At a Toronto International Endocine conference,Melbourne (Clayton) Prince Henry's Institute, Senior Fellow Prof. John FUNDER AO, MD,PhD, FRCP,FRACP pointed out that Dr. Michal LYTINSKI published in Polish before Dr.Jerome CONN.
Primary Aldosteronism is missed in most hypertensives.. 20% of the Canadian population are hypertensive( 6,800,000) 10% of hypertensives have Primary Aldosteronism (680,000). Mainly undiagnosed at present through "cost, ignorance & indifference". Less than 1% of those with Primary Aldosteronism are screened; especially indicated in Atrial fibrillation.
"Guidelines for Primary Hypertension need revision".
Low potassium is not the main sign. Resistant hypertension, weakness and nocturnal polyuria are clinical clues. Small adrenal tumours may be seen on CT scans.
A quick diagnostic test of eplerenone (INSPRA) or spironolactone (ALDACTONE) will immediately drop blood pressure in patients with Primary Aldosteronism. INSPRA does not cause gynaecomastia or erectile disfunction..
A FORUM on ONTARIO MEDICINE: business and professional Information from various contributors edited by Dr.Alex Franklin MBBS(Lond.)Dip.Phys.Med(UK) DPH & DIH(Tor.)LMC(C)FLex(USA).Fellow Med.Soc.London, Liveryman of London Society of Apothecaries. Freeman of City of London. Member Toronto Faculty club & Toronto Medico-Legal society.
30 Oct 2011
24 Oct 2011
ASTRAZENICA FREE PROSTATE CANCER PATIENT NOTEBOOK
Black-cover breastpocket-sized 35 page treatment notebook provided free by AstraZenica.including a PSA tracking graph
22 Oct 2011
UK DAILY MAIL: CIRRHOSIS, DEMENTIA & DRINK
Don't drink on 3 days a week... As the liver crisis deepens, leading doctors warn of the dangers
- More than 16,000 people die from liver disease every year in the UK
- Young regular drinkers and middle-class women particularly at risk
- Royal College of Physicians say current guidelines must be rewritten
By Daniel Martin
Last updated at 11:23 AM on 22nd October 2011
Current official guidance on healthy drinking limits is ‘extremely dangerous’ and must be rewritten – because it implies that drinking every day is fine, the Royal College of Physicians said.
Government advice states men should drink no more than four units a day and women no more than three.
New guidelines: Leading doctors now say drinkers should have at least three alcohol-free days a week
They told MPs the risk of liver disease, alcohol dependence and serious illness increases if people drink every day rather than taking time off.
More...
They also urged Ministers to consider imposing stricter guidelines on pensioners – perhaps as little as seven units a week for older women and 11 for older men.
One unit is the equivalent of one small glass of wine (125ml) or half a pint of lager.
Limits: Government advice states men should drink no more than four units per day and women no more than three
Yet pensioners are currently given the same guidelines as all adults.
In their submission to MPs on the Commons science and technology committee, the doctors said: ‘Government guidelines should recognise that hazardous drinking has two components: frequency of drinking and amount of drinking.
‘To ignore either of these components is scientifically unjustified.
‘A simple addition would remedy this – namely a recommendation that to remain within safe limits people have three alcohol-free days a week.’
They added: ‘The implied sanctioning of a pattern of regular daily drinking is potentially extremely dangerous.
The RCP disputes the claim that drinking every day will not accrue a significant health risk.
‘Frequency is an important risk factor for development of alcohol dependency and alcoholic liver disease.’
More than 16,000 people die from liver disease, usually caused by excessive drinking, every year in the UK.
It is Britain’s fifth biggest killer and the only major cause of death increasing year-on-year. Twice as many people die of it now than in 1991 and rates have soared by 13 per cent since 2005.
The British Liver Trust says liver disease is the biggest cause of premature death for women, and the second only to heart attacks for men.
The first drinking guidelines in 1987 – which were written by the RCP – stated that men should drink no more than 21 units a week and women no more than 14.
On top of this, everyone should take two or three days off a week. Doctors are angry that reforms to the advice in 1995 dropped this reference to alcohol-free days.
‘This in effect appeared to sanction daily or near-daily drinking, one of the key risk factors for alcohol-related harm and dependency,’ they said.
‘If the daily limit of four units was drunk with no drink-free days, this would be the equivalent of 28 units per week; a 30 per cent increase on the RCP’s guidelines.’
Habitual: Young regular drinkers are particularly at risk of developing liver disease later in life
Young regular drinkers were particularly at risk, it said.
A 2009 study showed increases in UK liver deaths ‘are the result of daily or near-daily heavy drinking, not episodic or binge drinking. This regular drinking pattern is discernable at an early age’, the paper said.
Government experts expect the cost of treating people with liver disease will soar by 50 per cent in four years to more than £2billion.
Middle-class women are particularly at risk of daily drinking as they often have a glass or two of wine after work, followed by more at the weekend.
Lower limits should be considered for older people, as even modest levels of alcohol consumption can have a more profound effect on their bodies ‘due to physiological changes associated with ageing’, the paper said.
‘There is concern current guidelines are not appropriate for older people,’ it added.
Sir Ian Gilmore, RCP special adviser on alcohol, said: ‘We recommend a safe limit of 0-21 units a week for men and 0-14 units a week for women provided the total amount is not drunk in one or two bouts and that there are two to three alcohol-free days a week.
‘At these levels, most individuals are unlikely to come to harm.’
In June, a Royal College of Psychiatrists report called for a limit of 11 units a week for men aged over 65 and seven for women of this age.
The RCP quoted these suggested limits but did not explicitly endorse them.
Read more: http://www.dailymail.co.uk/news/article-2052070/Alcohol-abuse-Dont-drink-3-days-week-avoid-liver-disease.html#ixzz1bVrk6v8M
21 Oct 2011
MOSCOW Prof.A.P.NESTEROV: Inventer of the scleral DIATON TONOMETER
"Diaton tonometer has accuracy enough for clinical purposes, requires no
anesthetics and sterilization. Besides, they are safe (can not damage the cornea),
comfortable for the patients and easy in use. They can be used not only in ophthalmology
studies but at home as well".
LITERATURE
1. Илларионова А.Р., Пилецкий Н.Г.//Клин.офтальмол.-2001-№2.-С.55-56
2. Маклаков А.Н.//Мед.обозр.-1884.-Т.22-С.1092-1095
3. Нестеров А.П., Бунин А.Я., Кацельсон Л.А. Внутриглазное давление: физиология и паталогия.-М.,1974
4. Нестеров А.П. Глаукома.-М.,1995
5. Goldmann H., Schmidt T.//Opthalmologica.-1957-Bd 136.-S.221-231.
6. Mark H.H.//Am.J.Ophthalmol.-1973.-Vol.76-P.223-227
7. .//Ibid.-1960.-Vol.49.-P.1149
8. Moses R.A., Liu C.H.// Ibid.-1968.-Vol.66.-P.89-94
9. Motolko M.A.//Can/J/Ophthalmol.-1982.-Vol.17.-P.93-97.
10. Phelps C.D.,Phelps G.K.//Graefes.Arch.Clin.Exp.Ophthalmol.-1976.-Vol.198.-P.39-44
11. Schottenstein M.H.//The Glaucomes/Eds R.Ritch et al.-St.Louis, 1996.-Vol.1.-P.407-428.
12. Whitacre M.M., Stein R.A., Hassanein K.//Am.J.Ophthalmol.-1993.-Vol.115.-P.592-597
Diaton tonometer now in use in Ontario: often in University emergency departments. Cost aprox. $3000.
anesthetics and sterilization. Besides, they are safe (can not damage the cornea),
comfortable for the patients and easy in use. They can be used not only in ophthalmology
studies but at home as well".
LITERATURE
1. Илларионова А.Р., Пилецкий Н.Г.//Клин.офтальмол.-2001-№2.-С.55-56
2. Маклаков А.Н.//Мед.обозр.-1884.-Т.22-С.1092-1095
3. Нестеров А.П., Бунин А.Я., Кацельсон Л.А. Внутриглазное давление: физиология и паталогия.-М.,1974
4. Нестеров А.П. Глаукома.-М.,1995
5. Goldmann H., Schmidt T.//Opthalmologica.-1957-Bd 136.-S.221-231.
6. Mark H.H.//Am.J.Ophthalmol.-1973.-Vol.76-P.223-227
7. .//Ibid.-1960.-Vol.49.-P.1149
8. Moses R.A., Liu C.H.// Ibid.-1968.-Vol.66.-P.89-94
9. Motolko M.A.//Can/J/Ophthalmol.-1982.-Vol.17.-P.93-97.
10. Phelps C.D.,Phelps G.K.//Graefes.Arch.Clin.Exp.Ophthalmol.-1976.-Vol.198.-P.39-44
11. Schottenstein M.H.//The Glaucomes/Eds R.Ritch et al.-St.Louis, 1996.-Vol.1.-P.407-428.
12. Whitacre M.M., Stein R.A., Hassanein K.//Am.J.Ophthalmol.-1993.-Vol.115.-P.592-597
Diaton tonometer now in use in Ontario: often in University emergency departments. Cost aprox. $3000.
18 Oct 2011
OTTAWA Internist Christiane FARAZLI MD(Montreal 73) FRCPC (78)
Some facts from Toronto Star. (K.WALLACE)
Ont.College Phys. Surgeons found in MAY 2011 that cleaning of endoscopes(stomach & colon) at Dr. Farazli's clinic was less than satisfactory. Ontario Ministry of Health informed OTTAWA Medical Officer Health Dr.Isra LEVY MB BCh (Witwatersrand 86) FRCPC(Community med.) in JULY. Public advised in OCTOBER. Ottawa Public Health sent 6,800 letters sent to patients (2002 - June 2010) advising testing for Hep. B/C & HIV.
Dr.FARAZLI's clinic at PARKDALE MEDICAL TOWER,1081 Carling avenue is next to Ottawa Civic Hosp.
Ont.College Phys. Surgeons found in MAY 2011 that cleaning of endoscopes(stomach & colon) at Dr. Farazli's clinic was less than satisfactory. Ontario Ministry of Health informed OTTAWA Medical Officer Health Dr.Isra LEVY MB BCh (Witwatersrand 86) FRCPC(Community med.) in JULY. Public advised in OCTOBER. Ottawa Public Health sent 6,800 letters sent to patients (2002 - June 2010) advising testing for Hep. B/C & HIV.
Dr.FARAZLI's clinic at PARKDALE MEDICAL TOWER,1081 Carling avenue is next to Ottawa Civic Hosp.
17 Oct 2011
INVENDO MEDICAL Gmbh,KISSING: INVENDOSCOPY system.
The invendoscopy™ system adresses for the first time the gentle, medication-less performed colonoscopy and the solution of hygiene issues.
Gentle
Highly flexible materials are being used to ensure a small bending diameter of the endoscope. In addition the electrohydraulic deflection mechanism of the endoscope tip obviates the need to use Bowden cables, and thus maintains the flexibility. The combination of these technologies ensures that the forces exerted by the endoscope are reduced. Watch videoHygienic
Resource-intensive and critical cleaning processes of the endoscope are avoided as the invendoscope is designed for single-use only. Watch videoEasy-to-use
All endoscope functions including forward and backward driving, deflection of endoscope tip, rinsing, suction, insufflation and recording of images are controlled via a simple handheld device. This makes performance of colonoscopies ergonomical and supports ease-of-use. Watch videoInterventional Versatility
Due to its 3.1mm working channel the invendoscope SC20 can be also used for biopsies and routine therapeutic procedures such as polypectomy. The centralized working channel with the support of the deflectable electrohydraulic tip allows access to all locations in the colon. Watch video11 Oct 2011
CPSO TORONTO ELECTION: CANDIDATES URGENTLY NEEDED
CPSO jobs used as "retirement" income for aged MDs.
Two Toronto candidates
GP M.GABEL graduated 1962 (aged approx.74y)
Retired Nephrologist D.DAVIDSON graduated1963 (aged approx. 73y)
Both practice as GP-psychotherapists. If elected would sit in judgement over MDs who actively practice Modern medicine.
Dr.Gabel is also listed as "Chair" of CPSO Discipline committee, (actually just a member),in SHIATSU SOC. of ONTARIO Advisory Council
Two Toronto candidates
GP M.GABEL graduated 1962 (aged approx.74y)
Retired Nephrologist D.DAVIDSON graduated1963 (aged approx. 73y)
Both practice as GP-psychotherapists. If elected would sit in judgement over MDs who actively practice Modern medicine.
Dr.Gabel is also listed as "Chair" of CPSO Discipline committee, (actually just a member),in SHIATSU SOC. of ONTARIO Advisory Council
Shiatsu Society of Ontario
BOARD OF DIRECTORS
Mirela Stosic - President
Anna Dix - Vice President
Carol Culhane - Secretary
Roselle Quesnel - Treasurer
Keane McMillan - Membership Director
John Kirkham - Director
Carlotta Trenholm - Director
Liam Ellis - Director
Brian Globus - Director of Communications
ADVISORY COUNCIL
Chair: Marc Gabel, M.D., M.P.H.,
Chair, Discipline Committee,
College of Physicians and Surgeons of Ontario
Tanya Harris – The Shiatsu Clinic
Sensei Yula – Zen Institute of Oriental Medicine
COMMITTEE
Governmental Relations / Policy – Dimitri Tkhinvalleli
Mirela Stosic - President
Anna Dix - Vice President
Carol Culhane - Secretary
Roselle Quesnel - Treasurer
Keane McMillan - Membership Director
John Kirkham - Director
Carlotta Trenholm - Director
Liam Ellis - Director
Brian Globus - Director of Communications
ADVISORY COUNCIL
Chair: Marc Gabel, M.D., M.P.H.,
Chair, Discipline Committee,
College of Physicians and Surgeons of Ontario
Tanya Harris – The Shiatsu Clinic
Sensei Yula – Zen Institute of Oriental Medicine
COMMITTEE
Governmental Relations / Policy – Dimitri Tkhinvalleli
Death Oct.10 of Prof.Robert Alexander Amiel BUCKMAN MB BChir(Cantab.) PhD (London) FRCP FRCPC (1948-2011)
Some info.fromToronto STAR.
Actor, Atheist, Author, Medical radio, television journalist and Oncologist Prof R.A.A. Buckman died on a flight from UK to Toronto from DERMATOMYOSITIS.which developed at 31y (1979).
Attended private London (Hampstead) University College School and Cambridge.Univ. Postgraduate training at Royal Marsden (Cancer) Hospital.
Emigrated to Ontario in 1988 (37y).Worked at Princess Margaret Cancer Hospital.
Was Pres. Can .Humanist (Atheist) association. Also Hon.Phys. Toronto St.George's Soc.
Married to University Toronto Pathologist Dr.Patricia SHAW MD(Tor.1976) FRCPC(1985)
4 Children.
In 26y held no office in the Ontario Medical association or College of Physicians & Surgeons of Ontario.
OBIT from LONDON GUARDIAN
Culture
Books
Health, mind and body
Actor, Atheist, Author, Medical radio, television journalist and Oncologist Prof R.A.A. Buckman died on a flight from UK to Toronto from DERMATOMYOSITIS.which developed at 31y (1979).
Attended private London (Hampstead) University College School and Cambridge.Univ. Postgraduate training at Royal Marsden (Cancer) Hospital.
Emigrated to Ontario in 1988 (37y).Worked at Princess Margaret Cancer Hospital.
Was Pres. Can .Humanist (Atheist) association. Also Hon.Phys. Toronto St.George's Soc.
Married to University Toronto Pathologist Dr.Patricia SHAW MD(Tor.1976) FRCPC(1985)
4 Children.
In 26y held no office in the Ontario Medical association or College of Physicians & Surgeons of Ontario.
OBIT from LONDON GUARDIAN
Rob Buckman obituary
Oncologist, writer and broadcaster who investigated medical matters with humour and zest
The oncologist, writer and performer Rob Buckman, who has died aged 63 in his sleep on board a plane, spent last week making a series of short films. We were working on them together, and Rob was his usual irrepressible self, full of good humour, jokes and kindness. On Sunday the whole film crew had lunch in a pub, and Rob left to catch the flight to Toronto on which he died. The films, ironically, are called Top Ten Tips for Health.
The Guardian writer Nancy Banks-Smith described Rob as "one of those exciting scientists in full fizz who look as if they have access to a strong tonic not yet on the market". She was reviewing a film he made in 1981 called Your Own Worst Enemy. He was then suffering from an autoimmune disease called dermatomyositis, in which the body's defences start to attack the body itself. At the time he started filming, Rob assumed the disease would prove fatal, and had determined to make the film to educate people on the subject. But one last treatment of blood plasma replacement and a new drug stopped the disease. However, he later suffered from another autoimmune disease that left him semi-paralysed. Banks-Smith remarked on his courage and fortitude: "The surviving drive to describe his own disease and dissolution was one of the most striking scientific achievements I have seen on television."
Rob was born in London to Bernard Buckman, a trader, and his wife, Irene, a barrister. He began his acting career at the age of 13, while still at University College school, north London, playing the Midshipmite in Gilbert and Sullivan's HMS Pinafore at the Savoy theatre. Then he went on to St John's College, Cambridge, where he graduated in medicine in 1972, after having featured in a vintage Footlights team.
Despite his physical problems, Rob was the most positive and energetic person I have met. He was constantly in good spirits, able to fill a room with warmth and laughter, and never short of ideas and projects. He was also a fount of kindness – always thinking about other people and never about his own problems.
With his first wife, Joan van den Ende, he had two daughters, Joanna and Susie, and with his second, Pat Shaw, two sons, James and Matthew. All of them survive him.
Russell Davies writes: The long and serious careers of Rob Buckman would have been hard to predict in the late 1960s, when he was an irrepressible, rubber-legged star of the Cambridge Footlights Revue. True, he took an unsparing view of medical matters even then – in one of his sketches, the television series on surgery Your Life in Their Hands re-emerged as Their Knife in Your Glands – but he was better known for the capering glee he communicated on stage. I shared many routines with him, most of them directed by Clive James: a pseudo-Russian dance ensemble; a slow-motion wrestling sketch that was taken up, bizarrely, by the BBC for The Val Doonican Show; and Rob's curiously rhapsodic, but not very rude, striptease number.
This was mostly physical stuff but verbally he was also very sharp. We worked up a piece called Chippenham Wrexham, in which two chefs intertwiningly recited a long but quick-fire recipe, incorporating as many British place-names as would fit the theme of cookery. It was a beast to perform, but I never knew him to flub a word of it. He was always more energetic than the rest of us put together, and his later illnesses caused us – who knew nothing of medicine – to wonder if it is possible to have too much vitality. We shall always remember him grinning – and making us grin.
• Robert Alexander Amiel Buckman, doctor, writer and broadcaster, born 22 August 1948; died 9 October 2011
The Guardian writer Nancy Banks-Smith described Rob as "one of those exciting scientists in full fizz who look as if they have access to a strong tonic not yet on the market". She was reviewing a film he made in 1981 called Your Own Worst Enemy. He was then suffering from an autoimmune disease called dermatomyositis, in which the body's defences start to attack the body itself. At the time he started filming, Rob assumed the disease would prove fatal, and had determined to make the film to educate people on the subject. But one last treatment of blood plasma replacement and a new drug stopped the disease. However, he later suffered from another autoimmune disease that left him semi-paralysed. Banks-Smith remarked on his courage and fortitude: "The surviving drive to describe his own disease and dissolution was one of the most striking scientific achievements I have seen on television."
Rob was born in London to Bernard Buckman, a trader, and his wife, Irene, a barrister. He began his acting career at the age of 13, while still at University College school, north London, playing the Midshipmite in Gilbert and Sullivan's HMS Pinafore at the Savoy theatre. Then he went on to St John's College, Cambridge, where he graduated in medicine in 1972, after having featured in a vintage Footlights team.
As a junior doctor at University College hospital, London, he met Chris Beetles, and they teamed up as Beetles and Buckman to perform live comedy and revue. Rob wrote for the long-running satirical BBC Radio 4 show Week Ending, and for an LWT sitcom, Doctor On the Go, based on Richard Gordon's Doctor in the House books.
Beetles and Buckman then performed their own material in another LWT series, The Pink Medicine Show (1978). I first encountered them at the Amnesty International fundraiser The Secret Policeman's Ball in 1979, and Rob went on to front a long-running ITV medical series in the 1980s with Miriam Stoppard, Where There's Life.Unable to find a consultant's job in oncology in the UK, Rob emigrated to Canada in 1985 and took up a post at the Sunnybrook hospital in Toronto. But he carried on making television programmes. In Magic or Medicine? (1994), he investigated alternative therapies, while Human Wildlife: The Life That Lives On Us (2002) looked at microbes in the home environment.
Besides contributing to Punch and writing a weekly column for the Toronto Globe and Mail, Rob also wrote many books, including Jogging from Memory: Letters to Sigmund Freud (1980); How to Break Bad News: A Guide for Healthcare Professionals (1992); Not Dead Yet: The Unauthorized Autobiography of Dr Robert Buckman, Complete With Map, Many Photographs and Irritating Footnotes (1999); Cancer is a Word, Not a Sentence (2006); and Can We Be Good Without God?: Biology, Behaviour and the Need to Believe (2002).
He was president of the Humanist Association of Canada; chair of the advisory board on bioethics of the International Humanist and Ethical Union; and a fellow of the Royal College of Physicians in the UK, and of its Canadian counterpart. He became a pioneer of communication and supportive care in medicine at the Princess Margaret Hospital in Toronto, and was professor in the department of medicine at the University of Toronto.Despite his physical problems, Rob was the most positive and energetic person I have met. He was constantly in good spirits, able to fill a room with warmth and laughter, and never short of ideas and projects. He was also a fount of kindness – always thinking about other people and never about his own problems.
With his first wife, Joan van den Ende, he had two daughters, Joanna and Susie, and with his second, Pat Shaw, two sons, James and Matthew. All of them survive him.
Russell Davies writes: The long and serious careers of Rob Buckman would have been hard to predict in the late 1960s, when he was an irrepressible, rubber-legged star of the Cambridge Footlights Revue. True, he took an unsparing view of medical matters even then – in one of his sketches, the television series on surgery Your Life in Their Hands re-emerged as Their Knife in Your Glands – but he was better known for the capering glee he communicated on stage. I shared many routines with him, most of them directed by Clive James: a pseudo-Russian dance ensemble; a slow-motion wrestling sketch that was taken up, bizarrely, by the BBC for The Val Doonican Show; and Rob's curiously rhapsodic, but not very rude, striptease number.
This was mostly physical stuff but verbally he was also very sharp. We worked up a piece called Chippenham Wrexham, in which two chefs intertwiningly recited a long but quick-fire recipe, incorporating as many British place-names as would fit the theme of cookery. It was a beast to perform, but I never knew him to flub a word of it. He was always more energetic than the rest of us put together, and his later illnesses caused us – who knew nothing of medicine – to wonder if it is possible to have too much vitality. We shall always remember him grinning – and making us grin.
• Robert Alexander Amiel Buckman, doctor, writer and broadcaster, born 22 August 1948; died 9 October 2011
7 Oct 2011
For RUSSIAN READERS
RUSSIANS mainly live in BATHURST & STEELES WEST area in North Toronto.
RUSSIAN physicians avoid long process of getting MEDICAL licence by becoming Acupuncturists, Chiropractors, Naturopaths, Opticians, Pharmacists and Pedorthists (fitting orthotics - extremely well paid by Insurance companies).
RUSSIAN immigrants in Toronto have their own private schools, ballet academies, and night clubs with dinner-dancing (the only ones in Toronto). There is a RUSSIAN POLYCLINIC at 4646 Dufferin, N.of Finch owned by Mother & Son GPs PLIAMM (Father-in-Law is Cardiology Professor M.J.SOLE who also works at the clinic with other U.Tor. retired Medical academics.)
(UKRANIANS mainly in Bloor West area: RUNNYMEDE subway)
NB Please click on ads to provide income for the blog.
RUSSIAN physicians avoid long process of getting MEDICAL licence by becoming Acupuncturists, Chiropractors, Naturopaths, Opticians, Pharmacists and Pedorthists (fitting orthotics - extremely well paid by Insurance companies).
RUSSIAN immigrants in Toronto have their own private schools, ballet academies, and night clubs with dinner-dancing (the only ones in Toronto). There is a RUSSIAN POLYCLINIC at 4646 Dufferin, N.of Finch owned by Mother & Son GPs PLIAMM (Father-in-Law is Cardiology Professor M.J.SOLE who also works at the clinic with other U.Tor. retired Medical academics.)
(UKRANIANS mainly in Bloor West area: RUNNYMEDE subway)
NB Please click on ads to provide income for the blog.
PSA POLICY: USA College of American Pathologists.
PSA Testing In The Early Detection, Diagnosis and Monitoring of Prostate Cancer |
Ported March 19, 2010 Policy Synopsis Application of Prostate-specific antigen (PSA) as a screening test is controversial because its sensitivity and specificity for cancer are poor, and because in some cases of slow growing prostate cancer early detection and treatment may have little benefit. It is, however, reasonable to offer PSA screening to most men aged 50 and older, and at an earlier age for African-American men and men with one or more first degree relatives with prostate cancer. PSA testing is useful in diagnosing patients who present with prostatic symptoms and in the investigation of a nodule detected by digital rectal examination. It is also useful as a monitoring tool for detecting recurrence or recognizing metastasis in a patient with prostate cancer. For monitoring and serial screening purposes, the same PSA assay method should be used for each measurement. Policy Prostate-specific antigen (PSA) is a protein found in serum that is derived almost entirely from prostatic glandular tissue. PSA measurement is used as a monitoring test to detect local recurrence or metastasis in patients with established prostate cancer (adenocarcinoma). PSA is also used to investigate patients who present with prostatic symptoms and signs and also for asymptomatic patients being screened for prostatic cancer. Screening The American Cancer Society, the American Urological Association, and the National Comprehensive Cancer Network have issued detailed advice regarding use of PSA for screening. The CAP is in general agreement with their information but does not endorse any specific screening policy. Application of PSA as a screening test is controversial for two reasons: 1) PSA levels are increased in prostate cancer, prostatitis and benign enlargement of the prostate; therefore sensitivity and specificity for cancer are poor. Some aggressive tumors elevate PSA only slightly, particularly in young African-American men. Cancer detection may be improved to some extent by using age-adjusted cutoffs, PSA “density”, PSA ”velocity”, and fraction of free or complexed PSA. * 2) Some prostate cancers are so indolent that early detection and treatment may have little benefit and potential for significant morbidity. At present, these cancers cannot be clearly distinguished from cancers that are more aggressive. It is reasonable to offer PSA screening to men of age about 50 or older, and at an earlier age for African-American men and men with one or more first degree relatives with prostate cancer. For a man in poor health with serious medical illness and/or a man who is unlikely to live for more than 10 years, there may be no benefit to the early detection of prostate cancer. PSA testing may actually do more harm than good since prostate cancer investigation and treatment can seriously affect one's quality of life. Men who are being offered PSA screening should be informed about the limitations of PSA testing and the consequences of an abnormal result. PSA testing should be performed by accredited laboratories applying rigorous quality control, because small analytic changes can cause inappropriate patient care decisions. Different PSA assay methods can yield different results. Accordingly, for monitoring and serial screening purposes, it is important to use the same PSA assay method for each measurement, and preferably in the same laboratory. Efforts to improve the agreement of commercial PSA tests should continue. Diagnosis PSA is a useful test in patients presenting with prostatic symptoms and in the investigation of a nodule detected by digital rectal examination. Elevated PSA measurements or rising PSA values in a patient with suspected prostate cancer may be followed up with a prostate biopsy. Evaluation of prostate tissue by a qualified pathologist is required for the diagnosis of prostate cancer. Monitoring PSA is a clearly useful test for detecting recurrence or recognizing metastasis in a patient with prostate cancer. The test should be performed periodically in patients who have received any type of treatment for prostate cancer including those on watchful waiting protocols. It is important that the laboratory measurements be made with assays, which have adequate sensitivity, to monitor patients who have had their prostate glands surgically removed and that clinicians preferably utilize the same laboratory for serial measurements. The time interval over which the concentration of PSA doubles in these men is an important indicator of progression of prostate cancer. * Definitions: PSA “density” is determined by dividing the PSA level by the volume of the prostate gland as determined by transrectal ultrasound - the higher the PSA density, the greater the likelihood of cancer. PSA “velocity” is the increase in PSA level occurring over a period of time. The measurement of PSA velocity should be made on three specimens taken over at least an 18-month period. A PSA velocity over 0.75 ng/mL per year is considered high. Free PSA indicates how much PSA circulates alone or unbound in the blood where as complexed PSA indicates how much PSA is bound together with other blood proteins. For PSA results between 4 and 10, a low percent free PSA means that a prostate cancer is more likely to be present. Revision History Adopted March 2004Revised February 2010 |
4 Oct 2011
Nobel Prizewinner Late Henry G.Kunkel Professor STEINMAN BSc(McGill) MD(Harvard 68)
04 October 2011
Nobel Prize winner Late Dr.R.STEINMAN BSc(McGill 63) MD (Harvard 68)
Ralph M. Steinman
http://lab.rockefeller.edu/steinman/dendritic_intro/
Born: 1943, Montreal, Canada
Died: 30 September 2011 (Cancer pancreas)
Affiliation at the time of the award: Rockefeller University, New York, NY, USA
Prize motivation: "for his discovery of the dendritic cell and its role in adaptive immunity"
(Never received an Order of Canada or Academic Medal)
http://lab.rockefeller.edu/steinman/dendritic_intro/
Born: 1943, Montreal, Canada
Died: 30 September 2011 (Cancer pancreas)
Affiliation at the time of the award: Rockefeller University, New York, NY, USA
Prize motivation: "for his discovery of the dendritic cell and its role in adaptive immunity"
(Never received an Order of Canada or Academic Medal)
LEGAL SINKING FUND. $100 a day.
Ont. MDs`need a legal sinking fund as CMPA & OMA do not fund Appeals of CPSO "trials".
Case of Amanda Knox is example of $1,000,000 needed to fight an unjust verdict.
$25,000 year About $100 each working day.
Case of Amanda Knox is example of $1,000,000 needed to fight an unjust verdict.
$25,000 year About $100 each working day.
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