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Actos Bladder Cancer Headlines

By admin | Published January 27, 2012

Actos Bladder Cancer : Keep your doctor informed if you are experiencing any of the above side effects. There are drugs that can help minimize these con”ditions and make your treatment more comfortable. Luckily, these side effects tend to disappear once you are no longer receiving chemotherapy, and you will gradually feel stronger and become less vulnerable to bleeding or infections.

For invasive bladder cancer, chemotherapy is sometimes given before you have a cystectomy. Sometimes it’s given afterwards. Sometimes it’s not given at all. It depends entirely on the type of tumor you have, where it may have spread, and whether you have another medical condition that might make it difficult for you to tol”erate chemotherapy. Very advanced age can also be a factor in decid”ing whether chemotherapy is appropriate.

The choice of drugs used to treat invasive bladder cancer is similar to the choice in advanced or metastatic disease. If you have invasive transitional cell carcinoma you will probably undergo chemotherapy, as this type of cancer is responsive to either radiotherapy or surgery with chemotherapy, and many stud”ies have examined this type of cancer treatment.

If you have been diagnosed with squamous cell cancer or adeno”carcinoma, the track record for chemotherapy is not so clearly defined. Most physicians don’t recommend chemotherapy as standard treatment in conjunction with cystectomy for these types of cancer. It is, however, quite reasonable for your team to suggest that you look into a clinical trial (for example, one that is exploring the use of chemotherapy) if you have been diagnosed with squamous cell or adenocarcinoma.

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Most of the reported trials indicate that the use of single chemother”apy drugs does not have an extensive beneficial effect, but that the use of combinations of three or four chemotherapy drugs can shrink the bladder cancer in around 70 percent of cases and can also improve the cure rate and length of survival. For you as a patient, the information gleaned from these clinical trials means that if you have TCC, your doctors are likely to recom”mend treatment that includes a “cocktail” of several carefully targeted chemotherapy drugs as well as cystectomy or radiotherapy.

In some cancers, such as breast cancer, it is pretty standard practice to give several doses of chemotherapy after surgery, especially for tumors with high-risk pathological features, such as lymph-node involvement. We know of six studies that have looked at this question in bladder cancer, but the results are somewhat inconclusive as to whether chemotherapy is most effective given before or after surgery.

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When radiation is used alone or with chemotherapy there is an increased likelihood that your other organs, such as the prostate and uterus, will remain functional, as does your ability to void urine normally and have sex. The intention when chemotherapy and radio”therapy are given is usually to improve the chances of curing the cancer while preserving the bladder and avoiding the need to remove it surgically. This area is still somewhat controversial; while some physicians believe that this approach is nearly as effective as surgical removal of the bladder, others feel that cystectomy is the best treat”ment The decision depends in part upon the physical fitness of the patient as well as upon the patient’s personal preferences.

The use of radiotherapy doesn’t mean that it is without side effects. There can be scarring of the bladder tissue, and that can reduce the amount of urine your bladder can hold. The result would be an increase in the number of times you have to urinate, which can be irritating, especially at night. You also may experience an increase in bouts of cystitis.

There has been much discussion about whether the results achieved by radiotherapy are the same as those from cystectomy with, respect to achieving cure. We think that when one considers all types of bladder cancer, in the hands of a highly experienced urologist who specializes in this operation, cystectomy gives better results than radiotherapy. However, there are some patients, particularly those with other significant medical conditions, who will benefit from radiotherapy despite the possibility of a lower chance of permanent cure. In some centers, such as Massachusetts General Hospital, where the techniques of chemoradiotherapy and bladder preservation have been piloted, a urologist wall perform a cystoscopy about halfway through the planned course of radiotherapy. If the tumor is shrinking well, radiotherapy will be completed. However, if it appears that the cancer is not responding to radiotherapy, the plan wall be abandoned and replaced with a radical cystectomy.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit Report

By admin | Published January 26, 2012

Actos Lawsuit : There are two broad types of cancers in the bladder: primary and metastatic. Primary bladder cancers are those that begin in the bladder itself. Metastatic cancers are those that originated in another organ and then spread to the bladder. Other tumors can get into the bladder through the bloodstream, through the lymphatic system, or by directly extending from a nearby organ, such as the prostate or the cervix.

Cancers originating in the bladder are far more common than cancers that spread to the bladder from another loca­tion. There are several types of primary tumors. Recall that transitional cell cancer accounts for at least 90% of all bladder cancers. Transitional cell tumors can be classi­fied as (1) papillary, (2) sessile, or (3) a mix of both types. Papillary tumors look like a piece of cauliflower attached to the wall by a short stalk; sessile tumors look flat and are broad-based. Almost 70% of transitional cell tumors are papillary types, which tend to have a better prognosis than sessile tumors. Less common types of bladder can­cer include squamous cell cancer, adenocarcinoma, and urachal carcinoma.

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Squamous cell carcinoma accounts for 3% to 7% of bladder cancers in the United States; however, in Egypt it accounts for 75% of the bladder cancers. There is a parasitic infection called schistosomiasis that is very common in Egypt. Infection with this parasite strongly predisposes a person to the development of squamous cell cancer. The parasite burrows into the wall of the bladder, which chronically irritates the bladder. Over many years, this chronic irritation can lead to the devel­opment of bladder cancer, most often squamous cell cancer. Other conditions that cause chronic irritation also predispose to this type of tumor. Chronic indwelling catheters, for example, can irritate the bladder and pre­dispose someone to this tumor. Squamous cell carci­noma does not tend to spread to the lymph nodes like transitional cell cancer does, although it does tend to spread aggressively directly through the bladder into neighboring structures. Because it is so locally aggres­sive and relatively resistant to chemotherapy or radia­tion, it usually has a worse prognosis than transitional cell cancers.

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Adenocarcinoma of the bladder is quite uncommon, accounting for approximately 2% of all bladder cancers in the United States. These tumors are also associated with chronic irritation. They tend to be high-grade aggressive tumors and are therefore usually associated with a worse prognosis. Urachal carcinoma is a specific type of adenocarci­noma of the bladder, but it is unique in that it does not originate in the lining of the bladder. These develop from the outer surface of the bladder, extending toward the inside of the bladder. They can then metastasize to the lymph nodes, the liver, lung, and bone.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Safyral Lawsuit News

By admin | Published January 26, 2012

Safyral Lawsuit: A dry, nonproductive cough is frequently associated with ACEI therapy and can be attributed to kinin accumulation. Patients should be urged to continue therapy, if tolerable. An alternative ACEI should be attempted prior to substitution with an ARB. A rare, but well-known, risk associated with ACEI therapy is angioedema. This life-threatening adverse reaction is most com­monly acute in onset but may occur late in therapy. Re-exposure to ACEI is not recommended, therefore alternative therapies such as hydralazine and ISDN should be considered. Angioedema has also been associated with ARBs, thus switching from an ACEI should be done with extreme caution.

Aldosterone antagonists are yet another class of agents available to target the RAAS. Sodium and water retention, hypokalemia, fibrosis, and ventricular remodeling are all consequences of excess aldosterone. The favorable effects of aldosterone antagonism in HF are due primarily to the inhibition of collagen deposition and fibrosis, therefore preventing ventricular remodeling. Spironolactone was the first aldosterone antagonist studied in the HF population. The RALES trial, which compared spironolac­tone to placebo, was halted early after a 30% relative risk reduc­tion in the primary endpoint of all-cause mortality was discovered during an interim analysis.11 Eplerenone, a selective aldosterone receptor antagonist, was studied in patients post-myocardial infarction with left ventricular dysfunction (EF < 40%).12 There was a significant reduction in mortality, risk of hospitalization due to HF, and sudden death due to cardiac causes. Unlike in the RALES trial, there were more cases of hyperkalemia and no differ­ence in gynecomastia in the eplerenone group.

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Diuretics are key ingredients in the successful management of HF patients. They are often necessary to combat the water and sodium retention elicited by angiotensin II and aldosterone. Diuretics allow for a rapid improvement in signs and symptoms of HF, such as peripheral edema, pulmonary congestion, and jugular venous pressure. These agents are often used long term to maintain symptomatic relief and improve exercise compliance. Although there have not been any clinical trials evaluating the effect of diuretics on mortality, they are indicated in all patients exhibiting signs and symptoms of volume overload.19 Diuretics should never be used alone to treat symptomatic HF. They should be used in combination with an ACEI and beta blocker to prevent further decompensation.

Diuretics, including loop and thiazide, prevent renal tubule absorption of sodium and water. Loop diuretics inhibit reabsorp­tion of sodium in the ascending limb of the Loop of Henle, while thiazide diuretics act in the distal convoluted tubule. Bumetanide, furosemide, and torsemide, all loop diuretics, increase sodium excretion by 20-25% whereas hydrochlorothiazide and metola- zone increase excretion by only 10-15%. It should also be noted that loop diuretics maintain efficacy in renal dysfunction while thiazides are less effective in patients with a creatinine clearance below 50 mL/min. Loop diuretics are, therefore, the most com­monly used diuretics in the management of HF.

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The surgical approach for left ventricular remodeling is predicated on the concept of restoring the geometry of the left ventricle to a conical shape. As shown below the left ventricle is opened in the area of dilatation or scar and direct inspection of the interior of the LV allows the surgeon to determine the beginning area of normal myocardium. This demarcation zone is used to fashion a new LV apex utilizing a constricting stitch and apical patch. The volume of the LV is determined by the patient’s preoperative LV dimensions and body surface area using a balloon template of known volume to adequately but not overly downsize the LV. Additional areas of thinning or dilatation can be plicated and the remaining LV scar is then closed to complete the repair.

Left ventricular failure secondary to myocardial cell dysfunction remains the pressing problem for the future and despite the uti­lization of surgical techniques and devices carries a significant long-term mortality. The future treatment of left ventricular fa.il- . ure may in large part reside in the new technologies surrounding the use of precursor cells growing in areas of myocardial scar or cellular dysfunction providing eventual improvement in left ven­tricular function. The use of stem cells, myoblasts, and skeletal muscle among others are currently under investigation utilizing tissue engineering by seeding cells in three-dimensional matrices of biodegradable polymers without artificial scaffolds to form new myocardial constructs. This technology of cell growth and cell implantation via vectors is well established but many questions are present and hopefully future answers will open this Pandora’s Box allowing successful treatment of end-stage heart failure.

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One of the largest series of apico-aortic conduits in elderly high risk patients has been reported by Dr John Brown in which 45 elderly patients received valved conduits for risk factors men­tioned above. The procedure as pictured below is carried through a left thoracotomy and be accomplished without cardiopulmonary’ bypass in many cases. The operative mortality was low and mid­term durability of the prostheses was good allowing the conclu­sion that high risk elderly patients with no other option could be successfully palliated.

Initially carried out for compassionate use for extremely high risk patients, clinical trials are currently under way in the US and Europe to evaluate the percutaneous or apical implantation of an expandable aortic valve prosthesis. In view of the results of per­cutaneous AVR, the optimism expressed is premature. In fact, the only published series (6 patients affected by end-stage aortic stenosis), presented by Cribier and associates, evidenced some major drawbacks, such as perivalvular leakage, which is caused by the persistence of empty space between the percutaneous and native valves owing to calcifications and which was observed in the majority of patients. Moreover, coronary’ flow obstruction provoked by the valved stent and atheroembolism of calcific debris during the positioning of the derice is possible. Grube and colleagues have recently described 1 single case of implantation of self- expandable valve prosthesis by the retrograde approach, which was deemed to facilitate coaxial positioning and to reduce the risk of perivalvular leakage, but required extracorporeal circulatory support (ECC) as a “safety measure.”

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Certainly in the setting of acute RV failure, the underlying cause needs to be addressed to the extent possible. If treatment of the underlying etiology is unsuccessful or not possible, attempts should be made to maximize right ventricular performance. According to the Frank-Starling principle, volume loading may improve RV output (even in the setting of RV contractile dysfunc­tion). Invasive monitoring (central venous or pulmonary artery catheters) is often necessary to determine the optimal filling pres­sures because excessive volume loading may be detrimental to the RV contractile function. Inotropic support using agents such as dobutamine or milrinone may improve RV contractile function, especially in the setting of high pulmonary artery pressures. In few’ cases when RV failure persists despite optimizing function using the above strategies, right ventricular assist devices are required.

Currently, MCSDs are broken down into distinct types of pumps based on their design as well as there indications for use. Current FDA-approved indications for pump use include bridge-to-recov- ery, bridge-to-transplant, and permanent lifetime therapy. The type of pumps based on design can be either paracorporeal or intracorporeal in relation to the actual location of the pump. The pumps may be either pulsatile/displacement pumps or nonpulsa­tile continuous flow pumps inclusive of the rotary impeller type or centrifugal type. The pumps may have bearings or be bearing-less as in the totally magnetically levitated pumps. The utilization of the different systems is determined most notably by the clinical situation and specifically the ultimate goals of therapy. A single institution may have an array of different pumps that are utilized in different clinical scenarios. At our institution we typically divide the pumps into two groups – those intended for acute decompen­sated support and those for more elective implant for chronic heart failure. The ultimate goal of therapy is paramount to the specific device utilized being either short-term (days to weeks) or long-term (years) support in relation to the ultimate goals of recovery, transplant, or permanent lifetime therapy.

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Total artificial heart pumps are orthotopically implanted and the native heart ventricles are excised. The first successful utiliza­tion of temporary total artificial heart was by Denton Cooley in 1969 utilizing a device developed by Liotta and DeBakey. The first permanent implant of a TAH system was done in 1982; a Jarvik-7 was implanted into Dr. Barney Clark by Dr. William DeVries at the University of Utah. Dr. Clark was supported on the Jarvik-7 for a total of 112 days. The S3>ncardia Cardiowest TAH-t system was approved as a temporary system for bridging to cardiac transplant by the FDA in 2004.Medicare approved reimbursement for the Syncardia Cardiowest TAH-t on 5/1/200S reversing its 1986 non­coverage policy for total artificial heart systems.

The goal of mechanical circulatory support is to restore normal physiologic blood flow to the body and prevent end-organ dys­function. In doing so the ventricle is unloaded thereby decreasing the myocardial workload and reducing the myocardial oxygen demand. Use of a VAD will reduce preload, myocardial wall ten­sion and oxygen consumption.15 Numerous studies have high­lighted the ability of MCSDs to adequately restore tissue perfusion and maintain as well as reverse end-organ dysfunction.

Our use of the term or terms Safyral Lawsuit: is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Asbestos Claim News

By admin | Published January 26, 2012

Asbestos Claim News – 1/25/2012: Exposure to asbestos is the link to the development of mesothelioma. People who end up with this disease usually have had some type of previous exposure to asbestos. How this works is not fully understood. It is thought that asbestos fibers are inhaled and first travel through the upper air passages, which include the throat, the trachea (windpipe), and the large bronchi (large breathing tubes of the lungs). These airways are lined with mucus, and therefore most of the fibers are cleared from these upper airways by sticking to this mucus and being coughed up or swallowed. When the fibers continue to travel and reach the small airways (the alveoli), the body’s immune system is able to sur­round, engulf, and remove the smaller fibers by a process known as phagocytosis. The large, long, thin fibers cannot be cleared as easily and may eventually reach the pleura (the lining of the lung and the chest wall), where they may irritate and injure the cells and lead to the development of calcium containing plate­like structures on the pleural lining (pleural plaques), fibrosis (scar tissue formation), or mesothelioma. These same asbestos fibers can also damage cells in the lung itself, which can lead to asbestosis (scar tissue in the lung) and/or lung cancer. Patients with these pleu­ral plaques seem to be at highest risk for developing mesothelioma.

The best way to prevent mesothelioma is to decrease one’s exposure to asbestos in the workplace, at home, and in the environment. The federal government is responsible for developing regulations that deal with asbestos exposure in the workplace. The agency that issues these regulations is known as the Occupational Safety and Health Administration (OSHA). Employ­ers are required to follow these regulations, and there­fore workers who are concerned about asbestos exposure should be discussing these concerns with their employers or union. Also, employees should be using all protective equipment provided to them by their employers and following recommended safety procedures and practices while at work. If you are exposed to asbestos in the workplace, you should be aware of the potential of bringing the fibers home on your clothes, skin, and hair. It is best to change your clothes and shower at work if at all possi­ble. If not, then it is important to do this immediately upon arriving home, which will limit the amount of exposure to others. Remove your clothes and put them in the washing machine as soon as possible.

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Malignant mesothelioma is a rare form of cancer that is found m the lining of the chest and lung (the pleura), the abdomen (the peritoneum), or the saclike space around the heart (the pericardium). Although it is rare, mesothelioma is a very serious disease that is often at an advanced stage when the diagnosis is made. In the United States an estimated 2000 to 3000 new cases of mesothelioma are diagnosed each year. Approximately three fourths of these cases start in the chest cavity and are called pleural mesothe­liomas. Another 10% to 20% begin in the abdomen and are called peritoneal mesotheliomas. Lastly, those that start in the lining around the heart are called pericardial mesotheliomas, but these are extremely rare. Mesothelioma is divided into three main types, based on what the cancer cells look like under the micro­scope. The most frequent type is epithelioid. About 50% to 70% of mesotheliomas are of this type. It usu­ally has the best prognosis or outiook of the three. The second type is called the sarcomatoid, which makes up about 7% to 20% of mesotheliomas. It has a very unpredictable pattern or nature. The last type, called mixed or biphasic, is a combination of the first two types and makes up about 20% to 35% of mesotheliomas. Although there are different types of mesothelioma, the treatment options, at this time, are essentially the same for all types.

Family members of people exposed to asbestos at work are also at an increased risk for mesothelioma. This is because these asbestos fibers are carried home on the clothes, shoes, skin, and hair of these workers and can be inhaled by others. Simian virus 40, or SV40, is a virus that has been asso­ciated with the development of malignant mesothe­lioma. This virus is found in rhesus monkeys and is now widespread among humans. The way this virus was transferred from monkeys to humans is uncertain, but it is postulated that some of the transfer occurred from 1954 to 1963 through SV40-contaminated polio vaccines administered worldwide. Those people who received the injectable form of the polio vaccine are believed to be those at greatest risk. This vaccine doesn’t folly explain the transfer of this virus, because many humans who could not have received the contaminated vaccines are now infected with the SV40 virus. One theory that has been proposed is that the SV40 virus continues to be transferred from monkeys to humans or that humans can pass the virus from person to per­son. The latter theory has been supported by data showing that SV40 can be excreted in human feces, breast milk, and semen. It is unlikely that this virus acts alone in the development of mesothelioma as most cancers have multiple risk factors associated with their development, and most mesotheliomas occur in asbestos exposed individuals. Instead, it is more likely that asbestos and SV40 may act together to develop into mesothelioma.

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Asbestos is associated with lung cancer too! Many studies have shown that the combination of smoking and exposure to asbestos is particularly haz­ardous. The risk of lung cancer is greatly increased in asbestos-exposed individuals who smoke. However, smoking in the absence of asbestos exposure has not been associated with the development of mesothe­lioma. Nevertheless, did you know that certain ciga­rette filters were constructed from asbestos fibers? Fortunately, this brand, Kents, is no longer on the market. Because of the combined effect of smoking and asbestos exposure, it is important for anyone who has ever been exposed to asbestos, or who suspects that he or she may have been exposed to the fibers, to quit smoking, or not to start. People who have been exposed to asbestos should also get regular physical exams and should seek prompt medical treatment for any respiratory illnesses.

Asbestos is a naturally occurring group of minerals that have been mined and used in different industries since the late 1800s. It is an extremely poor conductor of heat and does not conduct electricity, and therefore it has been widely used as an insulator. The flexible asbestos fibers are woven after being separated into thin threads. The fibers tend to break easily, and the dust that is formed from them breaking can float in the air and stick to clothes. The fibers can also be inhaled or swallowed and can result in serious health problems, including asbestosis, lung cancer, and mesothelioma.

There are six types of asbestos: amosite, crocidolite, anthophyllite, actinolite, tremolite, and chrysotile. The first five types are called amphibole asbestos, and they all have needlelike fibers. Chrysotile has a different texture, composition, and behavior than amphibole asbestos. Although some findings suggest that amphi­bole asbestos is more cancer causing than chrysotile, the topic remains controversial. Mesothelioma has a very long latency period (the time from the initial asbestos exposure to the development of cancer), making it doubly treacherous. This latency period can be anywhere from 25 to 40 years. The length of time it takes patients to report symptoms varies but can range from two weeks to two years, with the average being about two months. As many as 25% of patients with the disease can have symptoms for six months or more before seeking medical attention. Due to its slow onset, the disease tends to affect people between 50 and 70 years of age. It affects men three to five times more often than women and is less common in African Americans than in Caucasians. The right side of the chest is affected more than the left. The right lung is bigger than the left lung, or the right lung is of greater size and volume than the left lung.

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If you experience shortness of breath, pain in the chest or abdomen, swelling in the abdomen, or any other unusual symptom, see your doctor! The doctor will take a history from you and perform a physical exam. In listening to your chest, the doctor may not hear breath sounds clearly on one side or may hear scratchy sounds in the chest (rub). Or the doctor may notice that your abdomen is swollen. After the examination, the doctor mil link the symptoms you reported to the findings on the physical exam. The doctor will want to know whether you have had other symptoms, like fever, chills, pain, or unusual lumps on the torso. The doctor will also want to know whether your appetite is good and whether you have lost any weight. He or she may ask about asbestos exposure and cigarette use.

A patient with a large, unexplained fluid accumulation in the chest or abdomen and who has a small or moder­ate amount of thickening of the pleura should have a biopsy performed, using semi-invasive techniques (tech­niques that require only local anesthesia and that do not involve cutting into the chest or abdomen). For exam­ple, the biopsy might involve an initial thoracentesis (drainage of fluid in the chest) or paracentesis (drainage of fluid in the abdomen) and a pleural biopsy. These are relatively safe procedures that can be performed by a pulmonologist (lung physician), a radiologist, or a sur­geon. A local anesthetic (a numbing medicine such as lidocaine) is given to temporarily reduce the feeling in the area before the needle is inserted. It is important that you get the best information avail­able regarding your particular condition in order to decrease confusion, establish confidence in the treat­ment team, and have every opportunity to fight the disease and live as long as possible. In the majority of cases, your physician -will inform you whether the institution he or she is associated with has a special interest in the disease and treats more than 50 cases of mesothelioma per year. If those resources are not at your physician’s disposal, he or she should recommend a second opinion at a cancer center, which is a spe­cialized institution to which he can refer you for mesothelioma. You should not lose your primary physician or the physician who made this initial diag­nosis as your advocates.

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Oncology is a branch of medicine that deals with can­cer, and an oncologist is a specialized doctor who treats people with these cancers. Depending on your particular treatment plan and which cancer center you are referred to, you may be seen first by a medical oncologist (a specially certified physician who treats cancer and delivers chemotherapy), a thoracic surgical oncologist (a general thoracic surgeon whose practice is almost exclusively the treatment of cancers in the chest and who does not perform heart surgery), or a radiation oncol­ogist (a physician who delivers radiation). Mesothe­lioma is a very rare disease and therefore should be managed by doctors who have experience in treating it. The ideal situation is to be referred to a cancer center that deals with the disease in a multimodal way. That is, one that has a team of physicians from medicine, surgery, and radiation; nurses; and pain specialists who meet and discuss every patient in an individual­ized fashion. This group of specialists is called the multidisciplinary team. The key words here are “expe­rience” and “protocols.” You should insist on seeing individuals experienced in treating mesothelioma and who offer clinical trials (protocols) studying new ways to treat the disease.

It is important that you and your doctor communicate clearly and understand each other well. Before you visit a center or a specific doctor, see whether either has a website that you can visit. You may be pleasandy surprised that a lot of your questions about the place or physician j^ou are visiting are dealt with on this web­site. Nevertheless, how comfortable you are with your doctor will determine what questions you are able to ask and how successful your visit will be. If you don’t understand something that your doctor tells you, let him or her know this! You should be able to receive the information in a form that is understandable to you. Ask the doctor to speak in simple terms if you find the language too complex. If you have concerns about any­thing that is said, speak up and discuss these issues. Take the time to repeat back to the doctor what you heard so that he or she knows what information to reinforce and what to correct. Talk with your doctor about what your knowledge is of the disease and its treatment and any concerns and/or fears you may have.

Telling family members about a diagnosis of mesothe­lioma is a difficult thing to do. They may experience a lot of the same emotions that you do, including fear, worry, concern, anger, and sadness. These emo­tions need to be expressed, even when they are strong. The best recommendation is to communicate openly and honestly with one another. This enables you and your family to cope better with the cancer diagnosis. The entire adult family should discuss all aspects of the disease before you start treatment. This includes the type of mesothelioma, the prognosis, treatment options, goals of treatment, and side effects expected.

Our use of the term or terms Asbestos Claim is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Trans Vaginal Mesh Lawsuit Proceedings

By admin | Published January 26, 2012

Trans Vaginal Mesh Lawsuit : Any neurological lesion or condition that interrupts the cortical inhibition of detrusor contractions can result in neurogenic DO, eg multiple sclerosis or spinaL cord lesions. Urethral outflow obstruction can lead to incomplete bladder emptying, and subsequent symptoms of urgency and frequency. Treatment consists of a combination of bladder retraining and ‘bladder drill’, with anticholinergic medication to help relearn the cortical inhibition of detrusor contractions. This may be time-consuming and frustrating – correct diagnosis is necessary to ensure maximum patient compliance with this treatment.

Overflow incontinence occurs when the bladder, secondary to an injury or insult, becomes large and flaccid, and has Little or no detrusor tone or function. The condition is diagnosed when the urinary residual is more than 50% of the capacity. The bladder simply leaks as it becomes full. These injuries can occur because of injudicious and inappropriate care of the bladder after epidural anaesthesia. In the obstetric setting, lack of sensation or awareness in the mother, in combination with a busy postnatal ward, may mean that the mother does not pass urine for many hours after leaving the delivery suite. Inappropriate management, combined with a post-partum diuresis, can result in several overdistension injuries, compounding the original problem. Even a single episode of overdistension may result in permanently impaired detrusor function. The female bladder is especially sensitive to overdistension .

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Functional incontinence includes cases of UI where no organic cause can be found. Several other factors may be responsible for problems with incontinence due to interference with voiding behaviour. These include cognitive factors, such as dementia and learning difficulties, as well as physical factors, such as immobility and disability.

Symptomatic UTI is a cause of acute incontinence, especially in young women, often because of extreme frequency, urgency and pain. If symptoms persist, despite negative cultures, it is worth considering culture for fastidious organisms, such as Chlamydia trachomatis, Ureaplasma urealyticum or Mycoplasma hominis. Alternatively, empirical treatment might be considered. Atrophic urethritis and/or vaginitis in postmenopausal women are often associated with urinary tract symptoms. These conditions are due to epithelial and submucosal thinning of the urethra, with consequential irritation and loss of the mucosal seal. Incontinence associated with atrophic urethritis tends to be characterized by urgency and occasionally ‘scalding’ dysuria, and may be underreported.

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Alcohol and medications are major causes of acute incontinence in the elderly. Polypharmacy and the use of psychotropic medication compound problems with incontinence, and are most prevalent in women aged 85 years or over. The prevalence appears to be increasing . Nighttime incontinence can be exacerbated by return of peripheral oedema fluid in heart failure, peripheral venous insufficiency and hypoalbuminaemia. Other reasons for UI include cognitive impairment, such as dementia, as well as physical immobility and disability, and these may be responsible for exacerbating the impact of incontinence.

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Actos Side Effects Scoop

By admin | Published January 25, 2012

Actos Side Effects :

WHAT IS THE FUNCTION OF THE BLADDER?

A bladder stores urine and expels it at a convenient time. The bladder is a very useful organ, (tissues working together to accomplish a function), but an individual can live a normal life without one, if required, by surgical creation of a substitute.

 

ARE THERE DIFFERENT TYPES OF BLADDER CANCER?

More than 90% of bladder cancers arise from the lining bladder cells called transitional cells. Bladder cancer is almost always transitional cell cancer. These cells are also present in the urethra (the body tube which drains the bladder), as well as the renal pelvis (inner lining of the kidneys), and the ureters (the body tube draining the kidneys).

Bladder cancer can vary from the non serious, low grade superficial type (approximately 70%), to the invasive, aggressive type that can spread and prove to be fatal (approximately 30%).

5% of bladder cancer is accounted for by squamous cell carcinoma. This cancer is usually secondary to long term inflammation or infection of the bladder. Even rarer is adenocarcinoma, which accounts for less than 2% of all bladder cancers.

HOW COMMON IS BLADDER CANCER?

The American Cancer Society estimates that in 2006,61,420 new cases of bladder cancer were diagnosed in the United States with approximately 73% of those occurring in men. In the same year, this cancer caused approximately 13,060 deaths with approximately two out of three of those being in men. The disease is more common in whites than blacks. The incidence of bladder cancer increases with age in both sexes. When bladder cancer occurs in young people, it tends to grow slower and not be as serious. In men, it is the fourth most common cancer. However, because of the rate of recurrences and long term survival, it is the second most prevalent cancer in middle aged and elderly men. In women, it is the eighth most common cancer. The average age at diagnosis is 65. Over the past decade, there has been both an increased incidence, but also an increased rate of survival for bladder cancer [1]

WHAT CAUSED MY CANCER?

A mutation is a disruption in the DNA of a cell, leading to a loss of regulated cell growth. Mutations can occur spontaneously as we age. It is truly amazing that all of us don’t develop cancer as we are composed of trillions of cells dividing regularly over decades. Fortunately, our cells have repair mechanisms which can often fix damaged cells before cancer arises. In addition, the immune system can destroy cancer cells before they have a chance to grow into tumors.

Mutations and cancer can also be triggered by environmental factors. Certain chemicals have been identified to be particularly effective at inducing mutations in our DNA and subsequent cancer. These chemicals are called carcinogens. Smoking is the most common culprit! Cigarette smoking has a strong link with bladder cancer. Studies have shown approximately 50% of bladder cancer is secondary to tobacco smoke. Smoking releases dozens of carcinogens into the lungs and then into the blood stream. Many of these carcinogens are excreted by the kidneys.

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IT IS TOO DIFFICULT TO QUIT SMOKING; IS THERE ANY SURE FIRE WAY TO QUIT?

Tobacco smoke contains nicotine, an extremely addictive chemical. Men overall find it easier to quit smoking than women. When facing the prospects of losing your bladder to cancer or possibly your life, most individuals will become convinced and many simply stop smoking “cold turkey.” Unfortunately, many choose not to quit until their cancer repeatedly recurs or becomes invasive, needlessly placing their health at risk. For those who need assistance in quitting, nicotine patches, gum, and lozenges are all available over the counter. These products allow the smoker to quit without experiencing the discomfort of withdrawal from nicotine. Many smokers also find hypnosis or support groups useful. In addition, prescription medication is available.

ARE THERE ANY OTHER KNOWN CAUSES?

Occupational exposure may account for up to 20% of bladder cancers. Those exposed to aniline dyes (used to color fabrics), aldehydes (used in chemical dyes and in the rubber and textile industries) and those using organic chemicals (used in a wide range of occupations) are all at increased risk. Individuals previously treated with radiation to the pelvis or having received cyclophosphamide (a type of chemotherapy) are at markedly increased risk for developing bladder cancer. If your well water is high in arsenic, your risk may also be increased. Studies have also correlated obesity and a high fat diet, especially with increased cholesterol, as a possible contributing factor.

CAN I HELP TO PREVENT BLADDER CANCER BY DRINKING MORE FLUIDS?

Surprisingly, the answer may be yes. In a recent study, the relationship of diet to cancer was analyzed in a group of47,000 health professionals.[1] In the case of bladder cancer, those who drank the most fluid (greater than 10 cups/day) had half the risk as those who drank the least (less than 5 cups/day). The type of nonalcoholic beverage was less important than the total amount.

WILL MY CHILDREN BE AT HIGHER RISK OF DEVELOPING BLADDER CANCER?

Although there have been clusters of bladder cancer reported, most researchers believe these may be secondary to risk factors such as smoking and exposure to carcinogens. At this time, there is no convincing evidence bladder cancer risk is hereditary. If an environmental factor caused your cancer and your children are exposed as well, their risk of cancer may be increased.

WHAT IS CANCER?

The basic building block of the body is the cell. Cells are specialized to perform a particular function. Skin cells are distinctly different from liver cells which are different from bladder cells. An organ is composed of various cells working in unison to carry out a body function. Cells eventually get old and die. New cells are created by cell division. When cells are behaving normally, they only generate enough new cells to replace the old dying ones. Occasionally, cell growth becomes unchecked. As the cells continue to divide, a tumor (abnormal growth of cells) may form. Such tumors may be benign (no ability to spread beyond their organ of origin) or cancerous (a malignant tumor with the ability to spread beyond their organ of origin and cause harm and possibly death).

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HOW CAN I TELL IF MY BLADDER CANCER IS LIKELY TO SPREAD?

Larger tumors are more likely to spread than smaller tumors. Another critical concern is the grade of the tumor. Normal cells are specialized, differentiated to perform specific function, and have a typical structural arrangement with surrounding cells. As cancers worsen, the cells become less specialized, less differentiated, and lose their normal structural arrangement, resulting in a higher pathologic grade.

In the case of bladder cancer, pathologists classify them into 3 grades based on a number of criteria:

Grade 1: low grade, well differentiated Grade 2: intermediate grade, moderately differentiated Grade 3: high grade, poorly differentiated The higher grade tumors have a greater propensity to metastasize- spread throughout the body.

For bladder cancer, another key indicator for likelihood to spread is the depth of penetration into the bladder wall. The bladder wall is composed of an inner lining called the urothelium (made up of transitional cells) which rests on a membrane layer called the basement membrane, below which is the connective tissue layer (support tissues) called the lamina propria. Within the lamina propria lies a small amount of muscle called the muscularis mucosa. Deep to the lamina propria is the deep muscle of the bladder arranged in three layers. This layer is called the muscularis propria. Tumors located in the inside, superficial layers of the bladder wall are unlikely to spread. Tumors that grow into the deeper layers (down into the muscle of the bladder wall) are much more likely to spread. Furthermore, there is a definite link between the grade of the tumor and its likelihood of invasion. Low grade tumors are almost always noninvasive, while high grade tumors are usually invasive. In general, papillary tumors, which are delicate and frond like in appearance are usually low grade and superficial. This is to be contrasted to sessile tumors which appear solid, are often high grade and invasive. Depth of invasion is critical in establishing prognosis. The tumor which invades into the lamina propria is a far more serious tumor than the superficial tumor which demonstrates no invasion. It has a much higher propensity to progress to the muscle invasive tumor, a much more dangerous cancer, with a high risk for spreading beyond the bladder. For further information see Chapter 6.

 

 

Our use of the term or terms Actos Side Effects is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos and Bladder Cancer Scoop

By admin | Published January 25, 2012

Actos and Bladder Cancer: For the practicing urologist it is often difficult to inform the patient on muscle invasive bladder cancer and the often need for radical surgery and some kind of urinary diversion to follow; however, it is even more elaborate to do so in case of a nonmuscle invasive tumor where the evidence calls for radical treatment. In Chap. 15, Waalkes, Merseburger, and Kuczyk present pathologies where a radical treat­ment is strongly advised.In Chapters 16-18 focus various aspects of cystectomy. In Chap. 16, radical surgery of the bladder is discussed by Dr. Gschwend. The improvement in surgical techniques had led this formerly challenging procedure into a more standardized one. Chapter 17 includes urinary diversion by Drs. Richard and Stefan Hautmann. The ileal neobladder has become one of the worldwide chosen procedures for con­tinent orthotopic urinary diversion. Chapter 18, laparoscopic cystectomy by Dr. John, is the latest evolvement in bladder surgery and covers innovative tech­niques as well as the well-established surgical routines in radical treatment of invasive bladder cancer.

 

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In 2010, only 5% of all urologists are performing neoadjuvant chemotherapy in patients with muscle invasive bladder cancer, hence the 5% survival benefit in5 years and possible down staging of the tumor. Dr. Sherif guides us along the current literature and discusses the pros and cons of the neoadjuvant chemotherapy. Diagnosis and treatment of upper tract tumors is challenging and Chap. 20 by Dr. Remzi discusses the basics as well as recent advances in this field. In Chap. 21, De Santis and Bachner focus on the development and optimal use of new regimens for systemic agents as well as standard treatment options for the treatment of meta­static urinary carcinoma in the areas of targeted drugs. Options for “unfit” patients and elderly as well as in second-line setting are discussed. In Chap. 22 non-TCC tumors: Diagnosis and treatment is discussed by Dr. Abol-Enein. He focuses mainly on the squamous cell and adenocarcinoma of the bladder.

We hope that this brief synopsis of the topics covered in each chapter will encourage the readers to use this book for a general read on bladder cancer and as a reference guide for specific molecular and clinical aspects of bladder cancer. We again thank the authors for contributing to this project. We thank our Mr. Michael Koy, production editor at Springer and Spi Editorial Department, India for helping us in the publication of this book. We would like to thank Brian Halm of Springer for helping us with the publication of this book.

 

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Abstract Bladder cancer (BC) is a worldwide health problem. In 2006 in Europe, there were an estimated 104,400 incident cases of BC diagnosed (82,800 in men and 21,600 in women) that represent a 6.6% of the total cancers in men and 2.1% in women.Tobacco use is a major preventable cause of death, and especially involved with BC carcinogenesis. Tobacco smoking is the most well-established risk factor for BC, causing around 50%-65% of male cases and 20%-30% of female cases.

Occupational exposure has been considered the second most important risk factor for BC. Work related cases account for a 20%-25% of all BC cases in several series.

In addition, chronic urinary tract infection had been related to BC, particularly, with invasive squamous cell carcinoma. Bladder schistosomiasis has particularly- been considered by the international agency for research on cancer (IARC) as a definitive cause or urinary BC with an associated fivefold risk.

 

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Actos Warning News Flash

By admin | Published January 25, 2012

Actos Warning : Recently, a metaanalysis of observational studies on cigarette smoking and cancer from 1961 to 2003 has been published. The authors extracted data from 254 reports published during that period of time and included them in the 2004 IARC Monograph on Tobacco Smoke and Involuntary Smoking. The analyses were arried out on 216 studies with reported estimates for current and/or former smokers. The pooled risk estimates for BC demonstrated significant association for both current and former smokers. In an analysis of 21 studies, the overall rela­tive risk calculated for current smokers was 2.77 [95% confidence interval (CI) 2.17, 3.54]; while from the analyses of 15 studies, the overall relative risk calcu­lated for former smokers was 1.72 (95% CI 1.46, 2.04) (Gandini et al. 2008).

 

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In a pooled analysis of 11 case-control studies regarding cigarette smoking and BC, the following three variables were analyzed: duration of smoking, average number of cigarettes smoked per day, and time since quitting smoking. The popula­tion consisted of 2600 cases and 5524 controls. An increasing risk of BC was observed with increasing duration of smoking, which appeared to be linear. The relative increase was approximately 100% after 20 years smoking and reaches to 400% after 50 years smoking. In addition, a relationship was observed between the number of cigarettes smoked per day and BC.

The OR increased to nearly threefold for those who smoked between 15 and 20 cigarettes per day, after which a plateau in the risk graph was observed. They concluded that the duration of smoking habit and not the amount of cigarettes smoked per day was the main determining factor for BC. An immediate decrease in risk of BC was observed for those who quit smoking. This reduction was about 40% within 1-4 years of quitting smoking and reaches 60% after 25 years of cessation. However, the risk does not reach the level of nonsmokers even after 25 years. This suggests that tobacco has a late effect in the carcinogenesis of BC, but the fact that this risk does not reach the levels of nonsmokers until 25 years after quitting smoking suggests that tobacco may also be involved in an early irreversible stage in the carcinogenesis process (Brennan et al. 2000).

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Other issues as type of tobacco could be taken into account. Six studies have published a significant higher risk of BC for the blacks who are cigarette smokers compared to smokers of otherraces. Also, case-control studies suggest a strong evidence of a carcinogenic effect of cigars and pipe, which is comparable to that of cigarettes (Boffetta 2008). The mode of inhalation of tobacco smoke has been related to BC risk, as well. In a case-control study of smoking and BC from Spain that included 1219 cases and 1271 controls, they concluded that the former and current smokers experienced risks of BC three to seven times higher than nonsmok­ers, respectively.

In addition, they found that the risk was higher for subjects who inhaled into the throat or chest [OR 4.8 (95% CI 2.3-9.9)] compared with those who inhaled only into the mouth [OR 10.0 (95% CI 6.7-15.0)], at each level of duration (Samanic et al. 2006).

Taking into account that current smokers have higher risk of BC than nonsmokers, and that this risk decreases by 40% after 1-4 years of quitting smoking, the promotion of cessation of smoking would allow reducing the incidence of BC in men and women.

Internationally, there is a general agreement on the broad strategy needed to successfully combat the tobacco epidemic.

 

Our use of the term or terms Actos Warning is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer News Flash

By admin | Published January 25, 2012

Actos Bladder Cancer : Bladder tumor “seeding” may occur during the procedure. As the tumors are resected, cancer cells are released into the irrigant which fills the bladder. These cells may implant in other areas of the bladder traumatized during the procedure. It should be understood that the bladder is generally filled with urine, and tumor cells can naturally implant at other locations even without surgery. Implantation can be lessened during surgery by avoiding injury to other bladder areas and by the use of adjuvant intravesical chemotherapy. There have been numerous studies over the past decade showing a number of chemotherapy agents can be effective in decreasing initial tumor recurrence, possibly by preventing seeding. Reduction in recurrence may however be short lived.

Previously, it was common practice to obtain multiple random bladder biopsies at the time of initial tumor resection. This was recommended to rule out the possibility of hidden CIS. Understanding these biopsy sites may increase the possibilities of tumor recurrence by tumor seeding, biopsies are now often limited to areas adjacent to the tumors removed and suspicious appearing areas only. CIS can be ruled out by using cytology, or by obtaining biopsies during future cystoscopy after the tumor has already been removed. When dealing with low grade tumors, random biopsies of the bladder will rarely show cancer.

After your procedure, depending on the level of anesthesia and the extent of surgery, you will be brought either to the recovery room or back to the area where you were first prepared for your procedure. You will be released to home only when you have fully recovered from you anesthetic and are doing well. The recurrence rate for superficial bladder cancer can be as high as 60-90%. Recurrences can cause bleeding and other difficulties and are best handled sooner rather than later. In addition, depending on the initial tumor grade and stage, progression to a more serious form of bladder cancer is an ongoing concern. Surveillance cystoscopy is therefore recommended. Cystoscopy is still the best means to check for recurrent disease. It is however, an invasive procedure and should be accomplished only as often as required. For solitary, low grade, non invasive disease, follow up cystoscopy can be accomplished with the flexible cystoscope if available. If negative at three months, further cystoscopic exams can be done yearly and eventually lengthened even further. For those with multiple tumors, large tumors, high grade tumors or those who also have CIS, frequent cystoscopies, initially every three months are called for. As long as there are no recurrences, the time between cystoscopies can be lengthened. Cytology can also be utilized to reduce the number of cystoscopies. If recurrence or progression does occur, heightened scrutiny is again called for.

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Adverse reactions are side effects of treatment. Approximately 95% of individuals will tolerate treatments well. Adverse reactions may be mild. Common reactions include cystitis (inflammation of the bladder characterized by burning on urination), hematuria, mild fever, malaise, and nausea. These symptoms generally pass without any treatment. For bothersome symptoms, various medications may prove helpful. Your physician can prescribe medication for burning or urinary frequency. For those with persistent cystitis, antibiotics can be utilized. For individuals experiencing severe symptoms lasting more than 48 hours, isoniazid, an anti-tuberculous drug can be prescribed.

A short course of 3 days, starting the day before the next dose of BCG can be used to prevent severe side effects. Fortunately severe reactions resulting in sepsis, a life threatening condition characterized by high fever, chills and drop in blood pressure, is exceedingly rare. Sepsis would be treated in a hospital with triple anti-tuberculous drugs, steroids, and broad spectrum antibiotics. There are other serious adverse reactions which may require dose reduction or discontinuation. These are all rare and include: inflammation of the prostate, persistent hematuria, hepatitis, inflammation of the testicles and or epididymis, bladder contraction, ureteral obstruction, joint pain or inflammation of the lungs.

Recurrence of bladder cancer after the initial induction course, or relapse after complete response, would indicate failure of therapy. When two or more courses result in recurrence or when recurrence develops during the first six to twelve months after induction and maintenance therapy, patients generally are felt to have disease which is at higher risk for progression. A high percentage of patients who are complete responders remain tumor free for up to five years. However, with the passage of more time, additional patients will have late recurrences. For those with late recurrences (two to three years after therapy), most will respond to repeat BCG therapy.

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Invasive bladder cancer is often recognizable to the urologist by its appearance during cystoscopy. These cancers are generally large, sometimes multi-focal, and solid in appearance as compared to the fine papillary appearance of superficial bladder cancers. During the transurethral resection of the tumor, the urologist can generally tell the tumor is invading into the deeper portions of the bladder wall.

The pathologist’s report will then indicate the grade of the cancer and the depth of invasion. If the tumor invades into muscle, it is an invasive tumor. Further staging would then include a CT Scan or MRI to assess local contiguous spread, lymph node spread, or more distant spread of the cancer. A chest X ray is also routine. If there are any suspicious areas, a CT Scan of the chest is ordered. A bone scan is generally not required unless the individual has had a new onset of bony pain that is not explained by injury or arthritis.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Multaq Warning Advice

By admin | Published January 25, 2012

Multaq Warning : Individuals with chronic hepatitis B infection, especially those with cirrhosis, are at increased risk for development of hepatocellular carci­noma (primary liver cancer), as in Case 5. As noted previously, while relatively rare in the United States, hepatocellular carcinoma is the num­ber one or number two cause of cancer death in the world, especially in certain Asian and African countries. Individuals with hepatitis B and cirrhosis bear the greatest risk for development of hepatocellular carci­noma. Individuals with hepatitis and no cirrhosis are also at increased risk compared to the general population.

Chronic hepatitis B infection is separated into two distinguishable “states.” The best way to distinguish these two states of hepatitis B virus infection is by the presence or absence of hepatitis Be antigen (HBeAg) in blood. In instances where the hepatitis B virus is rapidly replicating, a short form of the hepatitis B core antigen, called HBeAg, is usually detected in the blood. HBeAg is detected in the blood dur­ing acute infection, when the virus rapidly replicates, and becomes undetectable as the acute infection resolves. In most cases of chronic infection, HBeAg is not detected because the virus enters a state of low replication and its genetic material integrates into the DNA of infected cells. In some cases of chronic infection, however, the virus maintains a highly replicative “lifestyle” (are viruses alive?) and, in most of these cases HBeAg will be detected in the blood. In individuals chronically infected with hepatitis B virus, the state of infection can switch from HBeAg-positive (high replication) to HBeAg-negative (low replication) at any time.

The distinction between HBeAg-positive and HBeAg-negative chronic hepatitis B is critical regarding disease severity, prognosis, con­tagiousness, and treatment. Patients who have HBeAg in their blood usually have more severe clinical disease with a greater amount of inflammation in the liver. They are usually sicker and have more symp­toms. The chances of progression to cirrhosis and hepatocellular car­cinoma are greater. In addition, individuals with detectable HBeAg in their blood are highly infectious as high viral replication is associated with the presence of more viral particles in the blood. A major goal of treatment for chronic hepatitis B is to convert a patient who has detectable HBeAg in the blood (a state of high virus replication) to one who does not have detectable HBeAg in the blood (a state of low-level virus replication). This change after treatment is associated with a bet­ter long-term prognosis.

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Individuals with chronic hepatitis B virus infection can sponta­neously convert from HBeAg-negative to HBeAg-positive. This is asso­ciated with worsening disease severity and prognosis. Paradoxically, conversion from HBeAg-positive to HBeAg-negative, which is associ­ated with a better long-term outlook, is associated with a transient worsening of hepatitis and higher elevations in blood ALT and AST activities. This probably occurs because the immune system attacks the hepatocytes in which the virus is rapidly replicating, causing increased liver inflammation and cell death as infected cells are killed. The “flare” in hepatitis associated with conversion from HBeAg-positive to HBeAg-negative usually resolves with improvement in condition.

An exception to the rule that HBeAg is detectable in the blood of individuals infected with the hepatitis B virus when the virus is rapidly replicating occurs when there is infection with mutant forms of hepati­tis B virus known as precore mutants. Precore mutants of the hepati­tis B virus have mutations in their core proteins. As a result, they do not make HBeAg, even when they are rapidly replicating. Therefore, in precore mutant infection, the presence or absence of HBeAg in the blood is not a determinant of prognosis. It may be suspected when patients do not have detectable HBeAg but do have high concentra­tions of hepatitis B virus DNA in the blood. Precore mutants are defin­itively identified only by isolating the virus irony the patient and exam­ining its DNA sequence.

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Approximately 350 million individuals throughout the world are chronically infected with the hepatitis B virus, making it the number one worldwide cause of liver disease. The geographic distribution of cases varies tremendously from one part of the world to another. Hepatitis B virus infection is relatively uncommon in the United States and other Western countries. In the United States, just over one mil­lion individuals are chronically infected with hepatitis B virus. On the other hand, hepatitis B virus infection is endemic in Southeast Asia and sub-Saharan Africa. In countries such as Senegal, Thailand, and parts of China, as many as 25 percent of the population may become infected with hepatitis B virus by early childhood.

Transmission of hepatitis B virus from mother to baby may occur either before delivery or by exposure to the mother’s blood at the time of delivery. The hepatitis B virus is also present in the breast milk of infected mothers, but a large study has shown that breast-feeding is not a major source of transmission of hepatitis B. Some babies of infected mothers who are not infected with the hepatitis B virus at birth become infected during the first few months or first year of life—prob­ably by household exposure to the mother’s blood or that of infected brothers or sisters.

A major route of transmission of hepatitis B in the West was trans­fusion of blood and blood products. Since the association of the Aus­tralia antigen with serum hepatitis in the 1960s, tremendous efforts have been taken to screen the blood supply and keep it free of hepati­tis B virus. In most industrialized countries, the risk of contracting hepatitis B from a blood transfusion is extremely low as donated blood is screened for the virus. In addition, intravenous drug users and other individuals at high risk for hepatitis B are excluded from donating blood if they are identified. Although the blood supply is remarkably safe, no screening test is perfect, and the risk of contracting hepatitis B from a transfusion of one unit of blood in the United States is approx­imately one in sixty thousand to one in one hundred thousand. The hepatitis B virus can also be transmitted by organ transplantation, but the organ donor’s blood is generally tested for hepatitis B virus infec­tion before an organ is used.

Our use of the term or terms Multaq Warning is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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