Australian Scientists Discover New Disease
Extreme laziness may have a medical basis, say a group of Australian scientists in this week’s BMJ, as they describe a new condition called motivational deficiency disorder (MoDeD).
The condition is claimed to affect up to one in five Australians and is characterised by overwhelming and debilitating apathy. Neuroscientists at the University of Newcastle in Australia say that in severe cases motivational deficiency disorder can be fatal, because the condition reduces the motivation to breathe.
Neurologist Leth Argos is part of the team that has identified the disorder. “This disorder is poorly understood,” he says. “It is underdiagnosed and undertreated.”
Serum tumor markers predict extravesical disease in clinical stage T2 bladder cancer
Bladder cancer clinical staging is notoriously poor in patients with muscle invasive disease.
While prospective randomized trials have demonstrated a small survival benefit when neoadjuvant chemotherapy strategies are employed, the selection criteria for preoperative chemotherapy are not well defined. Improving clinical staging with novel imaging or laboratory modalities remains a challenge.
In the April issue of the Journal of Urology, Margel and colleagues evaluated the utility of preoperative levels of CEA, CA-125 or CA 19-9 to predict extravesical disease in patients with clinical stage T2 bladder cancer. Quantitative beta-hcg was not measured. Serum levels of these markers were measured in 91 patients treated with radical cystectomy. Of these patients, 51% (46) had disease localized to the bladder and 49% had extravesical disease. Nineteen percent of patients had evidence of lymph node metastases.
UK Plans for Pandemic Flu Don’t Go Far Enough
The UK’s contingency plans for pandemic flu don’t go far enough, argues a director of public health in this week’s BMJ.
Plans for pandemic flu in the United Kingdom are said to be among the best in the developed world, but important lessons from the past have been missed, writes Hilary Pickles. These include the need to prepare for high death rates, being open with the public, and understanding population behaviour. Clear and appropriate accountability and communications are also needed, she concludes.
In response, David Salisbury, Director of Immunisation at the Department of Health, argues that preparedness has been strengthened through cross government working, enhanced communications, and international cooperation.
Underutilization of partial nephrectomy for localized renal cell carcinoma in the U.S.
In the past, the gold standard for the treatment of localized renal tumors has been radical nephrectomy. Over time however, experience with nephron sparing surgery and, now, laparoscopic approaches have demonstrated oncologic equipoise and may provide for an improved quality of life for patients as compared to those undergoing radical nephrectomy for localized renal masses.
The incidence of localized small renal tumors is increasing (3.8-5.6% annually) and one would predict that the incidence of nephron sparing approaches would increase in concert. Though more technically demanding than radical nephrectomy, nephron sparing offers the intuitive benefit of maximizing residual functioning renal tissue, while maintaining cancer control. A recent evaluation of the SEER database revealed that in 2001, 58% of patients with tumors < 2cm, and 80% of patients with tumors 2-4 cm were managed with radical nephrectomy. This study by Hollenbeck and colleagues suggests that while the use of nephron sparing approaches in the management of small renal masses has increased, it remains underutilized and very much regionalized to urban, teaching, high volume centers in the United States.
Real Battle Over Mental Health Law About to Begin
The UK government’s climb down on reform of mental health legislation is not a victory - the real battle is about to begin, warns a senior doctor in this week’s BMJ.
The UK government’s announcement that it has abandoned its eight year attempt to achieve a new Mental Health Act for England and Wales is an apparent victory for patients, professionals, and liberal democracy, writes Professor Nigel Eastman of St George’s Hospital, London.
But faced with almost unanimous opposition from those with an interest in mental health care, the government has stated that it will instead introduce a shortened and streamlined bill amending the 1983 Mental Health Act.
