Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2003
Review[Cyclooxygenase(COX)-2-inhibition in the prevention and treatment of colorectal carcinoma].
Epidemiological studies have found that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a lower risk of colorectal cancer (CRC). Cyclooxygenase (COX)-2 expression is present in colorectal cancer and overexpression is associated with metastases and poorer prognosis in multivariate analysis. NSAID treatment results in a reduction of the incidence of colorectal adenoma in patients with familial adenomatous polyposis, in patients with a history of colorectal adenomas and in patients with a history of CRC. ⋯ An anticarcinogenic effect has been shown specifically in selective COX-2 inhibitors in animal models. Selective COX-2 inhibitors have fewer adverse effects than the non-selective NSAIDs and are promising chemopreventative and chemotherapeutical agents. The effects of selective COX-2 inhibition in the prevention of and treatment for colorectal carcinoma will be investigated in clinical randomized multicentre trials.
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Ned Tijdschr Geneeskd · Nov 2003
Case Reports[Diagnostic image (164). A man who drank formalin by mistake. Caustic lesions of esophagus and stomach].
A 71-year-old male was admitted because of unintentional ingestion of formalin, which caused severe caustic lesions of oesophagus and stomach.
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One of the undoubted major breakthroughs in the recent treatment of cancer is imatinib, a tyrosine-kinase inhibitor of the bcr-abl fusion protein, the stem-cell factor receptor c-kit (KIT) and the platelet-derived growth-factor receptor. The successes obtained with imatinib in the treatment of chronic myeloid leukaemia (CML), gastrointestinal stroma-cell tumours (GIST), and dermatofibrosarcoma protuberans, demonstrate that targeted therapy with a rationally designed, small, synthetic molecule can be highly successful. However, experience so far with imatinib in KIT-positive tumours indicates that imatinib seems only to be effective in those tumours with a gain-of-function mutation in c-kit. There are arguments in favour of investigating a combined therapy of imatinib and classical chemotherapy.
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Ned Tijdschr Geneeskd · Oct 2003
Review[Imatinib, a specific tyrosine-kinase inhibitor, for the treatment of patients with a gastrointestinal stroma cell tumor].
The c-kit oncogene, encoding for a transmembrane growth-factor receptor with tyrosine-kinase activity (KIT), plays an important role in the tumourigenesis of gastrointestinal stroma-cell tumours (GISTs). GISTs are a heterogeneous group of mesenchymal tumours, mainly localised in the abdomen. Immunohistochemical staining using antibodies directed towards the c-kit protein on the cell surface, is a useful tool in the often difficult differential diagnosis of GISTs from other mesenchymal tumours. ⋯ As a result of the short period of time between the drug's experimental introduction and actual registration, many unanswered questions about its use for the treatment of GISTs remain. These can only be answered in well-designed clinical trials. It is therefore recommended that patients with these rare tumours are referred to a centre with experience in the diagnosis and treatment of these soft-tissue sarcomas.
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Ned Tijdschr Geneeskd · Oct 2003
[Advantages and disadvantages of a "no-fault" compensation system].
Should the present legal regulation of medical negligence be replaced by a no-fault compensation system (NFCS)? The Dutch government is preparing a viewpoint on this issue on the basis of a research report that describes the pros and cons of a NFCS. Recently, the British chief medical officer (CMO) rejected the introduction of a comprehensive NFCS. ⋯ A NFCS has certain advantages but is supposedly very expensive. Other policy measures can be considered as well.