The impact of performance status on survival in patients of 80 years and older with vulvar cancer

OBJECTIVE: There are no data available on the impact of performance status on outcome in patients with vulvar cancer. It was the objective of this study to determine the impact of performance status on survival in a group of elderly patients. METHODS: A retrospective review of records of patients with vulvar cancer aged 80 years or greater and treated in a gynecological referral center was performed. Multiple clinical and pathological variables together with performance status were assessed and the impact on overall survival was determined both by univariate and multivariate analysis. RESULTS: Of 75 patients aged 80 years or older, 57 (76%) had standard treatment. The patients who had standard treatment were characterized by an earlier clinical stage and a better performance status compared with patients who had nonstandard treatment. When preoperatively available parameters of all patients were assessed in relation to survival in the total group, Eastern Cooperative Oncology Group (ECOG) performance status was the only independent prognostic indicator for survival. When all clinical and histopathological variables were assessed in the subgroup who had standard treatment, both ECOG performance status and extracapsular lymph node involvement were independent prognostic variables for overall survival. Age was not a significant prognostic variable. CONCLUSIONS: ECOG performance status is the only available pretreatment variable with independent prognostic value for survival in this group of elderly patients with vulvar cancer. These data show the importance of individualizing the treatment of patients with vulvar cancer. Performance status takes a more important place than age in the management process of these patients.     

Update in diagnosis and treatment of esophageal atresia

The paper present a number of 17 cases of esophageal atresia, hospitalised and operated in a period of 4 years (2001-2004). The authors are underlining the importance of the prenatal diagnosis, preoperative and postoperative care, the chance for primary anastomosis for type III A of the disease, complications and prognosis related to the type of atresia. Esophageal atresia is a success of a complex team where the role of the neonatologist and anesthesiologist, next to the surgeon, is very important.     

Coronal restoration with all ceramic inlay

We present a 29 years old female patient treated with an all ceramic inlay. The IPS Empress system has been used to make an optimal, esthetic and morpho-functional restoration. An inlay restoration is a biological prosthetic solution that is indicated as a proper treatment possibility for the young patients. The IPS Empress inlays are characterized by a good biomechanical behavior, law abrasion rate and perfect chromatic integration.     

Alcohol consumption and problems among road rage victims and perpetrators

OBJECTIVE: Road rage has generated public concern; however, data on the causes of this behavior have not been available. We examine the alcohol consumption correlates of road rage victimization and perpetration based on a population survey of adults. METHOD: Data are based on the 2001-2002 Centre for Addiction and Mental Health Monitor, a repeated cross-sectional telephone survey of Ontario adults aged 18 and older (N = 2,610). Logistic regression analyses were performed with drinking measures (Alcohol Use Disorders Identification Test [AUDIT] consumption, dependence and problems) and demographic factors as independent variables. RESULTS: In the past year, 44.4% of respondents reported that someone shouted, cursed or made rude gestures at them, 6.0% were threatened with damage to their vehicle or personal injury, and 5.2% had someone attempt to or actually damage their vehicle or hurt them. Over the same period, 32% admitted shouting, etc., at someone, 1.7% threatened someone, and 1.0% attempted to or actually did damage someone's vehicle or hurt someone. Univariate analyses revealed several significant relationships between road rage and alcohol measures. Multivariate analyses revealed that the AUDIT alcohol problems measure was most consistently associated with measures of road rage victimization and perpetration, including reporting attempting or actually hurting someone or attempting or actually damaging his or her vehicle. CONCLUSIONS: These data indicate there is a significant relationship between alcohol problems, as measured by the AUDIT, and road victimization and perpetration. Further work must be undertaken to identify the mechanisms involved.     

Rivastigmine (Exelon) for dementia in patients with Parkinson's disease

OBJECTIVES: To study the efficacy of cholinesterase inhibitors in the treatment of dementia in patients with Parkinson's disease (PD). METHODS: We treated twenty-eight demented patients with PD openly for 26 weeks with rivastigmine (mean daily dose 7.2 +/- 3.3 mg/day). Baseline scores were compared with those at weeks 12, 26 and after 8 weeks of washout. RESULTS: Twenty patients completed 26 weeks of treatment and eight dropped out because of side effects. The Unified Parkinson's Disease Rating Scale mental subscore improved significantly at week 26 (P < 0.01) while the motor score (part III) did not change. The mean ADAScog total score improved by 7.3 points at week 26 (P < 0.002). The subscores for recognition, word finding, remembering instructions and concentration items of the ADAScog improved significantly as well (P < 0.02, P < 0.05, P < 0.005 and P < 0.003, respectively). CONCLUSIONS: Rivastigmine may improve the cognitive functions in PD patients with dementia with no worsening of motor function.     

Esophagin and proliferating cell nuclear antigen (PCNA) are biomarkers of human esophageal neoplastic progression

PCNA and esophagin have been implicated in the multistep process of carcinogenesis, but simultaneous characterization of these proteins in the early stages of esophageal neoplastic progression has yet to be undertaken. In morphologically normal esophageal epithelium, esophagin stains the granular layer cells, principally in their cell membrane portions. PCNA, in contrast, stains the nuclei of cells in the parabasal and basal layers. We examined 201 regions from 47 patients that represented different stages of esophageal neoplasia, comprising 34 areas of normal mucosa, 18 of dysplasia in squamous epithelium (DYS/SC), 39 squamous cell carcinoma (SCCA), 29 areas of Barrett's esophagus, 48 of Barrett's dysplasia (DYS/BAR) and 33 areas of adenocarcinoma (AC). The immunostaining patterns of esophagin and PCNA were evaluated and graded for level of expression. There was loss of esophagin expression in the high- and low-grade dysplasias compared to normal epithelia. In the squamous dysplasias, there was more intense staining (of esophagin) in the atypical nuclei and superficial squamous epithelial cells than in the basal cells. PCNA staining was increased in intensity in the high-grade dysplasias relative to normal basal layer cells. Combined analysis of esophagin and PCNA appears to reveal an inverse relationship between proliferation and differentiation during esophageal neoplastic progression. Moreover, this combined staining approach also offers promise for detecting esophageal cancer in early, precancerous stages.     

Treatment of malignant gliomas: radiotherapy, chemotherapy and integration of new targeted agents

Progress in the biological and molecular characterization of gliomas and studies of factors associated with tumor growth and progression have led to translational research projects and the development of rational new approaches regarding prognostic models, better prediction of response to treatment and innovative therapeutic strategies. This review summarizes the available data on established and emerging prognostic factors and prognostic scores, and discusses their limitations as well as their potential influence on future therapeutic efforts. Recent developments in standard treatment options (i.e., surgery, radiotherapy and chemotherapy) are reviewed. Experimental data indicate that inhibition of several signaling pathways (e.g., epidermal growth factor, transforming growth factor-beta and phosphatidylinositol 3 kinase) may represent a promising therapeutic strategy. Some inhibitory agents (i.e., drugs, antibodies and antisense oligonucleotides) have now entered clinical trials, mainly for recurrent gliomas and a small number are being tested in combination with radiotherapy. Early results of such approaches are presented.     

RNA degradation precedes DNA cleavage in autoreactive CD4 T cells suppressed by calicheamicin gamma1

Calicheamicin gamma1 (Cal gamma1) is a hydrophobic enediyne antibiotic known to cleave the DNA and lead to apoptosis in a variety of cells. Herein, we show that Cal gamma1 exhibits a 1000-times stronger suppressogenic effect on antigen-specific (diabetogenic), and na?ve CD4 T cells than Doxorubicin (Dox), another strong apoptotic drug. The thymic precursors and mature T cells incubated with Cal gamma1 for only 30 min showed a drastic decrease or loss of cytokine production and proliferation following stimulation with the immunogenic peptide, or with CD3 and CD28 antibodies. The suppressogenicity of Cal gamma1 correlated with a rapid and non-selective degradation of RNA, whereas the DNA cleavage occurred at a later time point and at higher doses. Cal gamma1 may represent a potential therapeutic agent to eliminate self-reactive T cells in autoimmune diseases, providing that is delivered by antigen-specific T-cell ligands. Targeting of highly suppressogenic drugs such as Cal gamma1 to autoreactive T cells may reduce considerable the therapeutic dose and the drug-related side effects.