Metachronous metastases from renal cell carcinoma to uterine cervix and vagina: case report and review of literature

BACKGROUND: Although renal cell carcinoma (RCC) is characterized with unpredictable clinical presentation, multiple genital tract metastases are still surprising and mode of spread is obscure. CASE: We report a case of RCC metastases to uterine cervix and vagina 1 year after radical nephrectomy in a 19-year-old virgin. To our knowledge, this case is the second youngest patient with RCC metastasis to vagina, and also third patient with RCC metastasis to uterine cervix. CONCLUSION: Detection of genital lesion may precede diagnosis of RCC. The primary renal tumor was mostly left sided. Retrograde venous extension seems to be the most plausible mode of spread. Limited total experience and variability in therapeutic approach prevent generalizations regarding prognosis, optimal treatment and survival.     

Fixed eruption caused by ciprofloxacin without cross-sensitivity to norfloxacin

We report the case of a female patient who presented fixed exanthema following administration of ciprofloxacin. To our knowledge, only one case of fixed exanthema in response to this agent has appeared in the literature, and it was associated with cross-sensitivity to norfloxacin.     

Can micronucleus technique predict the risk of lung cancer in smokers?

Smoking is the main etiological factor in the carcinogenesis process of lung cancer. But genetically defined factors such as increased levels of oxidase enzymes or chromosome aberrations have been shown to correlate with the higher possibility of contracting lung cancer among smokers. In this study, chromosome aberrations measured by micronucleus (MN) technique following in vitro irradiation were investigated in peripheral blood lymphocytes of long term smokers with or without lung cancer. Our aim is to establish the role of MN scores in identifying the individuals who might develop cancer among smokers. Twelve lung cancer patients and appropriately matching 10 healthy controls were evaluated. Spontaneous and radiation induced MN frequencies were evaluated in the two groups. An increase in the amounts of MN after 3 Gy irradiation was observed in the patient and control group when compared to spontaneous frequencies. Absolute MN frequencies as a determinant of radiosensitivity were calculated by subtraction of spontaneous aberration frequencies from the frequencies that were obtained following 3 Gy of irradiation. Absolute MN frequency range was between 0.0116 and 0.3883 with the average value of 0.1114 +/- 0.0390 (SE) for the lung cancer patients, and was between 0.0216 and 0.2291 with the average value of 0.1410 +/- 0.0234 (SE) for the controls. When the comparison was made between the absolute MN frequencies of both groups, there was no difference (p=0.159) between the two groups. In our study, it can be concluded that radiation induced MN scores in peripheral blood lymphocytes of long term smokers do not predict the risk of lung cancer.     

Alpha,beta-unsaturated lactones 2-furanone and 2-pyrone induce cellular DNA damage,formation of topoisomerase I- and II-DNA complexes and cancer cell death

The alpha, beta-unsaturated lactones 2-furanone and 2-pyrone are part of the chemical structure of a variety of naturally occurring compounds (e.g., cardenolides, bufadienolides, acetogenins, coumarins, and food-flavoring furanones), some of which have shown anticancer activity and/or DNA damaging effects. Here we report that 2-furanone and 2-pyrone induce cellular DNA damage (assessed by the comet assay and the gamma-H2AX focus assay) and the formation of topoisomerase I- and topoisomerase II-DNA complexes in cells (visualized and quantified in situ by the TARDIS assay). Cells mutated in BRCA2 (deficient in homologous recombination repair) were significantly hypersensitive to the cytotoxic activity of 2-pyrone, therefore suggesting that BRCA2 plays an important role in the repair of DNA damage induced by this lactone. Both lactones were cytotoxic in A549 lung cancer cells at lower concentrations than in MRC5 non-malignant lung fibroblasts. The possible involvement of 2-furanone and 2-pyrone in the anticancer and DNA-damaging activities of compounds containing these lactones is discussed.     

In vivo anti-ulcerogenic effect of okra (Abelmoschus esculentus) on ethanol-induced acute gastric mucosal lesions

Context: Okra, Abelmoschus esculentus (L.) (Malvaceae), is a medicinal plant widely used in Turkish traditional medicine for the treatment of various diseases such as ulcers and gastritis.

Objective: In the present study, we evaluated the gastroprotective effect of okra against ethanol-induced acute gastric mucosal injury in animal models.

Materials and methods: Wistar rats were treated with 500, 250 or 100?mg/kg okra; 20?mg/kg famotidine (Fam); and 75?mg/kg quercetin (Que). Following a 60?min period, all the rats were given 1?mL of ethanol (80%). One hour after the administration of ethanol, all groups were sacrificed.

Results: At 5000?mg/kg, the extract produced (okra) no signs of toxicity in animals. Okra 500, 250, 100, Fam 20 and Que 75 inhibited ulcer formation by 81.0, 67.5, 67.0, 76.3 and 72.4%, respectively. Okra 500 significantly decreased edema, hemorrhage and inflammation scores compared with the ethanol group (p?p?p?p?Discussion and conclusions: Our in vivo data indicate that okra has a gastroprotective effect against ethanol and could reduce the gastric ulcer as seen from biochemical and histopathological results. We suggest that okra could be a possible therapeutic antiulcer agent.     

Follow-up of aspirin-resistant patients with end-stage kidney disease

Background

Aspirin resistance is defined by platelet function testing and presumed clinical unresponsiveness to aspirin. Aspirin-resistant patients are at a greater risk of clinically important adverse cardiovascular events. We aimed to investigate whether end-stage renal disease patients with aspirin resistance are at increased risk for long-term major adverse clinical events.

Methods

We prospectively enrolled 78 end-stage renal disease patients between January 2008 and November 2008. The effect of aspirin on platelet functions was determined using a new generation impedance aggregometer (Multiplate analyser, Dynabyte Medical, Munich). The primary end-point was the composite of death, myocardial infarction, unstable angina, or cerebrovascular accident. Mean follow-up was 20.7 ± 6.1 months.

Results

Of the patients studied, 34 (43.58 %) were aspirin resistant and 44 (56.42 %) were not aspirin resistant. Among patients who were aspirin resistant, 13 of 34 (38.2 %) experienced death, MI, or CVA, compared to 7 of 44 (15.9 %) patients who were not aspirin resistant (p = 0.034). Multivariate analyses identified aspirin resistance to be independently associated with major adverse long-term outcomes ([HR] 2.722; 95 % CI, 1.068–6.942; p = 0.04).

Conclusion

This study demonstrates that end-stage kidney disease patients resistant to aspirin are at a greater risk of long-term major adverse events than patients who are sensitive to aspirin.     

Does postoperative radiotherapy provide any survival advantage over observation in stage IC endometrial cancer after comprehensive surgical staging?

ObjectiveTo compare postoperative radiotherapy and observation for survival and recurrence rates in stage IC endometrial carcinoma patients who underwent comprehensive surgical staging.Study designFifty-seven stage IC endometrial cancer patients who underwent surgical staging were included in this study. Twenty cases (35%) received postoperative radiotherapy and 37 (65%) were observed without additional therapy. The two groups were compared for survival and recurrence rates.ResultsMean follow-up times for the radiotherapy and observation groups were 52.05 and 38.71 months, respectively. Five-year disease-free survival rates for the radiotherapy and observation groups were 91% and 63%, respectively, and 5-year overall survival rates for the radiotherapy and observation groups were 90.0% and 80.8%, respectively. Both the disease-free and overall survival rates were similar between the two groups (p > 0.05). One (5%) of the 20 patients in the radiotherapy group, and four (10.8%) of the 37 patients in the observation group had recurrences and there was no statistical difference for the recurrence rates (p > 0.05). Disease grade had no prognostic significance in terms of survival after surgical staging.ConclusionsComprehensive surgical staging might minimize the unfavorable role of deep myometrial invasion and grade. After surgical staging, postoperative observation without radiotherapy may be an appropriate approach in stage IC, all grades, endometrial carcinoma.     

Radiation-associated extraskeletal osteosarcoma of the chest wall

Radiation-associated sarcoma is a rare but potential complication of radiation therapy. Most reported cases of osteosarcoma of the chest wall following radiation therapy for breast cancer arise from the chest wall skeletal structures. In contrast, few cases of extraskeletal osteosarcomas have been reported. We report a rare example of an extraskeletal osteosarcoma involving the pectoralis major muscle occurring after radiation therapy for breast cancer. Extraskeletal osteosarcomas are rare soft tissue tumors with a high rate of local recurrence and a poor prognosis.     

The mycotoxin ochratoxin A inhibits DNA topoisomerase II and induces polyploidy in cultured CHO cells

Ochratoxin A (OTA), a known nephrotoxin and carcinogenic mycotoxin, was investigated to examine its effectiveness to induce cytotoxicity and DNA damage (Comet assay), as well as its possible inhibition of topoisomerase II (topo II) catalytic activity in cultured Chinese hamster ovary (CHO) cells. The analysis of OTA-induced DNA strand breaks as well as the flow cytometric assessment of polyploidy has provided evidence that is consistent with the idea of a mixed mode of action of the mycotoxin: in addition to its genotoxic activity, OTA may also interfere with chromosome distribution during cell division.