Axitinib Trough Concentration and its Influence on the Efficacy and Toxicity of Second-line Renal Cell Carcinoma Treatment.

INTRODUCTION: There are known correlations between axitinib exposure and treatment response. The aim of the article was to study relationships between the axitinib steady-state trough concentration and the treatment efficacy and toxicity. PATIENTS AND METHODS: 35 patients (24 men and 11 women), treated or initiating treatment with axitinib, were included in the study over the period 2016-2019. Blood samples were collected following 2 weeks of treatment (in patients who initiated the therapy) and at the end of Cycles 1, 2, and 3 thereafter (in the entire study population). For concentration measurements, high-performance liquid chromatography - mass spectrometry (HPLC-MS) was applied. Treatment efficacy was assessed according to the RECIST 1.1 criteria. Therapy toxicity was evaluated according to the CTCAE criteria. RESULTS: A statistically significant relationship between the first measured axitinib trough concentration (Ctrough first) value and treatment response (P = .004) as well as the median progression-free survival (mPFS) (P = .003) was observed. The association between axitinib Ctrough first and the median overall survival (mOS) was not statistically significant (P = .142). A statistically significant relationship was observed between the mean trough concentration from 3-month observation (Ctrough 1-3m) and treatment response (P = .008) as well as mPFS (P = .001), without a significant relationship for mOS (P = .097). At least grade 3 adverse reactions were meaningfully associated with Ctrough first (P = .012) and Ctrough 1-3m (P = .003). CONCLUSION: There are significant relationships between axitinib Ctrough and treatment response, PFS, and grade ≥ 3 toxicity. The data collected may be used to determine indications for axitinib therapy monitoring based on Ctrough measurements.

A rare case of a right common iliac venous aneurysm imitating a neoplastic tumour.

BACKGROUND: Aneurysms of the deep lower limbs veins are extremely rare. Diagnosis of such conditions may be confusing and suggest the presence of a neoplastic lesion. CASE PRESENTATION: We herein report a case of a 68-year-old woman who was admitted with a large vein tumour revealed by sonography and computed tomography. A direct phlebography revealed a large venous aneurysm of the right common iliac vein with an adhering thrombus and a large collateral circulation. Anticoagulant treatment and compression with an elastic stocking were initiated because the patient refused surgical treatment. A 2-year follow-up showed no aneurysm growth or thromboembolic complications. CONCLUSIONS: We show herein that conservative management can be effective and safe in cases of this rare condition.

Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas?

INTRODUCTION: Chronic venous disease is a group of symptoms caused by functional and structural defects of the venous vessels. One of the most common aspects of this disease is the occurrence of varicose veins. There are many ways of prevention and treatment of varicose veins, but in Poland the leading one is still surgery. As in every medical procedure there is the possibility of some complications. One of them is deep vein thrombosis (DVT). The diagnosis of DVT can be difficult, especially when access to a specialist is limited, such as in case of rural patients. The aim of the study. The aim of the study was estimation of the influence of LMWH primary prophylaxis on the formation of postoperative DVT, as well as sensitivity and specificity of clinical examination and D-dimer value in diagnosis of postoperative DVT in women. MATERIALS AND METHODS: The study was conducted in a group of 93 women operated on in the Department of General, Vascular Surgery and Angiology at the Karol Marcinkowski University of Medical Sciences in Poznan, Poland. The patients had undergone a varicose vein operation and were randomly divided into two groups: A - 48 women receiving LMWH during two days of the perioperative period, B - 45 women receiving LMWH during seven days of the perioperative period. RESULTS: There was no significant difference in the postoperative DVT complications in both groups. The value of D-dimer > 0.987 mcg/ml and swelling > 1.5 cm of shin (in comparison to the preoperative period) plays a significant role in diagnosis of DVT. CONCLUSIONS: The extended primary prophylaxis with LMWH does not affect the amount or quality of thrombotic complications after varicose vein operation. If the DVT occurs, the evaluation of the D - dimer and careful clinical examination can be a useful method for its diagnosis.

The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap.

The anterolateral thigh (ALT) flap was first described in 1984. It is now widely used in reconstructive surgery following extensive tumour resection in head and neck cancer. Routine preoperative perforator mapping is recommended due to variability of the vascular anatomy of the flap. A wide array of diagnostic tools is available for this purpose, including colour duplex sonography (CDS). In this study, we report our experience with CDS. The number, location, and course (myocutaneous or septocutaneous) of ALT perforators were assessed by CDS prior to reconstructive surgery in 22 patients with head and neck cancer. These data were compared with the intraoperative anatomical findings to assess agreement and reliability. The positive predictive value and sensitivity of CDS in detecting perforator location was 89.4 and 94.4%, respectively, when compared to the surgical report. CDS also identified the perforator course with 100% accuracy. Colour duplex sonography is an effective, non-invasive, and relatively inexpensive technique for assessing the location of skin perforators.

Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management.

Thoracic endovascular aortic repair (TEVAR) has become the most common procedure in the treatment of thoracic aorta aneurysms. However, potential long-term complications of this technique could be life-threatening. Hemoptysis is a common symptom of lung tumor, especially cancer. On the other hand, hemoptysis can also be caused by bronchitis, tuberculosis, mycosis, and trauma. In this case report, we present a patient with hemoptysis and lung tumor suggesting lung cancer, which was a unique symptom of type IA endoleak after TEVAR and led to rupture of the thoracic aneurysm. It was decided to perform next an endovascular procedure due to the severe state of the patient. Next the thoracotomy was performed because drainage of the left pleural cavity was unsuccessful. In the last stage bronchoscopy was needed to remove the thrombus, which occluded the left main bronchi. Successful management has led to the patient's full recovery. Despite justified popularity of endovascular procedures in the treatment of thoracic aorta aneurysms, we should remember about potential long-term complications. Hemoptysis could be a unique symptom of the endoleak after TEVAR and treatment of such complications could be complex and demanding.

[Early surgical revision as a salvage procedure in the anterolateral thigh flap failure prevention--case report]. / Interwencja chirurgiczna w obrebie szypuly naczyniowej jako wczesna profilaktyka martwicy plata ALT--opis przypadku.

Microsurgical free flaps are considered state of the art in head and neck reconstruction after composite tumor resections. The anterolateral thigh (ALT) flap is frequently used in ablative head and neck surgery, providing superior functional and aesthetic restoration with a minor donor-site morbidity. However, flap failures do occur occasionally, vascular obstruction within first 24 postoperative hours is one of the main reasons of flap compromise. We present a case report of an early surgical exploration as a successful salvage procedure for ALT flap used for reconstruction of the massive scalp excision due to basal cell carcinoma.

[Our experience in the use of anterolateral thigh flap for reconstruction of the head and neck neoplasms]. / Doswiadczenia wlasne w zastosowaniu wolnych platów udowych w rekonstrukcji ubytków po rozleglych operacjach nowotworów zlosliwych glowy i szyi.

INTRODUCTION: Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections caused by neoplasms of the head and neck. The anterolateral thigh flap (ALT) constitutes very good reconstructive material due to the long vascular pedicle, the appropriate diameter of vessels, the large skin island plane, and thickness depending on requirements. MATERIAL: The own material comprises 5 patients who have had extensive neoplastic infiltrations removed at different anatomic locations within the area of healthy tissue. RESULTS: Reconstructions have been conducted using a microvascular thigh flap (ALT). All of the operated patients are under constant supervision. The observation period ranges from 2 to 3 months. No recurrence of the neoplastic process or graft rejection has been observed in any of the patients.

Takayasu's arteriopathy with associated occlusion of right coronary artery, brachiocephalic trunk and left subclavian artery and aortic regurgitation. Cardiovascular approach leading to a successful outcome - a case presentation.

In a 37 year-old woman with Takayasu's arteriopathy angiography revealed occlusion of right coronary artery (RCA), brachiocephalic trunk and left carotid artery (LCA), as well as aortic regurgitation. She underwent a complex cardiovascular surgery consisting of aortic valve implantation, RCA grafting and implantation of vascular bifurcated graft anastomosed between ascending aorta and brachiocephalic trunk and LCA. The multi-slice computed tomography performed two weeks after the operation revealed preserved grafts patency.