Is chemotherapy always necessary for patients with nonmetastatic gestational trophoblastic neoplasia with histopathological diagnosis of choriocarcinoma?

Objective

To evaluate expectant management versus immediate chemotherapy following pathological diagnosis of gestational choriocarcinoma (GCC) in patients with nonmetastatic disease.

A Phase I study of pazopanib in combination with gemcitabine in patients with advanced solid tumors

Purpose

Pazopanib plus gemcitabine combination therapy was explored in patients with advanced solid tumors.

Methods

In a modified 3 + 3 enrollment scheme, oral once-daily pazopanib was administered with intravenous gemcitabine (Days 1 and 8, 21-day cycles). Three protocol-specified dose levels were tested: pazopanib 400 mg plus gemcitabine 1,000 mg/m², pazopanib 800 mg plus gemcitabine 1,000 mg/m², and pazopanib 800 mg plus gemcitabine 1,250 mg/m². Maximum-tolerated dose was based on dose-limiting toxicities during treatment Cycle 1. In the expansion phase, six additional patients were enrolled at the highest tolerable dose level.

Results

Twenty-two patients were enrolled. At the highest dose level tested (pazopanib 800 plus gemcitabine 1,250), patients received >80 % of their planned dose and the regimen was deemed safe and tolerable. The most common treatment-related adverse events included fatigue, neutropenia, nausea, and decreased appetite. Neutropenia and thrombocytopenia were the most common events leading to dose modifications. Pharmacokinetic interaction between pazopanib and gemcitabine was not observed. One objective partial response at the highest dose was observed in a patient with metastatic melanoma. Prolonged disease stabilization (>12 cycles) was reported in three patients (metastatic melanoma, cholangiocarcinoma, and colorectal carcinoma).

Conclusion

Combination pazopanib plus gemcitabine therapy is tolerable, with an adverse event profile reflective of that associated with the individual agents. There was no apparent pharmacokinetic interaction with pazopanib plus gemcitabine co-administration, although patient numbers were limited. Further investigation of combined pazopanib plus gemcitabine is warranted.     

Cerebellar mediation of the complexity of bimanual compared to unimanual movements.

OBJECTIVE: To study rapidly alternating movements under fMRI in order to identify the brain regions that mediate increased complexity in bimanual vs unimanual movements and to verify the localization of a clinical test of limb ataxia (diadochokinesis). METHODS: Unimanual and bimanual movements, that is, palm(s) pronated then supinated, served as stimulation in a block design fMRI investigation at 1.5 T. Analyses compared bimanual movements and rest for each hand separately and the unimanual conditions combined. A pronation/supination task was chosen as it provides the same objective motor output during unimanual and bimanual formats. The increased coordination demand of the bimanual format (phase/antiphase movements) was expected to result in distinct activation in supplementary motor, primary motor, prefrontal, and cerebellar regions. RESULTS: The bimanual task uniquely elicited responses in specific anterior medial and posterior (vermal) cerebellar regions. CONCLUSIONS: The study corroborated clinical use of diadochokinesis tasks to test for aspects of cerebellar integrity. The data do not support the literature emphasizing basal ganglia mediation of this type of coordinated movement. Cerebellar medial and vermal regions (in connection with central nuclei) are proposed as the locus within the cerebellum for mediating complexity, that is, the effective integration of separate limb movements that proceed in an asynchronous but systematic fashion.     

Intensive Psychiatric Rehabilitation Treatment (IPRT): An Overview of a New Program

Intensive Psychiatric Rehabilitation Treatment (IPRT) is a new program of outpatient psychiatric rehabilitation which is currently operating in New York State and Iowa. IPRT is based upon a process of psychiatric rehabilitation which was developed at the Boston University Center for Psychiatric Rehabilitation. The purpose of IPRT is to assist individuals with serious and persistent mental illness in identifying and achieving personally meaningful goals within the community. This article will provide an overview of IPRT by examining the program as it operates in New York State, the research foundations of the program, and the preliminary results of a state-wide evaluation of IPRT programs. IPRT is an important new program of outpatient psychiatric rehabilitation. Controlled studies are needed to establish the effectiveness of the program.     

Bilateral Mirror-Symmetrical Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: A Case Report

Giant cell tumor of the tendon sheath is a slowly growing benign tumor. It usually arises from the tendon sheath and periarticular soft tissue of small joints. However, it may infrequently involve the large joints emerging around the knee, elbow, and hip joints. Giant cell tumor of the tibialis tendon sheath is rarely reported in the foot and ankle joint. Here, we report the first case in the medical literature of bilateral mirror-symmetrical giant cell tumor of the tendon sheath in the foot and ankle. A 12-year-old male presented with a bilateral and mirror-image mass on his ankles extending to the foot. It was painless but affected his gait and footwear. Staged complete resection was done first on the right then on the left side, with no recurrence after 1 year. The role of genes can be argued for this presentation and giant cell tumor's etiology, owing to the bilateralism and mirror-image presentation. Studies are needed to explore this genetic aspect and its role in management.     

p53 as tumor marker for the early detection of reincidence in lung cancer

To examine the p53 expression in cancer development, we studied the case of a 59-year-old male suffering from squamous cell lung cancer. He was submitted to surgery for resection of the tumoral mass. Through immunoblot and immunohistochemical analysis, the tumor fragment was shown to bear p53 and hsp70 accumulation not detected in the normal lung tissue sample. Six months later, immunohistochemical analysis of a biopsy sample taken from the previous tumor site showed p53 accumulation. Considering the high specificity for p53 detection (100%), this result suggests probable tumor reincidence, not detected by the ordinary H&E staining.