Role of chemotherapy in the management of vulvar carcinoma

The aim of this review is to evaluate the use of chemotherapy (CT) in the treatment of squamous vulvar cancer. Since the 90s there was a continuous evolution in the therapeutic approach to this tumour. Although primary surgery is now considered the most effective approach, there are advanced diseases in which surgery may compromise anatomical structures causing severe mutilation. These are the reasons why CHT, with or without concomitant radiotherapy RT, started to be strongly recommended as neoadjuvant strategy. Chemotherapeutic agents have also been used alone as adjuvant treatment or in association with RT, by exploiting the radiosensitizing effect of these drugs. There are few data about the use of CHT as palliative treatment but recent studies point to the use of target therapy. In conclusion, clinical data and the evidence of chemo-sensitivity in vulvar squamous cell carcinoma open new possibilities to future research in this field.     

Management of acute left main obstruction after transcatheter aortic valve replacement: the “tunnel technique”

Two cases of acute left main (LM) obstruction complicating transcatheter aortic valve replacement (TAVR) and their management are reported. TAVR with a self-expandable transcatheter aortic prosthesis was performed for treating severe aortic stenosis with small aortic root and severe aortic regurgitation of a degenerated stentless bioprosthesis, respectively. Left main coronary obstruction occurred at a different time from the index procedure. A novel stent-based angioplasty treatment, denominated “the tunnel technique,” was successfully applied in both cases and herein described.     

如何改善靶向药物在胆管癌中的疗效？

10年中胆管癌(CC)的处理方法已经有了巨大的改变.仅仅在几年前,胆管癌晚期患者还没有效的治疗方案,只有支持治疗.并且在没有有效证据及随机研究结果的情况下,常给予患者姑息化疗. 根据两个随机试验的结果已经建立了一个新的治疗标准:吉西他滨和铂化合物的联合化疗方案已被证明能显著延长胆道肿瘤不能手术切除的患者的生存期[1-2].此外,新治疗方式的发展,包括具有开拓性的靶向性治疗也正开辟治疗CC的新途径[3].毫无疑问,考虑如何针对不同肿瘤类型使用新制剂治疗是个合乎时机的研究主题.一些Ⅱ期靶向药物研究,主要是抗-EGFR和VEGF药物,但是结果仍不明确.