Rates of venous thromboembolism in multiple myeloma patients undergoing immunomodulatory therapy with thalidomide or lenalidomide: a systematic review and meta‐analysis

Summary. Introduction: The incidence of venous thromboembolism (VTE) in patients with multiple myeloma (MM) treated with thalidomide‐ and lenalidomide‐based regimens is high. Recent observational studies have suggested that thromboprophylaxis might be efficacious in decreasing the risk of VTE in this population. Purpose: To determine the absolute rates of VTE with and without different thromboprophylactic agents in patients with newly diagnosed or previously treated MM receiving thalidomide‐ or lenalidomide‐based regimens. Results: Patients with newly diagnosed MM treated with thalidomide in combination with dexamethasone have a VTE risk of 4.1 (95% CI, 2.8–5.9) per 100 patient‐cycles. Therapeutic doses of anticoagulants seem to provide the largest absolute risk reduction of VTE. The rate of VTE in patients with previously treated MM receiving thalidomide in combination with dexamethasone is 0.8 (95% CI, 0.1–2.1) per 100 patient‐months. A combination of lenalidomide and dexamethasone is associated with of risk of VTE of 0.8 (95% CI, 0.07–2.0) per 100 patient‐cycles and 0.7 (95% CI, 0.4–0.9) per 100 patient‐cycles in patients with newly diagnosed and previously treated MM, respectively. Similarly, the rates of VTE in patients also receiving thromboprophylaxis with aspirin were 0.9 (95% CI, 0.5–1.5) and 0.6 (95% CI, 0.01–2.1), respectively. Conclusion: Patients with newly diagnosed or previously treated MM receiving thalidomide‐ or lenalidomide‐based regimens in combination with dexamethasone are at high risk of VTE. The benefit of various types of thromboprophylaxis is difficult to quantify in patients with MM receiving immunomodulatory therapy, especially in those receiving lenalidomide‐based therapy or who have previously treated MM. Randomized controlled trials are needed to address this important clinical need.     

Extraosseous osteosarcoma: Single institutional experience in Korea

Aim: Extraosseous osteosarcoma (EOO) is a rare soft tissue form of osteosarcoma without involvement of the skeletal system. Due to the rarity of disease, its clinical features and optimal treatment are yet to be defined. Methods: Between 1 January 1999 and 30 June 2008 ten patients were pathologically confirmed with extra‐skeletal osteosarcoma. A retrospective analysis of the ten patients was performed. Results: The anatomical distribution of the osteosarcomas was as follows: lower extremities (n = 3), upper extremities (n = 2), breast (n = 2), lung (n = 1), cheek (n = 1) and retroperitoneum (n = 1). Nine patients initially underwent resection of the primary mass. One patient, who received six cycles of adjuvant doxorubicin and cisplatin chemotherapy was alive in remission at 42.6 months. One patient with postoperative radiotherapy after curative surgery was alive in remission at 6.2 months. However, all three patients who received curative resection but no postoperative radiotherapy or chemotherapy died of the disease at 10.7, 11.1 and 15.6 months after surgery. The median time to failure was only 4.4 months (95% CI, 0.6, 8.2 months) and the median survival time of all patients was only 11.1 months (95% CI, 5.6, 16.6 months). At the time of analysis, seven patients were dead and all died of the disease recurrence. Conclusion: EOO should be treated as a soft tissue sarcoma with aggressive behavior and multimodality treatment should be actively sought to improve treatment outcome. The impact of adjuvant chemotherapy on survival of EOO needs further investigation.     

SALMONELLA ENTERITIDIS IN LIVER ABSCESS REPORT OF A CASE

Salmonella enterit.idis infection in man other than that of acute gastro-enteritis is uncommon. It usuaHy takes the form of septicemia, though local infection of the gall bladder, ano of the meninges has been reported. Dean fIl reported a case in which S. enteritidis was isolated from the gall-Wadder, the feces and from the gall-stones in a case of chronic cholecystitis with cholelithiasis. Stuart and Krikorian (2) claimed it to be the cause of meningitis. In view of its distribu- tion in nafural and artificial infections in animals, as demonstrated by Topley (3), in the spleen, liver, gall-bladder and in the lymph-nodes, even months after the infection, it may not be impossible to find them in the various organs in the human being. So far, among the various bacferial agents of liver abscess reported in the literature, no mention has been found of the finding of this organism, and according to the records of this hospital, this is the first occasion in fourteen years on which such an organism has been isolated from liver pus. In view of this rarity it seems of sufficient interest to report the finding of S. enleritidis in the present case briefly and to discuss its significance in relation to liver abscess.     

Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer

Choi JH, Song YS, Yoon JS, Song KW, Lee YY. Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer. APMIS 2010; 118: 196–202. The enhancer of zeste homolog 2 (EZH2), a member of the polycomb group of proteins, plays an important role in cell proliferation and cell cycle regulation. EZH2 is overexpressed in aggressive forms of prostate, breast, bladder, and endometrial cancers. However, the role of EZH2 expression in gastric cancer has not been fully determined. This study was conducted to investigate the correlation between EZH2 and cell cycle‐related molecules, and the clinical value of EZH2 expression in gastric cancer. We analyzed EZH2 expression using Western blotting in AGS, MKN‐28, SNU‐16, SNU‐484, SNU‐601, and SNU‐638 gastric cancer cell lines. After transfection of EZH2 siRNA into MKN‐28 cells, the change in cell cycle‐related molecules was assessed by Western blot analysis. Expression of EZH2, Ki‐67, and p53 was determined by immunohistochemical staining of tissue microarrays from specimens of 137 cases of resected gastric cancer. We found high expressions of EZH2 in all of the tested gastric cancer cell lines. RNA interference of EZH2 induced upregulation of p53 and HDAC1 and downregulation of cyclin D1 and cyclin E. High EZH2 expression was observed in 60.6% of gastric cancers and in 6.7% of non‐neoplastic gastric tissues (p < 0.01); 40.1% were positive for p53 in gastric cancers. High EZH2 expression was correlated with Ki‐67 and p53 expressions and was significantly associated with distant metastases and non‐signet ring cells. Our results suggest that high EZH2 expression is associated with tumor cell proliferation and metastasis in gastric cancer.     

Assessing real-time performances of N95 respirators for health care workers by simulated workplace protection factors

To assess performances of N95 respirators for Health Care Workers (HCWs) in a simulated health-care setting, we measured the Simulated Workplace Protection Factors (SWPFs) in real-time from the volunteers. A total of 49 study subjects, wearing 3 M respirator Model N95 1860 and 1860S, were fit tested using the OSHA Exercise Regimen. The test subjects were asked to perform simulated scenarios, including patient assessments, suction, and intravenous injection (IV) treatment. Two TSI PortaCount instruments continuously measured concentrations in the respirator and the room concentration. For Quantitative Fit Testing (QNFT), 36 out of 49 (73.5%) passed the fit factor (FF) criteria set at 100 and 13 (26.5%) failed. The results of QNFT were found to have a low correlation with SWPF, with R²=0.32. The geometric means (GM) and geometric standard deviations (GSD) of SWPF were 68.8 (1.1) for those subjects who passed and 39.6 (1.3) for those who failed. Real-time assessments of SWPF showed that lower SWPFs were; moving head up and down, and bending at the waist. This study identifies the needs for providing different sizes of respirators for HCWs and the importance of performing fit tests for HCWs regularly. And particular movements were identified as attributing factors affecting more on SWPFs.     

Severe Thigh Abscess Two Years after Transobturator Sling Operation

Objectives: Tension‐free vaginal tape has gained large popularity owing to the ease of the procedure and its effectiveness. These procedures were initially thought to rarely involve any significant morbid complications. The transobturator tape (TOT) procedure reproduces the natural suspension similar to the tension‐free vaginal tape with a reduction in potential bladder, bowel, and vascular complications by the retropubic approach. However, the TOT procedure is not risk‐free when improperly performed. We report a rare case of abscess formation after TOT. Methods: A 45‐year‐old woman was admitted to the orthopedic department with the chief complaint of right side thigh pain and swelling. Pelvis MRI showed abscess formation and inflammatory changes extending into the soft tissues and muscles between the right gracilis and adductor femoris. During incision and open drainage, the remnant mesh could not be located. On urologic consult, the pelvic examination located the remnant mesh to the right upper vaginal wall. Our patient underwent excision of the mesh material. Results: She had significant improvement of the leg pain and was discharged home in good condition on postoperative day 7. Ultimately, the treatment for this complication was the removal of the mesh. Conclusion: Treatment for thigh abscess after TOT was the removal of the mesh. All patients should be counseled about this potential complication.     

Prospective study on dialysis patients after total parathyroidectomy without autoimplant

Aim: Secondary hyperparathyroidism is common in chronic kidney disease. When medical treatment fails, subtotal or total parathyroidectomy with autoimplant is done but both are associated with a high recurrence rate. The third surgical strategy is total parathyroidectomy without autoimplant. We evaluate the outcomes of patients who had total parathyroidectomy with no autoimplant. Methods: Thirteen patients who had total parathyroidectomy without autoimplant were prospectively studied from 1998–2002. Intact parathyroid hormone, biochemistry and bone mineral densities were measured at baseline and serially. All patients had bone biopsies done preoperatively and seven had repeat bone biopsies at a mean of 37.7 months postoperatively. Histomorphometric studies were done for all bone biopsies. Patients were observed for fractures. Results: Five patients were on haemodialysis and eight on peritoneal dialysis. Mean duration of follow up was 68 months. Postoperatively, mean intact parathyroid hormone decreased precipitously and remained within or just above normal. Mean serum calcium phosphate product decreased and remained normal. Out of seven patients who had repeat bone biopsies, two showed reversal of hyperparathyroid bone disease to normal, two had mild hyperparathyroidism, while three had adynamic bone disease. One patient with adynamic bone disease subsequently developed biochemical recurrence of hyperparathyroidism. Serial bone densitometry showed remarkable improvement. There was no fracture. Conclusion: In the studied series of total parathyroidectomy without autoimplant, adynamic bone disease occurred in three out of seven repeat bone biopsies while improvement occurred in the rest. Bone mineral density was much improved and there was no fracture.