Clinical Abstracts from Overseas

By Stanton R. Mehr
Published: Tuesday, Jun 29, 2010
%u25BA ITALY

Is the Knee Bone Connected to the Lung?


A study from the Hospital of Prato, Italy, raises some interesting questions between two disorders not ordinarily considered linked. What does arthritis, which is focally limited to one joint, have to do with a lung cell? It may well predict it.

In this Italian study of 296 patients who experienced arthritis in one knee only over a six-year period, five patients (1.7%) had early stage non–small cell lung cancer. Though this may not seem remarkable, surgical resection of the early tumor seemed to alleviate the arthritic symptoms in each patient.

Each of the patients were middle-aged men, and each had a chronic history of heavy smoking. Drainage of the affected knee revealed nonerosive arthritis. The fluid collected was mildly articular in nature, without inflammatory features.

A median follow-up of 41 months has not revealed any neoplastic or arthritic recurrence. The investigators conclude that “knee monoarthritis may represent in some cases a paraneoplastic syndrome” that heralds non–small cell lung cancer. They suggest that when faced with a patient with arthritic symptoms in one knee who smokes heavily, evaluation for non–small cell lung cancer may turn up surprising results.


  Cantini F, Niccoli L, Nannini C, et al: Isolated knee monoarthritis heralding respectable non small-cell lung cancer: A paraneoplastic syndrome not previously described. Ann Rheum Dis 2007; Sep 3 (E-pub ahead of print).





%u25BA TURKEY

Gabapentin Helps Opioid Treatment Alleviate Neuropathic Pain


In patients with advanced cancer, neuropathic pain commonly requires multiple drugs, including opioids and narcotics, to improve patients’ quality of life. Sometimes, adjuvant analgesics added to the combination of pain medications provide improved pain relief.

Researchers from Istanbul University, Turkey, sought to compare the effectiveness and safety of gabapentin (Neurontin) combined with an opioid versus opioid monotherapy for the management of neuropathic cancer pain.

Using the World Health Organization analgesic ladder guidelines, these physicians treated 75 patients with advanced cancer who were receiving opioid therapy. The patients had reported receiving adequate alleviation of their nociceptive, but not neuropathic, pain. The 75 patients were assigned to receive either 1) gabapentin in addition to their present opioid monotherapy (in which the gabapentin only was titrated according to pain response) or 2) no gabapentin and only continuation of opioid therapy. Sixty-three patients completed the study, which evaluated treatment effects by the fourth and 13th day of treatment.

The researchers found that reduction of pain intensity at Day 4 and Day 13 were similar between the two groups. The opioid-only group had significantly greater mean pain intensity for burning and shooting pain (P = .0001) at both time points compared with the gabapentin group. Interestingly, the gabapentin group had a significant decrease in the rate of allodynia, but only at the day 4 data point (P = .002).

The side effects experienced in the gabapentin group were milder than those receiving opioids only, according to the researchers. On the basis of these results, they conclude that the use of gabapentin added to opioid therapy can offer improved neuropathic pain relief in relief of neuropathic pain in patients with cancer who receive opioid monotherapy alone. Larger investigations are needed to determine if this approach should be used as first-line management of pain in these patients.


  Keskinbora K, Pekel AF, Aydinli I: Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: A randomized open trial. J Pain Symptom Manage 2007;34:183-189.





%u25BA CHINA

Is a Blood Test for Early Diagnosis of Liver Cancer Within Reach?


With the prevalence of hepatitis B virus increasing in Asia, researchers from the Chinese University of Hong Kong have uncovered a marker in the blood that could lead to a blood test that can help detect the presence of early-stage hepatic cancer.

Previous research had revealed that the RASSF1A gene, which is involved in tumor suppression, is turned offin tumor cells through a process referred to as “hypermethylization.” The investigators have designed a new, sensitive method of testing for the specific methylated DNA.

They matched 63 patient pairs (1 with primary hepatocellular cancer and 1 with hepatitis B virus). The new polymerase chain reaction test detected the hypermethylated RASSF1A gene in 93% of those with liver cancer, and 58% of those with chronic hepatitis B infection. The test was also given to healthy volunteers, none of whom tested positive for the altered gene.

In a separate investigation, the scientists evaluated 44 patients who were carriers of hepatitis B virus. Twenty two developed hepatic cancer over time, and their circulating levels of the altered RASSF1A gene increased from baseline to cancer diagnosis. The patients who did not develop hepatic cancer experienced no increase in RAAF1A gene levels.


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