Despite an increasing concern that atypical antipsychotics seem to have a stronger diabetogenic risk than conventional antipsychotics, little information is available on the prevalence of diabetes among schizophrenia patients, and prescription patterns for patients with comorbid schizophrenia and diabetes in Japan.To compare the prevalence of diabetes between schizophrenia patients and the general population and to investigate whether diabetes status correlates the prescription patterns of antipsychotics at hospital discharge.Schizophrenia patients who were discharged between April 2004 and March 2005 and who continued to receive outpatient treatment from 526 hospitals were included in this retrospective open cohort study. We collected information about the doctor diagnosis of diabetes during hospitalization, and drug prescriptions for schizophrenia at hospital discharge using medical charts.The overall prevalence of diabetes was 8.6% among patients with schizophrenia. Compared with the general population, the estimates of diabetes prevalence in the schizophrenia population were 2.6–10.8 percentage point higher among males aged 30–49 years, and 1.9–9.9 percentage point higher among females aged 40–59 years. The odds of being prescribed conventional antipsychotics were about 2 times higher among patients with diabetes than without diabetes, relative to atypical and combination of conventional and atypical antipsychotics. These results were robust across various sensitivity analyses.When treating schizophrenia patients with preexisting diabetes, psychiatrists need to monitor the occurrence of diabetes regularly regardless of antipsychotic class, strike a balance, and provide the most efficacious antipsychotic medication.

BACKGROUND:Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis.METHODS:This was a retrospective analysis of sixty-one (61) cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005.RESULTS:Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no cases died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA (i.e. no lymph node affection).CONCLUSION:There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. Prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative.

To evaluate hemoglobin (Hb) levels before and during radiotherapy and its role as prognostic factor on treatment results of patients treated for cancer cervix.One hundred and seven patients with cervical cancer were registered and managed at KCCC during 1995 - 1999. The pre-treatment and mid treatment Hb levels were found for 47 patients only. Follow-up was done for these cases aiming at evaluation the overall and disease-free survival. Statistical analysis was done using SPSS statistical package version 10.0.The median age of patients were 45 and ranged between 26-80 years. Kuwaiti patients represented 21.3% of cases. The most common stage was Stage IIb representing 51.1% followed by IIIb representing 27.7%. Stage Ib and IIa represented 12.8%. About 89.4% were squamous cell carcinoma, while adenocarcinoma was 6.4%. Treatment outcome revealed 18 relapses (38.3%). Disease-free survival for cases with pre-treatment Hb level < 12 was 16.3%, while for those with Hb level > or = 12 g/dL it was 62.9%. The difference was statistically significant (P = 0.02).Patients with pre-treatment Hb < 12 g/dL had a significantly lower disease-free survival.

Aim: Incidence of rectal and rectosigmoid cancer has wide geographical variation. Disease pattern in developing countries is different from developed countries. This analysis was undertaken to describe patient profile and to review the outcome of adjuvant therapy for rectal and rectosigmoid cancer at Kuwait Cancer Control Center.Patients and Methods: We retrospectively evaluated rectal and rectosigmoid cancer patients diagnosed between 1998 - 2004. One hundred and ninety three patients with rectal and rectosigmoid cancer were included. Only 11% of the patients were diagnosed with stage I disease, 28% with stage II, 53% were stage III, and 7.9% were stage VI. About 76.6% underwent anterior resection while 23.3% underwent abdomino-perineal resection or Hartman procedure. Only 63.2% of the patients received radiotherapy, and of those only 36 patients had preoperative radiotherapy. Only 35.2% of patients received adjuvant chemotherapy. Results:The male to female ratio was 1.4 and the median age of the patients was 52.11 years. Cancer of the rectum constituted 64.2% while rectosigmoid cancer constituted 35.8% of the cases. About 17.7% had tumor located within 5 cm from anal verge. Locally advanced or metastatic disease were found in 67.6%. Tumor involving more than _ of the lumen circumference was found in 49.1% of cases. Liver was the most frequent site (14.5%) of metastasis followed by lung (4.1%). Well, moderately and poorly differentiated adenocarcinoma constituted 16.8%, 68.8% and 14.5% of the cases, respectively. The disease free survival was influenced significantly by the lymph nodes status and chemotherapy. Among the whole group, the local recurrence was 18.7%, while the disease free survival and overall survival were 42.7 and 90.04%, respectively. Conclusions: Rectal cancer in Kuwait differs from western countries with a high propensity for locally advanced tumors because of delayed referral and misdiagnosis.

OBJECTIVE:To determine the frequency of anemia in patients with advanced or metastatic non-small cell lung cancer (NSCLC) at the time of initial oncologic consultation.MATERIAL AND METHOD:We reviewed 144 consecutive charts of patients with advanced or metastatic NSCLC, who were seen in consultation at the Hamilton Regional Cancer Center (Canada) between January and June of 1998.RESULTS:Eighty nine patients had pre-treatment hemoglobin (Hb) levels available and 30 of those patients (33.7%) had levels below 12 gm/dl. The likelihood of anemia increased with advancing stage of underlying disease, found in 25% and 40.8% of stage III and IV patients respectively.CONCLUSION:Although only 89/144 patients had Hb results available, 33.7% had hemoglobin level below 12 g/dl. Anemia was more common with an increased burden of disease. Shortness of breath and fatigue were more commonly reported in anemic patients.

Spinal cord compression is a major cause of morbidity and or mortality in a cancer patient. This is one of the few oncologic emergencies, as delay in therapy leads to frank paralysis. Several key areas must be considered in the diagnosis and management of spinal cord compression. Because the outcome can be devastating, a diagnosis must be made early and treatment initiated promptly. The purpose of this paper is to present an overview of the important points to radiation oncologists regarding the management of spinal cord compression in an evidence-based approach.

OBJECTIVE:To determine the value of staging investigations in detecting metastases in newly diagnosed asymptomatic patients with breast cancer.MATERIALS AND METHODS:A retrospective review of patients' files with newly diagnosed breast cancer in the period from 1993 to 1998 was performed. Due to inadequate information, thirty-eight files were excluded leaving 785 files for analysis.RESULTS:Of the total 785 patients, we found distant metastases at the time of primary diagnosis in 36 (4.6%) patients, bone metastases in 29 (3.7%) patients, pulmonary metastases in 6 (0.8%) patients and liver metastases in 5 (0.6%) patients. Overall, 0.7% of patients with clinical stage I and II disease had metastases compared with 16.2% of patients with clinical stage III disease (statistically significant p = 0.0001).CONCLUSION:The results confirm the low yield of routine bone scans, liver ultrasound and chest X-ray among patients with asymptomatic early-stage breast cancer. These tests are therefore not recommended for such patients, although intensive investigations are appropriate for more advanced tumors.

Purpose: Staging for prostate cancer often includes bone scanning and computerized tomography (CT). We systematically reviewed the published evidence for these tests.Materials and Methods: We searched MEDLINE for articles on these investigations in newly diagnosed cases of prostate cancer. Data were pooled based on prostate specific antigen (PSA), grade and tumor stage.Results: Among 23 studies examining the role of bone scan metastases were detected in 2.3%, 5.3% and 16.2% of patients with PSA levels less than 10, 10.1 to 19.9 and 20 to 49.9 ng/ml, respectively. Scanning detected metastases in 6.4% of men with organ confined cancer and 49.5% with locally advanced disease. Detection rates were 5.6% and 29.9% for Gleason scores 7 or less and 8 or greater, respectively.Among 25 studies CT documented lymphadenopathy in 0 and 1.1% of patients with PSA less than 20 and 20 ng/ml or greater, respectively. CT detection rate was 0.7% and 19.6% in patients with localized and locally advanced disease, respectively. Detection rates in patients with Gleason scores 7 or less and 8 or greater were 1.2% and 12.5%, respectively. These risks were typically much greater on pathological evaluation.Conclusions: Patients with low risk prostate cancer are unlikely to have metastatic disease documented by bone scan or CT. Therefore, these investigations should not be standard practice. However, patients with PSA 20 ng/ml or greater, locally advanced disease, or Gleason score 8 or greater are at higher risk for bone metastases and should be considered for bone scan. CT may be useful in patients with locally advanced disease or Gleason score 8 or greater but appears not to be of benefit in patients with increased PSA alone.

BACKGROUND AND OBJECTIVES:In Kuwait, breast cancer is the most common form of cancer among women. The present study reviews the clinical features, treatment methods and treatment results of breast cancer patients registered in the Kuwait Cancer Control Center (KCCC) and compares these features with those reported in other Arab countries, Europe and North America.MATERIAL AND METHODS:The present study examines 823 patients with breast cancer who were registered in the KCCC from 1993 to 1998. Patients were identified through the Kuwait Cancer Registry and their cases were followed for at least five years.RESULTS:Eleven males accounted for 1.3% of all patients. The average age was one decade younger than that reported in western countries but similar to reports from Egypt and GCC countries. Surgery was applied in 90.4% of patients. Breast conservation (lumpectomy and axillary clearance) was performed in 19.6% of patients, while mastectomy and axillary clearance was adopted in 60.8%. Radiotherapy was applied in 67.7% of patients and chemotherapy in 60.8%. The long-term overall survival and disease-free survival amounted to 76+/-6.4% and 54+/-4.6% respectively. Prognostic factors were analyzed using univariate and multivariate analysis. According to multivariate analysis the nodal status, the number of involved nodes and histopathology were independent prognostic factors. Comparable results were achieved after both breast conservation and mastectomy.CONCLUSIONS:Since breast conservation protocols yield results similar to mastectomy, its use should be extended. Search for biological prognostic indicators should continue for their potential use as guides for treatment decisions.