Merckel cell carcinoma of the skin treated with somatostatin analogue and mTOR inhibitor exhausted after primary surgery, adjuvant radiotherapy and palliative chemotherapy.

Merkel cell carcinoma is a highly aggressive neuroendocrine skin tumor. This type of tumor is primarily based on Merkel cells located in the basal layer of the epidermis. The tumor occurs predominantly in elderly individuals (average age 69 years) and has a strong tendency to local recurrence and locoregional metastasis. Diagnosis of the tumor is based on histological and immunohistochemical examination. The therapy is radical surgery followed by adjuvant radiotherapy to the site of the primary tumor and regional lymph nodes. The authors describe a case report of Merkel cell carcinoma of the skin treated with somatostatin analogue and mTOR inhibitor exhausted after primary surgery and adjuvant radiotherapy and paliative chemotherapy (Fig. 2, Ref. 17).

The role of sibutramine in weight reduction.

BACKGROUND: The effectiveness of pharmacologic support with sibutramine along with the preservation of dietary and regimen measures is shown in a group of long-term treated patients at the Metabolic Clinic of the University Hospital in Hradec Králové. METHODS: In ambulatory patients, basic anthropometric parameters as body weight, BMI, waist circumference and the total amount of adipose tissue were compared before substitution with 10 mg sibutramine and after a four-month therapy. This group included 94 patients who were administered the same dose of sibutramine for the whole period of time. This group consisted of 37 men and 57 women. RESULTS: After a four-month therapy with sibutramine there was a mean reduction in weight by 7.9 ± 3.8 kg in the monitored group of patients. Their BMI was reduced by 2.3 ± 1.5 kg/height2 and the waist circumference by 4.4 ± 3.8 cm. The decrease in the percentage of the total body lipid was 2.9 %. CONCLUSION: Despite a surprising decision of the European Drug Agency to suspend the registration of sibutramine in the whole of Europe since January 2010 we can state that in our patients we have proven a positive effect of sibutramine substitution on their weight reduction (Tab. 1, Ref. 19).

[Changes in immune reactivity in cancer patients]. / Zmeny imunologické reaktivity u onkologických pacientu

It appears that the long-accepted paradigm that cytostatic and radiation therapy cause only immunosuppression, is not so clearly true. With regard to new knowledge in cancer immunology field, it seems that not only cytostatic and radiation therapy plays an important role in the alteration of immune system. There are many other factors influencing immunity like tumour environment itself, the use of immunomodulatory drugs or even the mental condition of cancer patients. The aim of review is to familiarize physicians with possible alterations of the immune system in cancer patients.

[Palliative cancer care within the Hradec Králové Region Health Care System: own experience]. / Paliativní onkologická péce v systému poskytování zdravotní péce v Královéhradeckém kraji: vlastní zkusenosti.

Palliative cancer care is an active treatment and nursing intervention in patients in whom cancer therapy has been withdrawn due to untreatable progression of the cancer disease. The main aim of palliative cancer care is to ensure the best possible quality of life of a cancer patient and the patient's family members. Palliative cancer care is provided in two basic forms, general and specialized. In the present paper, the authors discuss palliative cancer care and its implementation into clinical practice with reference to their own experience in providing this care.

Malignant thymoma as etiology of bilateral, biventricular cardiac failure.

The authors report on a case of a 60-year-old female admitted to hospital with symptoms of bilateral cardiac failure. Upon ultrasonic examination of the heart, a massive pericardial exudate was diagnosed. Pericardial drainage was done to find the cause of pericardial effusion. Cells of malignant lymphoma were detected cytologically while immunophenotypization demonstrated a malignant lymphoma exudate. A computed tomography (CT) examination of the thorax disclosed a mediastinal tumour with infiltration of both lungs, vascular structures and dissemination on the chest wall. A CT-guided tumour biopsy was performed to confirm or exclude a lymphoproliferative process. Histopathologically, an invasive cortical thymoma was verified. The tumour was evaluated as stage III thymoma according to Masaoka. This case report highlights a rare malignant thymoma, its clinical symptoms, diagnosis, therapy and prognosis (Fig. 2, Ref. 10).

[Can cancer patient in terminal stage of cancer die with dignity at home? And under what conditions?]. / Muze pacient v terminálním stadiu onkologického onemocnení dustojne zemrít doma? A za jakých podmínek?

In their brief communication, the authors are discussing the issue of palliative care for cancer patients in terminal stage of cancer. The authors are also contributing their own experience with the provision of such care to patients who wish to die at home.

Tamoxifen/norfloxacin interaction leading to QT interval prolongation in a female patient with extracranial meningioma.

The authors report on a case of tamoxifen/norfloxacin interaction leading to QT interval prolongation in an 83-year-old female patient with extracranial meningioma treated with radiation and hormonal therapy (with Tamoxifen). This case report highlights the potential risk of tamoxifen causing depression of electrical impulse in sinoatrial node, leading to symptomatic sinus bradycardia with prolonged QT interval. At the same time it indicates the need to be on the look out for drug interactions (in our case between tamoxifen and norfloxacin), as well as to be aware of other drugs possibly inducing QT interval prolongation (Fig. 2, Ref. 7).

Sexual dysfunction in females treated with peripheral blood progenitor cell transplantation: review of literature.

BACKGROUND: Peripheral blood progenitor cell transplantation (PBPCT) is a therapeutic modality used in the anti-tumorous treatment of hemato-oncological diseases and solid tumors. Apart of that, it is also used in therapy of non-malignant and hereditary diseases. AIM: As is the case with other treatments, PBPCT also affects not only the disease process but also the quality of life (QoL). MATERIALS AND METHODS: In the last decade of 20th century, several QoL studies among patients treated with PBPCT were undertaken and an influence on particular dimensions of QoL was observed. One of closely watched aspects was sexuality in patients treated with PBPCT. RESULTS: Sexuality and its expression belong to very important aspects of human behavior. It is also a very sensitive and sensible aspect, so with no doubts it is affected by the diagnosis of neoplasm and cancer treatment. CONCLUSION: Physical and psychosocial factors of PBPCT do affect patient's sexuality and sexual functioning as part of QoL. They remain in focus because of the complex care of patients treated with PBPCT (Fig. 2, Ref. 21).

Screening for depression in survivors of metastatic ovarian cancer in a programme of palliative cancer care.

BACKGROUND: Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. MATERIALS AND METHODS: This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic. RESULTS: The incidence of depression was 83.3% (25 of all 30 survivors). The relevance of depression is characterized: severely depressed was proved in 9 of all 30 survivors, the moderately depressed in 5 of all 30 survivors, the mildly depressed in 11 of all 30 survivors and normal range in 5 of all 30 survivors. The statistical evaluation not presents statistically significant dependence of ZSRDS on smoking abuse, marital status, age, number of associated diseases and type of palliative cancer care. CONCLUSION: The results of the pilot depression study showed that subsist clear association between metastatic ovarian cancer and depression (Fig. 2, Ref. 30). Full Text (Free, PDF) www.bmj.sk.

Depression symptoms and health-related quality of life among patients with metastatic breast cancer in programme of palliative cancer care.

Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. The quality of life term contains the information on an individual's physical social and spiritual condition. The study evaluated incidence and relevance of depression symptoms and level of health-related quality of life (HRQoL) among patients with metastatic breast cancer in programme of palliative cancer care. This study was local prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hrader Králové, Czech Republic. Dates were obtained during year 2008 among 41 patients with metastatic breast cancer in programme of palliative cancer care. The mean age for all 41 subjects was 58 years old (aged 41 - 80 years old). The Czech version of Zung self-rating depression scale was performed for evaluation of depression symptoms. The Czech version of genetic EuroQol questionnaire EQ-5D was performed for evaluation of level of HRQoL. The statistical evaluation presents that mean ZSDS (Zung self-rating depression score) certifies the presence of signs of moderately depression symptoms among patients with metastatic breast cancer (ZSDS range was 60-69). The mean ZSDS in all patients was 60,6. The mean ZSDS is group of healthy females was 38,9 (normal range of ZSDS). The incidence of depression was 61% (25 of all 41 subjects). The relevance of depression is characterized: severely depressed was proved in 5 of all 25 subjects, the moderately depressed in 10 subjects of all 25 subjects and mildly depressed in 10 of all 25 subjects. The statistical evaluation not presents statistically significant dependence of ZSDS on age, number of associated diseases and type of palliative cancer care. The HRQoL among patients with metastatic breast cancer is on very low level. The mean EQ-5D score (dimension of quality of life) was 55%. The mean EQ-5D VAS (subjective health condition) was 59,2%. The mean EQ-5D score in group of healthy female was 78,4% and the mean EQ-5D VAS was 85% (both QoL parameters show very good of QoL level). The statistical evaluation not presents statistically significant dependence of EQ-5D score and EQ-5D VAS on age, number of associated diseases and type of palliative cancer care. The results showed that subsist clear association between metastatic breast cancer in programme of palliative cancer care and depression. Also, the results showed that subsist low level of HRQoL of patients with metastatic breast cancer.

Sibutramine--its impact on health-related quality of life and depression among adult obese non-diabetic patients.

BACKGROUND: Obesity is a multifactorial, chronic disorder that has reached epidemic proportions in most industrialised countries and is threatening to become a global epidemic. AIMS: The pilot study evaluates the effect of sibutramine therapy on health-related quality of life and occurence of depression symptoms among adult obese non-diabetic patients. PATIENTS AND METHODS: This study was prospective and longitudinal. It was conducted at the Department of Hygiene of Faculty of Military Health Sciences in Hradec Králove, Czech Republic. Dates were obtained during year 2007. Twenty two adult obese non-diabetic patients (6 males and 16 females) were treated with sibutramine in dose of 10 mg daily. All of these 22 patients were over 18 years old. The European Quality of Life Questionnaire--EQ-5D Version was used for evaluation of health-related quality of life. The self-assessement Zung-SDS was applied for evaluation of occurrence of depression. RESULTS: The statistical evaluation demonstrated that health-related quality of life (EQ-5D score and EQ-5D visual analogue scale) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). The statistical evaluation demonstrated that index of depression (SDS index) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). CONCLUSION: The results show that sibutramine therapy has a highly positive effect on health-related quality of life among adult obese non-diabetic patients. Also, the results show that sibutramine therapy has a highly positive effect on occurence of depresion symptoms among adult obese non-diabetic patients (Fig. 2, Ref. 10).

Cancer and depression: a prospective study.

Cancer diagnosis and treatment often produce psychologic stresses resulting from the actual symptoms of the disease, as well as from perceptions of the disease and its stigma. Depression is seen in many cancer patients. Depression occurs in approximately 25% of palliative care patients. It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. The study is aimed for screening of depression among palliative care female patients. This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hradec Kralove, Czech Republic. Dates were obtained during year 2007 - 2008 in 64 palliative care female patients. The mean age for all 64 subjects was 60,5 years old (aged 29 - 88 years old). The Czech version of Zung self-rating depression scale was performed. The statistical evaluation presents that mean SDS (self-rating depression score) certifies the presence of signs of mildly depression among palliative care female patients (SDS range was 50-59). The mean SDS in all subjects was 56. The mean SDS in group of healthy females was 38,9 (normal range). The incidence of depression is 71,8% (46 of all 64 subjects). The relevance of depression is characterized: severely depressed was proved in 8 of all 46 subjects, the moderately depressed in 21 subjects of all 46 subjects and mildly depressed in 17 of all 46 subjects. The statistical evaluation not presents statistically significant dependence of SDS on smoking abuse, marital status, age, number of associated diseases and type of palliative care. The statistical evaluation presents that patients with cancer of lung, with cancer of endometrium, with cancer of gallbladder and with melanomas are moderately depressed (SDS 60-69), patients with cancer of ovary, with cancer of breast, with primary brain tumour, with cancer of ventricle, with cancer of pancreas head and with cancer of bucall cavity are mildly depressed (SDS 50-59). The results show that subsists clear association between oncological disease in palliative care and depression.

Multimarker approach to evaluation of cardiac toxicity during preparative regimen and hematopoietic cell transplantation.

Cardiac toxicity of preparative regimen (PR) containing high-dose Cyclophosphamide (120 mg/kg) followed by hematopoietic cell transplantation (HCT) was evaluated with 6 biomarkers of cardiac injury: N-terminal pro brain natriuretic peptide (NT-proBNP), creatine kinase MB (CK-MB mass), cardiac troponins (cTnT, cTnI), heart-type fatty acid binding protein (H-FABP), glycogen phosphorylase BB (GPBB). Twenty-three patients (mean age 44.5+/-10.6 years, 15 males) with acute leukemia were studied. All biomarkers were measured the day before PR, the day after PR, the day after HCT and 14 days after HCT. We found NT-proBNP elevations above 500 ng/L in 6 (26.1 %) patients after PR, in 9 (39.1 %) after HCT and in 7 (30.4 %) 14 days after HCT. GPBB became elevated (above 7.30 microg/L) in 5 (21.7 %) patients after PR, remained elevated in 5 (21.7 %) after HCT and in 2 (8.7 %) 14 days after HCT. A significant correlation between elevation in NT-proBNP and GPBB was found. Other markers remained within the reference range early after PR and HCT. Our findings show that administration of PR and HCT for acute leukemia is associated with acute neurohumoral activation of cardiac dysfunction (significant rise in NT-proBNP) and may lead to GPBB elevation. These changes could indicate acute cardiac toxicity due to treatment and require further follow-up. The predictive value for development of cardiomyopathy in the future is unclear. Further studies will be needed to define the potential role of new biomarkers in this context.

Quality of life and arterial endovascular intervention by means of balloon angioplasty.

AIM: The aim of this study was to evaluate the quality of life (QoL) and the effect of arterial balloon angioplasty (ABA) on QoL of patients with peripheral arterial occlusive disease (PAOD). METHODS: The study is a prospective and longitudinal one and was carried out at the 2nd Internal Clinic of Charles University Hospital in Hradec Kralove, Czech Republic. Forty-two patients with PAOD, hospitalized for the endovascular intervention by means of percutaneous transluminal angiography, were evaluated for QoL. Thirty patients with PAOD (20 male, 10 female) were treated by endovascular intervention by means of ABA. The evaluation of QoL was performed by means of the Czech version of the international generic European Quality of Life Questionnaire EQ-5D. Statistical analysis was determined by means of analysis of variance and paired t-test. The QoL questionnaires were evaluated by means of descriptive analysis. RESULTS: The study has shown the following results: patients with PAOD had low global QoL; a statistically significant relation between QoL of patient with PAOD and the their age (P<0.01); a statistically significant relation between global QoL and stage of PAOD by Fontaine classification (P<0.01); and a statistically significant relation between global QoL and ABA (P<0.0001). CONCLUSION: The QoL of patients with PAOD is low. The QoL is lower with increasing age and with severity of PAOD. The results show the existence of a positive effect of ABA on QoL in patients with PAOD.

Tamoxifen-induced QT interval prolongation.

We report on a case of tamoxifen-induced QT interval prolongation in a 56-year-old-female patient with hormone-dependent carcinoma of the right breast, stage T2N0M0, grade 3 and HER-2 negative. Partial mastectomy with axillary lymph node excision was performed in July 2007 with adjuvant hormonal and radiation therapy. This case highlights the risk of tamoxifen causing depression of electrical impulse in the sino-atrial node, leading to symptomatic sinus bradycardia with prolonged QT interval. It indicates the necessity of regular monitoring of patients undergoing tamoxifen treatment. ECG should be performed not only before and after, but also during treatment. with an average duration of treatment of 5 years, we would advise an annual ECG for asymptomatic patients. In the presence of symptomatic sinus bradycardia, constant monitoring is necessary. We also highlight potential drug interactions, between tamoxifen and acitretin and the need to be aware of drugs which may induce QT interval prolongation.

Health-related quality of life in multiple myeloma survivors treated with high dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation: a retrospective analysis.

A pilot study analyses an effect of selected demographic, psychosocial and health aspects on quality of life (QoL) in multiple myeloma survivors treated with high-dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation (PBPCT). The total number of respondents with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT between years 2001-2003 at the Department of Clinical Haematology of the 2nd Department of Internal Medicine of Charles University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic was 32 (18 male, 14 female). The average age of respondents was 60 years old. The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The effect of selected demographics, psychosocial and health aspects on QoL was determined by means of analysis of variance (ANOVA). The QoL questionnaires were evaluated by means of descriptive analysis. The above-mentioned aspects proved statistically significant dependence of QoL on respondents age and on smoking abuse. EQ-5D score (dimensions of QoL) and EQ-5D VAS (a subjective health condition) significantly decrease with increasing age and with smoking abuse. The effect of other aspects on QoL was not proven as statistically significant. Prevailing complaints in respondents with multiple myeloma were: 1. regular activity with complaints 81,2 % (26/32 respondents), 2. medium serious pain / discomfort 68,8 % (22/32 respondents), 3. movement with complaints 59 % (19/32 respondents), 4. medium serious anxiety / depression 59 % (19/32 respondents). The QoL in patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level (mean EQ-5D score was 68,9 %, mean EQ-5D VAS was 66,6 %). The results had shown that with an increasing age, the QoL of patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT, declines. The smokers and former smokers have lower QoL than non smokers. The global QoL in all studied patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level.

Biochemical markers and assessment of cardiotoxicity during preparative regimen and hematopoietic cell transplantation in acute leukemia.

INTRODUCTION: Cardiotoxicity is a relatively frequent and potentially serious complication of antitumor treatment. Anthracyclines and other high-dose chemotherapy represent the greatest risk. The aim of the study was to assess cardiotoxicity during preparative regimen (PR) and hematopoietic cell transplantation (HCT) in acute leukemia (AL) with biochemical markers - "N-terminal pro brain natriuretic peptide" (NT-proBNP), cardiac troponin T (cTnT) and creatine kinase MB (CK-MB mass). METHODS: Nineteen adult AL patients previously treated with anthracyclines--idarubicine, daunorubicine, mitoxantrone with standard doses for a cycle as 3 x 12 mg/m(2), 3 x 50 mg/m(2), 3 x 10 mg/m(2) accordingly were studied. PR consisted of high-dose cyclophosphamide (HD-C) in combination with busulphan or total body irradiation (TBI). Plasma NT-proBNP, cTnT and CK-MB mass concentrations were measured the day before PR, the day after PR, the day after HCT and 14 days after HCT. RESULTS: Before PR, mean plasma NT-proBNP value was 106.3+/-55.7 ng/l. After PR, it increased to 426.1+/-391.5 ng/l. After HCT, a further increase to 847.6+/-780.6 ng/l was observed. Fourteen days after HCT, the mean NT-proBNP was 330.8+/-236.8 ng/l. The differences were statistically significant in comparison with the baseline values (p<0.01). The NT-proBNP elevations were more pronounced in patients with cumulative doses (CD) of anthracyclines above 450 mg/m(2) (p<0.05), in patients with PR containing HD-C and TBI (p<0.05). In all patients, plasma cTnT and CK-MB mass concentrations remained unchangable during PR and HCT. CONCLUSION: Our results suggest that administration of PR and HCT is in most AL patients associated with acute neurohumoral activation (significant rise in NT-proBNP). Persistent NT-proBNP elevations, in our study in 12 (63.2%) patients, indicate subclinical cardiotoxicity (risk for development of heart failure) and require further follow-up. More pronounced NT-proBNP elevations in patients with higher CD of anthracyclines and in patients with PR containing combination of HD-C and TBI confirm that these therapeutic procedures seem to be more cardiotoxic and not very appropriate for patients with cumulation of risk factors for cardiotoxicity. Negative plasma cTnT and CK-MB mass concentrations show no detectable damage of cardiomyocyte structure during PR and HCT.