MINOAS: A Single-arm Translational Phase II Trial of FOLFIRI Plus Aflibercept as First-line Therapy in Unresectable, Metastatic Colorectal Cancer.

BACKGROUND: FOLFIRI/aflibercept is approved as a second-line treatment in metastatic colorectal cancer (mCRC) but there are limited data for its use as a first-line treatment. OBJECTIVE: To investigate the activity and safety of first-line FOLFIRI/aflibercept in mCRC, as well as to prospectively evaluate biomarkers of early response to treatment. PATIENTS AND METHODS: MINOAS was a phase II trial that aimed to evaluate the activity and toxicity of first-line FOLFIRI/aflibercept in mCRC. The primary endpoint was objective response rate (ORR). The secondary endpoints were toxicity, progression-free survival (PFS), overall survival (OS), and the evaluation of CEACAM-positive circulating tumor cells (CTC) and diffusion-weighted (DW)-MRI as biomarkers. RESULTS: Thirty-one patients were enrolled and 259 chemotherapy cycles were administered. At the time of the preplanned interim analysis, all patients had discontinued treatment and the ORR was 61.3%, crossing the activity threshold for trial discontinuation. Median PFS was 8.4 months (95% CI 7.8-9.0). Median OS had not been reached. There was one toxic death due to sepsis; grade 3/4 adverse events included neutropenia (n = 5), diarrhea (n = 6), hypertension (n = 4), asthenia (n = 3), proteinuria (n = 1), and bowel perforation (n = 1). Retaining CTC-negative status predicted better OS compared to continuous detection of CTCs (p = 0.015). Early decrease of the apparent diffusion coefficient (ADC) in DW-MRI was associated with an objective response. CONCLUSION: The activity and safety of first-line FOLFIRI/aflibercept merit further evaluation in randomized studies. CLINICALTRIALS. GOV REGISTRATION NUMBER: NCT02624726.

CT in appendicitis.

Appendicitis is the most common abdominal emergency occurring in 7%-12% of the population. The aim of this article was to pictorially present the spectrum of appendix and acute appendicitis appearances on computed tomography (CT). The various appearances on CT of the normal appendix are shown as well as the CT criteria for the differentiation of perforated and non-perforated appendicitis.

Intracranial hemorrhage in a HIV patient. Case report and review of the literature.

The authors report on a case of a hemophilic male patient, aged 43, HIV positive, HCV positive, who had an episode of intracerebral hemorrhage after a car accident. Intracranial hemorrhage is the most feared complication of hemophilia, especially among HIV positive, who now are considered to be a group at high risk for bleeding. In this report, it is reviewed available data on clinical and imaging features of ICH and the association between ICH and HIV.

Patient presenting with lipoma of the index finger: a case report.

INTRODUCTION: Lipomas can be found anywhere in the body with the majority located in the head and neck region as well as in the shoulder and back. They are not very common in the hand and those involving the fingers are very rare. Although, it is not the only case reported, lipoma of the index finger is very uncommon. CASE PRESENTATION: A 52-year-old Caucasian man presented with a lipoma of the right index finger. He complained of no pain but he had difficulty in manual movements. Treatment was surgical excision of the lipoma. There has been no recurrence for two years. CONCLUSION: Although lipomas of the fingers are rare entities, their awareness is imperative since the differential diagnosis from other soft tissue tumors and from the special lipomatous subtype involved is quite extensive.

Hysterosalpingography: technique and applications.

Hysterosalpingography (HSG) remains an important radiologic procedure in the investigation of infertility and has become a commonly performed examination due to recent advances of reproductive medicine. HSG demonstrates the morphology of the uterine cavity, the lumina, and the patency of the fallopian tubes. In this review article, we present the technical parameters of the examination, indications, contraindications, and possible complications of HSG. We also illustrate a variety of abnormalities of the uterus and fallopian tubes that can be detected accurately with HSG. We believe that, with the increased demand for HSG, radiologists should be familiar with HSG technique and the interpretation of HSG images.

HIV-infected hemophilia a patient presenting with gynecomastia.

We describe the case of a 24-year-old hemophilic man who had been a human immunodeficiency virus (HIV)-positive for the past 22 years and presented to our hospital with bilateral breast enlargement with the presence of microcalcifications. Etiology of breast enlargement in male HIV population and differential diagnosis between true gynecomastia and lipomastia are also discussed.

Non-arteritic anterior ischaemic optic neuropathy: evaluation of the brain and optic pathway by conventional MRI and magnetisation transfer imaging.

The purpose of the study was to examine the brain and the visual pathway of patients with non-arteritic anterior ischaemic optic neuropathy (NAION) by using conventional MRI (cMRI) and volumetric magnetisation transfer imaging (MTI). Thirty NAION patients, aged 67.5 +/- 8.14 years, and 28 age- and gender-matched controls were studied. MTI was used to measure the magnetisation transfer ratio (MTR) of the chiasm and for MTR histograms of the brain. The presence of areas of white matter hyperintensity (WMH) was evaluated on fluid-attenuated inversion recovery (FLAIR) images. Area of the optic nerves (ONs) and volume of the chiasm were assessed, as were coronal short-tau inversion recovery (STIR) and MTI images, respectively. More areas of WMH were observed in patients (total 419; mean 14.4; SD 19) than in controls (total 127; mean 4.7; SD 5.7), P < 0.001. Area (in square millimetres) of the affected ONs, volume(in cubic millimetres) and MTR (in percent) of the chiasm (10.7 +/- 4.6), (75.8 +/- 20.2), (56.4 +/- 6.5), respectively, were lower in patients than in controls (13.6 +/- 4.3), (158.2 +/- 75.3) (62.1 +/- 6.2), respectively, P < 0.05. Mean MTR of brain histograms was lower in patients (53.0 +/- 8.0) than in controls (58.0 +/- 5.6), P < 0.05. NAION is characterised by decreased ON and chiasmatic size. The low MTR of the chiasm and brain associated with increased areas of WMH may be suggestive of demyelination and axonal damage due to generalised cerebral vascular disease.