Mode-selective optical packet switching in mode-division multiplexing networks.

A novel mode-selective optical packet switching, based on mode-multiplexers/demultiplexers and multi-port optical micro-electro-mechanical systems (MEMS) switches, has been proposed and experimentally demonstrated. The experimental demonstration was performed using the LP(01), LP(11a) and LP(11b) modes of a 30-km long mode-division multiplexed few-mode fiber link, utilizing 40 Gb/s, 16-QAM signals.

Bleomycin cardiotoxicity during chemotherapy for an ovarian germ cell tumor.

INTRODUCTION: Platinum-based chemotherapeutic regimens, including BEP (bleomycin, etoposide, cisplatin) represent the standard of care, first line therapy in non-epithelial ovarian tumours. Cardiovascular toxicity is a rare adverse effect of bleomycin. CASE REPORT: A 41-year-old woman with ovarian granulosa tumor, treated with first line BEP chemotherapy experienced chest discomfort rapidly progressing to severe precordial pain during bleomycin infusion. The infusion was stopped and electrocardiographic changes indicative of myocardial ischemia were revealed. Anti-anginal and anti-thrombotic treatment was introduced. Cardiac enzymes were not elevated and echocardiographic findings showed no wall motion abnormalities. Twenty four hours after the episode the elctrocardiographic changes insisted and chemotherapy was decided to be continued, excluding bleomycin, with no symptom recurrence. DISCUSSION: Cardiovascular complications pose a rare but potential fatal adverse effect of BEP chemotherapy and should be carefully addressed, especially in patients with additional cardiovascular risk factors. Physicians dealing with bleomycin-based therapies may find this knowledge useful for a more comprehensive evaluation of chest pain syndromes in those patients.

Testicular germ cell tumors.

Testicular cancer is the most frequent solid tumor in young male adults and a disease with elusive pathogenesis. Germ cell tumors represent 95% of all testicular cancers. There was an increasing incidence of testicular germ cell tumors during the second half of the 20th century. Despite their increased incidence, mortality is lower than 10% and the cure rate has reached 95%. Epidemiology of the disease shows remarkable geographic and racial variation. Known risk factors and the increased incidence during the last 50 years have led to the development of the two prevalent theories for the pathogenesis of the disease, Henderson theory and Rajpertde Meyts and Skakkebaek theory. Appropriate diagnosis and staging of the disease are crucial for successful management. Testicular ultrasound, CT scans, histological examination and serum tumor markers should be utilized in order to stratify the patient correctly. Treatment strategy is chosen according to the patient stage and prognostic group stratification. "Fine tuning" is needed in order to find the balance between treatment, cure and toxicity. Despite progress in therapeutic management, cure rates for poor risk patients do not exceed 50%. These patients should be encouraged to participate in clinical trials. Long-term toxicity of testicular germ cell tumors' treatment is also another issue that should be kept in mind during follow-up of these patients. This disease became the model of "curable" cancer and gave hope for cure of metastatic malignant diseases in general, as only 400 patients die from this disease in USA annually. More progress will be made only through well-designed clinical trials.

Matrix metalloproteinases and proangiogenic factors in testicular germ cell tumors.

PURPOSE: Testicular cancer is the most frequent solid tumor in young male adults and a disease with elusive pathogenesis. The purpose of this study was to determine the role of matrix metalloproteinases and angiogenic factors in the pathogenesis of testicular germ cell tumors (GCTs). METHODS: Between 2003 and 2006 we measured the serum levels of matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2), vascular endothelial growth factor A (VEGF-A), basic fibroblast growth factor (bFGF), platelet derived growth factor BB (PDGF-BB) and angiopoietin 2 (Ang-2) in 50 patients with testicular GCTs, at baseline, one month after the completion of the second cycle of chemotherapy and one year after the completion of chemotherapy, and in 16 male age-matched controls at baseline. RESULTS: At baseline, mean TIMP-2 value was lower in patients than controls, mean MMP-2/TIMP-2 ratio was higher in patients than controls and MMP9/TIMP-2 ratio was also higher. Ang-2 value was higher in patients than controls and bFGF value was also higher. Comparisons of the same parameters were also made among the 3 consecutive serum samples of the patients. All parameters normalized after chemotherapy except Ang-2 which remained elevated. CONCLUSION: The present study supports the hypothesis that tumor invasion and angiogenesis play a role in testicular GCTs pathogenesis. Also an interesting hypothesis was formed, concerning the role of elevated levels of Ang-2 found in testicular GCTs patients in the pathogenesis of the increased long term cardiovascular morbidity of these patients. Larger prospective studies are needed to confirm our results.

Neoadjuvant chemotherapy followed by radiotherapy versus concurrent chemoradiotherapy for larynx preservation in patients with advanced laryngeal cancer.

PURPOSE: The efficacy and toxicity of neoadjuvant chemotherapy followed by radiotherapy and concurrent chemoradiotherapy and their impact on larynx preservation have been studied in patients with advanced (stage III, IVa, and IVb) squamous cell cancer of the larynx. PATIENTS AND METHODS: Fifty patients were treated with either 2-4 cycles of induction chemotherapy with cisplatin 100 mg/m(2), day 1 and infusional 5-fluorouracil (5-FU 1000 mg/m(2), days 1-5), followed by radiotherapy 70 Gy, 1.8-2 Gy per fraction, or concurrent chemoradiotherapy (the above-mentioned radiotherapy concurrently with carboplatin 300 mg/m(2) every 21 days or weekly paclitaxel 80 mg/m(2)). Patients were allocated in the 2 arms by 1:1 selection. At the end of both protocols, patients without complete response (CR) underwent laryngectomy and/or neck lymph node dissection. Assessed were response and toxicity rates, overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 31 (62%) patients achieved larynx preservation with acceptable organ function. No statistically significant difference in response rate and OS was found between the two treatment arms. Patients submitted to concurrent chemoradiotherapy showed significantly longer DFS (14 vs. 10 months, p= 0.0397) and higher rates of larynx preservation (p <0.05). All grade IV side effects occurred in the concurrent chemoradiotherapy group. CONCLUSION: Concurrent compared to alternating chemoradiotherapy was more toxic, but achieved significantly longer DFS and higher rate of larynx preservation.

Knowledge and attitude of the Greek educational community toward epilepsy and the epileptic student.

The purpose of this study was to investigate primary and secondary school teachers' knowledge of and attitudes toward epilepsy and the epileptic child. A 14-item questionnaire was administered to 300 teachers in three major Greek cities. The focus of interest was the teachers' basic knowledge of epilepsy, their perceptions of the consequences of epilepsy on a student's academic potential and behavior, their tendency to accept or reject the epileptic child, and their ability to help a convulsing child. The majority of teachers have a correct opinion about the nature of epilepsy and its short-term prognosis (control by medication), but are very pessimistic about its long-term prognosis (cure). They believe that although some epileptic children may have mental, learning, or behavioral problems, most of then do not and are therefore capable of academic achievements. The attitude of most teachers is very positive toward the epileptic child, and almost all believe that these children should continue their studies at their regular school. An alarming finding is the reported inability of most teachers to help a convulsing child. Personal knowledge of an epileptic student was a significant factor in determining many of the teachers' responses. Better education of teachers concerning epilepsy and the practical skills involved in first-aid are necessary measures for Greek teachers.

A neolithic case of Down syndrome.

The aim of the study is to draw attention to the existence of a Neolithic figurine from Greece with characteristics compatible with Down syndrome. We have reviewed the relevant medical and archaeological literature, and we have compared photographs of the figurine with photographs of a patient with typical Down syndrome (DS). From the above data we conclude that the 7000 years old artefact may well be the most ancient representation of the disease in Western civilisation.

The effect of puberty on the course of epilepsy.

It has been stated that puberty adversely affects epilepsy. In this retrospective study, 39 patients (24 girls and 15 boys) with onset of epilepsy before puberty were followed up for seven years extending from prepuberty into puberty. A general trend toward fewer seizures during puberty was observed, but this trend reached statistical significance for only the female patients after menarche. These changes were not related to treatment. We conclude that, in general, puberty does not influence epilepsy. In the postmenarche phase of puberty, however, female patients might experience a better seizure control.

Biotinidase deficiency: accumulation of lactate in the brain and response to physiologic doses of biotin.

Biotinidase deficiency is the most common cause of late onset, biotin-responsive multiple carboxylase deficiency (MCD). We studied the two oldest known boys with this disorder who had high CSF content of lactate that could have contributed to the clinical disorder. The symptoms of these patients implied that near physiologic, rather than pharmacologic, doses of biotin may be sufficient for treatment.

Actinomycosis meningitis in a girl with incontinentia pigmenti.

A 7-year-old girl with incontinentia pigmenti and a history of multiple bacterial infections developed chronic meningitis with Actinomycosis odontolyticus, which was successfully treated with long-term penicillin administration. Although all tests of immunologic function were normal in this patient, her history of recurrent and unusual infections is consistent with previous suggestions of an undefined immunodeficiency state associated with incontinentia pigmenti.