Combined percutaneous radiofrequency ablation and cementoplasty for the treatment of extraspinal painful bone metastases: A prospective study

Publication date: Available online 27 June 2018
Source:Journal of the Egyptian National Cancer Institute
Author(s): Andrew Fares, Mohamed H. Shaaban, Raafat M. Reyad, Ahmed S. Ragab, Mohga A. Sami
IntroductionAbout 50% of patients with cancer develop bone metastasis mainly presenting with distressing, drug-resistant pain.Aim of the workThe study evaluated efficacy and safety of combined cementoplasty and bony radiofrequency ablation in palliation of intractable pain and disability in cancer patients with bony metastases.Patients and methodsThe study included 30 adult patients suffering from localized bony metastases causing refractory moderate to severe pain. Radiofrequency bony ablation performed followed by cementoplasty were done under computed tomography (CT) guidance with conscious sedation and local anesthesia. Final CT check was done to ensure adequate lesion filling and to exclude any cement leakage. Pain, hemodynamic variables, and neurological status were checked for a minimum of 2 h before discharge. The patients were followed up weekly in the pain clinic. The primary outcome measures pain severity and daily opioid consumption. The secondary outcome measures were quality of life and the degree of disability, and procedure-related adverse outcomes.ResultsPain score, daily morphine consumption, and Oswestry Disability Index score decreased significantly after 1 day, and 1, 4 and 12  weeks. None of the patients had serious complications during the postoperative follow up visits. Only 4 patients (13.3%) experienced discomfort during, and few days after the procedure, 3 patients (10%) suffered from local infection, and 2 patients (6.7%) reported cement leakage.ConclusionCombined radiofrequency ablation and cementoplasty is a safe and effective pain relief modality in patients suffering from extraspinal painful bone metastases with improvement of the quality of life.



https://ift.tt/2Kvr1aR

Mannitol in Critical Care and Surgery Over 50+ Years: A Systematic Review of Randomized Controlled Trials and Complications With Meta-Analysis

Objective: Despite clinical use spanning 50+ years, questions remain concerning the optimal use of mannitol. The published reviews with meta-analysis frequently focused on mannitol's effects on a specific physiological aspect such as intracranial pressure (ICP) in sometimes heterogeneous patient populations. A comprehensive review of mannitol's effects, as well as side effects, is needed. Methods: The databases Medline (OvidSP), Embase (OvidSP), and NLM PubMed were systematically searched for randomized controlled trials (RCTs) comparing mannitol to a control therapy in either the critical care or perioperative setting. Meta-analysis was performed when feasible to examine mannitol's effects on outcomes, including ICP, cerebral perfusion pressure, mean arterial pressure (MAP), brain relaxation, fluid intake, urine output, and serum sodium. Systematic literature search was also performed to understand mannitol-related complications. Results: In total 55 RCTs were identified and 7 meta-analyses were performed. In traumatic brain injury, mannitol did not lead to significantly different MAP (SMD [95% confidence interval], CI)=−3.3 [−7.9, 1.3] mm Hg; P=0.16) but caused significantly different serum sodium concentrations (SMD [95% CI]=−8.0 [−11.0, −4.9] mmol/L; P

https://ift.tt/2yPZjUx

The pivotal role of DNA methylation in the radio‐sensitivity of tumor radiotherapy

Cancer Medicine, EarlyView.


https://ift.tt/2Kr9U9M

S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies

S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies

S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies, Published online: 28 June 2018; doi:10.1038/s41416-018-0167-x

S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies

https://ift.tt/2tAWzFv

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study, Published online: 28 June 2018; doi:10.1038/s41416-018-0148-0

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study

https://ift.tt/2IxOPc5

Phase II Studies with Refametinib or Refametinib plus Sorafenib in Patients with RAS-mutated Hepatocellular Carcinoma

Purpose: Refametinib, an oral MEK inhibitor, has demonstrated antitumor activity in combination with sorafenib in patients with RAS-mutated hepatocellular carcinoma (HCC). Two phase II studies evaluated the efficacy of refametinib monotherapy and refametinib plus sorafenib in patients with RAS-mutant unresectable or metastatic HCC. Methods: Eligible patients with RAS mutations of cell-free circulating tumor DNA (ctDNA) determined by beads, emulsion, amplification, and magnetics technology received twice-daily refametinib 50 mg ± sorafenib 400 mg. Potential biomarkers were assessed in ctDNA via next-generation sequencing (NGS). Results: Of 1318 patients screened, 59 (4.4%) had a RAS mutation, of whom 16 received refametinib and 16 received refametinib plus sorafenib. With refametinib monotherapy, the objective response rate (ORR) was 0%, the disease control rate (DCR) was 56.3%, overall survival (OS) was 5.8 months, and progression-free survival (PFS) was 1.9 months. With refametinib plus sorafenib, the ORR was 6.3%, the DCR was 43.8%, OS was 12.7 months, and PFS was 1.5 months. In both studies, time to progression was 2.8 months. Treatment-emergent toxicities included fatigue, hypertension, and acneiform rash. Twenty-seven patients had ctDNA samples available for NGS. The most frequently detected mutations were in TERT (63.0%), TP53 (48.1%), and β-catenin (CTNNB1; 37.0%). Conclusions: Prospective testing for RAS family mutations using ctDNA was a feasible, non-invasive approach for large-scale mutational testing in HCC patients. A median OS of 12.7 months with refametinib plus sorafenib in this small population of RAS-mutant patients may indicate a synergistic effect between sorafenib and refametinib - this preliminary finding should be further explored.

https://ift.tt/2lHOUAR

The Role of Adding Somatostatin Analogues to Peptide Receptor Radionuclide Therapy as a Combination and Maintenance Therapy

Purpose: Although somatostatin analogues (SSA) and peptide receptor radionuclide therapy (PRRT) are validated therapies in patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs), it remains unclear whether SSA combined with PRRT or as maintenance therapy can provide prolonged survival compared to patients treated with PRRT alone. In this retrospective study, we aimed to investigate whether there is a survival benefit to adding SSA to PRRT as a combination therapy and/or maintenance therapy. Experimental Design: The investigation included 168 patients with unresectable GEP-NETs treated at the University Hospital Bonn, Germany. The patients were divided into two main groups: PRRT monotherapy (N=81, group 1) and PRRT plus SSA (N=87, group 2) as combined therapy with PRRT and/or as maintenance therapy after PRRT. Results: Data for overall survival (OS) were available from 168 patients, of whom 160 had data for progression-free survival (PFS). The median PFS was 27 months in group 1 vs. 48 months in group 2 (p = 0.012). The median OS rates were 47 months in group 1 and 91 months in group 2 (p < 0.001). The death-event rates were lower in group 2 (26%) than in group 1 (63%). SSA as a combination therapy with PRRT and/or as a maintenance therapy showed a clinical benefit rate (objective response or stable disease) of 95%, which was significantly higher than group 1 (79%). Conclusions: SSA as a combination therapy and/or maintenance therapy may play a significant role in tumor control in patients with GEP-NET who underwent a PRRT.

https://ift.tt/2tGAlRS

IFN-{gamma}-induced chemokines are required for CXCR3-mediated T cell recruitment and anti-tumor efficacy of anti-HER2/CD3 bispecific antibody

Purpose: The response to cancer immune therapy is dependent on endogenous tumor reactive T cells. To bypass this requirement, CD3-bispecific antibodies have been developed to induce a polyclonal T cell response against the tumor. Anti-HER2/CD3 T cell-dependent bispecific (TDB) antibody is highly efficacious in the treatment of HER2 over-expressing tumors in mice. Efficacy and immunological effects of anti-HER2/CD3 TDB were investigated in a mammary tumor model with very few T cells prior treatment. We further describe the mechanism for TDB-induced T cell recruitment to tumors. Experimental Design: Immunological effects and mechanism of CD3-bispecific antibody-induced T cell recruitment into spontaneous HER2 over-expressing mammary tumors was studied using human HER2 transgenic, immune-competent mouse models. Results: Anti-HER2/CD3 TDB treatment induced an inflammatory response in tumors converting them from poorly infiltrated to an inflamed, T cell abundant, phenotype. Multiple mechanisms accounted for the TDB-induced increase in T cells within tumors. TDB treatment induced CD8⁺ T cell proliferation. T cells were also actively recruited post-TDB treatment by IFN-g-dependent T cell chemokines mediated via CXCR3. This active T cell recruitment by TDB-induced chemokine signaling was the dominant mechanism and necessary for the therapeutic activity of anti-HER2/CD3 TDB. Conclusions: In summary, we demonstrate that the activity of anti-HER2/CD3 TDB was not dependent on high level baseline T cell infiltration. Our results suggest that anti-HER2/CD3 TDB may be efficacious in patients and indications that respond poorly to checkpoint inhibitors. An active T cell recruitment mediated by TDB-induced chemokine signaling was the major mechanism for T cell recruitment.

https://ift.tt/2lHOSJf

Therapeutic Immune Modulation Against Solid Cancers with Intratumoral Poly-ICLC: A Pilot Trial

Purpose: Polyinosinic-polycytidylic acid-poly-l-lysine carboxymethylcellulose (Poly-ICLC), a synthetic double-stranded RNA complex, is a ligand for toll-like receptor-3 (TLR3) and MDA-5 that can activate immune cells such as dendritic cells and trigger NK cells to kill tumor cells. Experimental Design: In this pilot study, eligible patients included those with recurrent metastatic disease who failed prior systemic therapy (head and neck squamous cell cancer (HNSCC), melanoma). Patients received 2 treatment cycles, each cycle consisting of 1mg Poly-ICLC 3x weekly intratumorally (IT) for 2 weeks followed by intramuscular (IM) boosters biweekly for 7 weeks with a 1-week rest period. Immune response was evaluated by immunohistochemistry (IHC) and RNA Sequencing (RNASeq) in tumor and blood. Results: Two patients completed 2 cycles of IT treatments and one achieved clinical benefit (stable disease, PFS 6 months), while the remainder had progressive disease. Poly-ICLC was well tolerated with principal side effects of fatigue and inflammation at injection site (< grade 2). In the patient with clinical benefit, IHC analysis of tumor showed increased CD4, CD8, PD1 and PDL1 levels compared to patients with progressive disease. RNASeq analysis of the same patient's tumor and PBMC showed dramatic changes in response to Poly-ICLC treatment including upregulation of genes associated with chemokine activity, T cell activation and antigen presentation. Conclusions: Poly-ICLC was well tolerated in solid cancer patients, and generated local and systemic immune responses as evident in the patient achieving clinical benefit. These results warrant further investigation, and are currently being explored in a multicenter phase II clinical trial (NCT02423863).

https://ift.tt/2tKcIrL

Mutational analysis identifies therapeutic biomarkers in inflammatory bowel disease-associated colorectal cancers

Purpose: Inflammatory bowel disease-associated colorectal cancers (IBD-CRCs) are associated with a higher mortality than sporadic colorectal cancers. The poorly defined molecular pathogenesis of IBD-CRCs limits development of effective prevention, detection and treatment strategies. We aimed to identify biomarkers using whole exome sequencing of IBD-CRCs to guide individualised management. Experimental Design: Whole-exome sequencing was performed on 34 formalin-fixed paraffin-embedded primary IBD-CRCs and 31 matched normal lymph nodes. Computational methods were used to identify somatic point mutations, small insertions and deletions, mutational signatures, and somatic copy number alterations. Mismatch repair status was examined. Results: Hypermutation was observed in 27% of IBD-CRCs. All hypermutated cancers were from the proximal colon; all but 1 of the cancers with hypermutation had defective mismatch repair or somatic mutations in the proofreading domain of DNA POLE. Hypermutated IBD-CRCs had increased numbers of predicted neo-epitopes, which could be exploited using immunotherapy. We identified 6 distinct mutation signatures in IBD-CRCs, 3 of which corresponded with known mechanisms of mutagenesis. Driver genes were also identified. Conclusions:IBD-CRCs should be evaluated for hypermutation and defective mismatch repair to identify patients with a higher neo-epitope load who may benefit from immunotherapies. Prospective trials are required to determine whether immunohistochemistry to detect loss of MLH1 expression in dysplastic colonic tissue could identify patients at increased risk of developing IBD-CRC. We identified mutations in genes in IBD-CRCs with hypermutation that might be targeted therapeutically. These approaches would complement and individualise surveillance and treatment programmes.

https://ift.tt/2lD3ucX

Perceptions of Cancer Status Disclosure in Lebanon

Abstract

In Lebanon, cancer used to be regarded as a taboo and referred to as "the disease" and was rarely disclosed to patients. However, patients are now increasingly interested in knowing their cancer status but with varying degrees of information requested. The aim of this qualitative descriptive study was to explore the perceptions of cancer patients, their families, oncologists, and healthy individuals concerning the disclosure of cancer prognosis. In-depth interviews were conducted with 21 family members, 20 middle-aged cancer patients, 11 elderly cancer patients, 22 healthy individuals, and 6 oncologists at the American University of Beirut Medical Center. The interviews focused on the following: general perception of cancer in Lebanese society, type, and extent of information that should be disclosed, factors affecting patient autonomy, and elements contributing to the decisions taken by oncologists and patients. The oncologist's compassion and communication with patients affected their emotional status greatly, and some gaps in communication skills of oncologists were in need of standardized training courses to improve the process of cancer status disclosure. Also, patients had an increased preference towards the disclosure of cancer prognosis, and a desire to know the truth and this need increased as the patient progressed to a terminal state. Future work should be directed at addressing the needs of cancer patients through every disease stage. More research and further deliberation are needed to confirm the findings of this study since the Lebanese Code of Medical Practice does not protect the right of full disclosure.

https://ift.tt/2lDJ3g0

Association Between the Oligomeric Status of p53 and Clinical Outcomes in Li-Fraumeni Syndrome

Abstract

Li-Fraumeni syndrome (LFS) is a rare hereditary cancer disorder with highly variable clinical outcomes that results from germline mutations in the TP53 gene. Here we report that the quaternary structure of p53 is an important factor affecting cellular functions and the clinical outcomes of LFS patients (n = 87). Specifically, carriers of monomeric p53 mutants (n = 56) exhibited complete penetrance, with a 2.11-fold greater risk of cancer-related death (95% confidence interval [CI] = 1.07 to 4.30) and a statistically significantly lower median survival age as compared with carriers of multimeric (dimeric or tetrameric, n = 31) p53 mutants (33 years, 95% CI = 30 to 50, vs 51 years, 95% CI = 40 to NA, respectively, two-sided P = .03), who presented incomplete penetrance. Cellular functional assays using p53-null H1299 cells expressing clinically relevant p53 mutants confirmed that the cellular effects observed upon loss of p53 oligomerization are associated with clinical outcomes of LFS patients. The association between p53 oligomeric state and clinical phenotype suggests that TP53 mutations are not all equivalent and supports the implementation of new genotype-adapted guidelines for the management of LFS patients with TP53 mutations in the oligomerization domain.

https://ift.tt/2N62mvd

Regional Anesthesiology and Acute Pain Medicine in the Era of Value-Based Health Care

Publication date: Available online 27 June 2018
Source:Anesthesiology Clinics
Author(s): Edward R. Mariano, Nabil M. Elkassabany




https://ift.tt/2MsG9pK

S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies

https://ift.tt/2tL8DU9

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study

https://ift.tt/2N3zPGp

Prognostic value of chromosomal imbalances, gene mutations, and BAP1 expression in uveal melanoma

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 387-400, August 2018.


https://ift.tt/2Iva3aE

MCL1 gene co‐expression module stratifies multiple myeloma and predicts response to proteasome inhibitor‐based therapy

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 420-429, August 2018.


https://ift.tt/2KrezIV

Correlation of TET2 SNP rs2454206 with improved survival in children with acute myeloid leukemia featuring intermediate‐risk cytogenetics

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 379-386, August 2018.


https://ift.tt/2Kqw9QI

Usefulness of BCOR gene mutation as a prognostic factor in acute myeloid leukemia with intermediate cytogenetic prognosis

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 401-408, August 2018.


https://ift.tt/2KtFqnU

Elucidation of the developmental mechanism of ovarian mature cystic teratomas using B allele‐frequency plots of single nucleotide polymorphism array data

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 409-419, August 2018.


https://ift.tt/2Kg5G9a

Table of Content Volume 57, Number 8, August 2018

Genes, Chromosomes and Cancer, Volume 57, Issue 8, Page 377-378, August 2018.


https://ift.tt/2KrpAtQ

Acute skin allergy to thermoplastic mask used for patient immobilization during radiation therapy: a case report

Radiosurgical treatments of brain tumors, vascular malformations, and functional disorders are more and more frequently used. Gamma Knife irradiation with the Icon system necessitates the use of a thermoplasti...

https://ift.tt/2lCFYNd

Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report

Fournier's gangrene is an acute surgical emergency characterized by high mortality rates ranging from approximately 13% to 45%. Therefore, aggressive multidisciplinary management is necessary.

https://ift.tt/2yQxBHq

Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042)

The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients.

https://ift.tt/2tAP7u5

Stereotactic radiosurgery and immunotherapy in melanoma brain metastases: Patterns of care and treatment outcomes

Preclinical studies have suggested that radiation therapy (RT) enhances antitumor immune response and can act synergistically when administered with immunotherapy. However, this effect in melanoma brain metastasis is not well studied. We aim to explore the clinical effect of combining RT and immunotherapy in patients with melanoma brain metastasis (MBM).

https://ift.tt/2yPrNhb

Age‐dependent prognostic value of body mass index for non‐metastatic clear cell renal cell carcinoma: A large multicenter retrospective analysis

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2KlwUdR

Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2MtTwWO

Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2KlwLqP

The ypT category does not impact overall survival in node negative gastric cancer

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2Ms8j4c

The association of length of hospital stay with readmission after elective pancreatic resection

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2KlwzI7

Monte Carlo simulations in radiotherapy dosimetry

The use of the Monte Carlo (MC) method in radiotherapy dosimetry has increased almost exponentially in the last decades. Its widespread use in the field has converted this computer simulation technique in a co...

https://ift.tt/2tHJaek

Monte Carlo verification of radiotherapy treatments with CloudMC

A new implementation has been made on CloudMC, a cloud-based platform presented in a previous work, in order to provide services for radiotherapy treatment verification by means of Monte Carlo in a fast, easy ...

https://ift.tt/2lBLW0R

RNA Sequencing of Carboplatin- and Paclitaxel-Resistant Endometrial Cancer Cells Reveals New Stratification Markers and Molecular Targets for Cancer Treatment

Abstract

Despite advances in surgical technique and adjuvant treatment, endometrial cancer has recently seen an increase in incidence and mortality in the USA. The majority of endometrial cancers can be cured by surgery alone or in combination with adjuvant chemo- or radiotherapy; however, a subset of patients experience recurrence for reasons that remain unclear. Recurrence is associated with chemoresistance to carboplatin and paclitaxel and consequentially, high mortality. Understanding the pathways involved in endometrial cancer chemoresistance is paramount for the identification of biomarkers and novel molecular targets for this disease. Here, we generated the first matched pairs of carboplatin-sensitive/carboplatin-resistant and paclitaxel-sensitive/paclitaxel-resistant endometrial cancer cells and subjected them to bulk RNA sequencing analysis. We found that 45 genes are commonly upregulated in carboplatin- and paclitaxel-resistant cells as compared to controls. Of these, the leukemia inhibitory factor, (LIF), the protein tyrosine phosphatase type IVA, member 3 (PTP4A3), and the transforming growth factor beta 1 (TGFB1) showed a highly significant correlation between expression level and endometrial cancer overall survival (OS) and can stratify the 545 endometrial cancer patients in the TCGA cohort into a high-risk and low-risk-cohorts. Additionally, four genes within the 45 upregulated chemoresistance-associated genes are ADAMTS5, MICAL2, STAT5A, and PTP4A3 codes for proteins for which small-molecule inhibitors already exist. We identified these proteins as molecular targets for chemoresistant endometrial cancer and showed that treatment with their correspondent inhibitors effectively killed otherwise chemoresistant cells. Collectively, these findings underline the utility of matched pair of chemosensitive and chemoresistant cancer cells to identify markers for endometrial cancer risk stratification and to serve as a pharmacogenomics model for identification of alternative chemotherapy approaches for treatment of patients with recurrent disease.

https://ift.tt/2yOOXEp

Does pelvic radiation increase rectal cancer incidence? – A systematic review and meta-analysis

Publication date: July 2018
Source:Cancer Treatment Reviews, Volume 68
Author(s): A.J.M. Rombouts, N. Hugen, J.J.P. van Beek, P.M.P. Poortmans, J.H.W. de Wilt, I.D. Nagtegaal
BackgroundOne of the late complications associated with radiation therapy (RT) is a possible increased risk of second cancer. In this systematic review, we analysed the incidence of rectal cancer following primary pelvic cancer irradiation.MethodsA literature search was conducted using the PubMed and EMBASE libraries. Original articles that reported on secondary rectal cancer after previous RT for a primary pelvic cancer were included. Sensitivity analyses were performed by correcting for low number of events, high risk of bias, and outlying results.ResultsA total of 5171 citations were identified during the literature search, 23 studies were included in the meta-analyses after screening. A pooled analysis, irrespective of primary tumour location, showed an increased risk for rectal cancer following RT (N = 403.243) compared with non-irradiated patients (N = 615.530) with a relative risk (RR) of 1.43 (95% confidence interval [CI] 1.18–1.72). Organ specific meta-analysis showed an increased risk for rectal cancer after RT for prostate (RR 1.36, 95%CI 1.10–1.67) and cervical cancer (RR 1.61, 95% CI 1.10–2.35). No relation was seen in ovarian cancer patients. The modality of RT did not influence the incidence of rectal cancer.ConclusionsThis review demonstrates an increased risk for second primary rectal cancer in patients who received RT to the pelvic region. This increased risk was modest and could not be confirmed for all primary pelvic cancer sites. The present study does not provide data to change guidelines for surveillance for rectal cancer in previously irradiated patients.



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Erratum to “Fat Embolism Syndrome: A Case Report and Review Literature”

https://ift.tt/2tHmieM

Repeat recurrence and malignant transition of phyllodes tumors of the breast

Abstract

Background

This study aimed to assess their characteristics and clinical course of each histologic type of the behavior of phyllodes tumor (PT).

Methods

We retrospectively reviewed 124 patients with PTs who underwent surgical treatment from 2003 to 2011. PTs were classified as benign, borderline, and malignant using surgical specimens. The clinicopathological characteristics according to solitary and multiple lesions on ipsilateral breast and histological change after local recurrence were examined.

Results

The median patient age was 42 years (range 12–72 years). The final pathologic diagnosis was benign PTs in 95 patients (76.6%), borderline PTs in 21 (16.9%), and malignant PTs in 8 (6.5%). The size of benign PTs [median 4.2 cm (range 1–21 cm)] was significantly smaller than that of malignant PTs [median 11.3 cm (range 6–27 cm)] (p < 0.001). Eight of the 95 benign PTs (8.4%) had multiple lesions, while all malignant PTs had solitary lesion. With a median follow-up period of 45 months, five patients with malignant PTs (62.5%) developed distant metastases while 13 patients with benign PTs (13.5%) and 6 patients with borderline PTs (28.6%) had local recurrence only without malignant transition. The median overall survival period of those with malignant PTs was 22.5 months (range 5–109 months).

Conclusions

Histologically benign and borderline PTs had a good prognosis without malignant transition even after developing repeat recurrence in contrast with malignant PTs that might be a solitary lesion.

https://ift.tt/2KpZW8J

Editorial Board

Publication date: July–August 2018
Source:Practical Radiation Oncology, Volume 8, Issue 4





https://ift.tt/2lCQFiL

Table of Contents

Publication date: July–August 2018
Source:Practical Radiation Oncology, Volume 8, Issue 4





https://ift.tt/2yK7uly

Masthead/Sub page

Publication date: July–August 2018
Source:Practical Radiation Oncology, Volume 8, Issue 4





https://ift.tt/2lENUOc

Review of thoracic reirradiation with stereotactic body radiation therapy

Publication date: July–August 2018
Source:Practical Radiation Oncology, Volume 8, Issue 4
Author(s): Michael T. Milano, Alina Mihai, Feng-Ming (Spring) Kong
Reirradiation of thoracic malignancies is clinically challenging in balancing the risks and efficacy. Stereotactic body radiation therapy (SBRT) can facilitate ablative dosing of discrete targets while minimizing normal tissue exposure; thus, SBRT is an attractive, minimally invasive option to consider for patients with recurrent or new malignancies within a previously irradiated field. Published data are summarized from 28 studies on the use of SBRT for thoracic reirradiation. We review clinical outcomes with a primary focus on toxicity risks, dosimetric correlates of normal tissue complication probability (NTCP), and other factors that correlate with NTCP. Meaningful compilation of published data on reirradiation with SBRT is limited because of the retrospective nature of published studies, which include mostly small numbers of patients, with various clinical scenarios and SBRT dosing and techniques. Nevertheless, these studies show that thoracic reirradiation with SBRT is feasible, with relatively favorable outcomes. Yet, severe to fatal toxicities do occur, and dosimetric measures to predict severe toxicity are poorly characterized, necessitating further study to better characterize predictive factors for NTCP.



https://ift.tt/2tKc0dO

Brown-Vialetto-Van Laere syndrome: a novel diagnosis to a common presentation

Brown-Vialetto-Van Laere syndrome (BVVLS) or riboflavin transporter deficiency (OMIM 211530) is a rare treatable autosomal recessive neurodegenerative disorder. This condition is associated with progressive pontobulbar palsy. We describe the clinical course of a 16-month-old boy with BVVLS and a novel homozygous mutation from Pakistan. Our patient presented with stridor and respiratory insufficiency. Hearing loss which is the most common sign of this condition was absent, making it an unusual presentation of BVVLS. His examination revealed ptosis and tongue fasciculation. His riboflavin receptor mutational analysis showed the homozygous mutation in the SLC52A3 gene. Per oral riboflavin was administered, and subsequently, he was able to be weaned off the ventilator. Now the child is improving and attaining developmental milestones.

https://ift.tt/2N56KKD

New headaches with normal inflammatory markers: an early atypical presentation of giant cell arteritis

An 80-year-old man presented repeatedly to his general practitioner with 3 months of unexplained persistent frontal headaches. CT head revealed no diagnosis. His dentist diagnosed his co-existing jaw pain as bruxism. Three months later, the patient happened to attend a routine ophthalmology follow-up appointment. During this routine appointment, features of giant cell arteritis (GCA) including worrying visual complications were first noted. His inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were not significantly raised—contrary to the norm. A temporal artery ultrasound and biopsy were performed, in light of the history. This confirmed GCA. He was commenced on high-dose oral prednisolone and was managed by ophthalmology and rheumatology. At 4 weeks, symptoms resolved with no permanent visual loss despite a prolonged initial symptomatic period. Multiple symptomatic presentations to different specialties should therefore alert clinicians to a unifying diagnosis, for example, vasculitis. Serious illnesses may present with severe symptoms despite normal screening investigations.

https://ift.tt/2KnSY43

Perioperative continuous glucose monitoring in a preterm infant

Surgery in the neonatal period presents challenges, especially in preterm infants weighing <1 kg. Their small size, minimal reserves and physiological immaturity means attention to detail and careful monitoring is critical to avoid cardiovascular instability; maintaining fluid balance and metabolic stability is also problematic due to often limited vascular access and small blood volumes. Developments in technology have meant that cardiovascular parameters such as heart rate, blood pressure and oxygen saturations are all routinely and continuously monitored before and during surgery.

We have been exploring the role of continuous glucose monitoring (CGM) for metabolic monitoring and management of glucose control in very preterm infants (24–32 weeks gestation). In this paper, we report on a preterm infant who uniquely underwent surgery while wearing a continuous glucose monitor, blinded to the clinical team. This case highlights the metabolic vulnerability of these babies and a possible role for real-time CGM during surgical procedures.

https://ift.tt/2txHXa2

Possible SAMe-induced mania

This paper describes a patient who presented with mania with psychotic features in the context of concomitant use of S-adenosyl-L-methionine (SAMe) and selective serotonin reuptake inhibitor (SSRI). The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of a psychotic episode and/or mania manifesting with concurrent use of SAMe and SSRI.

https://ift.tt/2Iv781L

Correction: Primary malignant melanoma of the ascending colon

Miliaras S, Ziogas IA, Mylonas KS, et al. Primary malignant melanoma of the ascending colon. BMJ Case Rep 2018. doi: 10.1136/bcr-2017-223282. 

In the 'Summary' and 'Discussion' sections, it is stated that 36 previous cases have been reported, while in fact this number is incorrect: the correct number of cases that have been previously reported is 15.

https://ift.tt/2txsVBa

Intravenous immunoglobulin for severe thrombocytopenia in secondary dengue

A 30-year-old woman with severe dengue presented on the sixth day of her illness with life-threatening thrombocytopenia, refractory to multiple platelet transfusions. Dengue IgM antibody and the non-structural-1 antigen tests as of day 3 were negative. The IgG antibody against the same was positive, suggesting a past episode of dengue. Since she had a history of menorrhagia prior to the current illness, a working diagnosis of idiopathic thrombocytopenic purpura was made, for which intravenous immunoglobulin (IVIg) was administered that led to a rapid rise in the platelet count with no adverse events. Subsequently, dengue IgM antibody repeated on day 6 came back positive, confirming dengue. This case report re-emphasises the potential use of IVIg in patients with severe thrombocytopenia in dengue.

https://ift.tt/2KsOuZY

Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.

Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm³ of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

https://ift.tt/2twsWVM

Cloudy Cornea with Arcus Juvenilis in a Case of Dense Deposit Disease

A 25-year-old male patient presented with complaints of blurred vision in both eyes since 2 years. The patient was a known case of nephrotic syndrome with dyslipidaemia for which he was on diuretics and lipid-lowering agents for 3 years. On examination, his visual acuity was 6/9 in both eyes with cloudy cornea and arcus juvenilis. Fundus examination was within normal limits. On systemic work-up, his lipid profile was deranged with increased serum total cholesterol, very low density lipoprotein, low density lipoprotein and triglyceride. The serum high density lipoprotein was decreased. Renal function test revealed elevated serum creatinine with significant proteinuria. Renal biopsy was suggestive of dense deposit disease on immunofluorescence and transmission electron microscopy. Ocular manifestation of dense deposit disease is characterised by retinal drusen, pigmentary atrophy, choroidal neovascular membrane and atypical serous retinopathy. To the best of our knowledge, anterior segment changes in dense deposit disease has not been reported. This is the first case reporting cloudy cornea with arcus juvenilis in a case of dense deposit disease.

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Craniovertebral junction cord compression due to neurofibroma

Description

A 26-year-old man with premorbid cutaneous neurofibromatosis presented with history of insidious onset, slowly progressive, bilaterally asymmetrical quadriparesis along with incontinence of urine since 4 weeks. Simultaneous to the onset of motor symptoms, he also complained of paraesthesias in all four limbs. On examination, multiple cutaneous neurofibromas were noticed all over his trunk, abdomen and all the limbs (figure 1). The upper and lower limbs were spastic. Motor power as per Medical Research Council grading was 3/5 in all four limbs. The deep tendon reflexes were brisk. The plantar response on both sides was extensor. The sensory level was clinically around C3/C4 dermatome.

Figure 1

Multiple cutaneous neurofibromas of varying sizes on the lower chest and abdomen (red arrows).

In view of the premorbid neurofibromata, a possibility of compressive cervical myelopathy was thought of. MRI of cervical spine T2-weighted sagittal view...

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Dural arteriovenous fistula presenting with acute subdural haematoma showing impending cerebral herniation

A dural arteriovenous fistula (DAVF) presenting with acute subdural haematoma (ASDH), which were not related to head injury, is rare. A 61-year-old woman was transported by ambulance because of deterioration of consciousness. On admission, she was comatose with anisocoria. Emergent CT demonstrated a severe midline shift associated with a left ASDH and an additional left occipital intracerebral haematoma, both of which had no continuity with each other. MRI showed flow void signs in the left occipital lobe. Because of the impending cerebral herniation, an emergent evacuation of the ASDH and external decompression was performed. Subsequent evaluation revealed a DAVF at the left occipital convexity near the confluence with retrograde leptomeningeal venous reflux and venous ectasia (Cognard type III DAVF). The patient underwent endovascular treatment for the DAVF involving transarterial embolisation using coils and N-butyl cyanoacrylate with complete obliteration. Her further clinical course was uneventful and discharged after cranioplasty.

https://ift.tt/2Ixbk0G

The microRNA signatures: aberrantly expressed miRNAs in prostate cancer

Abstract

MicroRNAs (miRNAs) are short, non-coding, conserved, oligonucleotides that are regulatory in nature and are often dysregulated in many cancers including prostate cancer. Depending on the level of complementarity between the miRNA and mRNA target, they can either inhibit translation or degrade the target mRNA. MiRNAs expression is specific to the type of cancer, its stage and level of metastasis, making miRNAs potential stage-specific biomarkers of cancer. Recent research has shown that these miRNAs have the potential to be a diagnostic and prognostic non-invasive biomarker for various cancers including prostate cancer. Various miRNAs have been reported as novel biomarkers for prostate cancer therapy. However, there is inconsistency in the data reported and no overlapping expression pattern could be found. In this review, we have highlighted the most consistently reported dysregulated miRNAs in prostate cancer from the existing literature and discussed the currently available data on their role in regulating the hallmarks of prostate cancer. These four most consistently reported dysregulated miRNAs viz. miRNA-141, miRNA-375, miRNA-221 and miRNA-21 need to be further validated in terms of their regulatory potential in regulating various pathways important for prostate cancer management.

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An uncommon granulocytic sarcoma of the breast: a case report and literature review

https://ift.tt/2ItRnIr

CAT3, a prodrug of 13a(S)-3-hydroxyl-6,7-dimethoxyphenanthro[9,10-b]-indolizidine, circumvents temozolomide-resistant glioblastoma via the Hedgehog signaling pathway, independently of O6-methylguanine DNA methyltransferase expression

https://ift.tt/2Kmpas1

Prognostic impact of the number of lymph nodes examined in different stages of colorectal mucinous adenocarcinoma

https://ift.tt/2IvXUSP

MiR-1301-3p inhibits human breast cancer cell proliferation by regulating cell cycle progression and apoptosis through directly targeting ICT1

Abstract

Background

MiRNAs regulate a variety of biological processes, such as cell proliferation and apoptosis and play critical roles in cancer progression. Accumulating studies have demonstrated that miR-1301-3p could regulate the development and progression of multiple cancers, but its biological behaviors in breast cancer (BC) are still elusive.

Methods

The expression of miR-1301-3p was determined in BC tissues and cell lines using quantitative real-time PCR analysis. The effects of miR-1301-3p on BC cell growth, proliferation, cell cycle distribution, and apoptosis were also explored in vitro using MTT, colony formation and Flow cytometry assays. The potential target gene of miR-1301-3p was determined by dual-luciferase reporter assay and verified by quantitative real-time PCR and western blot analysis.

Results

We found the expression of miR-1301-3p was observably significantly down-regulated in BC tissues and cell lines. MiR-1301-3p expression in BC tissues was significantly associated with tumor size and clinical stage. Gain-of-function assays demonstrated that miR-1301-3p inhibited the cell growth and proliferation in breast cancer cell lines, MCF-7 and T-47D. Moreover, up-regulation of miR-1301-3p induced cell cycle G0/G1 phase arrest and apoptosis. Mechanistically, up-regulation of miR-1301-3p reduced the expression of CDK4, Cyclin D1, Bcl-2, but elevated the expression of p21, Bad and Bax. ICT1 was confirmed as a direct target of miR-1301-3p. Furthermore, ICT1 overexpression could partially reverse the effects of miR-1301-3p on BC cell proliferation, cell cycle progression and apoptosis.

Conclusion

Our observations suggested that miR-1301-3p inhibits cell proliferation via inducing cell cycle arrest and apoptosis through targeting ICT1, and might be a therapeutic target for BC.

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Cancers, Vol. 10, Pages 219: Role of p53 in the Regulation of the Inflammatory Tumor Microenvironment and Tumor Suppression

Cancers, Vol. 10, Pages 219: Role of p53 in the Regulation of the Inflammatory Tumor Microenvironment and Tumor Suppression

Cancers doi: 10.3390/cancers10070219

Authors: Ikuno Uehara Nobuyuki Tanaka

p53 has functional roles in tumor suppression as a guardian of the genome, surveillant of oncogenic cell transformation, and as recently demonstrated, a regulator of intracellular metabolism. Accumulating evidence has shown that the tumor microenvironment, accompanied by inflammation and tissue remodeling, is important for cancer proliferation, metastasis, and maintenance of cancer stem cells (CSCs) that self-renew and generate the diverse cells comprising the tumor. Furthermore, p53 has been demonstrated to inhibit inflammatory responses, and functional loss of p53 causes excessive inflammatory reactions. Moreover, the generation and maintenance of CSCs are supported by the inflammatory tumor microenvironment. Considering that the functions of p53 inhibit reprogramming of somatic cells to stem cells, p53 may have a major role in the inflammatory microenvironment as a tumor suppressor. Here, we review our current understanding of the mechanisms underlying the roles of p53 in regulation of the inflammatory microenvironment, tumor microenvironment, and tumor suppression.

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Beyond the Bucket List: Unfinished and Business among Advanced Cancer Patients

Psycho-Oncology, Volume 0, Issue ja, -Not available-.


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Management of KRAS -Mutant Non-Small Cell Lung Cancer in the Era of Precision Medicine

Opinion statement

The discovery of genomic alterations that drive the development and progression of non-small cell lung cancer (NSCLC) has transformed how we treat metastatic disease. However, the promise of precision medicine remains elusive for the most commonly mutated oncogene in NSCLC, KRAS. This is perhaps due to the substantial heterogeneity within the broader genomic context of KRAS-mutant NSCLC. At this time, approaches for treating metastatic KRAS-mutant NSCLC mirror those for treating NSCLC that lacks a known driver mutation, including standard chemotherapeutic and immunotherapeutic approaches. Ongoing research aims to define further subgroups of KRAS-mutant NSCLC based on mutation subtype and co-occurring mutations. These efforts offer the potential to optimize standard-of-care regimens within these emerging subgroups and harness innovative strategies to realize precision medicine in this setting.

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Diagnosis and Management of Acral Lentiginous Melanoma

Opinion statement

Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.

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Effect of Health Education on Female Teachers’ Knowledge and Practices Regarding Early Breast Cancer Detection and Screening in the Jazan Area: a Quasi-Experimental Study

Abstract

Educational programs are important tools for breast cancer prevention. The purpose of this study was to assess the effectiveness of health education in improving the knowledge and practices of female teachers regarding screening tools and the early detection of breast cancer. A two-group quasi-experimental design was conducted among 150 female teachers, who were selected from 75 schools of the Jazan General Administration of Education. Schools were chosen by a simple cluster randomization method and non-randomly assigned to either the intervention or control group. Eligible participants were recruited by a simple randomization method, proportional to the total number of teachers at each school. Those in the intervention group (n = 75) were compared to the control group (n = 75) at baseline, as well as at 6 weeks and 3 months post-intervention. Knowledge of breast cancer screening tools was measured using a modified version of the Breast Cancer Knowledge test. Breast self-examination, clinical breast examination, and mammography practices were also measured. Compared to the control group, the intervention group showed a statistically significant increase in knowledge and practice levels at both 6 weeks and 3 months post-intervention. Thus, the results of this study provide evidence that group health education programs are effective in improving breast cancer knowledge and practices in female teachers. Clinical Trial Registration number: NCT03398057.

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Pituitary 'pseudotumor: an under-recognised complication of undertreated primary hypothyroidism

Description 

A woman in her 30s with medical history notable for hypothyroidism due to Hashimoto's thyroiditis had a brain MRI ordered by her neurologist due to change in chronic headache pattern. This had an incidental finding of enlarged pituitary gland. She was referred at that time to an endocrinologist but was not seen. Eighteen months later, she presented with worsening headaches, blurry vision, weight gain and galactorrhoea. Repeat brain MRI showed a 9x10x13 mm sellar mass extending superiorly, with mass effect on optic chiasm (figure 1A). Thyroid-stimulating hormone (TSH) was 185 mIU/mL with low free T3, low free T4, normal prolactin, normal FSH and normal LH. She was then referred to a neurosurgeon and an ophthalmologist. Visual field testing initially showed mild constriction of bilateral visual fields. The neurosurgeon referred her to an endocrinologist for preoperative hormonal evaluation, but the operation date was advanced when subjective visual...

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'Toxic ST elevation

Description 

A young man was admitted to the emergency department after consuming zinc phosphide, with severe drug refractory hypotension. ECG (refer figure 1) revealed ST segment elevation involving anterior, lateral and inferior leads. Serum levels of potassium, calcium, magnesium and phosphorous were normal; serum troponin-T was 1126 ng/nL (upper limit of normal 14 ng/nL), with associated metabolic acidosis. Echocardiogram revealed severe left ventricular systolic dysfunction. Severe myocardial depression with histopathological evidence of myocyte vacuolation and myocytolysis has been occasionally described with aluminium phosphide toxicity, primarily mediated by phosphine. The absence of an antidote makes the mortality high, once refractory shock ensues. Our patient succumbed to this condition. Zinc phosphide toxicity mediated by phosphine can have similar multisystem involvement, though dramatic electrocardiographic changes are uncommon.1 2 However, as evidenced by our report, ST segment elevation involving multiple leads on the ECG, though rare, maybe a hazardous manifestation...

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Unusual foreign body impacted in the upper oesophagus: original technique for transoral extraction

Foreign body ingestion is a common event; in the adult population, most ingestions occur in patients with mental disability, psychiatric disorders, alcohol intoxication or in prisoners seeking secondary gain. Removal through flexible endoscopy is generally the first-line approach but rescue oesophagotomy may be necessary for foreign bodies impacted in the upper oesophagus. A 27-year-old man was admitted in the emergency room after intentional ingestion of a wooden spherical object with a central hole. A total body CT scan showed that the object was completely obstructing the upper oesophageal lumen but there were no signs of perforation. In the operating room, a Weerda diverticuloscope and a 5 mm 0° telescope were used to visualise the foreign body under general anaesthesia. A standard endoscopic biopsy forceps was passed through the hole of the sphere and was retracted with the jaws open allowing transoral extraction without complications.

https://ift.tt/2lBeY0z

Hidden burden of osteoporosis in alpha-1 antitrypsin deficiency

This is a reminder of a rare cause of osteoporosis that remains widely underdiagnosed and lacks specific evidence on its optimal management. We bring a case report of a patient presenting with erectile dysfunction and high testosterone level but also elevated sex-hormone binding globulin hence low free androgen index as well as evidence of organ specific hypogonadal side effects such as osteoporosis. A unifying diagnosis of alpha-1 antitrypsin deficiency (AATD) brought together his coexistent mild chronic obstructive pulmonary disease as well as a new finding of previously unrecognised liver disease. This case highlights the uncertainties over the mechanism of osteoporosis in AATD as well as the controversies over best way to manage it. The efficacy of testosterone replacement in managing osteoporosis in the context of AATD remains untested. National registries for AATD would be best placed at gathering further evidence in this area.

https://ift.tt/2yOrx2e

Late-onset TNF receptor-associated periodic syndrome presenting as recurrent urticarial rash and lymph nodes

Description 

A 35-year-old Caucasian woman was referred by a general practitioner to our medical ward because she was suffering from recurrent arthralgia, urticarial rash with mild pruritus and cervical lymph nodes. There was no sign of arthritis, any fever, chills or night sweats, but she had lost 2.5 kg in 3 months. The average lengths of symptoms were more than 6 weeks.

She presented the same symptoms with cervical lymph nodes when she was 24 years old. She received doxycycline for a suspicion of Lyme disease and the evolution was favourable after 2 weeks of treatment. However, serology was not compatible with recent Lyme disease. Since then, the frequencies of the attacks were rare but occurred once a year.

The routine blood tests were normal except a slightly elevated C reactive protein at 12 mg/L (normal value <5 mg/L). Infectious serologies for Cytomegalovirus, Epstein-Barr virus, HIV, hepatitis C and B, Brucella, Bartonella henselae and...

https://ift.tt/2lFYKDj

Severe, reversible dysphagia and malnutrition in a patient with tumour-induced hypophosphataemia

Up to 20% of hospitalised patients may have low serum phosphate concentrations. In certain groups, such as patients with chronic alcohol overconsumption, severe trauma or sepsis, the prevalence may be 30%–50%. Profound hypophosphataemia is less common, but may lead to severe physiological disturbances. In rare cases, hypophosphataemia is caused by phosphaturic substances excreted from a tumour. Osteomalacia with chronic bone pain and fractures, as well as muscle weakness, is common in such patients. The tumours are often small and difficult to detect. Studies suggest that fibroblast growth factor 23 is a reliable marker for detection of these tumours. Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. If the tumour cannot be removed, treatment relies on supplementation with phosphate and active vitamin D compounds. We present a case report of a patient with severe hypophosphataemia, osteomalacia, dysphagia and malnutrition.

https://ift.tt/2yIP7NL

Stage 1 small cell cancer of the vagina

This is the case of a 56-year-old white woman with a medical history significant for chronic obstructive pulmonary disease, migraine, hypertension, tobacco abuse and hypercholesterolaemia. Her surgical history is significant for total hysterectomy and bilateral salpingo-oophorectomy for diffuse endometriosis. The patient presented with a vaginal lesion. The biopsy was positive for primary vaginal small cell carcinoma and human papilloma virus (HPV). Initial staging positron emission tomography (PET) scan confirmed stage 1 disease. The patient was started on chemotherapy with cisplatin and etoposide for four cycles, followed by concurrent chemotherapy with cisplatin/taxol and radiation therapy.

https://ift.tt/2lDq2u6

Successful treatment of intractable visual hallucinations with 5-HT2A antagonist ketanserin

Hallucinations, visual, auditory or in another sensory modality, often respond well to treatment in patients with schizophrenia. Some, however, do not and can be very chronic and debilitating. We present a patient with schizophrenia with intractable hallucinations despite state of the art care, including high-dose clozapine and transcranial magnetic stimulation. Based on the possible role of the 5-HT_2A receptor in hallucinations, we treated her with the antihypertensive drug ketanserin, a 5-HT_2A receptor antagonist.

This significantly reduced her visual but not her auditory hallucinations, suggesting a possible role of the 5HT_2A receptor in the pathophysiology of specifically visual hallucinations. This is the first time ketanserin has been described to successfully reduce visual hallucinations in a patient with schizophrenia.

https://ift.tt/2tItwPJ

Use of indocyanine green dye clearance in a patient with liver cirrhosis undergoing hepatectomy: a clinical image

Description 

Indocyanine green (ICG) is a water-soluble, non-toxic tricarbocyanine dye extracted exclusively from the hepatic parenchyma. Measurement of ICG clearance using pulse spectrophotometry is a simple, reproducible and non-invasive test, easily performed in the operating room. ICG plasma disappearance rate (PDR) and the retention rate at 15 min (R15) produce real-time metrics to aid assessment and decision-making before, during and after complex liver surgery. ICG clearance has also been used to suggest the presence of postoperative complications, including thrombosis of the hepatic artery and graft dysfunction following liver transplantation. We present a case of 65-year-old Caucasian man, with Child-Pugh A liver cirrhosis undergoing complex right hepatectomy for metastatic colorectal liver cancer where ICG clearance impacted on the extent of surgical resection.

Given the concerns about marginal postoperative liver function of the residual left hepatic lobe, we used pulse spectrometry intraoperatively to predict the risk of postoperative liver dysfunction. Immediately preoperatively, a...

https://ift.tt/2lFYDrn

Post-traumatic pseudoaneurysm of brachial artery in multiple hereditary exostoses

Pseudoaneurysms adjacent to exostoses have been commonly reported in the femoral and popliteal arteries and only rarely in the upper extremity. We describe a case of an 18-year-old man with multiple hereditary exostoses who developed a brachial artery pseudoaneurysm after minor trauma to his right upper arm, adjacent to a known lesion. He was referred to a vascular surgeon who removed the pseudoaneurysm and repaired the artery with a saphenous vein graft. We encourage a high suspicion of vascular injury even after minor trauma when an osteochondroma is adjacent to a vascular structure.

https://ift.tt/2yKYHj3

Perforated caecal carcinoma masquerading as lower limb necrotising fasciitis: lessons learnt

A 69-year-old man was admitted with non-resolving right leg cellulitis. Subsequent skin changes over the calf and discharging pus suggested necrotising fasciitis. After several wound debridements of the leg and imaging, the patient was found to have an iliopsoas abscess due to a metastatic perforated caecal tumour extending along the medial thigh to the calf. No micro-organisms indicative of typical necrotising fasciitis were isolated from the wound. The patient had an ileocaecal resection, and his leg was reconstructed with a split thickness skin graft. He continues to do well postoperatively. This case highlights key lessons when dealing with an unusual presentation leading to challenges in diagnosis such as: (1) the need for good interspecialty liaison, (2) prompt senior review and plan, and (3) 'thinking outside the box' when faced with a diagnostic challenge.

https://ift.tt/2lFYx2Z

Total hip arthroplasty infection caused by an unusual organism, Salmonella; its successful management and literature review

Prosthetic joint infection due to Salmonella spp is rare. Here we report an acute case of Salmonella enteritidis infection of a total hip arthroplasty in a man taking immunosuppressant medication. He was managed with antibiotics and two-stage revision surgery.

https://ift.tt/2tIg0eS

Steroid-induced protracted severe ocular hypertension in a 14-year-old girl

Steroid-induced ocular hypertension (SIOH) is a challenging entity in paediatric age, with many being refractory to medical therapy. Literature is scarce about surgical options in these cases. A 14-year-old girl with bilateral uveitis and macular oedema had received an intravitreal and subconjunctival triamcinolone injection in the right (OD) and left (OS) eye, respectively. While the steroid was effective in resolving the oedema, intraocular pressure (IOP) increased to about 40 mm Hg OD and 34 mm Hg OS, despite being under maximal IOP-lowering therapy. An initial conservative approach was preferred due to the young patient age and given that most cases of SIOH are transient. However, progressive structural changes were documented, and bilateral sequential minimally invasive glaucoma surgery (MIGS: XEN gel stent) was taken. With a follow-up of 6 months, the patient is drug-free with IOP around 14 mm Hg. This report discusses the role and efficacy of MIGS in a paediatric case of SIOH.

https://ift.tt/2lDekQp

Long-term complete remission of a patient with high grade neuroendocrine carcinoma of ampulla of Vater

We describe a case report of a 53-year-old man with a 5-months history of progressive jaundice and upper abdominal pain. The patient was further evaluated and finally diagnosed with a high-grade ampullary neuroendocrine tumour (based on endoscopic-guided biopsy). Thereafter, he underwent pancreatoduodenectomy and adjuvant platinum-based chemotherapy. This extremely rare case presents his long-lasting disease-free survival compared with similar cases; this case report exemplifies a new, potentially efficient method for treating high-grade papillary neuroendocrine tumour and may pave the way for further clinical trials utilising this blueprint in the treatment of related conditions.

https://ift.tt/2yKYexj

Solid pseudopapillary neoplasm of pancreas: an unusual aetiology for haematochezia

Solid pseudopapillary neoplasm of the pancreas is a rare condition. It is mostly seen among young women, with abdominal pain as the presenting complaint. This is a case of a young woman who presented with haematochezia, and was found to have splenic vein thrombosis and left-sided portal hypertension as a result of mass lesion at the tail of the pancreas which was diagnosed as solid pseudopapillary neoplasm.

https://ift.tt/2lATIIh

Giant arachnoid granulation with a thrombosed dural arteriovenous fistula

Arachnoid granulations are common incidentally detected small dural lesions which are usually asymptomatic and follow cerebrospinal fluid density/signal intensity on CT/MRI. Such lesions reaching a size of more than 1 cm are termed as giant arachnoid granulations (GAGs) which have been previously reported to cause venous hypertension and headaches. We report a case of GAG involving the proximal half of the superior sagittal sinus in a 45-year-old male patient which was associated with left temporal thrombosed dural arteriovenous fistula (AVF) whose thrombosed draining veins were seen converging towards the site of GAG. The patient presented with three episodes of generalised tonic-clonic seizures and improved with conservative treatment. No reports of such association of GAG with AVF is available in the literature, and we believe it could have occurred due to venous hypertension induced by GAG.

https://ift.tt/2tIfQUO

Acute torsion of a wandering spleen: a paediatric emergency

Description

A 5-year-old boy presented to the emergency department with intense dull aching pain in the left lower abdomen. On physical examination, his vitals were stable. A well-defined, tender, firm, 10x6 cm sized mass was palpable in the left lower abdomen occupying the left hypochondrium, left lumbar and umbilical regions. Urgent ultrasound revealed the absence of spleen in the normal position with a hypoechoic encapsulated mass in the left lower abdomen while Doppler study showed the absence of internal vascularity in it. Contrast-enhanced CT (CECT) of the abdomen (figure 1A,B) confirmed the presence of an enlarged, minimally enhancing and inferiorly displaced spleen with characteristic 'whirled appearance' of the splenic hilum. The diagnosis of splenic torsion was confirmed and an exploratory laparotomy was performed. Intraoperatively, the spleen was torsed 720 degrees on its pedicle with an engorged and thrombosed splenic vein (figure 2A,B). The ligamentous attachments (gastrosplenic, splenocolic,...

https://ift.tt/2lDejfj

Ciliary body tumour as the presenting manifestation of metastatic non-small cell adenocarcinoma of lung

We report a rare case of ciliary body metastasis from adenocarcinoma of the lung. Although the metastatic nodule was seen over the surface of the iris near the angle of anterior chamber, ultrasonography confirmed its origin from the ciliary body. Uveal metastasis may be the first sign of lung cancer.

https://ift.tt/2yOrvYa

Spontaneous bilateral perirenal and splenic haematoma in childhood onset polyarteritis nodosa

Spontaneous bilateral perirenal haematoma, as well as splenic haematoma, are rare occasions in polyarteritis nodosa (PAN). We report a case of a young man, who suffered from various typical and atypical manifestations of PAN since childhood. The diagnosis was delayed due to symptoms mimicking with other clinical conditions. Finally, the diagnosis was confirmed when presented with perirenal and splenic haematoma and was managed successfully.

https://ift.tt/2lzRQ2B

Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman

Non-arteritic anterior ischaemic optic neuropathy (NAION) may develop due to severe anaemia and hypotension which is seen in acute blood loss. The devastating visual loss is often irreversible. We report a case of NAION in a 20-year-old healthy woman, who presented on the third day of a heavy menstrual cycle with hypovolaemic shock. On day 2 of admission, she had sudden right eye blurring of vision at the superior field on awakening from sleep. Funduscopy revealed a pale and swollen right optic disc. There was a dense right superior altitudinal visual field defect. Her haemoglobin level was low (3.6 g/dL), but she refused blood transfusion due to her religious belief (Jehovah's Witness) and opted for conservative management. She later developed right optic atrophy with persistent visual field defect despite an improved haemoglobin level of 10.5 g/dL.

https://ift.tt/2tJlW7p

What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery

Publication date: Available online 26 June 2018
Source:European Journal of Surgical Oncology
Author(s): Thiago Brasileiro de Freitas, Kennya Medeiros Lopes de Barros Lima, Heloísa de Andrade Carvalho, Patricia de Azevedo Marques, Fabio Teixeira Belfort Mattos, Alexandre Siqueira Franco Fonseca, Alexandre Mendonça Munhoz, José Roberto Filassi, Silvia R. Stuart, Gustavo Nader Marta
Purpose/Objective(s)To evaluate the role of surgical clips placement in the definition of boost treatment volume.Materials/MethodsClinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant.ResultsA total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52cc, CTV Boost:36.59cc, CTV Quadrant:285.07cc, CTV NT:210.1cc and CTV MISS:13.57cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue.ConclusionSurgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.



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Cancers, Vol. 10, Pages 218: The Osteoclast in Bone Metastasis: Player and Target

Cancers, Vol. 10, Pages 218: The Osteoclast in Bone Metastasis: Player and Target

Cancers doi: 10.3390/cancers10070218

Authors: Antonio Maurizi Nadia Rucci

Bone metastases are frequently the final fate of breast and prostate cancer patients. According to the definition of metastasis as an incurable disease, to date there are no effective treatments for tumor-associated bone metastases and this represents a real challenge for the researchers in the field. The bone is a heterogeneous environment that represents a fertile soil for tumor cells, supporting their growth. Among the different cell types present in the bone, in this review we will focus our attention on the osteoclasts, which are crucial players in the so called &ldquo;vicious cycle&rdquo;, a phenomenon triggered by tumor cells eventually leading to both tumor proliferation as well as bone deregulation, thus fueling the development of bone metastasis. The complex network, linking tumor cells to the bone by activating osteoclasts, represents a fruitful target for the treatment of bone metastases. In this review we will describe how tumor cells perturb the bone microenvironment by actively influencing osteoclast formation and activity. Moreover, we will describe the current antiresorptive drugs employed in the treatment of bone metastases as well as new, targeted therapies able to affect both cancer cells and osteoclasts.

https://ift.tt/2Kos0Jw