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Clinical Notes

doi: 10.1097/01.COT.0000294156.71059.62
DEPARTMENTS: Clinical Notes
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New Handbook on Cancer Risk Assessment

To help oncology nurses to integrate recently discovered information about the genetic basis of cancer into their practice, the Oncology Nursing Society has published a new manual, Genetics in Oncology Practice: Cancer Risk Assessment.

Edited by Amy Strauss Tranin, RN, MS, AOCN, Agnes Masny, RN, MPH, MSN, CRNP, and Jean Jenkins, PhD, RN, FAAN, the book, which incorporates the latest insights from the Human Genome Project, introduces the reader to basic genetic concepts, the molecular mechanisms of carcinogenesis, genetic testing, and gene-directed therapies.



Additionally, nurses will find the background they need to interpret genetic cancer risk and present risk information and options to patients in a clear and ethical manner.

The book costs $52 for ONS members, $68 for nonmembers, and can be obtained by calling the toll-free number, 1-866-257-4ONS or via the ONS Web site:

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Implanted Biopsy Marker Remains Visible for at Least a Month

A new type of implantable breast cancer biopsy marker is still visible using ultrasound imaging techniques for at least as long as four weeks after it is placed in the breast, according to a poster study presented at the Radiological Society of North America Scientific Assembly and Annual Meeting. After the marker was deployed it could be seen throughout the study period, the researchers said.

“The ability to localize a tumor biopsy site preoperatively by ultrasound rather than by x-ray eliminates a dose of ionizing radiation,” said Mary Lechner, MD, Medical Director of the Jane Brittain Breast Center at Park Nicollet Clinic in St. Louis Park, MN. The study received support from SenoRx, Inc. of Aliso Viejo, CA.

Dr. Lechner, Assistant Clinical Professor of Radiology at the University of Minnesota, enrolled 20 breast cancer biopsy patients into the study. The patients were undergoing a vacuum-assisted biopsy of a breast lesion and agreed to participate in follow-up ultrasound examinations.

Dr. Lechner delivered the new marker, Gel Mark Ultra, into the biopsy cavity with a syringe. The marker is composed of 11 synthetic bioresorbable pellets, the central one of which contains an embedded stainless steel wireform.

The researchers performed repeat ultrasound examinations at two weeks and at four weeks, confirming that the marker was still highly visible with ultrasound imaging. “The gel marker allows for successful wire localization under ultrasound guidance whether the biopsy and marker placement were performed with ultrasound or x-ray guidance,” Dr. Lechner said.

The visibility of the marker was rated on a scale of 0–2, with two being highly visible. Upon placement of the gel marker, the researchers determined that at baseline the visibility was 1.4. At two weeks, among 16 evaluable patients, the visibility was rated at 1.7; at four weeks the average visibility was 1.5 among the 10 remaining patients. Patients dropped out for personal reasons or for cancer treatment.

“The marker was more than adequately visible on ultrasound imaging immediately after deployment and throughout the duration of the study,” Dr. Lechner reported. “This allows a choice of imaging modalities for a preoperative wire localization procedure, if necessary.”

She said the wireform part of the marker allows for x-ray imaging if that is desired; but the pellets or more likely, the shadowing caused by the pellets makes the marker visible with ultrasound.

“The marker might also enhance the accuracy of surgery by localizing the tumor from the most advantageous surgical approach, with the patient in a position that most closely simulates her position during surgery.”

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Imagine This!

Health care professionals who want to learn how to use imagery to facilitate healing and coping in their patients may want to check out the new Oncology Nursing Society book Voice Massage: Scripts for Guided Imagery.

The book is written and edited by Denise Murray Edwards, RN, CS, ARNP, MEd, MTS, of the Iowa Health System. Other authors are Mary Jane Ott, MN, MA, RNCS; Janice Post-White, RN, PhD, FAAN; and Mary L.S. Vachon, RN, PhD; and there is a foreword by James S. Gordon, MD, Director of the Center for Mind-Body Medicine.



Included are 15 scripts that can be used as guides for learning imagery as well as specific techniques for helping both adults and children to use the relaxation intervention to reduce pain, nausea, and anxiety.

There are also precautions regarding contraindications to the use of guided imagery in patients with certain comorbidities and tips for evoking sensory images of a specific type such as auditory or olfactory.

The book costs $30 for ONS members and $42 for nonmembers, and can be obtained by calling the toll-free number, 1-866-257-4ONS or via the ONS Web site:

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Focus on Heparin-Induced Thrombocytopenia

Vascular specialists have initiated a “Call to Action” to focus attention on heparin-induced thrombocytopenia, an immune reaction to heparin that could affect as many as 600,000 of the 12 million patients given the anticoagulant each year.

The campaign is sponsored by GlaxoSmithKline, which makes Argatroban, used for prophylaxis or treatment of thrombosis in patients with HIT.

Without prompt diagnosis and treatment, thrombotic events, including myocardial infarction, stroke, and pulmonary embolism, develop in one third to one half of patients with heparin-induced thrombocytopenia (HIT), according to Steven Deitcher, MD, Chief of Hematology and Coagulation Medicine at the Cleveland Clinic, which is collaborating with the company on the campaign.

But prompt diagnosis is problematic as “there's no obvious clue that it's coming,” said William Mathai, MD, Clinical Associate Professor of Medicine at the University of Pennsylvania School of Medicine.

By the time the diagnosis is obvious and “one says, ‘Oh this patient has HIT,’ it's likely you're too late…the patient has a thrombotic complication. The real question is how to recognize HIT before the thrombosis occurs,” he said.

Diagnosis is dependent on a high index of clinical suspicion, Dr. Mathai said. Factors to consider in making a diagnosis include:

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Exposure to heparin the last 100 days.

  • ▪ A drop in platelet count of 30% to 50% from pre-heparin levels or a platelet count of less than 150,000 per microliter.
  • ▪ The absence of any other clear cause for thrombocytopenia.
  • ▪ The timing of thrombocytopenia; HIT usually occurs five to 14 days after administration of heparin.
  • ▪ The broad clinical picture.
  • ▪ Supporting laboratory tests, if available.

Even a preliminary diagnosis of HIT should be followed by rapid treatment to minimize the chance of complications, the specialists said. Heparin should be immediately discontinued and anticoagulation with argatroban initiated.

Argatroban is the first synthetic direct thrombin inhibitor and is the only anticoagulant approved for both prophylaxis and treatment of thrombosis in patients with HIT. HIT patients who have already developed thromboembolic disease can also be treated with lepirudin.

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New Insights into Kaposi's Herpesvirus

Kaposi's sarcoma-associated herpesvirus (KSHV) facilitates the proliferation of tumor cells through immune evasion, report researchers at the University of Pittsburgh Cancer Institute.

Patrick S. Moore, MD, MPH, Professor in the Department of Molecular Genetics and Biochemistry, and Yuan Chang, MD, Professor in the Department of Pathology—the team who discovered KSHV—examined the expression of the viral cytokine known as virus-derived interleukin-6 (vIL-6) in KSHV.

They and their colleagues Malini Chatterjee (first author), Julie Osborne, and Giovanna Bestetti found that vIL-6 not only protects virus-infected cells from undergoing growth arrest and apoptosis, but also inhibits immune function.

“The importance of this finding is that it demonstrates that there is an overlap between the immune system and tumor-suppressor pathways which are targeted by KSHV,” Dr. Chang said in a news release.

To arrive at their findings, the team used a series to assays to examine how vIL-6 inhibits the signaling of antiviral factor interferon, which normally blocks virus-infected cells from reproducing.

They found that KSHV has a built-in sensor mechanism that perceives an increased signaling of interferon and responds by increasing the production of vIL-6.

“Infected cells that normally would either arrest or undergo apoptosis in response to interferon signaling continue to proliferate in the presence of vIL-6, resulting in a virus-human autocrine feedback circuit,” the team write in the report, which was published in Science (2002;298:1432–1435).

The autocrine loop established by vIL-6 may be a promising target for novel therapies directed against KSHV-related hematopoietic tumors, the researchers noted.

© 2003 Lippincott Williams & Wilkins, Inc.
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