Practical management of patients with non-small-cell lung cancer treated with gefitinib.

PURPOSE: The use of gefitinib, the first drug approved to inhibit the epidermal growth factor receptor tyrosine kinase, is indicated in patients with non-small-cell lung cancer with tumors progressive after chemotherapy. The unique mechanism of action of this agent leads to distinctive patterns of response and toxicity in persons with lung cancer. Many of the principles of management relevant to gefitinib are distinct from those with conventional cytotoxic drugs. To meet this need, we present practical guidelines on the use of gefitinib in patients with non-small-cell lung cancer. METHODS: This article reviews gefitinib's indications, dosing, response phenomena, and patterns of relapse in individuals with radiographic response. RESULTS: We present our recommendations for the management of rash and diarrhea caused by this agent. CONCLUSION: This information can guide practitioners and help them inform their patients about what to expect when they receive gefitinib.     

Repeat Transarterial Chemoembolization (TACE) for Progressive Hepatic Carcinoid Metastases Provides Results Similar to First TACE

Background Transarterial chemoemobolization (TACE) is commonly used to treat metastatic carcinoid tumors; however, the management of progressive disease is less clear. We sought to determine if patients with disease progression after TACE would benefit from repeat TACE. Methods The records of 27 patients undergoing repeat TACE for radiologic or symptomatic progression after TACE for metastatic carcinoid were reviewed and compared to 122 undergoing first TACE. Overall and progression-free survivals were estimated by the Kaplan–Meier method. Results Mean disease-free interval after first TACE was 11.8 months. Radiologic response was observed in 61% compared to 82% after first TACE (p = 0.058); hormone response in 64% compared to 80% (p = 0.159); and symptomatic response in 77% compared to 92% (p = 0.053). The complication rate after repeat TACE was lower than after first TACE (p = 0.03). Median overall survival was similar after repeat (28.1 months) and first TACE (33.3 months) (p = 0.53). Progression-free survival was shorter after repeat TACE but not significantly so. No factor examined could predict survival after repeat TACE. Conclusion Repeat TACE for patients with hepatic carcinoid metastases failing first TACE or having evidence of disease progression is safe and offers a viable treatment option. Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, DC, May, 2007.     

The heat shock proteins and plastic surgery.

Heat shock proteins are diverse and essential components of cell physiology. Their expression is elevated in the cell undergoing stress, where they protect the cell from death by necrosis or apoptosis and accelerate recovery. Significant advances have been made in studies relevant to plastic surgery regarding these proteins and their manipulation. This review introduces the heat shock proteins and appraises these studies in skin, ultraviolet light exposure, neoplasia, wound healing, ageing, burns, and reconstructive surgery.     

The health of children of low-income families.

Childhood poverty is common in Canada: 1,114,000 children under 16 years of age live below the poverty line. The incidence is highest among children of single mothers, unemployed parents, Canadian native peoples and recent immigrants, particularly refugees. Compared with the national average, the infant mortality rate is twice as high, deaths from infectious diseases are 2.5 times more common and accidental deaths are twice as common among children of low-income families. Other problems associated with poverty are iron deficiency anemia, dental caries, chronic ear infections, mental retardation, learning disabilities, poor school performance and increased suicide rates. Health care professionals can help address the poor physical and mental health associated with poverty in children by promoting a broad range of public policies.     

Phospho-akt expression is associated with a favorable outcome in non-small cell lung cancer.

Akt, a Serine/Threonine protein kinase, mediates growth factor-associated cell survival. Constitutive activation of Akt (phosphorylated Akt, P-Akt) has been observed in several human cancers, including lung cancer and may be associated with poor prognosis and chemotherapy and radiotherapy resistance. The clinical relevance of P-Akt in non-small cell lung cancer (NSCLC) is not well described. In the present study, we examined 82 surgically resected snap-frozen and paraffin-embedded stage I to IIIA NSCLC samples for P-Akt and Akt by Western blotting and for P-Akt by immunohistochemistry. P-Akt protein levels above the median, measured using reproducible semiquantitative band densitometry, correlated with a favorable outcome (P = 0.007). Multivariate analysis identified P-Akt as a significant independent favorable prognostic factor (P = 0.004). Although associated with a favorable prognosis, high P-Akt levels correlated with high tumor grade (P = 0.02). Adenocarcinomas were associated with low P-Akt levels (P = 0.039). Akt was not associated with either outcome or clinicopathologic variables.Cytoplasmic (CP-Akt) and nuclear (NP-Akt) P-Akt tumor cell staining was detected in 96% and 42% of cases, respectively. Both CP-Akt and NP-Akt correlated with well-differentiated tumors (P = 0.008 and 0.017, respectively). NP-Akt also correlated with nodal metastases (P = 0.022) and squamous histology (P = 0.037).These results suggest P-Akt expression is a favorable prognostic factor in NSCLC. Immunolocalization of P-Akt, however, may be relevant as NP-Akt was associated with nodal metastases, a known poor prognostic feature in this disease. P-Akt may be a potential novel therapeutic target for the management of NSCLC.     

Clean intermittent self-catheterisation for quadriplegic patients--a five year follow-up.

We present the findings of clean intermittent self-catheterisation (CISC) as a long term method of bladder management for 36 quadriplegic spinal cord injured patients, primarily at C6/C7 level, who were taught CISC between 1983 and 1987. Success in CISC was assessed by a mail survey, a telephone interview, and current sterile urine status. Twenty nine (81%) of 36 patients continued to use CISC after a mean discharge period of 2.9 years (p less than 0.001) with high levels of acceptance. Rao's V discriminant analysis showed success in CISC was affected by the interval between injury and initial self-catheterisation (Canonical Correlation Co-efficient = 1.34). Results of urinalysis for patients continuing CISC were obtained for 18 (62%) patients, 16 (88%) of whom had sterile urine. Implications of these and other findings along with reasons for cessation of CISC are discussed.     

Recurrent Cervical Abscess Due to Pyriform Sinus Fistula-A Case Report

The pyriform sinus fistula is rare congenital anomaly of either third or fourth branchial pouch, which most frequently presented itself by recurrent episodes of neck abscess for long time. Majority of patients with this anomaly presented with symptoms before 10 years and it is more common than has previously been commonly found on leftside (93%). Clinically high index of suspicion, cannulation of the tract under general anaesthesia, Direct laryngoscopy and fistulogram have freequently been successful in identifying the presence of these embryological remnants. Surgical exploration of sinus tract with its total excision, guided with cannula inside its lumen is the definitive treatment.