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    Mayo Clinic researchers report that primary care physicians can play a key role in preventing suicide by emphasizing a collaborative care approach.
    www.mayoclinic.org   ...Read On

    Study found primary-care physicians more likely to send breast cancer patients to oncologists
    domains.e-healthsource.com   ...Read On

    July 08, 2011
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    By Helen Albert
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    Contaminated cocaine use can cause painful, necrotic skin purpura
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    By
    Springer
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    MedWire News: Using cocaine contaminated with the animal de-worming drug levamisole can result in painful, necrotic purple skin lesions and low levels of white blood cells, report US researchers.

    "We've seen a lot of cases in Rochester alone, so it is important to alert the gatekeepers of medicine, the primary care physicians who are in the trenches every day, of this diagnosis," said study author Mary Gail Mercurio from the University of Rochester in New York.

    "This is one of those entities that with familiarity and recognition, can go a long way in helping physicians to quickly make a diagnosis and intervene without embarking on an elaborate workup where nothing will pan out," she said.

    Co-author Noah Craft (University of California, Los Angeles) and colleagues describe a series of six patients with remarkably similar dermatological symptoms after cocaine use, treated in clinics in New York and California over the past few months.

    Symptoms included net-like purple skin discoloration or purpura on the body, which included painful eruptions, skin necrosis, and scabbing, all occurring after cocaine use.

    In addition, all the patients had positive perinuclear antineutrophil cytoplasmic antibody values, a common feature of many autoimmune conditions. Three also had a low white blood cell count (neutropenia), which can significantly increase infection risk.

    The study authors believe that the cause of these symptoms is contamination of the cocaine with levamisole, rather than cocaine use per se, as the symptoms of purpura and neutropenia have been observed before in connection with levamisole-contaminated cocaine use.

    Craft et al explain that levamisole-contaminated cocaine has been in use in the USA since 2003, and resulting toxic reactions have increased dramatically since 2008.

    "When we first started seeing these patients they all had a similar clinical picture, but they were really an enigma because they weren't falling into any other pattern we'd seen before. When a colleague at the National Institutes of Health mentioned levamisole contamination, we did toxicity screens and lo-and-behold, all the patients came up positive for cocaine," said Mercurio.

    She concluded: "We believe these cases of skin reactions and illnesses linked to contaminated cocaine are just the tip of the iceberg in a looming public health problem posed by levamisole."

    The results of this study are published in the Journal of the American Academy of Dermatology.

    MedWire (http://www.medwire-news.md/ ) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
    hepatitiscnewdrugs.blogspot.com


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    Sessions on kidney cancer start tomorrow at 8:00 am, but in the meantime we are learning about Survivorship Care Plans — and why we need them for kidney cancer patients. Whose Job is It Anyway? Interesting study in the U.S. of over 1,000 oncologists and over 1,000 PCPs (primary care physicians) revealed that BOTH groups felt that the primary care physician should not have the primary responsibility for follow-up care. Oncologists strongly believed that primary care physicians do not have the required knowledge or skills to detect recurrent cancer (of either breast or colorectal cancer, two of the most common cancers). How Many Patients are given a Treatment Summary and Survivorship Care Plan? For breast or colorectal cancer in the U.S., only half (47%) of oncologists report that they give their patients a written treatment summary and follow-up care plan. That number is considered low with much discussion of what needs to happen to go beyond the written document. Patients need both guidelines and guidance — including discussions about exercise, fatigue, weight management, and smoking cessation. So What About Kidney Cancer in Canada? Not surprisingly, kidney cancer lags far behind breast and colorectal cancers. We have no templates for survivorship care plans for kidney cancer patients yet. (However, the Kidney Cancer Research Network of Canada discussed the need for survivorship plans in January of this year). In the meantime, all patients need to ask for a summary of their treatment and discuss what they can be doing for their own follow-up care (including surveillance schedules and lifestyle modifications) to help reduce the risk of further health complications. More tomorrow. Filed under: General Updates kidneycancercanada.wordpress.com


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    A report in Family Medicine gives us some insight into the views of primary care physicians (PCPs) with respect to PSA testing for prostate cancer risk and the appropriate roles of the patient and the physician in the decision to have or not have PSA tests. Most formal guidelines on the use of PSA testing now prostatecancerinfolink.net


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