Successful delayed coiling of a ruptured growing distal posterior cerebral artery mycotic aneurysm.

Intracranial infectious aneurysm (IIA) is a rare form of cerebrovascular malformation for which obliteration may be undertaken after rupture or non-response to targeted antibiotic therapy. We discuss the case of a 19-year-old man who presented with acute neurologic decline (Glasgow Coma Scale of 8) and endocarditis. CT images demonstrated subarachnoid haemorrhage, hydrocephalus and a mycotic aneurysm on the left posterior cerebral artery. Conservative management was initially decided due to the high risk of stroke and hemianopia. However, it was then escalated to endovascular treatment because of increased size of the aneurysm on surveillance scans.

Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study.

BACKGROUND: The current treatment of ovarian cancer consists of cytoreductive surgery (CRS) and systemic chemotherapy. The aim of this study was to examine if hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative modality to treat this category of patients along with a second attempt of surgical resection and second- or third-line systemic chemotherapy afterward. METHODS: In an 8-year period (2006-2013), 120 women with advanced ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] IIIc and IV) who experienced disease recurrence after initial treatment with conservative or debulking surgery and systemic chemotherapy were randomized into two groups. Group A comprised 60 patients treated with CRS followed by HIPEC and then systemic chemotherapy. Group B comprised 60 patients treated with CRS only and systemic chemotherapy. RESULTS: The mean survival for group A was 26.7 versus 13.4 months in group B (p < 0.006). Three-year survival was 75 % for group A versus 18 % for group B (p < 0.01). In the HIPEC group, the mean survival was not different between patients with platinum-resistant disease versus platinum-sensitive disease (26.6 vs. 26.8 months). On the other hand, in the non-HIPEC group, there was a statistically significant difference between platinum-sensitive versus platinum-resistant disease (15.2 vs. 10.2 months, p < 0.002). Complete cytoreduction was associated with longer survival. Patients with a peritoneal cancer index score of <15 appeared also to have longer survival. CONCLUSIONS: The use of HIPEC along with the extent of the disease and the extent of cytoreduction play an important role in the survival of patients with recurrence in an initially advanced ovarian cancer.

Advances in thymic carcinoma diagnosis and treatment: a review of literature.

Thymomas account for up to 50 % of anterior mediastinal neoplasms with an incidence of 0.13 per 100,000 person-years in the USA. Thymic carcinoma is a rare malignancy of the thymus gland distinguished from thymomas as it has a more invasive and metastasizing potential conferring poor prognosis. Due to the rarity of thymic carcinoma and the great variety of its histological subtypes, there is no solid evidence on optimal staging, imaging and treatment guidelines. Herein, we systematically review the literature on current clinical practice with regard to diagnostic evaluation, histopathological assessment, management and treatment of squamous thymic carcinoma.

Adjuvant platinum-based chemotherapy in patients with epithelial ovarian cancer: prognostic factors and final outcome.

PURPOSE: epithelial ovarian cancer (OVCA) prognosis depends on the clinical stage, histological grade and surgical cytoreduction. Our goal was to retrospectively analyze several prognostic factors in relation with the final outcome in patients with OVCA subjected to adjuvant platinum (PL)- based chemotherapy (CT). METHODS: three hundred OVCA patients were treated at the Department of Medical Oncology A', "Metaxa" Cancer Hospital, between 11/1989-3/2010. Of those, analyzed were patients with R0 debulking operation, treated with adjuvant PL-based CT. Their clinico/imaging/pathological findings and serum tumor marker CA 125 levels were analyzed and related to relapse rate (RR), progression-free survival (PFS) and overall survival (OS). RESULTS: out of 53 R0 OVCA patients 35 (66%) experienced long-term PFS (median follow up time 63 months, range 5-195(+)) and 18 (34%) relapsed after a median of 19 months. Fifteen of the 18 relapsing patients were treated with first-line CT. Twelve (80%) of them were PL-sensitive and 3 (20%) PL-resistant. Their median PFS was 9 and 3 months in PL-sensitive and PL-resistant cases, respectively (p=0.073). Statistical analysis of prognostic factors demonstrated FIGO stage and abnormal postoperative CA 125 values as significant. Patients with FIGO stage III had significantly shorter PFS (p=0.002) and OS (p=0.078) than those in earlier stages, and patients with abnormal postoperative CA 125 values had significantly worse PFS (p=0.017) but not OS (p=0.386) than those with normal values. Age, histological subtype and grade did not affect PFS and OS. CONCLUSION: FIGO stage and abnormal postoperative CA 125 have prognostic significance in OVCA patients after R0 surgical therapy and adjuvant PL-based CT. Patients with PL-sensitive disease achieved better results during therapy for relapse.

Treatment with trabectedin: should be indicated to all soft tissue sarcoma histotypes?

Trabectedin is a novel antineoplastic agent approved as monotherapy in patients with advanced soft tissue sarcoma (STS) after failure of standard therapy with anthracyclines or ifosfamide, or patients who are unsuited to receive these agents. Some histotypes of STSs appear to be particularly sensitive to trabectedin, but the sensitivity of some rare STSs histological subtypes to the drug is rather unknown. We report on two patients suffering from infrequent subtypes of STSs, fibrosarcoma and epithelioid sarcoma, who were treated with trabectedin. In these cases the treatment completely failed, and right after the first cycle of trabectedin administration an unusually rapid tumor growth and dissemination was documented. Of note, one of the patients showed objective response to MVIP chemotherapy (methotrexate, etoposide, ifosfamide and cisplatin), after trabectedin failure. Trabectedin activity against several subtypes has not been studied or well-documented due to the rarity and numerous histotypes of STSs. Case studies aiming at the individualization of treatment options against specific STS subtypes will further justify the usage of this agent in clinical practice.

Hereditary cancer predisposition syndromes and preimplantation genetic diagnosis: where are we now?

Hereditary cancer predisposition syndromes have been model diseases in order to understand carcinogenesis in many different organs such as colon, breast, ovaries, stomach and others. Better understanding and follow up of these diseases have led to the increasing acceptance of cancer genetic testing and the improving survival of young patients with cancer. Once the mutation is identified in the gene, patients and their relatives have the option of preimplantation genetic diagnosis (PGD) in order to select embryos without familial cancer-predisposing mutations. This procedure has already been performed in several syndromes, including the common syndromes of genetic predisposition to colon and breast cancer. Despite the numerous ethical objections and legal arguments, PGD for adult-onset cancers is today a reality and couples with an inherited predisposing mutation deserve the same respect, support and right to choose if their child will be born having an extremely high risk for cancer development as in the case of other life-threatening diseases for which prenatal screening has become a standard.

Implication of bevacizumab in fatal arterial thromboembolic incidents.

Bevacizumab, a humanized monoclonal antibody against vascular endothelial factor (VEGF), is approved for the treatment of metastatic colon cancer, but it has also shown efficacy in first line therapy of non-squamous-cell non-smallcell lung cancer, breast cancer and clear-cell renal cancer. Antiangiogenic therapy severe toxic effects such as stroke, myocardial infraction, angina, arterial thromboembolism, pulmonary embolism or haemorrhage, gastrointestinal perforation, heart failure should be taken into account during treatment with bevacizumab. We describe and discuss two cases of cancer patients who developed fatal arterial thromboembolic episodes after administration of bevacizumab. Due to the recent launch of antiangiogenic agents and the limited experience with their use in clinical practice, their adverse effects and pharmacological toxicities, sometimes fatal, are not well-established and a detailed registration of them is needed.

Multiple cutaneous ecchymoses associated with the administration of bevacizumab.

Nowadays, the introduction of combinational therapies with biological agents against advanced or resistant to chemotherapy tumors or for the treatment of cancer patients with organ failures becomes more and more attractive. The authors describe the case of a 60-year-old female patient with a multi-refractory to conventional cytotoxic therapy laryngeal cancer that was treated with cetuximab and bevacizumab combination therapy. Bevacizumab administration was associated with appearance of multiple cutaneous ecchymoses. This is a first-time reported adverse effect. Due to the recent launch of these agents and the limited experience of their use in clinical practice, their adverse effects and pharmacological toxicities are not well established and call for their detailed registration and reporting.

Reproductive hormones in menstrual blood.

Menstrual and peripheral blood samples were collected from 19 regularly cycling women on days 1-3 of the menstrual cycle. Menstrual samples were collected with a soft silicone rubber menstrual cup. Hematocrit, PRL, LH, FSH, estradiol (E2), and progesterone (P4) were measured in all samples. Validation studies were carried out for RIAs of PRL, LH, and FSH in menstrual plasma. The menstrual plasma PRL level was significantly higher than its peripheral blood level on day 1 (63.3 +/- 14.7 and 12.1 +/- 2.9 micrograms/L, respectively; t = 3.331; P less than 0.01), and menstrual PRL was significantly higher on day 1 than on day 2 (t = 3.340; P less than 0.01). There was a strong negative correlation between log menstrual PRL concentration and time of onset of menstruation (r = -0.596; P less than 0.01). Menstrual plasma FSH levels were significantly lower than peripheral levels on each of days 1-3 (day 1:t = 4.787; P less than 0.001), and there was a significant positive correlation between menstrual and peripheral levels (r = 0.607; P less than 0.01). By contrast, menstrual plasma LH was significantly higher than the peripheral level on days 1 and 2 (day 1:t = 3.105; day 2:t = 3.180; P less than 0.01), with no correlation between menstrual and peripheral levels. Menstrual E2 was slightly lower than and significantly positively correlated with peripheral E2 (r = 0.646; P less than 0.01). Menstrual P4 was lower than but showed no correlation with peripheral levels. As expected, the menstrual blood hematocrit was less than 0.20 and highly significantly lower than that of peripheral venous blood. These results suggest that PRL is released in substantial amounts from secretory endometrium into the menstrual flow during the first day of menstrual breakdown. LH may also be released in small amounts from menstrual endometrium, while menstrual FSH, E2, and P4 probably arise entirely from the peripheral circulation.

Post-traumatic orbit evaluation by three-dimensional surface reconstructions.

Post-traumatic orbital osseous and soft tissue surface evaluation was performed using high resolution computerized tomography and three-dimensional surface reconstructions (3DSR) using specially developed computer software. Four patients with facial fractures involving the orbit are presented as examples of the technique. Orbital volume was measured and surface images prepared using the original CT scans as input to CT computer software developed for this purpose. The results simplify interpretation of the nature and extent of traumatic orbital disruption. The interpretation of serial high resolution CT scans of the orbit (now obtained routinely in fractures involving the orbit) has been augmented by employing three-dimensional surface reconstructions (3DSR).

High school contact among persons with leukemia and lymphoma.

We studied frequency of contact among Connecticut high school students and teachers with leukemia and lymphoma diagnosed during or after high school from 1960 through 1971. Risk of having attended the same grade at the same school during the same year was greater among students with Hodgkin's disease (HD) than among simulated controls drawn in proportion to school enrollment (relative risk = 1.44; approximate 95% lower confidence limit = 1.05). Risk of developing HD was also greater among students enrolled simultaneously at the same school as students already diagnosed with HD than among students not so enrolled (relative risk = 2.05; 95% lower confidence limit = 1.39). However, fewer HD cases (16) were diagnosed from 1965 through 1970 at schools that formerly had patients enrolled (1959-64) than at matched schools without such patients (24). We found no evidence of increased contact among persons with non-HD lymphomas or leukemias, except between HD and non-HD lymphomas (relative risk = 1.41; approximate 95% lower confidence limit = 1.11).