Multilocular cystic renal cell carcinoma in a child

Multilocular cystic renal cell carcinoma is an extremely rare condition in adults with no previous case reports in the pediatric age group. The authors report on an 8-year-old girl who underwent nephrectomy for a right-sided renal cystic disease because of extensive involvement of the kidney. Subsequent histopathologic examination findings showed presence of renal cell carcinoma in all the cysts. Awareness of this malignancy in a child is extremely important in the background of recent reports advocating conservative wait and watch management in unilateral renal cystic disease, which has similar clinical and imaging findings.     

Interrupted sutures at the hinge site to manage a free flap during laser in situ keratomileusis

Two patients developed free flaps intraoperatively during laser in situ keratomileusis. After excimer laser treatment was performed, the free flap was replaced, maintaining proper alignment. Interrupted sutures were placed superiorly at the intended hinge site to secure the free flap. The uncorrected visual acuity was 20/30 in the affected eyes of both patients after treatment. At the 6-month follow-up, there were no flap-related complications and there was no loss of best corrected visual acuity.     

Intratumoral administration of a 1,2-dimyristyloxypropyl-3- dimethylhydroxyethyl ammonium bromide/dioleoylphosphatidylethanolamine formulation of the human interleukin-2 gene in the treatment of metastatic renal cell carcinoma

BACKGROUND: Leuvectin (Vical Inc., San Diego, CA) is a gene transfer product in which a plasmid encoding the human interleukin-2 (IL-2) gene is complexed with the cationic lipid 1,2-dimyristyloxypropyl-3-dimethylhydroxyethyl ammonium bromide/dioleoylphosphatidylethanolamine (DMRIE/DOPE). In the current study, the authors investigated the safety and efficacy of in situ vaccination with Leuvectin in patients with metastatic renal cell carcinoma. METHODS: Thirty-one patients with metastatic renal cell carcinoma were treated with intratumorally administered Leuvectin at doses ranging from 0.75 to 4 mg. These patients subsequently were evaluated for response and for treatment-related toxicity. RESULTS: Treatment was well tolerated: no Grade 3 or 4 toxicities were observed in association with the study agent. Documented side effects included Grade 1 pain at the injection site (20%); mild (i.e., Grade 1 or 2) constitutional symptoms, including malaise/myalgia, low-grade fever, and chills (74%); Grade 1 fatigue (19%); Grade 1 or 2 nausea (10%); and Grade 2 allergy (1 occurrence). Two patients experienced partial responses, which endured for 32 months and 6 years, respectively, and 1 patient currently is experiencing a pathologic complete response, which, to date, has persisted for 50 months; thus, the overall response rate was 10%. In addition, 7 patients (23%) experienced disease stabilization for a median of 8 months (range, 4-48 months). The median duration of survival from the start of Leuvectin treatment was 11 months (range, 2-72 months), with a 1-year survival rate of 48% and a 3-year survival rate of 19%. Laboratory analysis of tumor samples revealed the presence of IL-2 plasmid DNA in six of eight patients posttreatment, increased IL-2 expression in tumor cells in four of eight patients posttreatment, and increased tumor infiltration by CD8-positive lymphocytes in five of eight patients posttreatment. CONCLUSIONS: Immunotherapy with intratumorally administered Leuvectin is safe and can lead to durable objective responses in patients with metastatic renal cell carcinoma.     

Prevalence of open-angle glaucoma in a rural south Indian population

PURPOSE: To determine the prevalence of primary open-angle glaucoma (POAG) and the associated risk factors in a rural population in southern India. METHODS: Subjects aged 40 years or more (n = 3934) underwent a complete ophthalmic examination. Glaucoma was diagnosed according to the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS: Complete data were available for 3924 subjects (response rate, 81.75%). In eyes with normal suprathreshold visual fields, the mean intraocular pressure was 14.29 +/- 3.32 mm Hg (97.5th and 99.5th percentiles, 21 and 25 mm Hg, respectively). The mean vertical cup-to-disc ratio was 0.39 +/- 0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8, respectively). Sixty-four subjects had definite POAG (1.62%, 9.5% CI 1.42-1.82); 30 were men and 34 were women. Subjects with POAG (59.85 +/- 10.43 years) were older (P < 0.001) than the study population (53.78 +/- 10.71 years). In only one (1.5%) person was POAG diagnosed before the study. Two (3.12%) subjects were blind due to POAG; 21 (32.81%) subjects had a presenting IOP >21 mm Hg, and 43 (67.19%) had an IOP <21 mm Hg. The mean central corneal thickness in subjects with POAG (502.82 +/- 35.29 microm) was not different from that of the normal study population (505.93 +/- 31.11 microm). No association was found with diabetes mellitus, systemic hypertension, gender, and myopia. Increasing IOP (per mm Hg) was associated with the disease (OR 1.12; 95% CI, 1.08-1.16). The odds for POAG increased with advancing age after adjustment for gender. CONCLUSIONS: The prevalence of POAG in this population was 1.62%. The prevalence increased with age, and 98.5% were not aware of the disease.     

A comparison of participants and non-participants in the Chennai Glaucoma Study-rural population

PURPOSE: To study whether the difference in the demographic characteristics of participants and non participants could result in biased prevalence estimates and associations. AIM: To compare the non-participant and participant characteristics, and to ascertain if non-response bias is present in the rural population of the Chennai Glaucoma Study (CGS). METHODS: Rural participants and non-participants were compared with regard to socio-demographic variables (age, gender, religion, mother tongue, literacy and employment). RESULTS: 4800 subjects aged 40 years or over were enumerated, 82% (3934: 45% male and 55% female) responded. Gender did not influence participation (adjusted OR-1.11, CI: .91-1.36). Subjects in the 70-79 year age group were more likely to respond (OR-1.76; CI-1.31-2.38). Hindus had a higher participation rate than Christians or Muslims (adjusted OR-2.63, CI: 1.80-3.84). The other predictors of participation were illiteracy (adjusted OR-1.44, CI: 1.22-1.70), unemployment (OR-1.28, CI: 1.04-1.58), place of residence (main villages) (OR-6.66, 95% CI: 4.6-9.64). CONCLUSION: Based on our study findings, it does not seem likely that participation bias will affect the study results.     

A phase I trial of celecoxib in combination with docetaxel and irinotecan in patients with advanced cancer

Purpose This phase I study was conducted to determine the safety, tolerability and maximum tolerated dose of the combination of celecoxib, a selective cyclooxygenase-2 inhibitor, with docetaxel and irinotecan, in patients with advanced solid tumors.Patients and methods Patients with solid tumors received one of three escalating dose levels of daily celecoxib in combination with docetaxel and irinotecan administered on days 1 and 8 of an every 21-day cycle. Toxicities were graded by the National Cancer Institute Common Toxicity Criteria (NCI CTC) and recorded as maximum grade per patient for each treatment cycle.Results A total of 19 patients received 90 cycles of treatment through three dose levels. Dose-limiting toxicities were nausea and diarrhea. The most common treatment-related toxicities in all cycles of treatment were alopecia, fatigue, diarrhea, nausea, vomiting, anemia, anorexia, and edema.. The maximum tolerated dose was established at celecoxib 400 mg twice a day continuously, weekly docetaxel 30 mg/m² and irinotecan 50 mg/m² for 2 weeks every 21 days. Disease stabilization (five or more cycles) was documented in eight patients.Conclusion The combination of celecoxib with docetaxel and irinotecan did not ameliorate irinotecan-induced diarrhea. Although prolonged disease stabilization was achieved in some patients, we do not recommend combining celecoxib with docetaxel and irinotecan because of lack of activity and the side effect profile of this combination.This work was supported by Grants from the Pfizer Corporation and Aventis Corporation.     

Autoimmune hemolytic anemia in patients infected with human immunodeficiency virus-1

Four men were diagnosed with human immunodeficiency virus infection (AIDS) and autoimmune hemolytic anemia (HIV-AIHA) during the years 1997-2000 at Cook County Hospital, Chicago. All patients presented with the acute onset of severe hemolytic anemia, fever, and splenomegaly. The direct and indirect antiglobulin tests were positive in all, and three patients had mixed warm and cold autoantibody hemolytic anemia. Two patients responded to prednisone therapy and remain in remission from AIHA for 15 and 30 months, respectively.     

Seasonal changes in calciotropic hormones, bone markers, and bone mineral density in elderly women

Seasonal variation of serum vitamin D metabolites, PTH, bone turnover markers, and bone mineral density (BMD), adjusted for confounding variables, was studied in a cross-sectional population of 251 ambulatory elderly women aged 65-77 yr. A significant (P < 0.05) seasonal change was observed in serum 25 hydroxyvitamin D (25OHD), bone resorption marker (urine N-telopeptide), and BMD of the spine, total body, and mid-radius. Serum 25OHD was significantly lower (P < 0.05) in winter (December, January, February, March) compared with summer (June, July, August, September), with the nadir in February (68.4 +/- 6.74 nmol/liter) and the zenith in August (85.6 +/- 5.12 nmol/liter). Mean serum PTH levels were higher in winter when serum 25OHD was low, and mean serum PTH was lower in summer when serum 25OHD was high, although the seasonal change in serum PTH was not significant. The change in serum 1,25-dihydroxy vitamin D(3) paralleled that of serum 25OHD levels, but the seasonal effect was not significant. Mean 24-h urine N-telopeptide showed a significant seasonal change (P < 0.05); it was about 24% higher in February (zenith) compared with that in August (nadir). The zenith month of urine N-telopeptide levels corresponded to the nadir month of serum 25OHD levels and vice versa. A significant (P < 0.05) inverse correlation was observed between 24-h urine N-telopeptides and serum 25OHD levels. There was a significant (P < 0.05) seasonal change in mean BMD of spine, total body, and mid-radius. These changes paralleled those in serum 25OHD levels. Spine BMD was 8.4% higher in August (zenith) compared with that in February (nadir), whereas total body BMD and mid-radius BMD were 6.1 and 7.6% higher, respectively, in July (zenith) compared with that in January (nadir). There was a nonsignificant increase of 3.6% in total hip BMD. In summary (see Fig. 5), the seasonal changes in vitamin D metabolism in elderly women are closely associated with small changes in serum PTH, changes in bone resorption, and BMD.