Konstantinos Kamposioras

Combined vitamin C and E supplementation during pregnancy for preeclampsia prevention: a systematic review.

The effect of combined vitamin C and E supplementation during pregnancy on the prevention of preeclampsia and major adverse infant outcomes has been reviewed. We searched MEDLINE and the Central Library of Controlled Trials of the Cochrane Library through August 2006 for relevant clinical trials. Interstudy heterogeneity was evaluated using the &khgr;2 statistic (Q statistic) test. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with a fixed or random-effects model as appropriate. Four trials that collectively randomized 4680 pregnant women to either the combination of vitamin C and vitamin E or placebo were included in the analysis. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia, 11% versus 11.4%, RR 0.97 (95% CI 0.82–1.13), fetal or neonatal loss, 2.6% versus 2.3%, RR 1.10 (95% CI 0.78–1.57), or small for gestational age (SGA) infant, 20.6% versus 20%, RR 0.94 (95% CI 0.74–1.19). Although there was a higher risk for preterm birth in the vitamin group, 19.5% versus 18%, RR 1.07 (95% CI 0.96–1.20), this finding was not significant. Combined vitamin C and E supplementation during pregnancy does not reduce the risk of preeclampsia, fetal or neonatal loss, small for gestational age infant, or preterm birth. Such supplementation should be discouraged unless solid supporting data from randomized trials become available. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall that many methods have been used to prevent preeclampsia, state that increased oxidative stress has been postulated and many trials have used antioxidants to prevent the disease, and explain that MEDLINE analysis of the literature questions the use of vitamin C and E supplements.

Overall survival benefit for weekly vs three-weekly taxanes regimens in advanced breast cancer: a meta-analysis

BACKGROUND Taxanes have been extensively tested in patients with advanced breast cancer, but it is unclear whether their weekly use might offer any benefits against standard every three weeks administration. We therefore performed a meta-analysis of randomized controlled trials that compared weekly and every three weeks taxanes regimens in advanced breast cancer. METHODS The endpoints that we assessed were objective response rate, progression free survival (PFS) and overall survival. Efficacy data for paclitaxel and docetaxel were separately analyzed. Trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences. RESULTS Omicronbjective response rate was notably better when paclitaxel was used as every three weeks regimen (7 studies, 1772 patients, fixed effect model pooled RR 1.20 95%CI 1.08-1.32 p<0.001). No difference were found for PFS (6 studies, 1610 patients, random effect model HR 1.02, 95%CI 0.81-1.30 p=0.860); while OS was statistically higher among patients receiving weekly paclitaxel (5 studies, 1471 patients, fixed effect model pooled HR 0.78, 95%CI 0.67-0.89 p=0.001). No differences were observed for the weekly compared to the every three weeks use of docetaxel either for objective response, PFS and OS. Overall, the incidence of serious adverse events, neutropenia, neutropenic fever, and peripheral neuropathy were significantly lower in weekly taxanes schedules. The incidence of nail changes and epiphora were significantly lower in the every three weeks docetaxel regimens. CONCLUSIONS Use of paclitaxel in weekly regimen give overall survival advantages compared with the standard every three weeks regimen. The observed survival benefit does not seem to stem from an increased potency of the drug with weekly regimens. The use of weekly paclitaxel regimens is therefore recommended for the treatment of locally advanced/metastatic breast cancer.

Exploring the biology of cancer of unknown primary: breakthroughs and drawbacks

Cancer of unknown primary (CUP) ranks among the ten most common malignancies worldwide. Cancer of unknown primary presents as disseminated disease, has a dismal prognosis and remains a diagnosis of exclusion. The natural history and biology of the disease is poorly understood, and efforts are focused on identifying the specific ‘CUP signature’.

Screening chest radiography: results from a Greek cross-sectional survey

BackgroundPublic health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Despite the accumulated evidence, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. We therefore set out to index the use of chest radiography for screening purposes among the healthy adult population and to analyze its relationship with possible trigger factors.MethodsThe study was designed as a cross-sectional survey. Five thousand four hundred and ninety-nine healthy adults, coming from 26 Greek provinces were surveyed for screening practice habits in the nationwide anticancer study. Data were obtained for the use of screening chest radiography. Impact of age, gender, tobacco exposure, family history positive for malignancies and professional-risk for lung diseases was further analyzed.Resultswe found that 20% (n = 1099) of the surveyed individuals underwent chest radiography for screening purposes for at least one time during the previous three years. Among those, 24% do so with a frequency equal or higher than once yearly, and 48% with a frequency equal or higher than every three years. Screening for chest radiography was more commonly adopted among males (OR 1.130, 95% CI 0.988–1.292), pensioners (OR 1.319, CI 1.093–1.593) and individuals with a positive family history for lung cancer (OR 1.251, CI 0.988–1.583). Multivariate analysis confirmed these results.ConclusionDespite formal recommendations, chest radiography for screening purposes was a common practice among the analyzed sample of Greek adults. This practice is of questionable value since the positive predictive value of chest radiography is low. The implementation of even a relatively inexpensive imaging study on a national scale would greatly burden health economics and the workload of radiology departments.

Food for thought in women's health. The gynecologist: the new European gatekeeper in Chlamydia trachomatis infection

Genital Chlamydia trachomatis infection is the principal cause of bacterial sexually transmitted disease in industrialized countries. A wide spectrum of pathologic conditions has been associated with the disease ranging from urethritis, cervicitis, to pelvic inflammatory disease, ectopic pregnancy, tubal infertility and cervical neoplasia.

Systemic Therapy of Bone Metastases

A few solid tumors have the propensity to bone and they can form two distinct types of bone lesions, which depend on whether osteoclastic (breast and thyroid cancer) or osteoblastic (prostate cancer) activity prevails. Regardless the types of bone lesion, bone metastazing cancers usually behave indolently and share in common significant sensitivity hormone therapies. The efficacy of chemotherapy is limited, and it depends on the tumor type. In general bone marrow-sparing strategies as are weekly schedules and metronomic chemotherapy appears to be the most appropriate therapeutic approach for patients with bone metastases. Hormonotherapy of hormone-sensitive bone metastases is typically shown effective over protracted periods of time and it usually outperforms chemotherapy in benefiting these patients. Therefore hormonotherapy should be considered as an upfront treatment option for patients with such cancers. Cancer research is currently investigating the molecular mechanisms, which underlie the apparent close ties of hormonal driven cancers and the microenvironment of bone. Improvements in the biological understanding are hoped to boost clinical research into developing most optimal hormonal management of hormone sensitive bone metastases.

Hormonotherapy of Bone Metastases

Hormone-dependent tumors have a proclivity to metastasize to bone where they form two distinct types of bone lesions, which depend on whether osteoclastic (breast and thyroid cancer) or osteoblastic (prostate cancer) activity prevails. Regardless the types of bone lesion, these cancers usually behave indolently and share in common a significant sensitivity to surgical or medical hormone depleting therapies. Such therapeutic strategies are castration interventions and administration of selective inhibitors of hormone biosynthesis (aromatase inhibitors for breast cancer) or hormone receptors (tamoxifen for breast and anti-androgens for prostate cancer). Hormonotherapy of hormone-sensitive bone metastases is typically shown effective over protracted periods of time and it usually outperforms chemotherapy in benefiting these patients. Therefore hormonotherapy should be considered as an upfront treatment option for patients with such cancers. Cancer research is currently investigating the molecular mechanisms, which underlie the apparent close ties of hormonal driven cancers and the microenvironment of bone. Improvements in the biological understanding are hoped to boost clinical research into developing most optimal hormonal management of hormone sensitive bone metastases.