Statins may decrease skeletal-related events in breast cancer patients with bone metastases

Metastasis to the skeleton frequently occurs in breast carcinoma patients resulting in different skeletal-related events including pain, hypercalcemia, pathological fracture, and spinal cord or nerve root compression. Bisphosphonates are class of agents most frequently used to reduce skeletal-related events in patients with bone metastases by inhibiting osteoclast activity through inhibition of mevolanate pathway which is also important in cholesterol synthesis. Statins are cholesterol lowering agents and inhibit the same pathway. Therefore statins may also reduce skeletal-related events in breast cancer patients with bone metastases by inhibiting osteoclastic activity.     

Acute effect of exercise on plasma leptin level and insulin resistance in obese women with stable caloric intake

Obese individuals are frequently hyperleptinemic and insulin resistant. Chronic exercise is associated with improvements in plasma leptin level and insulin sensitivity; however, little is known about the acute effect of exercise on these parameters. The aim of this study was to evaluate the acute effect of aerobic exercise on plasma leptin and insulin sensitivity in obese women with stable caloric intake. Patients and Methods: Twenty-three obese women (age 41.2 +/- 10.3 years, body mass index 40.7 +/- 6.7 kg/m2) were included to the study. All subjects were admitted to an exercise program (45-minute walking sessions at 60-80% of maximum heart rate) every day except weekends for four weeks (total 20 exercise sessions). Insulin resistance was evaluated by HOMA model. Plasma glucose, insulin and leptin levels were determined at baseline and at the end of the first, seventh, and twentieth exercise session. RESULTS: Baseline and at the end of the first, seventh, and twentieth exercise session plasma leptin levels were 59.1 +/- 20.1, 58.5 +/- 21.0, 53.4 +/- 21.9, and 51.2 +/- 20.5 ng/ml and HOMA-r were 2.75 +/- 1.47, 1.77 +/- 0.71, 1.73 +/- 0.89, 1.62 +/- 0. 70, respectively. Compared to baseline, at the end of the seventh (p = 0.021) and twentieth exercise session (p = 0.003), plasma leptin levels were significantly low. Plasma leptin level did not change significantly at the end of the first exercise session (p > 0.05). At the end of the first exercise session (p = 0.005), end of the seventh (p = 0.003) and twentieth exercise session (p = 0.007) HOMA-r was lower than baseline. There was no correlation between weight loss during exercise period and the change of leptin, and HOMA-r. Fasting plasma glucose, insulin and leptin levels were determined at baseline and at the end of the first, seventh, and twentieth exercise session. CONCLUSION: Our study suggests that acute exercise decreases insulin resistance at the first exercise session with no effect on leptin levels. Significant leptin decrement was evident at the first week and lasted during the entire four weeks exercise session.     

Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura

Background To determine the clinical significance of the antinuclear antibody (ANA) test in children and adult patients with idiopathic thrombocytopenic purpura (ITP). Method We conducted a retrospective analysis of 365 children and 108 adult patients with ITP. Patients found to have positive ANA were regularly followed-up by an experienced hematologist until December 2006 for development of symptoms indicative of autoimmune disorder. Mean follow-up 3.6 years (range: 2.1–7 years) for all patients. At the time of diagnosis of ITP, patients with connective tissue diseases (CTD) were excluded. Out of 365 childhood ITP; 301 (82.4%) patients were acute, 64 (17.6%) patients were chronic ITP. ANA titer ≥1:80 were positive in 33 (9.04%) of 365 patients with childhood ITP; 21 patients (6.9%) were in acute, and 12 patients (18.7%) were in chronic group. Out of 108 adult patients with ITP; 31 (28.7%) patients were acute and 77 (71.3%) patients were chronic ITP cases. ANA titer ≥1:80 were positive in 36 (33.3%) of 108 patients with adult ITP; 12 patients (38.8%) were in acute, and 24 patients (31.2%) were in chronic group. At the end of follow-up period Sjogren’s syndrome (SS) was diagnosed in only one adult chronic ITP cases. None of the other ANA positive patients developed SLE or other CTD. Conclusions Our data demonstrated that ANA positivity is often found in adult and children patients with ITP, and indicate that the detection of ANA positivity is not enough to identify those patients with ITP who are at risk of developing SLE or other CTD. There is a statistically significant difference in terms of ANA positivity between childhood acute and chronic ITP patients. We think that ANA positivity may be an indicator in terms of chronicity for childhood ITP. However, large-scale studies should be considered to determine the significance of ANA positivity and their utility in differentiating acute from chronic ITP.     

Rectal angiolipoma： A case report and review of literature

Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically, and review the literature.     

Capecitabine-induced severe hypertriglyceridemia: report of two cases

OBJECTIVE: To report 2 cases of severe hypertriglyceridemia associated with the use of oral capecitabine. CASE SUMMARIES: The first patient was a 73-year-old woman with metastatic breast carcinoma who received capecitabine 2500 mg/m2/day in 2 divided doses for 2 weeks followed by a one week rest period. The baseline triglyceride level was 324 mg/dL; after 2 cycles of capecitabine, levels increased to 916 mg/dL. Although lipid-lowering treatment was initiated, triglyceride levels peaked at 1782 mg/dL by the end of the seventh cycle. Eight weeks after capecitabine treatment was stopped, triglyceride levels decreased to 118 mg/dL. The second patient was a 59-year-old man with metastatic colorectal carcinoma who was placed on capecitabine treatment at a dosage of 2500 mg/m2/day in 2 divided doses for 2 weeks followed by a one week rest period. The baseline triglyceride level was 244 mg/dL; levels peaked at 1455 mg/dL at the end of the fifth cycle. Capecitabine treatment was discontinued due to disease progression, and triglyceride levels decreased to 154 mg/dL after 11 weeks. DISCUSSION: The most frequently reported adverse effects of capecitabine are gastrointestinal and hematologic effects and palmar-plantar erythrodysesthesia. Drug-induced hyperlipidemia may appear more readily in individuals with hereditary lipoprotein lipase deficiency because decreased lipoprotein lipase activity might make these individuals more susceptible to a rise in triglyceride levels. The Naranjo probability scale indicated a probable relationship between capecitabine and severe hypertriglyceridemia. CONCLUSIONS: Capecitabine should be prescribed with care, especially in patients with preexisting hypertriglyceridemia. The question of whether capecitabine actually causes hypertriglyceridemia needs careful consideration, and the possible mechanism by which it may cause this adverse effect requires further investigation.     

Optic atrophy and macular degeneration as initial presentations of subacute sclerosing panencephalitis

PURPOSE: To report a case of subacute sclerosing panencephalitis in which the initial clinical presentations were optic atrophy and macular degeneration. DESIGN: Observational case report. METHODS: A 9-year-old boy with visual loss attributable to optic atrophy and macular degeneration had a diagnostic examination. RESULTS: The visual acuity levels of both eyes were light perception at presentation. Fundus examination revealed bilateral optic atrophy and macular degenerative changes including retinal pigment epithelial atrophy, macular scarring, and epiretinal membrane formation. The antimeasles IgG titers were high both in serum and cerebrospinal fluid samples. Neurologic symptoms of myoclonus, ataxia, motor, and mental disabilities occurred 4 months after the onset of first visual disturbances and 2 weeks after the patient applied to our clinic. CONCLUSION: Children with optic atrophy and macular degenerative lesions should be examined for sclerosing panencephalitis, even if the classical neurologic symptoms of this disease are not present.