Control of aggressive fibromatosis by treatment with imatinib mesylate. A case report and review of the literature

Objective There has been only one report available that focuses on the treatment with imatinib mesylate of two individual persons with aggressive fibromatosis. The authors concluded that after long-term treatment, for 9 and 11 months, with imatinib mesylate, both patients demonstrated radiographic and clinical responses. The novel therapy should be considered as salvage in patients with aggressive fibromatosis expressed platelet-derived growth factor receptor—alfa, beta (PDGFR-alfa, PDGFR-beta), and/or c-kit, whose tumors are uncontrollable by the standard management. On the other hand, the number of kinases blocked by imatinib mesylate is notching up, for instance the tyrosine kinase, which is associated with macrophage-colony stimulating factor receptor (M-CSFR). Methods The patient was suffering from aggressive fibromatosis after prior therapy including surgery (R2), radiotherapy, and systemic treatment with combination of tamoxifen and sulindac. The tumor specimen was immunostained for PDGFR-beta and c-kit (CD117), and PDGFR-alfa and cytokines platelet-derived growth factor-alfa and beta were not assessed. The tests for both assessed molecules revealed negative results. In spite of this, the patient underwent a unique treatment with imatinib mesylate at the dose of 400 mg orally once daily for 3 years and 2 months. Results After three months of the therapy, radiographic (met criteria of SD but small decrease of the tumor was noted) and clinical responses were recorded for the first time. The same was seen after 6 and 13 months of therapy continuation with imatinib mesylate. Currently, the patient is treated with imatinib mesylate (400 mg orally once daily) without any toxicity effects. The last MRI revealed readily a smaller tumor (35 × 20 mm) after such a therapy lasted more than 3 years. Conclusions Treatment with imatinib mesyalte has been a well-accepted therapy for chronic myelagenous leukemia (CML) and gastrointestinal stromal tumors (GIST). There have been established four kinases (p210^bcr/abl, c-kit, PDGFR-alfa, PDGFR-beta) suggested as the target for imatinib mesylate. Other potential targets will be discovered as it has lately been determined that M-CSFR kinase activity was blocked by imatinib mesylate. The salvage therapy for aggressive fibromatosis with imatinib mesylate seems to be an attractive opportunity for patients with the advanced disease, whose prior therapy failed.     

Computed tomography angiography for visualisation of distal coronary arteries and selection for surgical revascularisation in a patient with acute myocardial infarction

Patients with symptomatic multivessel coronary artery disease rejected for coronary revascularisation have adverse prognosis. We describe a 61 year-old male with non-ST-elevation myocardial infarction who was considered unsuitable for coronary revascularisation based on the conventional angiography findings. Unlike conventional angiography, computed tomography angiography visualised distal coronary segments and the patient underwent successful coronary artery bypass grafting.     

Differences in cortical serotonergic innervation among humans, chimpanzees, and macaque monkeys: a comparative study

In this study, we assess the possibility that the evolution of human intellectual capacities was supported by changes in the supply of serotonin to the frontal cortex. To this end, quantitative comparative analyses were performed among humans, chimpanzees, and macaques. Immunohistochemical methods were used to visualize serotonin transporter-immunoreactive (SERT-ir) axons within the cerebral cortex. Areas 9 and 32 were chosen for evaluation due to their roles in working memory and theory of mind, respectively. Primary motor cortex was also evaluated because it is not associated with higher cognitive functions. The findings revealed that humans do not display a quantitative increase in serotonin innervation. However, the results indicated region- and layer-specific differences among species in serotonergic innervation pattern. Compared with macaques, humans and chimpanzees together displayed a greater density of SERT-ir axons relative to neuron density in layers V/VI. This change was detected in cortical areas 9 and 32, but not in primary motor cortex. Further, morphological specializations, coils of axons, were observed in humans and chimpanzees that were absent in macaques. These features may represent a greater capacity for cortical plasticity exclusive to hominoids. Taken together, these results indicate a significant reorganization of cortical serotonergic transmission in humans and chimpanzees.     

DNA variation in MSR1, RNASEL and E-cadherin genes and prostate cancer in Poland

INTRODUCTION: We investigated whether or not inherited variation in MSR1, RNASEL and E-cadherin contribute to prostate cancer risk in Poland. MATERIAL AND METHODS: We sequenced the coding region of these three genes in individuals from Poland and identified five common DNA variants (R462Q and D541E in RNASEL, R293X and P275A in MSR1, and 2076C>T (A692A) in E-cadherin). These five variants and the -160C>A promoter change in E-cadherin were genotyped in 737 prostate cancer cases and 511 controls. RESULTS: The frequencies of genotyped variants in MSR1, RNASEL and E-cadherin genes in cases and controls were similar. We did not see any association for the studied variants when cases were stratified by age of diagnosis, by family history, by prostate-specific antigen level at the time of diagnosis, by Gleason sore or by tumor stage. CONCLUSIONS: Inherited variation in RNASEL, MSR1 and E-cadherin genes do not seem to contribute to prostate cancer development in Poland.     

Pressure induced nucleus DNA fragmentation

Purpose  

The present study was designed to investigate the impact of pressure on nuclear DNA integrity in viable cells of mouse blastocysts.     

Fibula free flap for mandible reconstruction: analysis of 30 consecutive cases and quality of life evaluation

The objectives of this study were to evaluate the use of fibula free flaps (FFF) for mandible reconstruction in patients with oral cavity cancer and to assess the quality of life (QOL) of the patients who underwent reconstructive surgery. Thirty patients with T(3), T(4) oral cavity carcinoma underwent surgical resection of the primary tumor infiltrating the mandible or primarily originating from the mandible. According to the length (less or more than 8 cm) and localization (anterior or posterior) of the mandibular defect, patients were subdivided into four groups. In all cases an osseoseptocutaneous FFF was chosen for postresective defect reconstruction. To reconstruct anterior mandibular defects, two osteotomies were needed to give the fibula a proper shape. For extended defects, the fibula usually required more than one osteotomy. Skin islands were designed based on Doppler cutaneous perforator findings. The fibular free skin islands remained viable in all patients and no partial or total skin loss was observed. In the majority of patients (87 percent) the facial artery was used for arterial anastomosis. In 6 month follow-ups, the QOL was evaluated as very good except for socioeconomic items. Pain was mild and incidental. Appearance and subjective feeling scores were excellent in two groups with mandibular defects smaller than 8 cm, although in patients with larger defects, they were still very good. Functional effects remained good, and they correlated with the size of defects. In contrast, social activities, recreation, and employment were below patients' expectations and generally reflected the current situation in Poland, but no correlation with the results of reconstruction was found. The present results show that osseocutaneous fibula free flap used in reconstructive surgery for cancer of the oral cavity allows more radical and aggressive resection with very good or excellent functional and aesthetic outcome. Estimated QOL seems an important part of evaluation of the treatment outcome.     

The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer—a cross-sectional study

BackgroundPneumonectomy is a high-risk radical resection procedure, with bronchopleural fistula (BPF) being its most challenging and severe complication. This study aimed to assess the surgical risk factors and the impact of the bronchial stump closure technique on the incidence of the BPF.MethodsThis is a single-center, cross-sectional study of the medical records of 455 post-pneumonectomy patients operated due to non-small cell lung cancer (NSCLC) in 2006–2017. We analyzed the following variables and their influence on the occurrence of the BPF: operation side, surgical techniques (i.e., manual suture or the stapler), stump buttressing, the extension of pneumonectomy, comorbidities, and postoperative complications.ResultsBPF occurred in 7.47% of post-pneumonectomy patients. BPF was more prevalent in right-sided pneumonectomy versus left-sided (10.98% vs. 5.32%; P=0.026). The use of a stapler or manual suture was not associated with the incidence of the BPF (7.96% vs.7.09%, P=0.72). There were no significant differences in the occurrence of BPF among bronchial stump buttressing with the parietal pleura (P=0.80), intercostal muscle flap (IMF) (P=0.46), and pericardial fat pad (P=0.88). When comparing data from 2006–2012 with those from 2013–2017, we found a steady decrease in the number of performed stump reinforcements, but this was not associated with a higher risk of BPF.ConclusionsThe method used for stump closure, additional tissue buttressing of the bronchial stump and year of the surgery had no significant impact on the occurrence of BPF. Only right-sided pneumonectomy was associated with higher BPF occurrence.     

Gender differences and bleeding complications after PCI on first and second generation DES

Background. The aim of this study was to evaluate gender differences in the long-term clinical outcomes and safety of patients treated with first- and second generation DES. Methods. The Katowice–Zabrze Registry included 1916 consecutive patients treated with either first or second generation DES. We evaluated major adverse cardiac and cerebrovascular events (MACCE) [composite of death, myocardial infarction (MI), stroke and target vessel revascularization (TVR)] at 12-month follow-up. Safety end point was bleeding complications and stent thrombosis. Results. Registry included [unstable angina (UA) 1500(78%), non-ST-segment elevation myocardial infarction (NSTEMI) 285 (15%), ST-segment elevation myocardial infarction/left bundle branch block (STEMI/LBBB) 131 (7%)]. There were 35.5% females and 64.5% males. Women were older and had higher prevalence of comorbidities. Males more often had multivessel disease and higher Syntax score when comparable to females. We did not observed difference in acute and subacute stent thrombosis in our data, however, females had more in-hospital bleeding complications. Univariable Cox regression analysis revealed that women had similar outcomes when compared to men in terms of a risk of death, MI, TVR, stroke and MACCE at 1-year follow-up. There were no differences between males and females in MACCE when first- and second generation DES were analyzed separately. Conclusion. Despite higher risk profile, women treated with DES have similar outcomes as males in 1-year follow-up. However there is, an increased risk of in-hospital bleedings in women.     

The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

Objective

To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population.

Methods

We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded.

Results

The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects.

Conclusions

IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.