Etanercept biosimilar associated with Guillain-Barré syndrome: insights from a case.

Anti-tumor necrosis factor drugs are used routinely according to treatment guidelines for several chronic rheumatologic problems. However, a rare and usually unpredictable adverse drug reaction namely peripheral nervous system demyelination is being increasingly recognized. Biosimilars are gaining momentum especially in countries like India. Hence, we report a case of Guillain-Barré syndrome secondary to an etanercept biosimilar, probably the first case reported so far.

Poncet's disease diagnostic criteria decodes conundrum: Poncet's vs pseudo Poncet's.

Poncet's disease is very important and yet a challenging diagnosis of importance in countries with high TB endemicity (e.g. India). In this case series, we present 5 patients with diagnosed as Poncet's disease and in our tertiary health care center over 12 months and examine the performance of the diagnostic criteria suggested by Sharma and Pinto. The majority (4/5) of the patients were subsequently diagnosed and responded to anti-tuberculous therapy. In the other patient, a diagnosis of atypical seropositive rheumatoid arthritis or Pseudo Poncet's disease was established on follow up.

Continued erlotinib maintenance and salvage radiation for solitary areas of disease progression: a usefull strategy in selected non-small cell lung cancers?

PURPOSE: Advanced non-small cell lung cancer (NSCLC) is a common and lethal malignancy that has rarely benefited from chemotherapy. Erlotinib is highly effective in NSCLC patients selected by clinical characteristics and/or the presence of epidermal growth factor receptor-sensitizing mutations. However, the way to delay or bypass erlotinib resistance is not systematically addressed. Different erlotinib-failure modes have been reported in NSCLC, and strategies to prolong erlotinib efficacy are perhaps adaptable to them. We report the feasibility and efficacy of continued erlotinib maintenance and local salvage radiation to overcome erlotinib resistances in selected NSCLC patients. PATIENTS AND METHODS: Thirty of 52 consecutive erlotinib-treated advanced NSCLC from the NYU Langone Medical Center and the Arnau de Vilanova Hospital of Lleida responded initially to erlotinib. Twenty-six patients eventually showed a generalized-progression to erlotinib, and four progressed in solitary tumor sites. These four patients were treated with continued erlotinib maintenance and local salvage radiation. RESULTS: The progression-free survival (PFS) was statistically similar in patients with oligo or generalized-progression to erlotinib. However, all four cases with solitary-progression did benefit from continued erlotinib maintenance and salvage radiation with 41-140 % prolongation of PFS. It was reflected in an improved overall survival when they were compared with patients with generalized-progression (76.4 vs. 19.9 months; p = 0.018). CONCLUSION: Continued erlotinib maintenance and local salvage radiation is feasible and could contribute to a better outcome in selected NSCLC patients with solitary-progression to erlotinib. Prospective randomized trials of this strategy are warranted (AU)

Continued erlotinib maintenance and salvage radiation for solitary areas of disease progression: a useful strategy in selected non-small cell lung cancers?

PURPOSE: Advanced non-small cell lung cancer (NSCLC) is a common and lethal malignancy that has rarely benefited from chemotherapy. Erlotinib is highly effective in NSCLC patients selected by clinical characteristics and/or the presence of epidermal growth factor receptor-sensitizing mutations. However, the way to delay or bypass erlotinib resistance is not systematically addressed. Different erlotinib-failure modes have been reported in NSCLC, and strategies to prolong erlotinib efficacy are perhaps adaptable to them. We report the feasibility and efficacy of continued erlotinib maintenance and local salvage radiation to overcome erlotinib resistances in selected NSCLC patients. PATIENTS AND METHODS: Thirty of 52 consecutive erlotinib-treated advanced NSCLC from the NYU Langone Medical Center and the Arnau de Vilanova Hospital of Lleida responded initially to erlotinib. Twenty-six patients eventually showed a generalized-progression to erlotinib, and four progressed in solitary tumor sites. These four patients were treated with continued erlotinib maintenance and local salvage radiation. RESULTS: The progression-free survival (PFS) was statistically similar in patients with oligo or generalized-progression to erlotinib. However, all four cases with solitary-progression did benefit from continued erlotinib maintenance and salvage radiation with 41-140 % prolongation of PFS. It was reflected in an improved overall survival when they were compared with patients with generalized-progression (76.4 vs. 19.9 months; p = 0.018). CONCLUSION: Continued erlotinib maintenance and local salvage radiation is feasible and could contribute to a better outcome in selected NSCLC patients with solitary-progression to erlotinib. Prospective randomized trials of this strategy are warranted.

Aortic cusp involvement causing severe aortic regurgitation in a case of relapsing polychondritis.

A case with relapsing polychondritis is described where primary involvement of the aortic valve cusps produced severe aortic regurgitation requiring valve replacement. An aneurysmal dilatation of the ascending aorta developing later led to disruption of the prosthesis requiring re-operation. Superior vena caval obstruction, an abdominal aortic aneurysm which ruptured and required resection, and obstructive lesions in common iliac arteries, presumably the result of the same process that involved the aorta and the cartilaginous structures, were also seen.

The effects of vasectomy on the testis and accessory sex glands of the Hartley strain guinea pig.

The short term effects of bilateral vasectomy on the testis and the accessory sex glands of the guinea pig were compared with the effects of sham operation and unilateral vasectomy at 3, 5, 7, and 9 weeks after operation. The testis weights, sorbitol dehydrogenase activity, histology, epididymal sperm number, and motility were recorded. Accessory sex glands were weighed and chemically analyzed for fructose and citric acid content. The citric acid concentration of the dorsolateral prostate of the bilateral vasectomy group was significantly higher than concentrations in sham-operated and unilateral vasectomy groups at 3 weeks only. This may indicate transient hormonal derangement as a result of vasectomy. No significant differences were noted between testes of vasectomy and sham-operated groups. The unligated side testes of the unilateral vasectomy group were different from the testes of vasectomy and sham-operated groups. We conclude that interruption and ligation of the vas deferens itself has no effect on the testis of the guinea pig. Furthermore, all vasectomy experiments should include sham-operated controls.