Basal cell carcinoma of trunk and extremities

Background Basal cell carcinoma is the most common malignancy in Caucasians. Information about basal cell carcinoma in the Mexican population is scarce. Objective To determine the epidemiologic and clinical characteristics and treatment results of basal cell carcinoma located on the trunk and extremities of patients seen at the Institute Nacional de Cancerología of Mexico. Methods A retrospective study was performed of patients with confirmed diagnosis of basal cell carcinoma located on the trunk and extremities seen at the Institute Nacional de Cancerología of Mexico between 1966 and 1993. Results Ninety-one patients with basal cell carcinoma located on the trunk and extremities were found (6% of all patients with diagnosis of basal cell carcinoma). The median age was 64 years; 52% of the patients were women and 48% were men. A total of 119 basal cell carcinomas at these locations were diagnosed. The size of the skin tumor ranged from 0.3 to 22 cm (mean, 3.9 cm). Treatment results were evaluated in 62 patients (follow-up ranged from 24 to 240 months; mean, 80 months). Overall tumor control was accomplished in 95% of cases. Three patients died as a result of basal cell carcinoma. Conclusions Basal cell carcinoma in the Mexican population is not as infrequent as previously thought, although it is less commonly located on the trunk and extremities than in Caucasians.     

Unique Morphological Variations of Transient Midventricular Syndrome: A Case Series‐Review

Older individuals (especially women) enduring an inciting emotional or physical event are prone to developing left ventricular ballooning syndrome. Ballooning of apical distribution is the most common type. However, a midventricular variant is increasingly reported. As this variant becomes further delineated, we describe a case series in which various morphological patterns of midleft ventricular segments are seen. Each case involves a female patient with a presumptive diagnosis of acute coronary syndrome, who upon further cardiac workup demonstrated normal epicardial coronary blood flow. Subsequent cardiac imaging, including transthoracic echocardiography, revealed unique midventricular dilation and akinesis, with preserved or hypercontractility of the basal and apical segments. However, more unique to this, was the fact that the left ventricular regional wall motion abnormalities were of either “symmetric” ballooning morphology, involving all mid segments of the left ventricle; or more dramatically, “asymmetric” ballooning morphology, which involves abnormal regional motion of only a focal left ventricular wall. Furthermore, we review current literature on midventricular ballooning and propose likely mechanisms and optimal treatment strategies in the face of potential complications of midventricular ballooning syndrome.     

Gastric atrophy and extent of intestinal metaplasia in a cohort of Helicobacter pylori-infected patients

Atrophy and intestinal metaplasia (IM) are preneoplastic gastric lesions associated with Helicobacter pylori infection. Atrophy and IM are usually found together; however, the association between increasing degrees of severity of both atrophy and IM has not been evaluated completely. Two pathologists graded atrophy and IM using the visual analog scale of the Sydney classification in gastric biopsies from 368 H pylori-infected patients. Extent of IM also included determining the number of specimens affected. We then correlated the degree of atrophy with the degree and number of specimens affected with IM by calculating relative risks (RR) and 95% confidence intervals (95% CI). The mean number of biopsies examined from each patient was 6.5. Atrophy and IM were found more frequently in the antrum (85% and 75% of biopsies, respectively). One hundred thirty-eight patients had a combination of atrophy and IM, 48 had IM only, and 89 had atrophy only. Fifty-three subjects had mild atrophy and IM (RR = 1.57; 95% CI 1.2-2.1), 69 had moderate atrophy and IM (RR = 1.86; 95% CI 1.9-2.4), and 16 had marked atrophy and IM (RR = 2.47; 95% CI 1.8-3.3). The median number of biopsy specimens with IM increased from 0 in subjects with no atrophy to 3 in subjects with severe atrophy. The degree of IM correlated with the degree of atrophy; the median degree was 0.6 in subjects with no atrophy and increased to 2.32 in those with severe atrophy. Our data suggest that higher degrees of IM in an individual specimen and increasing number of specimens with IM are associated with moderate or severe degrees of atrophy.     

Autopsy: reflection of intrahospital mortality

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.     

Efficacy and tolerability study of ciclesonide nasal aerosol in patients with perennial allergic rhinitis

A new nasal aerosol solution formulation of ciclesonide containing a hydrofluoroalkane propellant (CIC-HFA) delivered via a metered-dose inhaler is currently in clinical development as a potential treatment for allergic rhinitis (AR). This study evaluated the efficacy and tolerability of CIC-HFA 74- or 148-microgram doses compared with placebo in patients with perennial AR (PAR). Patients ≥12 years of age with a ≥ 2-year history of PAR were randomized in a placebo-controlled, double-blind, parallel-group, multicenter study to CIC-HFA 74 micrograms, CIC-HFA 148 micrograms, or placebo q.d. in the morning (A.M.) for 26 weeks. Change from baseline in reflective total nasal symptom score (rTNSS), instantaneous total nasal symptom score (iTNSS), and rhinoconjunctivitis quality-of-life questionnaire with standardized activities (RQLQ[S]) in patients with baseline RQLQ of ≥3.00 were evaluated for the first 6 weeks of treatment. Treatment-emergent adverse events (TEAEs) were monitored throughout the study. Eleven hundred eleven patients were randomized. CIC-HFA 74- and 148-microgram doses showed statistically significant improvements in rTNSS (least squares [LS] mean change, 0.70 and 0.54, respectively; p ≤ 0.001 versus placebo for both), iTNSS (LS mean change, 0.58 and 0.42, respectively; p < 0.05 versus placebo for both), and RQLQ[S] (LS mean change, 0.55 and 0.37, respectively; p < 0.01 versus placebo for both) from baseline. The overall incidence of TEAEs was comparable between the CIC-HFA treatment groups and placebo. In this study, once-daily treatment with CIC-HFA 74- or 148-micrograms showed statistically significant improvements in nasal symptoms of PAR. Both doses were well tolerated. Clinical trial registration URL and registration number: www.clinicaltrials.gov/ct2/show/NCT00953147.     

Increased sensitivity to testicular toxicity of transplacental benzo[a]pyrene exposure in male glutamate cysteine ligase modifier subunit knockout (Gclm-/-) mice

Polycyclic aromatic hydrocarbons (PAHs), like benzo[a]pyrene (BaP), are ubiquitous environmental pollutants formed by the incomplete combustion of organic materials. The tripeptide glutathione (GSH) is a major antioxidant and is important in detoxification of PAH metabolites. Mice null for the modifier subunit of glutamate cysteine ligase (Gclm), the rate-limiting enzyme in GSH synthesis, have decreased GSH concentrations. We investigated the effects of Gclm deletion alone on male fertility and spermatogenesis and its effect on the sensitivity of male embryos to the transplacental testicular toxicity of BaP. Gclm-/- males had dramatically decreased testicular and epididymal GCL enzymatic activity and total GSH concentrations compared with Gclm+/+ littermates. Ratios of reduced to oxidized GSH were significantly increased in Gclm-/- testes. GSH reductase enzymatic activity was increased in Gclm-/- epididymides. We observed no changes in fertility, testicular weights, testicular sperm head counts, or testicular histology and subtle changes in cauda epididymal sperm counts, motility, and morphology in Gclm-/- compared with Gclm+/+ males. Prenatal exposure to BaP from gestational day 7 to 16 was dose dependently associated with significantly decreased testicular and epididymal weights, testicular and epididymal sperm counts, and with vacuolated seminiferous tubules at 10 weeks of age. Gclm-/- males exposed prenatally to BaP had greater decreases in testicular weights, testicular sperm head counts, epididymal sperm counts, and epididymal sperm motility than Gclm+/+ littermates. These results show no effects of Gclm deletion alone on male fertility and testicular spermatogenesis and subtle epididymal effects but support increased sensitivity of Gclm-/- males to the transplacental testicular toxicity of BaP.     

Critical review of the evidence for a causal association between exposure to asbestos and esophageal cancer

Abstract

Esophageal cancers comprise about 1% of all cancers diagnosed in the US but are more prevalent in other regions of the world. Several regulatory agencies have classified asbestos as a known human carcinogen, and it is linked to multiple diseases and malignancies, including lung cancer and mesothelioma. In a 2006 review of the epidemiological literature, the Institute of Medicine (IOM) did not find sufficient evidence to demonstrate a causal relationship between asbestos exposure and esophageal cancer. To reevaluate this conclusion, we performed a critical review of the animal toxicological, epidemiological, and mechanism of action literature on esophageal cancer and asbestos, incorporating studies published since 2006. Although there is some evidence in the epidemiological literature for an increased risk of esophageal cancer in asbestos-exposed occupational cohorts, these studies generally did not control for critical esophageal cancer risk factors (e.g. smoking, alcohol consumption). Furthermore, data from animal toxicological studies do not indicate that asbestos exposure increases esophageal cancer risk. Based on our evaluation of the literature, and reaffirming the IOM’s findings, we conclude that there is insufficient evidence to demonstrate a causal link between asbestos exposure and esophageal cancer.     

Prolonged neoadjuvant treatment plus GM-CSF in locally advanced breast cancer: clinical and biological concepts

Results of standard multimodality treatment for locally advanced breast cancer (LABC) are still disappointing, due to a persistent high risk of relapse and death with longer-term follow-up. Increasing knowledge of tumour immunology provides the basis for new strategies in clinical trial design. Chemotherapy reduces tumor mass and tumor-derived immunosuppressive factors and, at the same time, causes release of tumor antigens; thereby favouring immune activation. An intermediate high-dose chemotherapy schedule with doxorubicin and cyclophosphamide, in combination with granulocyte-macrophage colony stimulating factor (GM-CSF) has been developed. Long-term neoadjuvant application of this regimen may overcome the dysfunction of the immune system and help to eradicate the tumor. Furthermore, tumor-derived antiangiogenic factors might inhibit outgrowth of micrometastases. This review aims to discuss current experience with LABC treatment, taking into account therapeutic alternatives and biological concepts tested in an international phase III trial; the Spinoza Trial.