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Journal Issue: Vol.10, No.2 - April 2011

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Incidence of Gall Bladder Cancer in Central Australian Populations

Dr Rahul Tipnis, Sarah Curnow, Gowan Creamer, Jacob Jacob

  1. Dr Rahul Tipnis
    Alice Springs Hospital
  2. Sarah Curnow
  3. Gowan Creamer
  4. Jacob Jacob

Gall bladder cancer is a highly malignant type of cancer and its rate varies in the different parts of the world. The reasons are not clear, although obesity and elevated prevalence of gallstones and chronic inflammation may play a part. Objective: The objective of this study was to study the incidence of Gall Bladder cancer in the unique patient population presenting to Alice Springs Hospital, Northern Territory, Australia. We have collected the date for the past ten years and have retrospectively studied the trend of the patients presenting with symptoms suggestive of acute cholecystitis and Obstructive jaundice and have attempted to compare it with other published studies. In our study over a period of ten years, we found 12 patients with Gall bladder cancer, out which eleven patients were aboriginal. Results: The incidence of gallbladder cancer for the total central Australian population was 22 per 100000. The incidence for indigenous population was 30 per 100000 while for non-indigenous was 6 per 100000. The incidence in males and females were 3.6 per 100000 and 18 per 100000. Conclusion: When we compared our findings at Alice Springs with the top 50 locations around the world for gall bladder cancer we found that the incidence of the said cancer was pretty high in the central Australian population group.


HIV and AIDS-related Cancer

Dr V Rajamanickam, B. Stephen Rathinaraj, Rathna Daisy, G. S Bangale, Md. Fareedullah, Farsiya Fatima, Fatima Shireen

  1. Dr V Rajamanickam
    M.Pharm, PhD
    Associate Professor, Department of Pharmaceutical Chemistry
  2. B. Stephen Rathinaraj
  3. Rathna Daisy
  4. G. S Bangale
  5. Md. Fareedullah
  6. Farsiya Fatima
  7. Fatima Shireen

Cancer remains a significant burden for human immunodeficiency virus (HIV)-infected individuals. Most cancers that are associated with HIV infection are driven by oncogenic viruses, such as Epstein?Barr virus, Kaposi?s sarcoma-associated herpes virus and human papillomavirus. Gaining insight into the epidemiology and mechanisms that underlie AIDS-related cancers has provided us with a better understanding of cancer immunity and viral oncogenesis


Germline Mutational Study of Von Hippel- Lindau Disease in Japan

Dr Masahiro Yao, Keiko Hattori, Masaya Baba, Minoru Yoshida, Kei-ichi Kondo, Noboru Nakaigawa, Takeshi Kishida, Hiroshi Kanno

  1. Dr Masahiro Yao
    MD, PhD
    Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine
  2. Keiko Hattori
  3. Masaya Baba
  4. Minoru Yoshida
  5. Kei-ichi Kondo
  6. Noboru Nakaigawa
  7. Takeshi Kishida
  8. Hiroshi Kanno

Von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited syndrome characterized by a predisposition to various neoplastic lesions. The gene responsible for the disease was isolated as the VHL tumor suppressor. In light of the disease?s clinical diversity, genetic testing by the characterization of germline mutation is quite important for accurate diagnosis, effective management, and surveillance of the patient?s family. Between 1993, when we began examining germline mutation in Japanese VHL patients, and 2007, we surveyed a total of 91 VHL families, including 76 type 1 and 15 type 2 families, consisting of more than 200 members in total. Among them, we detected a mutation in 62 families (67%) (51 type 1 and 11 type 2) by conventional sequencing analysis. Meanwhile, one of the substantive issues emerging in VHL genetic testing is that around one-third of the families have large genomic deletions spanning one or more exons, in which PCR-based sequencing does not work well. For such cases, many complicated molecular genetic techniques have been carried. We recently developed a real-time quantitative PCR assay with a TaqMan fluorescence probe, a simple, rapid, and sensitive detection method, for these large deletions. The new assay revealed germline deletions in 24/27 (89%) families. Overall, we detected germline mutations in 87/91 (96%) in the Japanese VHL families studied. We also genetically diagnosed 7 mutation carriers and 61 non-carriers among family members without clinical manifestations. Increased knowledge of the disease?s nature and improved diagnostic and therapeutic procedures, together with accurate genetic testing, will reduce the complications related to VHL and improve patient prognosis and quality of life.


Paradoxes of Functional Neurosurgery: Clues From Basal Ganglia Recordings

Prof Peter Brown, Alexandre Eusebio

  1. Prof Peter Brown
    Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology
  2. Alexandre Eusebio

Deep brain stimulation (DBS) can be remarkably effective in treating movement disorders such as Parkinson?s disease, dystonia and essential tremor. Yet these effects remain essentially unexplained, -even paradoxical. Equally challenging is the fact that DBS of motor targets in the basal ganglia appears to reverse abnormalities of movement without any obvious deleterious effects on remaining aspects of movement. Here we explore the extent to which the noisy signal hypothesis might help solve some of these apparent paradoxes. Essentially the hypothesis, first tentatively advanced by Marsden and Obeso (1994), suggests that disease leads to a pattern of basal ganglia activity that disrupts local & distant function and that surgery acts to suppress or over-ride this noisy signal. Critical to the success of this theory is that differ1ent disease phenotypes are associated with different patterns of noisy signal and we survey the evidence to support this contention, with specific emphasis on different types of pathological synchronisation. However, just as DBS may suppress or over-ride noisy signals in the basal ganglia, it must equally antagonise any remaining physiological functioning in these key motor structures. We argue that the latter effect of DBS becomes manifest when baseline motor performance is relatively preserved, i.e. when pathological activity is limited. Under these circumstances, the deleterious effects of DBS are no longer obscured by its therapeutic actions in suppressing noisy signals. Whether true, over-simplified or simply incorrect, the noisy signal hypothesis has served to focus attention on the detailed character of basal ganglia discharge and its variation with disease and therapy.


Next of Kin?s Conceptions of the Quality of Care in the Psychiatric Setting: A Phenomenographic Study

Dr Agneta Schr?der, Bodil Wilde Larsson, Gerd Ahlstrom

  1. Dr Agneta Schr?der
    Psychiatric Research Centre, ?rebro University Hospital
  2. Bodil Wilde Larsson
  3. Gerd Ahlstrom

The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient?s perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery and health-promoting surroundings. Good relations and communication between staff, patients and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to co-operate in the care. They avoid telling others about their family member?s psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatisation could be useful in furthering the understanding of the next of kin?s distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study.


Factors Affecting Patient Decision Making for Randomised Cancer Clinical Trials

Catherine Hutchison, Chloe Cowan, Tracey McMahon, Jim Paul

  1. Catherine Hutchison
  2. Chloe Cowan
  3. Tracey McMahon
  4. Jim Paul

Understanding a patient?s decision to participate or decline a clinical trial is important for health care professionals to better support their patients in the decision making process, and to identify any ethical opportunities to improve clinical trial recruitment. In this study, 148 patients completed a questionnaire about their clinical trial participation decision. Hope, altruism and trust in the doctor were identified as important motivators for participation, with reasons for refusal being less clear. The influence of others was important, particularly family and the doctor discussing the trial, highlighting the need for further research into the interactions involved in clinical trial discussions


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