Rare case of hemangiopericytoma responds to sunitinib

Hemangiopericytoma (HP) is a rare mesenchymal tumor associated with the capillary wall. We describe a 62-year-old man with a 20-year history of recurrent metastatic HP, in which a favorable clinical benefit was observed with sunitinib, an oral VEGFR, and PDGFR kinase inhibitor. Disease progression was evident during the 3 months before starting sunitinib therapy. Radiologic evaluation indicated that metastatic lesions in the lungs and pelvis remained stable during the 6 months on sunitinib therapy. Histologic analysis of the tumor 3 weeks after active sunitinib therapy did not reveal tumor necrosis, but recanalized thrombi within tumor blood vessels indicated previous tumor insult. Additional studies are warranted to confirm the possible effects of sunitinib in controlling widespread metastatic HP.     

Prevention of oral mucositis due to 5-fluorouracil treatment with oral cryotherapy

INTRODUCTION: One of the most common and important side effects of 5-fluorouracil (5-FU) is mucositis with ulcerations in the oral cavity. We investigated the effects of local cryotherapy on mucositis incidence administrated durng 5-FU treatment. METHODS: In a total of 99 courses, 5-FU and folinic acid combination chemotherapy was given to 40 patients. In our study, we considered every course as a single case, and cryotherapy was given to the same patient in one course but not given in the next. RESULTS: While mucositis developed in 6.7% of the courses given with cryotherapy, this ratio was 38.9% in courses given without cryotherapy. In the logistic regression analysis, development of mucositis had been found to correlate only with cryotherapy. Odds ratio (OR) = 11.5; in the 95% confidence interval (CI) = 3.2 - 41.9; (p = 0.001). DISCUSSION: Results of initial studies evaluating the effects of cryotherapy in preventing mucositis due to 5-FU based chemotherapy regimens were promising. We concluded that oral cooling prevents 5-FU induced mucositis. This effective prophylactic treatment should be used in patients who are at increased risk for developing 5-FU induced mucositis.     

Interaction of green tea polyphenol epigallocatechin-3-gallate with sunitinib: potential risk of diminished sunitinib bioavailability

Sunitinib, a novel oral multi-targeted tyrosine kinase inhibitor for patients with metastatic renal cell carcinoma (mRCC) and advanced gastrointestinal stromal tumor, has a good prospect for clinical application and is being investigated for the potential therapy of other tumors. We observed the phenomenon that drinking tea interfered with symptom control in an mRCC patient treated with sunitinib and speculated that green tea or its components might interact with sunitinib. This study was performed to investigate whether epigallocatechin-3-gallate (EGCG), the major constituent of green tea, interacted with sunitinib. The interaction between EGCG and sunitinib was examined in vitro and in vivo. ¹H nuclear magnetic resonance (¹H-NMR) spectroscopy and mass spectrometry (MS) were used to analyze the interaction between these two molecules and whether a new compound was formed. Solutions of sunitinib and EGCG were intragastrically administered to rats to investigate whether the plasma concentrations of sunitinib were affected by EGCG. In this study, we noticed that a precipitate was formed when the solutions of sunitinib and EGCG were mixed under both neutral and acidic conditions. ¹H-NMR spectra indicated an interaction between EGCG and sunitinib, but no new compound was observed by MS. Sticky semisolid contents were found in the stomachs of sunitinib and EGCG co-administrated mice. The $ {\text{AUC}}_{{0 - \infty }} $ and C _max of plasma sunitinib were markedly reduced by co-administration of EGCG to rats. Our study firstly showed that EGCG interacted with sunitinib and reduced the bioavailability of sunitinib. This finding has significant practical implications for tea-drinking habit during sunitinib administration.     

Macrocytosis in Down''s syndrome and during long-term anticonvulsant therapy

In a group of non-anaemic mentally retarded patients a significant increase in mean red cell volume has been demonstrated in epileptic patients being treated with anticonvulsants. The possible sites of interference of anticonvulsants with folate activity in the body, and problems associated with folic acid supplements during anticonvulsant therapy, are discussed.During the survey it was confirmed that the mean red cell volume is abnormally increased in many cases of Down's syndrome.     

Isoproterenol in the treatment of shock due to bacteremia with gram-negative pathogens.

A series of 12 patients with shock that followed bacteremia due to gram-negative pathogens is presented, and a case is reported. The hemodynamic alterations that occur in such patients are discussed. Initial therapy includes intravascular volume expansion and administration of glucocorticoids and antibiotic drugs; subsequent therapy, if necessary, includes administration of metaraminol and isoproterenol respectively. The problems encountered with this method of treatment are described. The use of isoproterenol (2.5 to 5 mg. in 500 ml. of 5 per cent dextrose in water administered intravenously at a rate of 0.5 to 2.0 ml. per minute) is suggested to correct the hemodynamic alterations usually present and permit further expansion of circulating blood volume with reduced risk of acute circulatory overload. Clinical use of this drug is recommended because of its positive ionotropic effect on the myocardium (beta-adrenergic stimulation) and direct peripheral arterial vasodilator effect (alpha-adrenergic blockade) that act to correct the hemodynamic alterations usually present in man in endotoxin shock.     

Surgical treatment of pulmonary diseases due to nontuberculous mycobacteria

Although the treatment of pulmonary diseases due to nontuberculous mycobacteria (NTM) requires the long-term use of antibiotics in combination, the treatment success rates are unsatisfactory. We evaluated the clinical characteristics and surgical outcomes of 23 patients with NTM lung diseases who had underwent pulmonary resection. The median age of the patients was 45 yr. Of the 23 patients, 10 had Mycobacterium avium-intracellulare complex infection, 12 had M. abscessus infection, and one had M. xenopi infection. The indications for surgery were antibiotic therapy failure (n=11), remnant cavitary lesion with high probability of relapse (n=8), and massive hemoptysis (n=4). The most common procedure was lobectomy (48%). Postoperative complications occurred in eight patients (35%), including postoperative pneumonia (n=3) and late bronchopleural fistula (n=2). Negative sputum culture conversion was achieved and maintained in all except two mortalities. Although it is associated with a relatively high complication rate, patients with NTM lung disease whose disease is localized to one lung and who can tolerate resectional surgery might be considered for surgery, if there has been poor response to drug therapy or if the patients develop significant disease-related complications such as hemoptysis.     

'Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular sperm'

Sir, I have read with great interest the article by Greco et al.,entitled ‘Efficient treatment of infertility due to spermDNA damage by ICSI with testicular spermatozoa’, publishedin the January issue of Human Reproduction. The study shows that DNA fragmentation levels (assessed by theTUNEL test) in testicular sperm from normozoospermic and oligozoospermicmales were significantly lower than those found in ejaculatedsperm from these same males (4.8±3.6 versus 23.6±5.1%,P<0.001). More     

Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa

BACKGROUND: Sperm DNA damage (fragmentation) is a recently discovered cause of male infertility for which no efficient treatment has yet been found. Previous findings have suggested that clinically relevant sperm DNA damage may occur at the post-testicular level. This study was undertaken to assess the clinical usefulness of ICSI with testicular spermatozoa in this indication. METHODS: The percentage of spermatozoa with fragmented DNA, assessed by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling assay, and ICSI outcomes were compared in two sequential attempts performed, respectively, with ejaculated and testicular spermatozoa in 18 men with increased sperm DNA fragmentation. RESULTS: The incidence of DNA fragmentation was markedly lower in testicular spermatozoa as compared with ejaculated spermatozoa. No differences in fertilization and cleavage rates and in embryo morphological grade were found between the ICSI attempts performed with ejaculated and with testicular spermatozoa. However, eight ongoing clinical pregnancies (four singleton and four twin) were achieved by ICSI with testicular spermatozoa (44.4% pregnancy rate; 20.7% implantation rate), whereas ICSI with ejaculated spermatozoa led to only one pregnancy which was spontaneously aborted. CONCLUSIONS: These data show that ICSI with testicular spermatozoa provides the first efficient assisted reproduction treatment option for men with high levels of sperm DNA damage.     

Successful treatment for leg ulcers due to hydroxyurea in a patient with chronic myelogenous leukaemia

A 51-year-old male who had intractable leg ulcers during treatment for chronic myelogenous leukaemia with hydroxyurea (HU) is reported. His leg ulcers were treated by application of tretinoin tocoferil (TT) ointment after surgical debridement; good results were obtained. Although stopping HU administration is vitally important, surgical debridement and TT application are effective for treating leg ulcers due to HU.     

Responsive treatment of pleural effusion due to probable tuberculosis infection

Early diagnosis of Mycobacterium tuberculosis disease is crucial for initiating treatment and interrupting disease transmission. In keeping with the pathophysiology of disease, bacteriological evidence in extra-pulmonary tuberculosis proves to be difficult. Clinical judgment and radiographic findings are important to establish diagnosis and to evaluate treatment response. A case of 27 year-old-male with shortness of breath and associated TB symptoms is reported. The tuberculin test was highly positive and chest X-ray showed massive right-lung pleural effusion. Pleural analysis showed exudates with high mononuclear cells (98%), protein level of 5.0 g/dL, glucose level of 87 mg/dL, and high LDH level (1240 IU/L). The acid-fast bacilli (AFB) tests were negative for pleural fluid and sputum. Cultures of fluid and sputum were also negative. After being treated adequately with non-specific treatment, which showed no improvement and having undergone pleural puncture for his treatment and diagnosis, the patient started to have antituberculosis treatment. His condition was improved significantly as shown by a serial of chest X-ray follow-up.