Results of plasma N-terminal pro B-type natriuretic peptide and cardiac troponin monitoring in GIST patients do not support the existence of imatinib-induced cardiotoxicity

Background: Recently, case reports of patients treated withimatinib (imatinib mesylate; Gleevec®; Glivec®) indicatedthat this tyrosine kinase inhibitor may induce cardiomyopathy.Consequently, careful cardiac monitoring was advocated for clinicalstudies. The purpose of this study was to prospectively evaluatewhether imatinib (Gleevec) induces early, subclinical, cardiactoxicity. Patients and methods: History and physical examination werecarried out with special attention for symptoms of heart failure.Additionally, assessments of serial plasma N-terminal pro B-typenatriuretic peptide (NT-proBNP) and serum cardiac troponin T(cTnT) measurement before and 1 and 3 months after the startof imatinib treatment (400–800 mg daily) were done inpatients with advanced and/or metastatic gastrointestinal stromaltumours (GIST). Results: A total of 55 GIST patients were enrolled. Only onepatient, with a normal pretreatment NT-proBNP, showed an increasein NT-proBNP to above age-specific normal values during imatinibtreatment and developed symptomatic heart failure due to pre-existentcardiac valvular disease. cTnT levels remained stable. Conclusions: In our study population, imatinib treatment forGIST was not associated with an increase in plasma NT-proBNPlevels, indicating that the risk of subclinical cardiac toxicityis limited with the use of this agent. These results do notsupport the current strategy to standard cardiac monitoringin all patients. This may be restricted to GIST patients witha history of cardiac disease. Key words: cardiotoxicity, GIST, imatinib mesylate, NT-proBNP, troponin T Received for publication August 15, 2007. Revision received August 24, 2007. Accepted for publication August 29, 2007.     

Latanoprost-associated recurrent herpes simplex keratitis

PURPOSE/METHOD: We present a case of a patient who developed recurrent epithelial herpes simplex keratitis after starting treatment with latanoprost. Her ophthalmic history was only remarkable for a past episode of herpetic keratitis 21 years previously. RESULTS/CONCLUSIONS: Episodes of herpetic keratitis were under remission only when latanoprost was discontinued. No recurrences of herpes simplex keratitis have been observed since then. Latanoprost usage might be associated with recurrent episodes of herpes simplex keratitis in patients with previous history of ocular herpes simplex virus infection.     

Peripheral multineuritis pointing at systemic sarcoidosis

We report a patient with a peripheral neuropathy as the first symptom of sarcoidosis. The systemic illness was proved by the presence of typic granulomes in the bone marrow. The fact that sarcoidosis is the cause for the neuropathy is supported by the temporary relation and by the good response of all clinical picture to the corticosteroid therapy.Sarcoid neuropathy can rarely be the presenting feature of sarcoidosis.     

山苍子水提物柠檬醛抗哮喘作用的实验研究

目的：研究山苍子水提物柠檬醛的抗哮喘作用及其机理。方法：通过豚鼠氯化乙酰胆碱-磷酸组胺喷雾致喘法、小鼠浓氨水喷雾引咳法、小鼠酚红排泻法观察柠檬醛的平喘、镇咳、祛痰作用，通过观察张力变化研究柠檬醛对豚鼠离体气管环张力的影响及乙酰胆碱对气管收缩的抑制作用。结果：柠檬醛能明显延长氯化乙酰胆碱-磷酸组胺喷雾引起的豚鼠哮喘潜伏期，能延长浓氨水喷雾诱发小鼠咳嗽反应潜伏期，明显减少咳嗽次数。能增加小鼠呼吸道酚红排泌量，能抑制乙酰胆碱对豚鼠离体气管平滑肌的收缩作用，使乙酰胆碱所致气管平滑肌量效曲线右移。结论：柠檬醛气雾剂具有一定的平喘、镇咳和祛痰作用，具有良好的支气管解痉作用。     

Routine chest X-rays have no additional value in the detection of relapse during routine follow-up of patients treated with chemotherapy for disseminated non-seminomatous testicular cancer.

BACKGROUND: The routine follow-up of patients with disseminated non-seminomatous testicular cancer (DNSTC) treated with the combination of orchidectomy, polychemotherapy, and if needed, resection of the residual mass, consists of regular physical examinations, chest X-rays (CXR) and tumor marker assessments. Most guidelines for this routine follow-up originate from multi-center trials. In order to estimate the value of CXR in the detection of tumor relapse after complete remission, we reviewed all patients with disseminated testicular cancer treated with chemotherapy at the University Hospital Groningen. PATIENTS AND METHODS: Three hundred and fifty-three consecutive patients with DNSTC treated between February 1977 and February 1999 at our institution were reviewed. Two hundred and ninety (82.2%) patients, who were in complete remission after cisplatin-containing chemotherapy followed by, if necessary, resection of the residual mass, entered this analysis. The follow-up schedule consisted of regular physical examinations, tumor marker assessment (lactate dehydrogenase, beta-human chorionic gonadotropin and alpha-FP) and CXR. In all patients the first diagnostic sign of tumor relapse was documented. RESULTS: During a median follow-up of 107 months (range 8-261) a tumor relapse was documented in 33 patients (11.4%). Median time to relapse was 17 months (range 6-179) after the start of chemotherapy. In 27 patients, tumor relapse was first detected by a rise in tumor markers. Two patients presented their relapse with neurological complaints. Both were diagnosed with brain metastasis. In four patients the relapse was detected by both increase in tumor markers and abnormalities in the physical examination. In none of the 33 relapsed patients was routine CXR during follow-up involved in the detection of tumor recurrence. All but one of the relapsed patients had elevated tumor markers before the start of chemotherapy. The total number of CXR made during follow-up in all 290 patients was 10 160; none were diagnostic for the detected relapses. CONCLUSIONS: These data suggest that routine CXR has no additional value in the detection of tumor relapses during follow-up after chemotherapy in the subset of patients who present their DNSTC with increased tumor markers and are in complete remission after treatment. In order to save valuable resources, CXR can be omitted from the follow-up schedule after chemotherapy for marker-positive non-seminomatous testicular cancer in complete remission.     

Variability of results of cavernous nerve stimulation during radical prostatectomy

PURPOSE: We assess the reliability of intraoperative cavernous nerve stimulation for producing an erectile response during radical prostatectomy. MATERIALS AND METHODS: In 61 patients cavernous nerve function was assessed during radical retropubic prostatectomy using a CaverMap nerve stimulator. Control stimulation was also performed before and after prostatic dissection by placing the nerve stimulator tip on the anterior bladder wall. An increase in penile circumference measured by the device was considered a tumescence response while any measurable detumescence was also categorized. RESULTS: Patient age ranged 43 to 72 years (mean 59.8). Before apical dissection 41% and 46% had tumescence, 31% and 21% had detumescence, and 28% and 33% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. After dissection 42% and 25% had tumescence, 16% and 18% had detumescence, and 42% and 57% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. CONCLUSIONS: A response to neurovascular bundle stimulation using this device does not necessarily correlate with the precise anatomical location of the cavernous nerves. There is considerable background variability related to anesthesia, surgical manipulation and other undefined factors that may cause minor but measurable changes in penile circumference.     

胃肠道、食管、腹膜后、腹腔干、颈部多发血管瘤1例

湘雅三医院消化科近年收治1例胃肠道、食管、腹膜后、腹腔干及颈部多发血管瘤患者,对其给予食管、胃血管瘤套扎及鱼肝油酸钠注射治疗,出院后随访,患者一般情况可.因本病罕见,现将其报告如下.