A novel presentation of Mycobacterium avium complex in a recipient of a lung transplant: a case report

Lung transplantation remains an important potential therapeutic option for end-stage lung disease. It can improve quality of life and in some cases be a life-lengthening therapy. Despite the possible benefits,...

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Neonatal renal and inferior vena cava thrombosis associated with fetal thrombotic vasculopathy: a case report

Fetal thrombotic vasculopathy is a described placental diagnosis associated with adverse perinatal outcomes. It may also predispose children to somatic thromboembolic events. As far as we know, this is the fir...

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Ocular metastasis from breast carcinoma simulating anterior scleritis: a case report

Breast cancer is one of the commonest sources of ocular metastasis. Patients with ocular metastatic disease can present with a variable clinical picture. Patients with a history of breast cancer presenting wit...

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Irradiation hypofractionnée du cancer de prostate : quelles connaissances radiobiologiques en 2017 ?

Publication date: Available online 26 August 2017
Source:Cancer/Radiothérapie
Author(s): J.-M. Cosset
L'irradiation hypofractionnée du cancer prostatique s'est développée sur des données radiobiologiques de 1999 en calculant que le rapport alpha/bêta de ce cancer était très bas (1,2 à 1,5Gy), suggérant que l'hypofractionnement serait susceptible d'améliorer les résultats, avec une meilleure efficacité anti-tumorale et sans augmentation de la toxicité par rapport aux schémas classiques. Dans la foulée, deux types d'hypofractionnement ont été proposés : des schémas d'hypofractionnement « modérés » avec des séances de 2,5 à 4Gy et des schémas d'hypofractionnement « extrêmes », en techniques stéréotaxiques, avec des séances de 7 à 10Gy. Pour les hypofractionnements modérés, il paraissait licite d'utiliser le modèle linéaire quadratique pour calculer les équivalences de dose. En revanche, les essais disponibles, s'ils ont souvent montré une « non-infériorité » des schémas hypofractionnés, n'ont pas montré d'avantage évident, même quand les doses équivalentes calculées étaient très supérieures à celles données dans les bras « conventionnels ». Cela pourrait suggérer soit que le rapport alpha/bêta du cancer prostatique n'est pas aussi bas qu'indiqué précédemment, soit que d'autres paramètres radiobiologiques allant dans un sens négatif ont pu annihiler le bénéfice attendu. Pour l'hypofractionnement « extrême », outre les réserves exprimées dans l'utilisation du modèle linéaire quadratique pour les très fortes doses, il persiste de nombreuses inconnues radiobiologiques. La durée totale de l'irradiation, très réduite dans ce cas de figure, peut constituer un élément soit positif (meilleure efficacité anti-tumorale) soit négatif (déficit de réoxygénation). Une durée de séance supérieure à 20–30minutes peut permettre la réparation de lésions subléthales et réduire l'efficacité. Enfin, l'impact des très fortes doses par fraction sur le microenvironnement ou sur l'immunité est diversement apprécié. Les protocoles actuels d'hypofractionnement extrêmes paraissent montrer des résultats à court-moyen terme encourageants, mais, en l'attente d'essais randomisés, ils doivent intéresser des volumes réduits, avec des techniques stéréotaxiques sans faille et probablement une sélection précise des patients.For prostate cancer, hypofractionation has been based since 1999 on radiobiological data, which calculated a very low alpha/beta ratio (1.2 to 1.5Gy). This suggested that a better local control could be obtained, without any toxicity increase. Consequently, two types of hypofractionated schemes were proposed: "moderate" hypofractionation, with fractions of 2.5 to 4Gy, and "extreme" hypofractionation, utilizing stereotactic techniques, with fractions of 7 to 10Gy. For moderate hypofractionation, the linear-quadratic (LQ) model has been used to calculate the equivalent doses of the new protocols. The available trials have often shown a "non-inferiority", but no advantage, while the equivalent doses calculated for the hypofractionated arms were sometimes very superior to the doses of the conventional arms. This finding could suggest either an alpha/beta ratio lower than previously calculated, or a negative impact of other radiobiological parameters, which had not been taken into account. For "extreme" hypofractionation, the use of the LQ model is discussed for high dose fractions. Moreover, a number of radiobiological questions are still pending. The reduced overall irradiation time could be either a positive point (better local control) or a negative one (reduced reoxygenation). The prolonged duration of the fractions could lead to a decrease of efficacy (because allowing for reparation of sublethal lesions). Finally, the impact of the large fractions on the microenvironment and/or immunity remains discussed. The reported series appear to show encouraging short to mid-term results, but the results of randomized trials are still awaited. Today, it seems reasonable to only propose those extreme hypofractionated schemes to well-selected patients, treating small volumes with high-level stereotactic techniques.



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Fusion anomaly of the pancreatic tail and spleen: a case report

Splenopancreatic fusion is a rare anomaly that is often associated with trisomy 13. Its diagnosis can be important in patients scheduled to undergo distal pancreatectomy or splenectomy, to avoid possible intra...

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Thrombo-hemorrhagic liability in children with congenital heart diseases

Publication date: Available online 26 August 2017
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Shebl Said Shebl, Walid Ahmed Naguib El-shehaby, Amira Hamed Darwish, Yasmin Shebl Said, Nabeh Helal Elfadaly, Eman Amer
BackgroundThe precise mechanisms of the increased incidence of hemostatic abnormalities in congenital heart disease (CHD) have not been determined. The aim of the study was to evaluate some indicators of activation of platelets and vascular endothelial cells in patients with CHD, evaluation of bleeding liability of these patients, and correlation with the clinical presentation of these patients.MethodsThis work was carried out on 20 patients with cyanotic congenital heart disease (CCHD), 20 patients with cyanotic congenital heart disease (ACHD), and 20 healthy children who served as the control group, aged between 1 and 10 years. All were subjected to full clinical examination, complete blood count, oxygen saturation, echocardiography, bleeding and coagulation times, PT, PTT, FDPs, plasma soluble P-selectin, E-selectin, and platelet factor 4 (PF4).ResultsThere was significant prolongation of PT and PTT, and there was a significant lowering of platelet counts. These results were obtained in CCHD and ACHD, but were more significant in CCHD patients. There was a significant elevation in PF4 (55.0 ± 25.5 ng/mL), P-selectin (128.9 ± 42.44 ng/dL), and E-selectin (9,461.5 ± 1,701.24 pg/mL) levels in children with CCHD as compared to those with ACHD (PF4, 21 ± 7.94 ng/mL; P-selectin, 80.1 ± 13.2 ng/mL; E-selectin, 7,969.6 ± 2,127.5 pg/mL), and significant increase in both groups when compared to the control group (PF4, 8.1 ± 4.7 ng/mL; P-selectin, 27.83 ± 9.73 ng/mL; E-selectin, 6,750.00 ± 3,204.00 pg/mL). There was a significant negative correlation between oxygen saturation, plasma P-selectin (r = –.865), E-selectin (r = –.401), and PF4 (r = –.792) in patients with CCHD.ConclusionPatients with CHD—both cyanotic and acyanotic—have variable degrees of increased liability for both thrombosis and hemorrhage that represents some sort of adaptation to preserve hemostasis and to protect these patients against the clinical presentation of both thrombosis and bleeding. This is to say that CHD patients have their own point of balance between thrombogenicity and bleeding liability. Wide-scale studies are needed to detect the normal levels of different thrombohemorrhagic parameters of these patients.



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Towards personalized medicine of colorectal cancer

Publication date: Available online 26 August 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Mohammad Azhar Aziz, Zeyad Yousef, Ayman Saleh, Sameer Mohammad, Bandar Al Knawy
Efforts in colorectal cancer (CRC) research aim to improve early detection and treatment for metastatic stages which could translate into better prognosis of this disease. One of the major challenges that hinder these efforts is the heterogeneous nature of CRC and involvement of diverse molecular pathways. New large-scale 'omics' technologies are making it possible to generate, analyze and interpret biological data from molecular determinants of CRC. The developments of sophisticated computational analyses would allow information from different omics platforms to be integrated, thus providing new insights into the biology of CRC. Together, these technological advances and an improved mechanistic understanding might allow CRC to be clinically managed at the level of the individual patient. This review provides an account of the current challenges in CRC management and an insight into how new technologies could allow the development of personalized medicine for CRC.



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