Amputation results from diabetes

Mr. B, age 46 years, was a physician assistant who had worked for the same internist for 10 years. He and Dr. K had an excellent relationship. Their office was in an area with a high prevalence of diabetes, and many of their patients lived with the disease. Both practitioners had an interest in conducting public outreach about the condition.
Mr. B often conducted seminars and lectures in the local pharmacy, adult education classes, and the senior center in town. His lectures covered such topics as metabolic syndrome, coping with newly diagnosed diabetes, foot and skin care for people with diabetes, and understanding medications. He also discussed lifestyle modifications that could improve health, the connection between diabetes and cardiovascular disease, and how to properly monitor blood glucose. These seminars were generally well attended, and a number of people asked interesting and sometimes challenging questions. Mr. B found this community service to be very personally rewarding, and Dr. K was supportive of his endeavors.
Both Mr. B and Dr. K brought this educational attitude into the clinic as well. They stressed the value of empowering patients by helping them understand their conditions. Both practitioners found this strategy effective, although there were always some patients that just couldn't be reached in this manner.
One such patient was Mr. X, a 64-year-old African American who had been a patient for close to 15 years. Mr. X had diabetes, and despite numerous attempts to educate him on the importance of lifestyle modifications, medication compliance, and regular checkups, he was generally noncompliant and mostly disinterested. Not surprisingly, his diabetes was not well controlled. Both practitioners had tried unsuccessfully to convey the importance of controlling his blood glucose, but Mr. X seemed less interested in managing the diabetes and staying healthy than he did in waiting until there was a problem and then coming in for a “quick fix.”

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Once-monthly treatment for arthritis

Product: Actemra
 
Company: Genentech 

Pharmacologic class: Interleukin-6 (IL-6) receptor inhibitor 


Active ingredient: Tocilizumab 20 mg/mL; solution for IV infusion after dilution; preservative-free. 


Indication: Moderately to severely active rheumatoid arthritis (RA) in patients who have had an inadequate response to one or more tumor necrosis factor (TNF) blockers. May be used with methotrexate or disease modifying antirheumatic drugs (DMARDs). 

 
Pharmacology: IL-6 is produced by monocytes and lymphocytes in the bloodstream and by synovial and endothelial cells in the joints, leading to systemic and local production of IL-6 in patients affected by inflammatory processes such as RA. Tocilizumab binds specifically to both soluble and membrane-bound IL-6 receptors and has been shown to inhibit IL-6-mediated signaling through these receptors. 


Clinical trials: The efficacy and safety of tocilizumab was assessed in five randomized, double-blind studies in patients >18 years with active RA. Tocilizumab was given every four weeks as monotherapy (Study I), in combination with methotrexate (MTX) (Studies II and III) or other DMARDs (Study IV) in patients with an inadequate response to those drugs, or in combination with MTX in patients with an inadequate response to TNF antagonists (Study V). The primary endpoint was the proportion of patients who achieved an American College of Rheumatology (ACR) 20 response at Week 24. In all studies, patients treated with tocilizumab 8 mg/kg had statistically significant ACR20, ACR50, and ACR70 response rates versus MTX- or placebo-treated patients at Week 24. Patients with inadequate response to DMARDs or TNF antagonist therapy treated with tocilizumab 4 mg/kg had lower response rates compared with patients treated with tocilizumab 8 mg/kg. 


Adults: Give once every four weeks as a 60-minute IV infusion. Initially 4 mg/kg, may increase to 8 mg/kg based on clinical response. Do not start if absolute neutrophil count (ANC) <2,000/mm3, platelets <100,000/mm3, or alanine transaminase/aspartate transaminase (ALT/AST) >1.5 upper limit of normal (ULN). Reduce dose to 4 mg/kg if elevated liver enzymes, neutropenia, or thrombocytopenia occur (see literature). 


Children: Not recommended. 


Precautions: ANC <500 mm3, platelets <50,000 mm3, or ALT/AST >5 ULN: not recommended. Monitor neutrophils, platelets, liver function tests every four to eight weeks. Active hepatic disease or impairment: not recommended. Hepatitis B or C virus or infection. Increased risk of serious or fatal infections (e.g., TB, bacterial sepsis, invasive fungal). Active infections: do not give therapy. Chronic or history of recurring or opportunistic infections. Conditions that predispose to infection. Travel to, or residence in, areas with endemic TB or mycoses. Test for and treat latent TB prior to starting therapy. Monitor closely if new infection develops; discontinue if serious or opportunistic infection or sepsis develops. Monitor lipids four to eight weeks after initiation, then every six months. Immunosuppression. Central nervous system demyelinating disorders. Malignancies. Elderly. Pregnancy (Cat. C). Nursing mothers: not recommended. 


Interactions: Increased risk for infection with concomitant immunosuppressants (e.g., TNF antagonists, IL-1R antagonists, anti-CD20 monoclonal antibodies, selective co-stimulation modulators). Avoid live vaccines. Caution with CYP3A4 substrate drugs (e.g., oral contraceptives, lovastatin, atorvastatin). Monitor warfarin, cyclosporine, theophylline, other drugs that are CYP450 substrates with narrow therapeutic indices. 


Adverse reactions: Upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT; infusion reactions, neutropenia, thrombocytopenia, gastrointestinal perforations, increased lipids. 


Containment: Single-use vials (80 mg/4 mL, 200 mg/10 mL, 400 mg/20 mL)—1, 4


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Choline reduces Down syndrome dysfunction, guard against dementia

Barbara Strupp, professor of nutritional sciences and of psychology. (Credit: Alexi Wenski-Roberts)

ScienceDaily (2010-06-03) More choline during pregnancy and nursing could provide lasting cognitive and emotional benefits to people with Down syndrome. The work indicated greater maternal levels of the essential nutrient also could protect against neurodegenerative conditions such as Alzheimer's disease.

The findings, published June 2 in Behavioral Neuroscience, could help lead to increasing the maternal dietary recommendations for choline (currently 450 milligrams a day during pregnancy, 550 milligrams for lactation), a nutrient found in egg yolks, liver, nuts and such vegetables as broccoli and cauliflower. "We found that supplementing the maternal diet with additional choline resulted in dramatic improvements in attention and some normalization of emotion regulation in a mouse model of Down syndrome," said lead author Barbara Strupp, professor of nutritional sciences and of psychology. The researchers also found evidence for "subtle, but statistically significant, improvement in learning ability in the non-Down syndrome littermates." In addition to mental retardation, Down syndrome individuals often experience dementia in middle age as a result of brain neuron atrophy similar to that suffered by people with Alzheimer's disease. Strupp noted that the improved mental abilities found in the Down syndrome mice following maternal choline supplements could indicate protection from such neurodegeneration "in the population at large." Strupp and her co-authors tested Down syndrome model mice born from mothers fed a normal diet and those given choline supplements during their three-week pregnancy and three-week lactation period, as well as normal mice born from mothers with and without additional choline. The choline-supplemented mothers received approximately 4.5 times more choline (roughly comparable to levels at the higher range of human intake) than unsupplemented mothers. At six months of age, the mice performed a series of behavioral tasks for about six months to assess their impulsivity, attention span, emotion control and other mental abilities. In addition to dramatic improvements in attention, the researchers found that the unsupplemented Down syndrome model mice became more agitated after a mistake than normal mice, jumping repeatedly and taking longer to initiate the next trial, whereas the choline-supplemented Down syndrome model mice showed partial improvement in these areas. "I'm impressed by the magnitude of the cognitive benefits seen in the Down syndrome model mice," Strupp said. "Moreover, these are clearly lasting cognitive improvements, seen many months after the period of choline supplementation." Strupp noted that the results are consistent with studies by other researchers that found increased maternal choline intake improves offspring cognitive abilities in rats. However, this is the first study to evaluate the effects of maternal choline supplementation in a rodent model of Down syndrome. This is also one of the few studies that has evaluated offspring attentional function and effects in mice, rather than rats, Strupp noted. Previous studies of humans and laboratory animals have shown that supplementing the diets of adults with choline has proven to be largely ineffective in improving cognition. "Although the precise mechanism is unknown, these lasting beneficial effects of choline observed in the present study are likely to be limited to increased intake during very early development," Strupp said. The study, funded in part by the National Institutes of Health (NIH), was part of the dissertation of Jisook Moon, Ph.D. '06. Other Cornell collaborators included Myla Strawderman, research associate in nutritional sciences; David Levitsky, professor of nutrition and of psychology; May Chen '07 and Shruti Gandhy '07. Strupp and collaborators have received additional NIH funding to study the neural mechanisms underlying the positive cognitive effects of perinatal choline supplementation observed in this study.

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New hope for better treatment for a rising cancer

Poor diet, too much alcohol, smoking and increasing obesity could be leading to an epidemic of oesophageal and upper stomach cancer, according to a leading UK team of specialists at The University of Nottingham and Nottingham University Hospitals.

The Nottingham Gastro-Oesophageal Cancer Research Group has been carrying out intensive research over the past five years to try to improve the treatment of this cancer. A major part of the research is published today in the British Journal of Cancer. The work has been prompted by a large increase in the incidence of cancer of the oesophagus (gullet) and upper stomach over the past 40 years.

According to Cancer Research UK statistics, rates of oesophageal adenocarcinoma and gastro-oesophageal (GOJ) adenocarcinoma have been increasing in the UK. Since the 1970s the incidence of this cancer has increased by 50 per cent in men and 20 per cent in women. Indeed the reported rates for white men in the UK are now the highest in the world.

Doctors believe changes in diet and lifestyle are the key factors behind the rapid rise in the number of cases. This new research is aimed at providing a better treatment and prognosis for a cancer that is historically not survivable past five years from diagnosis. Current standard treatment for potentially operable cancer consists of a 12 week intensive course of powerful chemotherapy, followed by surgery if the tumour is operable, and then a second 12 week course of chemotherapy. This prolonged, intense course of chemotherapy treatment is potentially toxic, impacts on quality of life and is likely to be beneficial only in those patients who respond to chemotherapy.

The Nottingham-based research using molecular cancer pathology and DNA protein expression techniques on tumour samples from around 250 patients after surgery has shown that only between 40 per cent and 50 per cent of these adenocarcinomas actually respond to the chemotherapy. The research has effectively tested a very promising monitoring test during treatment so that doctors can assess whether and how far the tumour is regressing during chemotherapy. In addition, the research has also identified a promising protein marker involved in DNA repair in cancer cells that predicts resistance to chemotherapy in tumours.

The new information could empower doctors to decide whether to recommend a second course of powerful chemotherapy after surgery. The research also paves the way for wider and more specialised clinical trials for this cancer which will monitor patients in real-time, rather than using past samples, and which could lead to new combinations of chemotherapy, including the new breast cancer drug, Herceptin, which has recently been proven to be effective in gastro-oesophageal cancers.

Dr Srinivasan Madhusudan, Clinical Associate Professor & Consultant in Medical Oncology at Nottingham University Hospitals and the University’s School of Molecular Medical Sciences, said: “Recent scientific advances have given real hope for patients with gastro-oesophageal cancers. The Nottingham Upper Gastrointestinal Cancer Group is a multidisciplinary research team consisting of Oncologists, Surgeons, Pathologists and Radiologists. We aim to exploit the ‘new science’ for patient benefit. This study published online today in the British Journal of Cancer provides evidence that it may be possible to tailor gastro-oesophageal cancer treatments based on ‘new’ biology. We are planning a larger prospective multicentre study to confirm these findings and we believe will have major clinical impact on how we treat these aggressive tumours in the future.”

Source:http://communications.nottingham.ac.uk/News/

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Unravelling the health-giving properties of fruit and veg

Scientists at The University of Nottingham are to use their share of a unique £6.5m research award to discover which genes control the health promoting properties of fruit and vegetables.

As part of a cross-channel partnership to enhance international collaboration in Systems Biology Graham Seymour, Professor of Plant Biotechnology, and Charlie Hodgman, Director of the Centre for Plant Integrative Biology, will be working on a systems biology approach to understand the metabolic networks underlying health based quality traits in tomato fruit.

With their award of nearly £300,000 from the Biotechnology and Biological Sciences Research Council (BBSRC) and the Agence Nationale de la Recherche (ANR) the bio-scientists will be working in collaboration with Royal Holloway University of London, the National Scientific Research Centre, Paris (CNRS) and the Plant Genomics Centre, INRA, Evry, near Paris.

Professor Seymour said: “The health promoting properties of diets rich in fruit and vegetables has been attributed to the synergistic effects of various phytochemicals in food such as vitamins, flavonoids and carotenoids.

"This project aims to study an experimental model tomato that has very high levels of these health-related compounds. The researchers aim to use a systems biology approach to integrate information at many different levels about the tomato and to produce a predictive model of how the formation of these phytochemicals is controlled.”

Professor Hodgman said: "The long-term intention of the Centre for Plant Integrative Biology which is funded by the BBSRC and the Engineering and Physical Sciences Research Council is to apply work and techniques developed on model plant organisms to crop species. This tomato work is a very welcome first step."

BBSRC and ANR, the leading public life-science funding agencies in the UK and France, are funding a total of 10 new projects involving 22 different universities and institutes in the UK and France.

Each project has at least one UK and one French partner institution and the initiative aims to build European collaboration in Systems Biology. BBSRC has already invested over £70m in UK and European Systems Biology initiatives and the UK is one of the world leaders in this new and growing approach to tackling bioscience problems.

Systems biology is a revolution in the way bioscientists think and work. It brings together researchers across different disciplines, combining theory, computer modelling and experiments. Systems biology will make the outputs of bioscience research more useful and easier to apply in the real world, as well as advancing our understanding of biological processes.

The new projects will give the researchers involved access to complementary expertise and skills and will help develop the field of Systems Biology by coordinating BBSRC and ANR resources.

Mr Steve Visscher, BBSRC Interim Chief Executive, said: “Systems Biology holds great promise for delivering real, practical advances in healthcare, biotechnology and environmental research much faster than traditional biology. Collaborative initiatives with international partners enable us to increase the impact of our funding and the impact of the research being done by our scientists.

“We have been pleased to see that not only has the partnership between BBSRC and ANR resulted in a successful initiative but that the range and quality of the projects funded is also broadening the areas being studied by Systems Biology.”

Mrs Jacqueline Lecourtier, ANR General Manager, said: “As a young agency created in 2005, this was the first bilateral call undertaken within the Health & Biology Department. By answering this call, Systems Biology growing communities showed that they were ready to share their views and expertises. Moreover, this initiative allowed BBSRC and ANR to fund high quality and cross-disciplinary proposals, which is one of our missions.

“ANR and BBSRC cooperation was very successful on both levels, management and scientific. Future collaborations involving additional countries are already on their way through the ERANET ERASysBio.”

Source:http://communications.nottingham.ac.uk/News/

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Do chemicals in the environment affect fertility?

The amount of chemicals absorbed is thought to be so minute that they would be difficult to discern through testing. However, through a process known as bioaccumulation, chemicals can become concentrated in individuals over a number of years, stored mostly in fat tissue. Though these chemicals may not be directly harmful to these individuals, if they are passed on — for example, through gestation in the womb or through the food chain — they might have consequences for human health.

“One of the concerns of bioaccumulation is that when the fat is broken down and passed on — for example during the breast feeding process — the offspring are exposed to a concentration of chemicals that the mother has built up over the years,” said Dr Sinclair.

Colleagues in Aberdeen have provided precise measurements of specific chemicals in the environment and in animal tissues. These often take the form of chemicals which mimic hormones.

“These chemicals come from a variety of sources including plastics, pesticides and industrial waste and many of these persist in the environment for a long time — albeit at very low levels,” said Dr Lea. “The problem is even low levels can still have an effect.”

The three-year study will look at how chemicals are passed on from mother to foetus, and how this impacts on the foetus. It is thought that, although this generation of animals may have no problems getting pregnant, the next and future generations could have fertility problems stemming from exposure to environmental chemicals in the womb.

Dr Lea said: “Though male fertility has been the subject of studies in recent years, this will be the first time that female fertility has been examined. Currently, less is known about the effects of hormone-like chemicals on the developing female foetus, so the consequences for reproductive development in females may be greater than in males.”

“We're not talking about obvious congenital defects here, but tiny changes caused by exposure to chemicals that have an impact on reproductive function — changes over generations rather than immediate effect,” added Dr Sinclair.

The inaugural meeting of the REEF consortium will take place in Copenhagen on Thursday 22 and Friday 23 May to formally launch the project.

Source:http://communications.nottingham.ac.uk/News/

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New insights into mushroom-derived drug promising for cancer treatment

A promising cancer drug, first discovered in a mushroom commonly used in Chinese medicine, could be made more effective thanks to researchers who have discovered how the drug works. The research, carried out by The University of Nottingham, was funded by the Biotechnology and Biological Sciences Research Council (BBSRC).

In research to be published in the Journal of Biological Chemistry, Dr Cornelia de Moor and her team, in the School of Pharmacy, investigated a drug called cordycepin, which was originally extracted from a rare kind of wild mushroom called cordyceps — a strange parasitic mushroom that grows on caterpillars (see image and notes on use of image) — and is now prepared from a cultivated form.

Dr de Moor said: “Our discovery will open up the possibility of investigating the range of different cancers that could be treated with cordycepin. We have also developed a very effective method that can be used to test new, more efficient or more stable versions of the drug in the Petri dish. This is a great advantage as it will allow us to rule out any non-runners before anyone considers testing them in animals.”

Properties attributed to cordyceps mushroom in Chinese medicine made it interesting to investigate and it has been studied for some time. In fact, the first scientific publication on cordycepin was in 1950. The problem was that although cordycepin was a promising drug, it was quickly degraded in the body. It can now be given with another drug to help combat this, but the side effects of the second drug are a limit to its potential use.

Dr de Moor continued: “Because of technical obstacles and people moving on to other subjects, it’s taken a long time to figure out exactly how cordycepin works on cells. With this knowledge, it will be possible to predict what types of cancers might be sensitive and what other cancer drugs it may effectively combine with. It could also lay the groundwork for the design of new cancer drugs that work on the same principle.”

The team has observed two effects on the cells: at a low dose cordycepin inhibits the uncontrolled growth and division of the cells and at high doses it stops cells from sticking together, which also inhibits growth. Both of these effects probably have the same underlying mechanism, which is that cordycepin interferes with how cells make proteins. At low doses cordycepin interferes with the production of mRNA, the molecule that gives instructions on how to assemble a protein. And at higher doses it has a direct impact on the making of proteins.

Professor Janet Allen, BBSRC Director of Research, said: “Research to understand the underlying bioscience of a problem is always important. This project shows that we can always return to asking questions about the fundamental biology of something in order to refine the solution or resolve unanswered questions. The knowledge generated by this research demonstrates the mechanisms of drug action and could have an impact on one of the most important challenges to health.”

An image of cordyceps mushroom growing on a moth pupa is at: http://www.bbsrc.ac.uk/media/releases/2009/091223-new-insights-mushroom-derived-drug-for-cancer.html.  Please note that you are permitted to use this image to accompany this story only. Additional usage is not permitted under the associated licence.

The research is due to be published in The Journal of Biological Chemistry and is available via early online publication at: http://www.jbc.org/cgi/doi/10.1074/jbc.M109.071159

Source:http://communications.nottingham.ac.uk/News/

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Helping smokers with mental illness

Researchers at The University of Nottingham have won government funding to improve the services which help people living with serious mental illness to tackle their tobacco dependence.

The grant is part of a £1.2 million package of funding from the Department of Health to the UK Centre of Tobacco Control Studies which is coordinated at the University. The funding will drive   six pilot projects across the country all aimed at improving ‘quit smoking’ services for vulnerable sections of the population. 

The researchers at Nottingham will be involved in all six projects and lead on one project focusing on mental health.  They will be working with the local mental health Trust, (Nottinghamshire Healthcare NHS Trust), and Nottingham’s Stop Smoking Service, New Leaf, to assess and improve the support given to smokers with severe mental illness who are trying to quit or need encouragement to stop smoking.
Patients diagnosed with mental health problems are up to three times more likely to be smokers than the general population. For example around 70 per cent of people with schizophrenia are smokers. Mental illness sufferers as a group are much more likely to be heavy smokers with severe nicotine addiction. The disproportionately high rates of smoking have also been found to cause a higher level of tobacco-related diseases and death rate among mental health patients. They also tend to need higher doses of antipsychotic medication because components of tobacco smoke speeds up drug metabolism.

The research programme is co-ordinated by Ann McNeill, Professor of Health Policy and Promotion at The University of Nottingham, and led by Dr Elena Ratschen who said:

“This project is vital to address the historical culture of tolerance of smoking in the mental health sector. It’s a largely neglected area with smoking being deeply embedded in the culture of treatment centres and largely condoned by clinicians and psychiatric staff. Despite the smoke-free policy, smoking in and around treatment settings is still the rule rather than exception, and often a not only accepted but expected (and reinforced) standard. We will introduce procedures that we hope will help to address the smoking culture and that will make sure smokers with mental health problems are offered the same support as smokers without mental health problems, if they so wish.”

Garry Bevis from the Nottinghamshire Healthcare NHS Trust said:

“We are delighted to be involved in offering the smoking cessation service to our inpatients as well as those in the community.  As a trust, Nottinghamshire Healthcare is committed to supporting our service users in leading healthier lifestyles and given the high proportion of smokers with mental health problems this is an issue that we are keen to further develop.”

Researchers from five other universities are involved in the other pilots which will focus on children’s services (University College, London), prisons (Stirling and Central Lancashire), relapse prevention and smokeless tobacco use (Queen Mary, London), and pregnancy (Bath University). The programme is expected to last from April 2010 to September 2011.

If the research and resulting pilot schemes are successful and have a positive effect on quitting rates in these areas of the population, the new services will be implemented across the UK.

Source:http://communications.nottingham.ac.uk/News/

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Symptoms of mesothelioma

The general symptoms of mesothelioma include:

• fever
• sweating - particularly at night
• unexplained weight loss
• feeling tired

Depending on which mesothelium is affected by the cancer, you may also have other symptoms.
If you have pleural mesothelioma you may:

• have chest or back pain
• feel breathless
• cough
• have a hoarse voice
• have difficulty swallowing

If you have peritoneal mesothelioma you may:

• have a swollen abdomen
• have abdominal pain
• lose your appetite
• have diarrhoea or constipation

Although not necessarily a result of mesothelioma, if you have these symptoms you should visit your GP.

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Causes of mesothelioma

In nine out of 10 people with mesothelioma, the cause is asbestos. Asbestos is a mineral which was used in construction, ship-building and household appliances until 1999 when its use was banned. For example, you may have breathed in asbestos when you worked in a factory which produced products containing asbestos, or when washing work clothes which had asbestos on them.
Your body reacts to asbestos by trying to get rid of it. Asbestos is made up of tiny fibres which, when breathed in, pass into the lungs and cause inflammation and fibrous tissue to form. The fibres then pass into other areas of the body such as the mesothelium as the body tries to get rid of the fibres from the lungs.
Mesothelioma caused by asbestos takes between 10 and 60 years to develop. It's been predicted that an increasing number of people will be diagnosed with it before 2015, when the number of people affected will be highest. When it peaks, about 3,000 people will be diagnosed each year. The number of people diagnosed should then decrease.
The causes of mesothelioma in people who haven't been exposed to asbestos aren't fully understood. But there are certain factors that may make mesothelioma more likely.

• Exposure to radiation.
• A mineral found in Turkey called Zeolite may cause mesothelioma.
• Previous infection with the Simian monkey virus (SV40). This may be a co-factor, making mesothelioma more likely if you have come into contact with one of the other risk factors, such as asbestos.

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Diagnosis of mesothelioma

Your GP will ask you about your symptoms and will examine you. He or she may refer you to a doctor who specialises in respiratory medicine; this is a doctor who treats conditions affecting the lungs, or a gastroenterologist, a doctor specialising in conditions of the digestive system. Further tests may include the following.

• A chest or abdominal X-ray.
• A CT (computerised tomography) scan, which uses X-rays to make a three-dimensional image of the body.
• An MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce images of the inside of your body.
• A sample of the fluid (either the pleural effusion or ascites) may be taken and sent to a laboratory for testing.
• A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• A flexible narrow tube may be used to look for mesothelioma. This is called a mediastinoscopy.
• A PET (positron emission tomography) scan involves the use of an injected weak radioactive substance to look for mesothelioma using a PET machine.

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Treatment of mesothelioma

Mesothelioma is difficult to treat because the cancer has usually spread and can't be removed. Treatments can include the following.

Medicines

There are a number of chemotherapy medicines which may be used to treat mesothelioma. Only one medicine is currently licensed in the UK, this is called pemetrexed. You may be advised to take supplements, such as folic acid and vitamin B12, with pemetrexed. Other medicines include methotrexate, vinorelbine, mitomycin and cisplatin. These, or other medicines, may be suggested to you as part of a clinical trial. Ask your doctor for advice.
Painkillers may be given to help reduce pain.
Steroid medicines, such as prednisolone, may be given to help reduce inflammation and can improve appetite.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. It may be used to try cure the mesothelioma or to reduce symptoms.

Surgery

You may have surgery if the cancer is only in one area of the mesothelium. This type of treatment may help pleural (lung) mesothelioma but isn't usually helpful for peritoneal (abdomen) mesothelioma. Surgery may involve taking the whole pleura (mesothelium) or part of the tissues near the pleura. Sometimes this may include the diaphragm and one of the lungs.

Other treatments

Chemical irritants may be used which will cause the layers of the mesothelium to become inflamed; this makes them stick together so fluid doesn't build up. The chemicals will be added using a tube which will be put through the skin.
Excess fluid can be drained using a needle to help you breathe more easily. You can have this done regularly as the fluid will return. For this you will need a local anaesthetic.
Physiotherapy and relaxation techniques may also be helpful.

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