Bone density in patients with chondromalacia patella

Chondromalacia of the patella is the most common cause of anterior knee pain in young women. The etiology of the disease is not well-understood but the initial lesion is a disorganization of collagenous structures. Since the disease is proposed to be due to generalized constitutional disturbance, we postulated that bony structures could also be involved. To investigate this hypothesis we measured the bone density of 286 patients with the diagnosis of chondromalacia of the patella during a 4-year period using dual energy X-ray absorptiometry (DXA) method. We found a significant number of patients having low bone densities. This problem was more pronounced in men and in younger age groups. We suggest base-line bone density evaluation in all patients, treatment of osteopenia or osteoporosis in select patients and regular follow-ups using DXA.     

Evaluation of continuous-infusion alpha-difluoromethylornithine therapy for colorectal carcinoma

Summary A total of 32 evaluable patients with measurable advanced colorectal carcinoma were treated with continuous-infusion alpha-difluoromethylomithine (DFMO) at a median daily dose of 8 g/m² (range, 6–14 g/m²). DFMO was infused over 24 h daily for 28 days, followed by a rest period of 7 days. Of the 32 patients, 14 had received no prior chemotherapy. A total of 65 courses was given, with the median being 2 (range, 1–9 courses). None of the patients achieved a partial or complete response; however, 3 patients achieved a minor response and 14 had stable disease. The frequent toxic effects of DFMO included thrombocytopenia (which was dose-limiting), malaise, nausea, vomiting, reversible hearing loss, and diarrhea. Our data suggest that continuous-infusion DFMO therapy is feasible and results in only mild gastrointestinal toxicity. Although DFMO proved to be ineffective as a single agent in this trial, it could probably best be used in combination with cytotoxic agents known to enhance its antitumor activity in a preclinical setting. This study was supported by grant RO1 CA34465 from the National Cancer Institute, Bethesda, Maryland, and by a grant from Baxter-Travenol Corporation, Deerfield, Illinois     

Oxaliplatin-based chemotherapy for the treatment of a metastatic carcinoid tumor

Carcinoid tumors are rare and often resistant to chemotherapy agents. Although a slow-growing tumor, patients can have significant morbidity associated with carcinoid syndrome and patients will often die as a result of tumor progression. We report the first case of a patient with a metastatic carcinoid tumor to respond to an oxaliplatin-based regimen. Further studies are needed to validate this observation.     

Noradrenergic and dopaminergic modulation of thyrotropin secretion in the rat

Noradrenergic and dopaminergic regulation of thyrotropin (TSH) secretion was investigated in adult male Wistar rats. TSH secretion displayed a circadian variation with peak serum TSH levels at 10.00 h. The alpha 2-adrenoceptor agonist, clonidine (250 micrograms/kg, i.p.), was found to cause an enhancement of serum TSH levels at 10.00 h (160 +/- 10% of control values, P less than 0.001) which was antagonized by prior administration of the alpha 2-adrenoceptor antagonist, yohimbine (3 mg/kg, i.p.). The alpha-adrenoceptor antagonist phentolamine caused a significant decrease in serum TSH levels at 10.00 h (62 +/- 15% of control values, P less than 0.05) at a dosage of 2 mg/kg, i.p. The alpha 1-adrenoceptor agonist, phenylephrine (0.2 or 2 mg/kg, i.p.), was without effect as were the dopaminergic receptor agonist, apomorphine (1 or 5 mg/kg, i.p.), and the antagonist, sulpiride (20 mg/kg, i.p.). The beta-adrenoceptor agonist, isoproterenol (1 mg/kg, i.p.) was found to cause a decrease in serum TSH levels at 10.00 h (70 +/- 16% of control levels, P less than 0.01), which was completely antagonized by prior administration of the beta-adrenoceptor antagonist, propranolol (10 mg/kg, i.p.). TSH-releasing hormone (TRH, 5 micrograms/kg, i.v.) caused a significant stimulation of TSH secretion (470 +/- 63% of basal levels, P less than 0.001), which was not affected by prior treatment of the rats with yohimbine (0.1 mg/kg, i.p.), phentolamine (2 mg/kg, i.p.), propranolol (10 mg/kg, i.p.) or sulpiride (20 mg/kg, i.p.). There was, however, a tendency towards a decrease in the TRH-stimulated release of TSH in rats pretreated with phentolamine or propranolol.(ABSTRACT TRUNCATED AT 250 WORDS)     

Docetaxel-related side effects and their management.

Docetaxel is an effective treatment approved in five key cancers, but its effectiveness in clinical practice can be compromised by sub-optimal side-effect management. The aim of this review was to investigate the extent of the published work on specific docetaxel-related side effects and to provide, where possible, evidence-based recommendations for their prevention and management. PubMed and the American Society of Clinical Oncology (ASCO) databases were systematically searched for articles published in English over the past 5 and 2 years, respectively, and pertaining to six side effects identified as being common to the majority of docetaxel regimens and indications of particular relevance to the oncology nurse. The Cochrane library was also searched. A total of 103 citations were identified, 14 of which discussed strategies for the prevention or management of febrile neutropenia (n=6), hypersensitivity reactions (3), fluid retention (1) and nail changes (4). No articles were identified that related to asthenia or neuropathy. Based on the literature review, evidence/guidelines-based advice for the use of G-CSF in febrile neutropenia is provided. The evidence base with respect to the other side effects does not permit the formulation of recommendations. It is the experience of the authors, however, that the severity of symptoms experienced by patients is generally mild and the side effects are for the most part easily managed with prophylactic and supportive care measures. It is therefore important to share and build on experiences, through research and discussion, to maximise the healthcare professional's ability to offer the best standard of care to patients.     

Central Lymph Node Metastasis in Gastric Cancer Is Predictive of Survival After Preoperative Therapy

Background

It is unclear how preoperative therapy for gastric cancer affects the metastasis rate of lymph nodes (LNs) and whether the location of positive LNs affects survival after preoperative therapy. Therefore, we determined the association between positive central lymph nodes (CnLNs) and disease stage and overall survival (OS).

Methods

We reviewed a prospectively maintained database to identify patients who had undergone resection of gastric adenocarcinoma at our institution from 2005 to 2015. CnLNs were defined as common hepatic, celiac, and proximal splenic artery LNs (stations no. 8, 9, and 11p). The frequency of CnLN metastases and risk factors affecting OS were examined.

Results

We identified 356 patients. Preoperative therapy was administered to 66% of patients. D2 LN dissection was performed in 80% of patients, and the median number of LNs examined was 25 (IQR, 18–34). In 243 patients (68%), CnLNs had undergone separate pathologic examination; the CnLN-positive rate was 9.1% (22 of 243; station no. 8, 4.5%; no. 9, 2.1%; and no. 11p, 4.8%). CnLN metastasis was associated with shorter 3-year OS in patients with pN2/3 disease (33 vs. 62%; p?=?0.004). Among patients who had undergone preoperative therapy, ypT3–4 stage (HR 2.44; p?=?0.01) and positive CnLNs (HR 5.44; p?<?0.001) were negatively associated with OS by multivariate analysis.

Conclusions

CnLN metastases are uncommon in gastric cancer and have an adverse effect on OS in patients who have undergone preoperative therapy. Larger multi-institutional studies are needed to determine whether CnLN positivity requires a separate staging category after preoperative therapy.

     

Ultrasound‐guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge

Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. We used ultrasound to identify focal ductal dilatation—hypothesized to be a radiographic manifestation of the causative lesion—in patients with PND and no relevant clinical or radiographic findings. Twenty‐two excisions guided by ultrasound wire localization of focal duct dilation were performed. Surgical pathology revealed papilloma in 20 cases (91%); atypia or carcinoma was detected in 7 cases (32%). The ultrasound finding of focal duct dilatation enables excision of otherwise occult though clinically significant lesions and is worthy of further study.