Unexpected rapid progression of metastatic adenoid cystic carcinoma during treatment with imatinib mesylate

BACKGROUND: There is a lack of effective treatment for metastatic adenoid cystic carcinoma (ACC), a usually indolent tumor. We studied the efficacy of imatinib mesylate, a potent inhibitor of KIT tyrosine kinase, in patients with KIT-positive metastatic ACC. METHOD: Five patients with lung metastasis were treated in a pilot study with imatinib 400 mg by mouth twice a day. Mutations of c-kit and platelet-derived growth factor receptor (PDGFR)-alpha in tumors from these patients were analyzed. RESULTS: Disease progression was noted in three of five patients during the short treatment periods, ranging from 2 to 3 weeks. Three patients died of disease within 6 months. No detectable mutations were found in c-kit and PDGFR-alpha. CONCLUSION: We observed an unexpected high progression rate of metastatic ACC within short periods during imatinib treatment. Use of imatinib to treat cancers without c-kit or PDGFR-alpha mutation should be approached with caution.     

Effects of acoustic noise on the auditory nerve compound action potentials evoked by electric pulse trains

This study investigated the effects of acoustic noise on the auditory nerve compound action potentials in response to electric pulse trains. Subjects were adult guinea pigs, implanted with a minimally invasive electrode to preserve acoustic sensitivity. Electrically evoked compound action potentials (ECAP) were recorded from the auditory nerve trunk in response to electric pulse trains both during and after the presentation of acoustic white noise. Simultaneously presented acoustic noise produced a decrease in ECAP amplitude. The effect of the acoustic masker on the electric probe was greatest at the onset of the acoustic stimulus and it was followed by a partial recovery of the ECAP amplitude. Following cessation of the acoustic noise, ECAP amplitude recovered over a period of approximately 100-200 ms. The effects of the acoustic noise were more prominent at lower electric pulse rates (interpulse intervals of 3 ms and higher). At higher pulse rates, the ECAP adaptation to the electric pulse train alone was larger and the acoustic noise, when presented, produced little additional effect. The observed effects of noise on ECAP were the greatest at high electric stimulus levels and, for a particular electric stimulus level, at high acoustic noise levels.     

Serum insulin-like growth factor-II as a serologic marker of small hepatocellular carcinoma

OBJECTIVE: Alpha-fetoprotein (AFP) is not a useful tumor marker for diagnosis of small hepatocellular carcinoma (HCC). There is over-expression of insulin-like growth factor (IGF)-II in HCC tissue. This study investigates the diagnostic application of IGF-II in small HCC. MATERIAL AND METHODS: Serum levels of IGF-II and AFP were determined in 41 patients with small cirrhotic HCC (< or = 3 cm), 41 sex- and age-matched patients with cirrhosis alone (LC), and 41 healthy adults. The optimal cut-off values for diagnosing HCC were determined with receiver operating characteristics (ROC) curve. RESULTS: Both IGF-II and AFP levels in HCC were higher than those in LC patients or controls (each p = 0.0001). The IGF-II levels in LC patients were lower than those in controls (p = 0.001). In HCC patients, multivariate analysis indicated that that both IGF-II (odds ratio, 4.54; 95% confidence interval, 2.15-9.55; p = 0.0001) and AFP (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; p = 0.003) were found to be associated with an increased risk of presence of HCC. The optimal cut-off values of IGF-II (4.1 mg/g prealbumin) and AFP (50 ng/ml) were determined with ROC curves. The sensitivity, specificity, and diagnostic accuracy values for IGF-II were 63%, 90%, and 70%, respectively. Those for AFP were 44%, 95%, and 70%, respectively. Determination of both markers in parallel significantly increase the diagnostic accuracy (88%) and sensitivity (80%), with a high specificity (90%). CONCLUSIONS: Serum IGF-II level can be used as an independent serologic marker or a complementary tumor marker to AFP for diagnosis of small HCC.     

Differential integration rates of hepatitis B virus DNA in the liver of children with chronic hepatitis B virus infection and hepatocellular carcinoma

BACKGROUND AND AIM: Integration of hepatitis B virus-DNA (HBV-DNA) into the host genome, a phenomenon found frequently in hepatocellular carcinomas (HCC) and causally linked to oncogenesis, has not been well characterized in children. The aim of the present study was to determine the prevalence of HBV integration more accurately and to decide whether the integration rate varies at different stages of chronic HBV infection in children. METHODS: Of 13 children with chronic hepatitis, 14 liver biopsy tissues were analyzed. One liver tissue with pure liver cirrhosis, nine non-tumor, and nine tumor liver tissues from children with HCC were analyzed by a very sensitive method, inverse polymerase chain reaction (IPCR). RESULTS: Thirteen genuine viral-host junctional sequences from 23 patients were successfully isolated and proved that IPCR is a useful method in this context. The results also indicated that the detection rate of HBV-DNA integration increased in parallel with the progress of liver histology towards the neoplastic transformation, with 0% in the liver of chronic hepatitis, 22.2% in non-tumor livers of HCC patients, and 66.7% in tumor liver tissues of HCC patients. CONCLUSION: The present results indicate that integration of HBV-DNA into the host genome was rarely confirmed at the early stage of chronic hepatitis in children until the stage of HCC formation.     

Prosthetic valve endocarditis from Granulicatella adiacens (nutritionally variant streptococci)

Nutritionally variant streptococci (NVS) are an unusual but significant cause of endocarditis, with increased morbidity and mortality compared to those caused by enterococci or viridans streptococci. For many reasons, NVS endocarditis has remained very difficult to treat medically with antibiotics, and when the bacteria infect prosthetic valves, surgical intervention has historically been required to effect cure. We report the first case of Granulicatella adiacens prosthetic valve endocarditis (PVE) in a patient with congenital heart disease who was successfully treated with a regimen of vancomycin, gentamicin, and rifampin and provide the first review of the literature on NVS PVE, as well as discussion of logistics behind the use of this antibiotic regimen.     

Menopausal women: perceiving continuous power through the experience of regular exercise

Background. Menopausal women are at high risk for cardiovascular diseases and osteoporosis. However, for so long, women have devoted much of their time and energy to family, children, and work such that they could not regularly exercise. There are few studies addressing the experiences of Taiwanese women who regularly exercise. Objectives. The aim of this study was to explore the experiences of regularly exercising, defined as thoughts or actions by menopausal women who did not regularly exercise before menopause, but who now exercise regularly. Design. A grounded theory research design was used. Methods. In‐depth interviews were undertaken with a purposive sampling of 12 menopausal women who began to do regular exercises after menopause and who have continued exercising for more than 6 months. The constant comparative method was used to analyse the interview data. Results. ‘Perceiving Continuous Power’ was the core category during the process of regularly exercising. Every participating woman perceived that her body and mind were filled with continuous power including the subcategories of ‘Overcoming the initial discomfort’, ‘Experiencing Benefits to Body and Mind’ and ‘Broadening’ during the process. ‘Awareness of Health Crisis’, which included the subcategories of ‘Cureless Chronic Disease’, ‘Mood Swings’, and ‘Conflict on Medication’, was identified as occurring when these women first began regularly exercising. Throughout the process of perceiving continuous power, women experienced the following interactive behaviour categories: ‘Exercise Selection’ with subcategories of ‘Self‐Evaluation’, ‘Seeking and Fitting’, ‘Comparing’ and ‘Health Becoming’ with the subcategories of ‘Releasing Health Crisis’, ‘Regaining Flowering Life’, and ‘Self‐Fulfilling’. Conclusions. Regular exercises provided continuous power for menopausal women. Relevance to clinical practice. The experiences with exercise we uncovered in this study can provide a reference for nurses to guide menopausal women with their regular exercise plans.     

Hepatic resection for hepatocellular carcinoma in elderly patients

BACKGROUND/AIMS: We present the clinical features and outcome of 34 patients with hepatocellular carcinoma older than 70 years of age who underwent hepatic resection (elderly-HCC). Nowadays, hepatic surgeons unavoidably have to perform hepatic resection on elderly patients with hepatocellular carcinoma due to increasing life expectancy. However, the outcome of hepatic resection on elderly patients with hepatocellular carcinoma varies in each series, and the exact role of surgery in the management of hepatocellular carcinoma in the elderly remains to be clarified. METHODOLOGY: From 1986 to 1998, the clinical features of 34 surgically treated cases of elderly-HCC were reviewed. Factors that may influence the outcome were also analyzed. Clinical features and outcome of 398 patients with hepatocellular carcinoma younger than 70 years old (younger-HCC) were also summarized for comparison. RESULTS: Of 432 surgically resected hepatocellular carcinomas, 34 (7.9%) were elderly-HCC. More underlying diabetes mellitus association, higher hepatitis C infection, and lower hepatitis B infection were observed in the elderly-HCC group. More blood loss, larger tumor size, less capsule formation, and more recurrence were significantly prominent in the patients in the younger-HCC group compared with the elderly-HCC group. The patients in the elderly-HCC group had a favorable disease-free survival rate compared with the younger-HCC group, although not statistically significant. The 1- and 5-year survival rates of elderly-HCC patients were 85.3% and 39.6%, respectively. No significant difference in survival or mortality rate was found between elderly-HCC and younger-HCC groups. CONCLUSIONS: We present the clinical features and outcomes of 34 elderly patients with hepatocellular carcinoma who underwent hepatic resection. The results seem to indicate that hepatic resection is safe and feasible in the elderly with hepatocellular carcinoma with or without cirrhosis. The prognosis after hepatic resection is as comparable as that of the younger patients with hepatocellular carcinoma.     

One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata

OBJECTIVE: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata. METHODS: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer. RESULTS: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients. CONCLUSION: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.     

Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery

The decrease of arterial blood pressure and body temperature after epidural or spinal anesthesia is thought to be the result of sympathetic block, which could cause pooling and redistribution of blood into the lower extremities. Studies have demonstrated that leg wrapping with elastic bandages may reduce the incidence of hypotension after spinal anesthesia. We tried to extend these previous observations to epidural anesthesia by testing the hypothesis that leg wrapping with elastic bandages should decrease the incidence of hypotension in patients receiving epidural anesthesia. Moreover, we evaluated the effect of this maneuver as regards hypothermia and shivering. Sixty parturients were randomly allocated to receive either leg wrapping with tight elastic bandages (leg-wrapped group) or not (control group) before anesthesia. Sublingual temperature was observed at five periods: baseline, immediately after epidural anesthesia, abdominal skin disinfection, skin incision, and delivery. Hypotension and shivering during the observation periods were also recorded. The incidence of hypotension was significantly less frequent (P = 0.03) in the leg-wrapped group (23%) compared with the control group (50%). Shivering incidences were similar in both groups (70% versus 70%). Sublingual temperature decreased significantly (P < 0.001) throughout the procedure in each group. However, no differences were found between the two groups at each designated observation, even if compared by the magnitude of temperature decrease. We conclude that although leg wrapping with elastic bandages prevents maternal hypotension after epidural anesthesia, it does not reduce the incidence or magnitude of hypothermia or prevent shivering.