Second-line irinotecan after cisplatin, fluoropyrimidin and docetaxel for chemotherapy of metastatic gastric cancer

Aim: Tumors of upper gastrointestinal tract are among the cancers that have a quite lethal course. Cytotoxicchemotherapy is the most efficient therapeutic modality for metastatic gastric cancer. In patients who do notrespond to first-line treatment, the response rate to second-line therapies is generally low and the toxicityrates high. This study concerned the efficacy and the side effect profile of second-line therapy with irinotecanin the patients who were being followed-up with the diagnosis of metastatic gastric cancer in İzmir, Turkey.Materials and Methods: We retrospectively evaluated the efficacy and toxicity in 31 patients with metastaticgastric adenocarcinoma who presented to the polyclinic of Medical Oncology of Izmir Ataturk Education andResearch Hospital between May 2008 and July 2011. All received chemotherapy regimens containing cisplatin,fluoropyrimidine (5-FU) and docetaxel as the first-line therapy for late stage disease. Irinotecan as a singleagent was given at a dose of 210 mg/m2 on each 21 days. Irinotecan (180 mg/m2 on day 1), 5-FU (500 mg/m2 ondays 1-2) and leucovorin (LV; 60 mg/m2 on days 1-2) as a combined regimen were given over a 14 day period.Results: Median age was 54 (range, 31-70). Irinotecan was given as a combined regimen for median 6 cycles(range, 3-12) and as a single agent for median 3 cycles (range, 1-10). Metastases were detected in one site in sixpatients (19%), in two different sites in 17 patients (55%) and in three or more sites in eight patients (26%).Four patients (12.9%) showed partial response and six patients (19.3%) showed stable disease. Progressionfreesurvival (PFS) was found to be 3.26 months (95% CI, 2.3-4.2). Median overall survival (OS) was found tobe 8.76 months (95% CI, 4.5-12.9). The most commonly seen grade 3/4 side effect was neutropenia but the thetherapy was generally well-tolerated. Conclusions: In this study, it was demonstrated that second-line therapywith irinotecan given following the first-line therapy with cisplatin, fluoropyrimidine (5-FU) and docetaxel wasefficient and safe. Further studies are needed for confirmation.     

Valve‐sparing repair with skeletonization of the pulmonary annulus for tetralogy of Fallot

Pulmonary valve preservation in tetralogy of Fallot (TOF) repair is one of the most challenging issues. Herein, we describe a novel valve‐sparing technique for TOF repair that primarily consists of skeletonization of the anterior part of the pulmonary annulus and gentle dilatation by preserving the pulmonary valve and annulus integrity. With encouraging early results, this technique is suggested to prevent severe pulmonary regurgitation and provide acceptable relief of pulmonary stenosis in patients with TOF.     

Effects of rapid maxillary expansion on conductive hearing loss

OBJECTIVE: To test the null hypothesis that rapid maxillary expansion (RME) with a rigid bonded appliance has no effect on conductive hearing loss (CHL) in growing children. MATERIALS AND METHODS: Fifteen growing subjects (mean age 13.43 +/- 0.86 years) who had narrow maxillary arches and CHL participated in this study. Three pure-tone audiometric and tympanometric records were taken from each subject. The first records were taken before RME (T1), the second after maxillary expansion (T2) (mean = 0.83 months), and the third after retention (mean = 6 months) and fixed appliance treatment (approximately 2 years) periods (T3). The data were analyzed by means of analysis of variance (ANOVA) and least significant difference (LSD) tests. RESULTS: Hearing levels of the patients were improved and air-bone gaps decreased at a statistically significant level (P < .001) during active expansion (T2-T1) and the retention and fixed appliance treatment (T2-T3) periods. Middle ear volume increased in all observation periods. However, a statistically significant increase was observed only in the T2-T3 period. No significant change was observed in the static compliance value. CONCLUSIONS: The hypothesis is rejected. RME treatment has a positive and statistically significant effect on both improvements in hearing and normal function of the eustachian tube in patients having transverse maxillary deficiency and CHL.     

An unusual cause of ureteral obstruction in a renal transplant recipient: ureteric aspergilloma

Mycotic infections in various organ transplant recipients represent severe and often fatal complications. Aspergillosis isolated from the urinary tract occurs quite infrequently in renal transplant recipients. Besides, fungus balls are rare causes of ureteral obstruction. We report a 51-year-old patient with the diagnosis of ureteral obstruction caused by aspergillosis in the early post-renal transplant period, who unfortunately died with the clinical picture of disseminated infection and its complications.     

Urgent laparoscopic cholecystectomy is the best management for biliary colic. A prospective randomized study of 75 cases

BACKGROUND/AIM: Delay of laparoscopic cholecystectomy after the diagnosis of biliary colic may increase the probability of recurrent emergency admission while awaiting elective cholecystectomy. The aim of this study was to compare the possible advantages and safety of urgent laparoscopic cholecystectomy (ULC) with elective laparoscopic cholecystectomy (ELC) in patients with biliary colic. PATIENTS AND METHODS: Between 2001 and 2003, 75 patients with biliary colic were included in this study. The patients were classified into following two groups: patients who had ULC in 24 h were in group I (n = 28) and patients who had ELC (mean interval 4.22 +/- 1.42 months) were in group II (n = 35). Conversion to open cholecystectomy, operative time, postoperative hospital stay, costs, and complications were evaluated. RESULTS: In group II, 9 patients made a total of 13 return visits to the emergency department with recurrent attacks of biliary colic or complications of gallstone disease. Mean operative time increased from 35.1 +/- 6.74 min for urgent laparascopic cholecystectomy to 49.9 +/- 6.12 min for ELC (p > 0.05) and hospital stay time increased from 1.06 +/- 0.4 to 2.31 +/- 2.36 days (p < 0.05). Conversion to open cholecystectomy increased from 0% in group I to 17.2% in group II (p < 0.05). DISCUSSION: ULC for biliary colic may be the most medically efficacious and cost-effective treatment.     

Effects of vitamin C and E on liver enzymes and biochemical parameters of rabbits exposed to aflatoxin B1

Hepatotoxic substances such as aflatoxin B1 (AFB1) produce free radical reactions during biotransformation damage to liver cells. Vitamins C and E are important natural antioxidants suppressing free radicals. This study investigated the effects of vitamins C and E on liver enzymes and other biochemical parameters in rabbits experimentally exposed to AFB1. The first group was control and fed the diet with dimethyl sulfoxide; the second group received 0.1 mg AFB1/kg diet; the third group received vitamin C (100 mg L-ascorbic acid/kg diet); the fourth group received vitamin E (100 mg alpha-tocopherol/kg diet); and the fifth group received vitamin C+vitamin E (100 mg L-ascorbic acid/kg diet+100 mg alpha-tocopherol/kg diet). Diets of the second, third, fourth and fifth groups were mixed with 0.1 mg AFB/kg diet) and feedings were continued for 10 w. Levels of aspartate transaminase, alanine transaminase, alkaline phosphatase, creatine phosphokinase and lactate dehydrogenase after receiving AFB1 were significantly increased, while activities of aspartate transaminase, alanine transaminase, amylase, creatine phosphokinase and lactate dehydrogenase in groups receiving AFB1 + vitamins C, E or C+E were significantly lower than that of the AFB1-alone group. Although of the activity of alkaline phosphatase increased with AFB1 exposure, it decreased with vitamin C administration. Levels of urea, triglyceride, cholesterol and albumin were affected by AFB1 and AFB1+vitaminC. AFB1 affected some liver enzymes and other biochemical parameters, but vitamins C, E and C+E partially prevented an increase in these liver enzymes and some the biochemical parameters induced by AFB1.     

Salutary effects of radiopaque contrast media on the survival of random-pattern skin flaps in the rat: an experimental study

The radiopaque contrast medium diatrizoate, has a vasodilator effect so that it is used in sudden-deafness secondary ischemic injury. However, ischemic problems are encountered, especially when longer flaps are elevated. A longer flap also has ischemic and relatively ischemic tissue, and may obtain some benefit from contrast media. Forty male Sprague-Dawley rats, weighing about 350-400 g, were used, and randomly divided into four groups (n = 10 rats each group): group 1 was the control, group 2 the diatrizoate, group 3 the iopamidol, and group 4 the iothalamate group. A rectangular 3 x 10 cm caudally based dorsal skin flap was elevated, and sutured back to its original place. In the control group, no pharmacologic agent was administered. Sodium-meglumine-diatrizoate 10 mg/kg/day was administered parenterally in the first experimental group (diatrizoate group); iopamidol 10 mg/kg/day in the second experimental group (iopamidol group); and iothalamate sodium 10 mg/kg/day in the third experimental group (iothalamate group) for 7 postoperative days. On postoperative day 7, all flaps were photographed, and the area of flap survival was measured by using a polar planimeter. The results were statistically evaluated with the Kruskal-Wallis test and Mann-Whitney U-test (P = 0.05). The mean flap survival ranged from 79% in the iopamidol group to 83% in the diatrizoate group, and was significantly greater in all experimental groups (P < 0.05) compared to the control group (59%). There was no significant difference between experimental groups (P < 0.05). We believe that radiopaque contrast media have a beneficial effect in improving skin flap viability when distal flap necrosis is a potential complication of longer flaps.     

Gastric emptying in patients on renal replacement therapy

In addition to gastrointestinal tract symptoms such as nausea, vomiting, and loss of appetite, impaired gastric emptying time (GET) may be related to nutritional parameters and nutritional status of patients on renal replacement therapy (RRT). Patients on RRT are affected by several factors such as uremic toxins, the presence of dialysate in the peritoneal cavity, and the drugs used against renal allograft rejection. In this study, we investigated the gastric emptying time and its relationship with biochemical and nutritional parameters in patients on RRT: those on hemodialysis and peritoneal dialysis, and renal transplantation patients. Seventy-five patients, 44 on hemodialysis, 16 on peritoneal dialysis, and 15 renal transplant patients, were included in the study. They were examined for gastric emptying time using a radioisotopic method. The results were compared with the GET of healthy subjects. Each group of patients was evaluated in terms of hemoglobin, hematocrit, blood urea nitrogen (BUN), creatinine, blood glucose, total protein, albumin, serum lipids, parathyroid hormone (PTH) and body mass index and biceps and triceps skinfold. The mean GET of patients on RRT was significantly longer than the mean GET of healthy subjects (87.8 +/- 23.4 vs. 55 +/- 18 min, p<0.05). The mean GET of each therapy subgroups was significantly longer than the healthy subjects (the mean GET was 85.1 +/- 22.4 min for hemodialysis, 87.7+/-31.8 min for peritoneal dialysis, and 94.6+/-16.7 min for renal transplant patients, respectively, p<0.05). On the other hand, the differences in the mean GET between the three therapy subgroups were not statistically significant (p>0.05). In addition, time on replacement therapy inversely and blood glucose positively correlated with GET in renal transplant patients. In conclusion, GET was longer in patients on all three RRT modalities than in healthy subjects. GET was not significantly different in dialysis patients and renal transplant patients.