Tissue invasion and metastasis: Molecular, biological and clinical perspectives.

Cancer is a key health issue across the world, causing substantial patient morbidity and mortality. Patient prognosis is tightly linked with metastatic dissemination of the disease to distant sites, with metastatic diseases accounting for a vast percentage of cancer patient mortality. While advances in this area have been made, the process of cancer metastasis and the factors governing cancer spread and establishment at secondary locations is still poorly understood. The current article summarizes recent progress in this area of research, both in the understanding of the underlying biological processes and in the therapeutic strategies for the management of metastasis. This review lists the disruption of E-cadherin and tight junctions, key signaling pathways, including urokinase type plasminogen activator (uPA), phosphatidylinositol 3-kinase/v-akt murine thymoma viral oncogene (PI3K/AKT), focal adhesion kinase (FAK), ß-catenin/zinc finger E-box binding homeobox 1 (ZEB-1) and transforming growth factor beta (TGF-ß), together with inactivation of activator protein-1 (AP-1) and suppression of matrix metalloproteinase-9 (MMP-9) activity as key targets and the use of phytochemicals, or natural products, such as those from Agaricus blazei, Albatrellus confluens, Cordyceps militaris, Ganoderma lucidum, Poria cocos and Silybum marianum, together with diet derived fatty acids gamma linolenic acid (GLA) and eicosapentanoic acid (EPA) and inhibitory compounds as useful approaches to target tissue invasion and metastasis as well as other hallmark areas of cancer. Together, these strategies could represent new, inexpensive, low toxicity strategies to aid in the management of cancer metastasis as well as having holistic effects against other cancer hallmarks.

Tensor fascia lata flap reconstruction in groin malignancy.

INTRODUCTION: Block dissection of inguinal lymph nodes is done in cases of malignant inguinal lymphadenopathy, which requires the removal of skin where it is involved, or elevation of the flaps which have precarious blood supply leading to necrosis. Thus, wound closure presents a big challenge. It can be done either by primary closure which is frequently complicated by necrosis, or by split thickness skin graft which is complicated by rejection on radiotherapy. Another option is to cover the wound by a vascularised pedicled graft. This prospective study was conducted after obtaining clearance from the ethical committee. The results were compared with the accepted complication rates of the operation. METHODS: We presented our experience of coverage of wounds after block dissection of inguinal lymph nodes for malignant deposits in 15 patients (with median age of 46 years) by pedicled tensor fascia lata thigh flap. RESULTS: The results following the surgery were good. Healing was satisfactory in all 15 cases. There were two cases of marginal flap necrosis, and three cases developed lymphoedema which was managed by stockings. There were two cases of infection which were settled by antibiotics. There were three cases of loss of a small area of skin graft at the donor site. There was no reported case of recurrence in the inguinal region. CONCLUSION: This technique of coverage of the defect after inguinal block dissection is easy with predictable good results.

Involuntary jerking of lower half of the body (spinal myoclonus).

A 55 years old, hypertensive, diabetic lady presented with sudden onset jerky movement of lower trunk and legs. It was present both in awake and sleep and got aggravated by mental stress as well as sensory stimulation. Examination revealed rhythmic jerks affecting muscles of lower abdomen and legs. The lower limbs had normal muscle bulk and power, increased tone, exaggerated deep tendon reflexes, bilateral flexor plantar response with normal sensory autonomic and cerebellar function. Investigations including CSF study, MRI of dorsal spine and NCV were normal. A combination therapy with tizanidine, baclofen and clonazepam induced gradual improvement within 6 weeks.

Powder microscopy of bark--poison used for abortion: moringa pterygosperma gaertn.

PIP: Moringa pterygosperma Gaertn. (Moringaceae) is a soft white wood tree with a gummy juice which grows all over India. The bark of the tree, powdered, produces an abortifacient which causes violent uterine contractions giving fatal results. This abortifacient agent is used in the Bengali area of India. Laboratory preparation and analysis of the powdered bark is described.^ieng