Primary desmoplastic small round cell tumor of the testis: First case in India and review of the literature.

The purpose of this study is to describe the aggressive clinical behavior of desmoplastic small round cell tumor (DSRCT) of the testis and review of the literature. A 17-year-old male having painless testicular mass and neck swelling diagnosed to have metastatic DSRCT of the testis. Patient received aggressive chemotherapy with P6 protocol. The patient progressed on treatment and died due to extensive metastasis. Primary DSRCT of the testis is extremely rare mesenchymal tumor occurring in adolescence, with a tendency for extensive metastases. Management should be multimodal approach with aggressive polychemotherapy, surgical tumor debulking and radiotherapy. However the overall prognosis is very poor with <20% survival rates at 2 years.

Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams.

PURPOSE: The goal of the work was to assess the role of RapidArc treatments in chest wall irradiation after mastectomy and determine the potential benefit of flattening filter free beams. METHODS AND MATERIAL: Planning CT scans of 10 women requiring post-mastectomy chest wall radiotherapy were included in the study. A dose of 50 Gy in 2 Gy fractions was prescribed. Organs at risk (OARs) delineated were heart, lungs, contralateral breast, and spinal cord. Dose-volume metrics were defined to quantify the quality of concurrent treatment plans assessing target coverage and sparing of OARs. Plans were designed for conformal 3D therapy (3DCRT) or for RapidArc with double partial arcs (RA). RapidArc plans were optimized for both conventional beams as well as for unflattened beams (RAF). The goal for this planning effort was to cover 100% of the planning target volume (PTV) with ≥ 90% of the prescribed dose and to minimize the volume inside the PTV receiving > 105% of the dose. The mean ipsilateral lung dose was required to be lower than 15 Gy and V(20 Gy) < 22%. Contralateral organ irradiation was required to be kept as low as possible. RESULTS: All techniques met planning objectives for PTV and for lung (3DCRT marginally failed for V(20 Gy)). RA plans showed superiority compared to 3DCRT in the medium to high dose region for the ipsilateral lung. Heart irradiation was minimized by RAF plans with ~4.5 Gy and ~15 Gy reduction in maximum dose compared to RA and 3DCRT, respectively. RAF resulted in superior plans compared to RA with respect to contralateral breast and lung with a reduction of ~1.7 Gy and 1.0 Gy in the respective mean doses. CONCLUSION: RapidArc treatment resulted in acceptable plan quality with superior ipsilateral tissue sparing compared to traditional techniques. Flattening filter free beams, recently made available for clinical use, might provide further healthy tissue sparing, particularly in contralateral organs, suggesting their applicability for large and complex targets.

Contribution of formulation and excipients towards enhanced permeation of curcumin.

Curcumin (CRM) (CAS number 458-37-07), a naturally-occurring molecule, has diverse pharmacological actions. Recently our research group demonstrated that poor permeability also contributes to its poor oral bioavailability. A self nano-emulsifying drug delivery system (CRM SNEDDS) consisting of Labrasol, Gelucire 44/14, Vitamin E TPGS and PEG 400 was designed and provided 16 times improvement in oral bioavailability in rats, at a dose of 250 mg/kg body weight. Caco-2 cell transport studies were conducted for CRM SNEDDS and CRM in the presence of individual excipients, to determine the extent of improvement in permeability. Papp values for CRM, CRM SNEDDS and CRM in combination with 4 individual excipients were calculated. Transepithelial electrical resistance value was assessed to evaluate the cell morphology and the cellular tight junctions. Permeation of a transcellular marker, Lucifer Yellow was used as a marker to assess monolayer integrity. The tested excipient concentrations were found to be non-toxic to the cell monolayer in 2 h incubation. Results showed that the Papp increased 6.35 times for curcumin in CRM SNEDDS as compared to CRM. Individual excipients enhanced permeation from 1.97 to 6.35 times, with Labrasol showing the highest enhancement of 6.35 times.

Spindle cell sarcoma of esophagus: a rare case presentation.

Sarcomas of the esophagus, including carcinosarcoma, are rare neoplasm cases and comprise 0.1-1.5% of all esophageal tumors. Leiomyosarcoma is the most common of the pure mesenchymal tumors of the esophagus, but sarcomas with combined histological types such as carcinosarcoma occur more frequently than pure sarcomas. We report a rare case of spindle cell sarcoma of esophagus in a 55-year-old woman, managed with radical radiotherapy alone.

Influence of E. coli lipopolysaccharide induced fever on the plasma kinetics of cefepime in cross-bred calves.

The pharmacokinetic behavior of cefepime was studied in healthy and febrile cross-bred calves after single intravenous administration (10 mg/kg). The fever was induced with E. coli lipopolysaccharide (1 microg/kg, IV). The drug concentration in plasma was detected by microbiological assay method using E. coli (MTCC 739) test organism. Pharmacokinetic analysis of disposition data indicated that intravenous administration data were best described by 2 compartment open model. At 1 min the concentration of cefepime in healthy and febrile animals were 55.3 +/- 0.54 microg/ml and 50.0 +/- 0.48 microg/ml, respectively and drug was detected up to 12 h. The elimination half-life of cefepime was increased from 1.26 +/- 0.01 h in healthy animals to 1.62 +/- 0.09 h in febrile animals. Drug distribution was altered by fever as febrile animals showed volume of distribution (0.27 +/- 0.02 L/kg) higher than normal animal (0.19 +/- 0.01 L/kg). Total body clearances in healthy and febrile animals were 104.4 +/- 2.70 and 114.2 +/- 1.20 ml/kg/h, respectively. To maintain minimum therapeutic concentration of 1 mug/ml, a satisfactory dosage regimen of cefepime in healthy and febrile cross-bred calves would be 15.5 mg/kg and 8.2 mg/kg body weight, respectively, to be repeated at 8 h intervals. The T>MIC values (8 h) of cefepime suggested that this agent is clinically effective in the treatment of various infections.