April 4, 2002
Neuroblastoma is the most common extracranial solid tumor in early childhood and can be identified in preclinical stages by detection of catecholamines in the urine. It is uncertain whether routine screening for neuroblastoma can reduce mortality due to this disease. In this study, parents of infants born in Quebec, Canada, during a five-year period (May 1989 through April 1994) were offered screening for neuroblastoma when the infants were three weeks and six months of age. After the initiation of screening, the cumulative childhood mortality from neuroblastoma over a nine-year period was no lower in the Quebec cohort than in several unscreened North American cohorts and was similar to that in Quebec before the screening program. Screening infants for neuroblastoma does not appear to reduce mortality from this disease and is not warranted.
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Neuroblastoma Screening at One Year of Age
To assess whether urine screening for neuroblastoma at one year of age reduces the incidence of disseminated disease and mortality from this type of tumor, the authors screened nearly 1.5 million children in six German states. As compared with the children in the other 10 German states, who served as controls, children in the screened group had a higher rate of diagnosis of neuroblastoma but no reduction in the incidence of stage 4 disease or mortality due to neuroblastoma. Screening for neuroblastoma at one year of age is not warranted and may lead to unnecessary treatment of cases that would otherwise be expected to regress spontaneously.
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Primary Chemoprevention of Familial Adenomatous Polyposis with Sulindac
Sulindac, a nonsteroidal antiinflammatory drug, can induce the regression of polyps in familial adenomatous polyposis, which is caused by a mutation in the adenomatous polyposis coli (APC) gene. This study investigated whether sulindac therapy could prevent the development of colonic polyps in young carriers of a pathogenic mutant APC gene who had no detectable adenomas. As compared with a placebo, sulindac had no influence on the number or size of new polyps. The results of this double-blind, placebo-controlled trial are clear: in the doses used, sulindac did not prevent adenomas in carriers of the APC gene. Since colorectal cancer develops in almost all patients with familial adenomatous polyposis, colectomy is still the only proven prophylactic measure.
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Images in Clinical Medicine: Hematogenous Anaerobic Osteomyelitis
A 42-year-old man had a history of fever, weight loss, night sweats, and pain and swelling in the right arm and thigh. There was no history of trauma.
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Images in Clinical Medicine (Web Only): Porcelain Gallbladder
A 45-year-old woman was hospitalized with a seven-day history of fever and pain in the right upper abdomen.
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Special Article: Understanding the Treatment Preferences of Seriously Ill Patients
A total of 226 patients 60 years of age or older who had a limited life expectancy were asked about their preferences with regard to treatment that could extend life. Eleven percent would not want the treatment if it carried a high burden. If the outcome were survival but with severe functional or cognitive impairment, many patients would not want the treatment, even if it were easy to tolerate. Discussions about end-of-life care often focus on whether patients would want specific interventions. With the use of hypothetical scenarios, this study shows that patients' preferences are greatly affected by both the burden of an intervention and the likelihood of a severe adverse outcome other than death.
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Current Concepts: Responding to In-Flight Medical Events
Physicians are often asked to provide assistance when symptoms develop in a passenger during a commercial flight. This Review Article identifies the most common problems that develop during air travel. The authors recommend ways to respond to such events and describe the resources that are available to physicians and flight crews while the aircraft is still airborne.
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Medical Progress: Living-Donor Liver Transplantation
The number of patients needing liver transplantation greatly exceeds the number of organs that can be obtained from cadavers. Living-donor liver transplantation has therefore received increasing attention. A total of 509 such procedures were performed in 2001. The procedure involves the transplantation of the right hepatic lobe of the donor into the recipient after the removal of the entire diseased liver. In coming years, the role of this procedure will be determined by weighing the risk to donors against the improvement in outcome for recipients.
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