Clinical Capsules

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.