Angiogenesis as targeted breast cancer therapy

Neo-angiogenesis appears to be a critical feature of tumor growth, migration, and metastasis. Therefore, inhibition of angiogenesis is an appealing strategy for treatment of cancer. Since angiogenesis is the result of several mechanistic processes, controlled by numerable pro- and anti-angiogenic factors and their receptors, multiple possibilities to prevent or reverse tumor-induced neo-vascularization have been proposed. Of these, currently, the most promising approach has been the use of bevacizumab, a humanized monoclonal antibody directed against the most potent pro-angiogenic factor, vascular endothelial growth factor (VEGF). Bevacizumab has been shown to be active in several malignancies, in particular colo-rectal cancer. Although early studies of bevacizumab in far-advanced metastatic breast cancer were disappointing, the results of a recently reported clinical trial by the Eastern Oncology Group comparing first line paclitaxel with or without bevacizumab has demonstrated statistically significant improvements in response rates and time progression. Ongoing studies are now investigating the benefits of bevacizumab with other chemotherapeutic and biologic agents in early metastatic disease as well as in the adjuvant setting. Other anti-angiogenic agents remain in early clinical trials. Small molecular inhibitors of VEGF receptor tyrosine kinase activity, such as sunitinib, appear promising. Nearly 40 years after it was first proposed, inhibition of angiogenesis appears to be gaining a role in medical oncology.     

Fragility fractures of the acetabulum

There are limited epidemiological data dedicated to geriatric acetabular fractures. The incidence in individuals older than 60 years of age has more than doubled in the past three decades and expected to double further over the next 20 years. These fractures represent a challenging subset of acetabular trauma patients to treat. Conservative treatment is a valid option in those with minimal displaced fractures and a preserved congruent hip joint. Similarly the frail patient with multiple medical co-morbidities and those unlikely to tolerate surgical intervention should have appropriate analgesia and their fracture managed or ignored by watchful neglect. Surgical treatment options include percutaneous fixation or open reduction and internal fixation techniques. Good outcomes may be expected should a concentric reduction be achieved. Age-related involutional osteoporosis associated with fracture comminution and acetabular dome impaction complicate surgical fixation with higher complication rates and the need for further surgery recognised. Historically described as central fracture dislocations, stoved in hip or burst fracture, acute arthroplasty is advocated in the setting of femoral head damage and in significant acetabular impaction injuries. Controversy remains whether geriatric patients should be treated by open reduction and internal fixation or total hip arthroplasty either acute or delayed and needs to be assessed based on the patient and personality of the fracture.     

A Case-Control Study of Nitrate in Drinking Water and Non-Hodgkin's Lymphoma in Minnesota

Nitrate in drinking water has been implicated as a possible risk factor for non-Hodgkin's lymphoma. The authors examined the association between non-Hodgkin's lymphoma and waterborne nitrate through a population-based case-control study of white men in Minnesota. The authors, by linking residential histories with community water records, estimated average long-term exposure to nitrate in drinking water from 1947 to 1975 for 73 cases diagnosed between 1980 and 1982 and for 147 controls who used community water supplies. No association was found between nitrate levels in community water supplies and non-Hodgkin's lymphoma within the range of study exposures (median of highest exposure category = 2.4 mg nitrate/l [range = 0.1-7.2 mg/l]). The findings provide some safety assurance for those who use water systems that have nitrate levels that are less than 2.4 mg/l.