha, NE
402-559-7081
Cancer Center

New Hampshire

Norris Cotton Cancer Center
Dartmouth-Hitchock Medical Center
One Medical Center Drive
Lebanon, NH 03756-0001
603-650-6300

New Jersey

The Cancer Institute of New Jersey
Robert Wood Johnson Medical School
195 Little Albany Street, Room 2002B
New Brunswick, New Jersey 08901
732-235-8064
Clinical Cancer Center

New York

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302
Cancer Center

American Health Foundation
320 East 43rd Street
New York, NY 10017
212-953-1900
Cancer Center

Cold Spring Harbor Laboratory
P.O. Box 100
Cold Spring Harbor, NY 11724
516-367-8383
Cancer Center

Herbert Irving
Comprehensive Cancer Center
College of Physicians and Surgeons
701 West 168th Street, Room 1509
New York, NY 10032
212-305-6921

Kaplan Cancer Center
New York University Medical Center
550 First Avenue
New York, NY 10016
212-263-5349
Clinical Cancer Center

Memorial Sloan-Kettering
Cancer Center
1275 York Avenue
New York, NY 10021
800-525-2225
212-639-6561

Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263-0001
213-845-5770
800-767-9355

University of Rochester Cancer Center
601 Elmwood Avenue
Rochester, NY 14642
716-275-6292
Clinical Cancer Center

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302

North Carolina

UNC Lineberger Comprehensive
Cancer Center
University of North Carolina
School of Medicine Chapel Hill
CB#7295
Chapel Hill, NC 27599-7295
919-966-3036

Duke Comprehensive Cancer Center
Duke University Medical Center
Box 3843
Durham, NC 27710
919-684-5613

Comprehensive Cancer Center of
Wake Forest University at Bowman
Gray School of Medicine
Medical Center Boulevard
Winston-Salem, NC 27157
336-716-7971

Ohio

Ohio State University
Comprehensive Cancer Center
Arthur G. James Cancer Hospital
300 West 10th Avenue
Columbus, OH 43210
614-293-4878

Case Western Reserve University
Cancer Research Center
11100 Euclid Avenue
Cleveland, OH 44106
Comprehensive Cancer Center

Oregon

Oregon Cancer Center
Oregon Health Sciences University
3181 S.W. Sam Jackson Park Road, L609
Portland, OR 97201-3098
503-464-1617
Clinical Cancer Center

Pennsylvania

Fox Chase Cancer Center
7701 Burholme Avenue
Philadelphia, PA 19111
215-728-3600

Wistar Institute Cancer Center
3601 Spruce Street
Philadelphia, PA 19104-4268
215-898-3926
Cancer Center

University of Pennsylvania Cancer Center
16 Penn Tower
3400 Spruce Street
Philadelphia, PA 19104
215-662-6334

University of Pittsburgh Cancer Institute
3471 5th Avenue
Pittsburgh, PA 15213-2592
412-692-4670

Kimmel Cancer Center
233 South 10th Street
Philadelphia, PA 19107
215-503-4645
Clinical Cancer Center

Jefferson Cancer Center
Thomas Jefferson University
233 South 10th Street
Philadelphia, PA 19107
215-503-4645

Tennessee

Vanderbilt Cancer Center
Vanderbilt University
649 Medical Research Building II
Nashville, TN 37232
800-811-8480
615-936-5847
Clinical Cancer Center

St. Jude Children's Research Hospital
332 North Lauderdale Street
Memphis, TN 38105
901-495-3300
Clinical Cancer Center

Texas

The University of Texas
M.D. Anderson Cancer Center
1515 Holcolmbe Boulevard
Houston, TX 77030
713-792-7500

San Antonio Cancer Institute
8122 Datapoint Drive, Suite 600
San Antonio, TX 78229
210-616-5580

Utah

Huntsman Cancer Institute
University of Utah Health
Sciences Center
15 North 2030 East, Room 2100
Salt Lake City, UT 84112
801-581-4048
801-581-4330
Clinical Cancer Center

Vermont

Vermont Regional Cancer Center
University of Vermont
Medical Alumni Building
Burlington, VT 05405-0068
802-656-4414

Virginia

Cancer Center
University of Virginia Health
Sciences Center
Box 334
Charlottesville, VA 22908
804-924-2562
Clinical Cancer Center

Massey Cancer Center
Medical College of Virginia
401 College Street
Richmond, VA 23298
804-828-0450
Clinical Cancer Center

Washington

Fred Hutchinson Cancer Research Center
1100 Fairview Avenue
P.O. Box 19024
Seattle, WA 98109-1024
206-667-5000

University of Washington
Academic Medical Center
Seattle, WA

Washington, D.C.

Lombardi Cancer Research Center
Georgetown University Medical Center
3800 Reservoir Road NW
Washington, DC 20007
202-687-2110

Wisconsin

McArdle Laboratory for Cancer Research
University of Wisconsin
1400 University Avenue, Room 1009
Madison, WI 53706-1599
608-262-2177
Cancer Center

University of Wisconsin
Comprehensive Cancer Center
600 Highland Avenue
Madison, WI 53792-0001
608-263-8600

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Mesothelioma Treatment

Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patients life span by five years or more [commonly known as remission][this percentage may increase or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patient's life span by five years or more [commonly known as remission]. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery

Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[14] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[15] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[17] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

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Mesothelioma Epidemiology

Incidence

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

Risk factors

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.

Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.

Exposure

Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villages in Turkey have death rates of 51% attributed to erionite related mesothelioma.[citation needed]

Occupational

Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.

The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

Paraoccupational secondary exposure

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.[citation needed] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

Asbestos in buildings

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.

Environmental exposures

Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition.
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Mesothelioma Pathophysiology

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.

Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.fibres.


Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

* Neurofibromatosis type 2 at 22q12
* P16INK4A
* P14ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

* Inactivation of tumor suppressor genes
* Activation of oncogenes
* Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
* Activation of DNA repair enzymes, which may be prone to error
* Activation of telomerase
* Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos
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Mesothelioma: Questions and Answers

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

1. What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

2. What is mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

3. How common is mesothelioma?

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

4. What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.

5. Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

6. What are the symptoms of mesothelioma?

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

7. How is mesothelioma diagnosed?

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

8. How is mesothelioma treated?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

* Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

* Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

* Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

9. Are new treatments for mesothelioma being studied?

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.


Related NCI materials and Web pages:

* National Cancer Institute Fact Sheet 3.21, Asbestos Exposure: Questions and Answers
(http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos)
* Clinical Trials Home Page
(http://www.cancer.gov/clinicaltrials)
* Malignant Mesothelioma Home Page (http://www.cancer.gov/cancertopics/types/malignantmesothelioma)
* Taking Part in Cancer Treatment Research Studies
(http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-Research-Studies)
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Mesothelioma

Mesothelioma is a form of cancer that is almost always caused by exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma. Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases risk of other asbestos induced cancer. Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.


Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss

In severe cases of the disease, the following signs and symptoms may be present:

* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
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VIETNAM MEDI-PHARM EXPO 2009

16th Vietnam International Medical and Pharmaceutical Exhibition
“VIETNAM MEDI-PHARM EXPO 2009”

Dear Sir/ Madam,

Aiming at introducing new achievements of science and technology in Medi-Pharm field, Vietnam Pharmaceutical Companies Association (VNPCA) in cooperation with Vietnam Medical Equipment Association and Vietnam National Trade Fair and Advertising Company (VINEXAD) – Ministry of Industry and Trade to organize successfully International Medical and Pharmaceutical Exhibitions in Hanoi. These annual exhibitions have attracted huge participation of local and foreign medical and pharmaceutical Enterprises.

VIETNAM MEDI-PHARM EXPO 2009 will be held in Hanoi from 2 – 5 December, 2009. With the purpose of best serving community healthcare and preventing deseases, the exhibition will showcase the most advanced and latest medical and pharmaceutical products of high quality from Vietnam and other parts of the world. This is also an actual activity when Vietnam is an official member of WORLD TRADE ORGANIZATION (WTO), the interchange of information, science, technology and mommodities more and more developed.
The Ministry of Health welcomes the active participation and support of all medical and pharmaceutical Enterprises from Vietnam and foreign countries in this exhibition.

I wish VIETNAM MEDI-PHARM EXPO 2009 brilliant success.

Yours faithfully,
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SAIGON MEDI PHARM EXPO 2009

From Minister of Health to medical & pharmaceutical companies
Participate in SAIGON MEDI-PHARM EXPO 2008

Dear Sir/ Madam,

On behalf of the Minsitry of Health of Vietnam, I warmly welcome all medical and pharmaceutical companies participate in the 9th International Medical and Pharmaceutical Exhibition in Ho Chi Minh City - SAIGON MEDI PHARM EXPO 2009 from 19 – 22 August, 2009 at Ho Chi Minh City International Exhibition & Convention Centre (HIECC), 446 Hoang Van Thu Str., Tan Binh Dist., Ho Chi Minh City, Vietnam.

SAIGON MEDI-PHARM EXPO 2009 with the participation of hundreds local and foreign Groups, Enterprises will showcase advancements and latest achievements in medical and pharmaceutical fields; modern medicines, medical, laboratory, technology and science products; healthcare and treatment services… This is a golden opportunity for professionals, specialists and businessmen to meet, exchange experiences, introduce products and services, extend international relationship, access hi tech facilities in order to apply latest achievements in examination, treatment and protection of people’s health.
Ministry of Health of Vietnam highly appreciates all participants in this event and well note the endeavour of VIMEDIMEX MEDI-PHARMA JSC and VIETNAM NATIONAL TRADE FAIR & ADVERTISING COMPANY (VINEXAD) to make SAIGON MEDI-PHARM EXPO become a prestiged and specialized exhibition, contribute to push up manufacturing and dealing activities and the development of healthcare course in Vietnam.

I wish the exhibition great success and exhibitors fruitful results through the exhibition.

Yours faithfully,

.
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Zoladex

Brand name: Zoladex
Generic name: Goserelin acetate

Why is Zoladex prescribed?
Zoladex relieves the symptoms of advanced prostate cancer in men and advanced breast cancer in premenopausal women. In combination with other forms of therapy, it is also prescribed during treatment of early prostate cancer.

In addition, it can be used in the treatment of endometriosis, a condition in which tissue from the lining of the uterus invades the abdomen. If you are scheduled for surgical removal of the lining, the drug may be used to thin the lining prior to the operation.

Zoladex works by reducing levels of testosterone in men and estrogen in women. These hormones can encourage the growth of certain cancers.

Most important fact about Zoladex
Symptoms may actually get worse during the first few weeks of therapy. However, as hormone levels subside, you should begin to feel an improvement.

How should you take Zoladex?
Doses are implanted under the skin of the upper abdomen every 4 or 12 weeks by your physician or a nurse.

* If you miss a dose...
Make an appointment as soon as possible.

What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Zoladex.

* Side effects may include:
Acne, application site reactions, breast development in men or enlargement in women, breast tenderness or pain, change in sex-drive, depression, dizziness, emotional problems, flu symptoms, fluid retention and swelling, hair growth in women, headache, hot flashes, infection, insomnia, lethargy, loss of appetite, loss of breast tissue in women, lung problems, nausea, nervousness, pain, rash, sexual impairment, sore throat, sweating, urinary problems, vaginal dryness, vaginal inflammation, voice changes, weak heart, weakness, weight gain

Why should Zoladex not be prescribed?
If Zoladex gives you an allergic reaction, it cannot be used. It should also be avoided during pregnancy and breastfeeding, and if you have unexplained abnormal vaginal bleeding. Women of childbearing age should use nonhormonal contraceptive measures while taking Zoladex.

Special warnings about Zoladex
Zoladex therapy can weaken the bones and cause bone pain. In men under treatment for prostate cancer, it has been known to cause osteoporosis and fractures. If you are a heavy drinker, smoke a lot, have family members with brittle bones, or take anticonvulsant drugs or steroids (such as prednisone), make sure your doctor is aware of the situation.

Men with a blockage in the tube from the kidney to the bladder (the ureter) or a case of spinal cord compression should get treatment for these conditions before beginning Zoladex therapy.

Severe allergic reactions, including hives and swelling of the lips and throat, have been reported with drugs similar to Zoladex. If these symptoms occur, call your doctor immediately.

When given with sex hormones, Zoladex may lead to overstimulation of the ovaries. It has also been known to cause ovarian cysts.

Women should remember that even though Zoladex stops menstruation, it is possible to become pregnant if you miss a dose. Since Zoladex could harm the developing baby, it's important to observe strict contraceptive precautions throughout Zoladex therapy.

If you are taking Zoladex to relieve endometriosis, your doctor may recommend hormone-replacement therapy to limit the effects of the reduced estrogen levels that result from Zoladex therapy.

Possible food and drug interactions when taking Zoladex
No interactions have been reported.

Special information if you are pregnant or breastfeeding
Zoladex can harm developing babies and newborn infants. It must not be used during pregnancy or breastfeeding.

Recommended dosage for Zoladex
Typically, the doctor will implant a dose of 3.6 milligrams every 4 weeks. Treatment for endometriosis lasts no longer than 6 months. Cancer therapy generally continues for a longer term.

For prostate cancer, the doctor can administer a longer lasting implant of 10.8 milligrams every 12 weeks. When the drug is given with flutamide, the treatment is one 3.6-millgram implant followed by one 10.8-milligram implant 4 weeks later.

If the drug is being used in preparation for endometrial surgery, you'll receive 1 or 2 implants before the operation.

Overdosage
An overdose of Zoladex is highly unlikely, and if one were to occur, it would not cause any harm.

---Collected---

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What Are the Risk Factors for Bladder Cancer?

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers, including lung and bladder cancer. But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that you will get the disease.

Many people with one or more risk factors never develop bladder cancer, while others with this disease have no known risk factors. It is important, however, to know about risk factors so that a person can take appropriate actions such as changing a health behavior or being monitored closely for a potential cancer. Because the bladder is the final exit from the body for many chemicals, these are the major risk factors for bladder cancer.

Smoking

The greatest risk factor for bladder cancer is smoking. Smokers are more than twice as likely to get bladder cancer as nonsmokers. Smoking causes about half of the deaths from bladder cancer among men (48%) and almost a third of bladder cancer deaths in women (28%). Some of the carcinogens (cancer-causing chemicals) in tobacco smoke are absorbed from the lungs and get into the blood. From the blood, they are filtered by the kidneys and concentrated in urine. These chemicals in urine damage the cells that line the inside of the bladder. This damage increases the chance of cancer developing.

Workplace exposures

Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer.

Other industries that use certain organic chemicals also may put workers at risk for bladder cancer if exposure is not limited by good workplace safety practices. The industries carrying highest risks include the makers of rubber, leather, textiles, and paint products as well as printing companies. Other workers with an increased risk of developing bladder cancer include painters, hairdressers, machinists, printers, and truck drivers (these because of exposure to diesel fumes).

Cigarette smoking and workplace exposures may act together to cause bladder cancer. Also, smokers who work with the cancer-causing chemicals noted above have an especially high risk of developing bladder cancer.

Race

Whites are about twice as likely to develop bladder cancer as African Americans and Hispanics. The reason for this difference is not well understood. Asians have the lowest incidence of bladder cancer.

Age

The risk of bladder cancer increases with age. Over 70% of people with bladder cancer are older than 65 years old.

Gender

Men get bladder cancer at a rate 4 times greater than women.

Chronic bladder inflammation

Urinary infections, kidney and bladder stones, and other causes of chronic bladder irritation have been linked with bladder cancer (especially squamous cell carcinoma of the bladder), but they do not necessarily cause bladder cancer. Schistosomiasis (also known as bilharziasis), an infection with a parasitic worm called Schistosoma hematobium that can get into the bladder, is also a risk factor for bladder cancer. In countries where this parasite is common, squamous cell cancers of the bladder are seen much more often. This parasite is an extremely rare cause of bladder cancer in the United States.

Personal history of bladder cancer

Urothelial carcinomas can form in many areas in the bladder as well as in the lining of the kidney, the ureters, and urethra. Having a cancer in any part of the urinary tract lining puts you at higher risk of forming another tumor. The tumor can form in the same area as before, or in another part of the urothelium (lining). This is true even when the first tumor is completely removed. For this reason, people who have had bladder cancer need close, routine medical follow-up.

Bladder birth defects

Before birth, there is a connection between the belly button and the bladder. This connection, called the urachus, normally disappears before birth. If part of this connection remains after birth, it could become cancerous. Cancers that start in the urachus are usually made up of malignant gland cells and are adenocarcinomas. Cancer starting in this way is rare, causing less than a half of 1% of bladder cancers. However, it does represent about one third of the adenocarcinomas of the bladder, which are also rare.

There is another rare birth defect called exstrophy, which greatly (about 400-fold) increases a person's risk of developing bladder cancer. In exstrophy, the skin, muscle, and connective tissue in front of the bladder fail to close completely so that there is a hole or defect in the wall of the abdomen. This leaves the inside of the bladder exposed to chronic infection, which may eventually lead to formation of an adenocarcinoma of the bladder.

Genetics

People who have family members with bladder cancer have an increased risk of getting it themselves. In some cases, these family members were all exposed to the same cancer- causing chemical. Another factor may be that their bodies are slow to break down toxins. This is determined by certain genes they inherit (like GST and NAT). People who inherit versions of these genes that lead to slow breaking down of chemicals are more likely to develop bladder cancer.

Bladder cancer does seem to run in some families. For a small number of people, this is because they inherited a gene syndrome, for example:

• A mutation of the retinoblastoma (Rb1) gene can cause cancer of the eye in infants, and also increases the risk of bladder cancer.

• Cowden disease, caused by mutations in a gene called PTEN, is linked to cancers of the breast and thyroid. People with this disease also have a higher risk of bladder cancer.

• Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome (also known as Lynch syndrome) is mainly linked to colon and endometrial cancer. People with this syndrome also have an increased risk of bladder cancer.

Chemotherapy and radiation therapy

High doses of the chemotherapy drug cyclophosphamide (Cytoxan) or ifosfamide (Ifex) increase the risk of bladder cancer. A drug called mesna can be used with these drugs to protect the bladder from irritation and decrease the risk of bladder cancer.

People who are treated with radiation to the pelvis are more likely to develop bladder cancer.

Arsenic

Arsenic in drinking water has been associated with an increased risk of bladder cancer. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a system that meets the standards for arsenic content.

Low fluid consumption

Not drinking enough fluids increases the risk of bladder cancer. People who drink a lot of fluids each day have a lower rate of bladder cancer. This is thought to be because they empty their bladders often. By doing this, they keep chemicals from lingering in their bodies.

Last Medical Review: 01/27/2009
Last Revised: 01/27/2009

Source: ACS

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More information of H1N1 Flu (Swine Flu)

What should you know about H1N1 Flu?
H1N1 Flu is a respiratory disease caused by type A inuenza viruses. The Centers for Disease Control and Prevention (CDC) has determined that the new H1N1 Flu cases are caused by an inuenza strain called H1N1, which appears to be easily transmitted from person to person. The most common method of transmission is airborne, and it is also possible to become infected by touching a surface with the virus on it and then touching one's mouth or nose. The CDC is advising people to wash their hands frequently, and also to avoid surfaces that might be contaminated.
Please note that the country’s food supply is not impacted by the swine u investigation, according to the U.S.
Department of Agriculture and the CDC. H1N1 Flu viruses are not transmitted by food and cannot be caught by eating properly cooked pork products.

What symptoms should you watch for?
If you develop u-like symptoms, such as fever, body aches, runny nose, sore throat, nausea, vomiting, or diarrhea, you should seek attention from your health care provider.

Emergency warning signs:
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children, emergency warning signs that need urgent medical attention include:
• Fast breathing or difficulty breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

How can you protect yourself and your family?
Currently, there is no vaccine available to protect against H1N1 Flu. There are, however, everyday steps to help protect your health:
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash
immediately after using.
• Wash your hands frequently using soap and warm water, especially after you cough or sneeze.
Alcohol-based hand cleaners or sanitizers are also eective.
• Avoid touching your eyes, nose or mouth.
• Avoid close contact with people who are ill.
• If you do get sick with inuenza, stay home from work or school and limit contact with others to keep
from infecting them.

Where can I get more information?
Centers for Disease Control and Prevention: http://www.cdc.gov/swineu/
U.S. Department of Health & Human Services: http://www.hhs.gov/
World Health Organization: http://www.who.int/csr/disease/swineu/en/index.html

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Safer Sex

The reason why sexual activity is a risk for HIV transmission is because it allows for the exchange of body fluids. Researchers have consistently found that HIV can be transmitted via blood, semen and vaginal secretions. However, researchers have also confirmed that some sexual practices are associated with a higher risk of HIV transmission than others.

I believe everybody-regardless of their HIV status-should enjoy sex to the fullest. Though the facts about HIV transmission are the same for HIV positive and HIV negative men and women, even the tiniest bit of misunderstanding about how HIV is (and isn't) spread can lead to a lot of confusion when it comes to making important decisions about safer sex.

There are a few basic facts to consider:

• Abstinence is the only 100-percent way to avoid HIV and other sexually transmitted infections.
• If you have a partner who has tested negative for HIV, does not inject drugs and is having sexual contact only with you, there is minimal risk of being infected with the virus.
• Being infected with a sexually transmitted infection (STI) can increase an HIV-positive person's chance of transmitting HIV, just as it can increase an HIV-negative person's chance of acquiring HIV.
• An HIV-positive person with a detectable viral load is more infectious-more likely to transmit the virus to somebody else-that an HIV-positive person who is receiving antiretroviral treatment and has an undetectable viral load.
• Safer sex practices, including correct and consistent use of condoms for vaginal or anal sex, can reduce the spread of HIV and other STIs.
• Getting intoxicated or high on drugs, including alcohol, can impair judgment and cause people to forget to take care of themselves-or their sexual partners.
• Safer sex is not just about vaginal, anal or oral intercourse. Masturbation (alone or with someone else), body rubbing, erotic massage and kissing-they're all fun, no-risk activities.

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How is HIV Transmitted?

HIV enters the body through open cuts, sores or breaks in the skin; through mucous membranes, such as those inside the anus or vagina; or through direct injection. There are several ways by which this can happen:

• Sexual contact with an infected person. Anal or vaginal intercourse without a condom with a partner who is either positive or does not know his or her HIV status account for the vast majority of sexually-transmitted HIV cases in the U.S. and elsewhere. Oral sex is not an efficient route of HIV transmission, but it can happen. Kissing, massage, masturbation and "hand jobs" do not spread HIV.
  
• Sharing needles, syringes or other injection equipment with someone who is infected.
  
• Mother-to-child transmission. Babies born to HIV-positive women can be infected with the virus before or during birth, or through breastfeeding after birth.
  
• Transmission in health care settings. Healthcare professionals have been infected with HIV in the workplace, usually after being stuck with needles or sharp objects containing HIV-infected blood. As for HIV-positive healthcare providers infecting their patients, there have only been six documented cases, all involving the same HIV-positive dentist in the 1980s.
  
• Transmission via donated blood or blood clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies, including in the United States.

HIV has been detected in saliva, tears and urine. However, HIV in these fluids is only found in extremely low concentrations. What's more, there hasn't been a single case of HIV transmission through these fluids reported. HIV cannot be transmitted through day-to-day activities such as shaking hands, hugging or casual kissing. You cannot become infected from a toilet seat, drinking fountain, or sharing food or eating utensils with someone who is positive. You also cannot get HIV from mosquitoes.

Since the beginning of the HIV/AIDS epidemic, new or potentially unknown routes of transmission have been thoroughly investigated by state and local health departments, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). To date, no additional routes of transmission have been recorded, despite a national system designed to detect unusual cases.

---Source: POZ---

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Radiation Therapy

What do you think of when you hear the word radiation? Do you think of getting X-rays of your teeth or a broken bone? Or do you think of something dangerous? Radiation is tricky to understand because you can't see it. It's a process in which energy is given off in the form of particles or rays. For example, the sun emits a kind of radiation.

Radiation is everywhere - in soil, water, food, building materials, and even our own bodies. Too much of it can be harmful, but in the right amounts, radiation has many uses. It can be used to make X-rays, create electricity, and even power submarines. And radiation can also be used to help people with cancer.

Radiation therapy (say: ray-dee-ay-shun ther-ah-pee) is one form of treatment for kids or adults who have cancer. Both adults and kids can get cancer, but kids don't get it very often. Cancer is a disease that causes normal cells in the body to grow out of control. If left untreated, these cells can grow throughout the body, making the person very sick. Radiation therapy kills cancer cells and keeps them from growing and multiplying. The fewer cancer cells, the better, because then a person can start feeling well again.

How Is Radiation Given?

Cancer can be treated with radiation therapy alone or in combination with chemotherapy or surgery. Chemotherapy (say: kee-mo-ther-uh-pee) is a treatment that uses medicine to destroy cancer cells. Some people may first have surgery to remove cancer cells or tumors and then have radiation therapy. Each person's treatment depends on the kind of cancer they have.

A doctor called an oncologist (say: on-kah-loh-jist) will make the decision about whether radiation therapy is best for the patient. Sometimes people stay in the hospital to get radiation therapy, but in most cases, the patient comes to the hospital or doctor's office for treatment and goes home afterward.

Radiation therapy can be given in two ways. A person may receive radiation directed to the outside of the body called external radiation. Or a person may receive radiation therapy that places the radiation inside the body, which is called internal radiation therapy (putting radioactive material directly in the tumor). Some people may receive both types of radiation therapy, but internal radiation is rarely used to treat the kinds of cancer kids get.

What Happens During Radiation Therapy?

Because the radiation treatment needs to be just right, the patient must go through a simulation first. During this process, the person lies on an X-ray table while the radiation therapist uses a special machine called a simulator to define the treatment area. When the therapist knows exactly which area of the body will get the radiation treatment, he or she marks it with ink. This "tattoo" should not be wiped off because these spots help to position the radiation for each treatment.

At each appointment, a large machine is positioned to deliver the exact amount of radiation necessary to kill the cells. It usually takes only a few minutes for a person to receive the daily dose of radiation. During a radiation treatment, a person has to lie still.

People who are having external radiation therapy usually visit the hospital on weekdays for several weeks. These doses of radiation are small, but they are strong enough to kill cancer cells. The radiation also can damage normal cells. Weekend breaks from radiation treatments give normal cells a chance to recover and let new, healthy cells grow.

How Does Radiation Therapy Make a Person Feel?

Getting a radiation treatment doesn't hurt and you do not see, smell, or feel the radiation. But these treatments can cause some temporary health problems called side effects. The kinds of side effects experienced by the patient depend on the location of the radiation and the dose, or how much radiation the patient receives. Common side effects include hair loss, rash, nausea, vomiting, and diarrhea. All of these side effects get better as the effects of the radiation wear off.

For a kid getting radiation therapy, it's normal to feel a little nervous. One important thing to remember is that a kid's parents will be there to help. Also, doctors, nurses, and other health care workers can answer questions and help patients feel comfortable. It's a good idea to visit the center where the treatment will be done, so the patient can see the place and meet the people who work there. Here are some more tips to help a person feel better during treatment:

• Get plenty of sleep.
• Try to eat healthy meals and drink plenty of fluids.
• Ask the doctor about medicine to help with nausea and stomach upset.
• Keep affected skin protected from the sun and ask about getting a special cream if a rash develops.

After the radiation treatments, patients visit the doctor for follow-up care. In many cases, the person will be well on the way to being cancer free.

Reviewed by: Maureen F. Edelson, MD
Date reviewed: February 2007

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