Phase II study of etoposide (VP-16) in patients with thyroid cancer with no prior chemotherapy: an Eastern Cooperative Oncology Group Study (E1385)

This study of etoposide in thyroid cancer was designed to determine the activity and toxicity of etoposide in a variety of inoperable, thyroid hormone insensitive, and radio-iodine resistant primary cancers of the thyroid. The patients were required to have an ECOG performance status of at least 3 and no previous exposure to chemotherapy. The etoposide was given at a dose of 140 mg/m² daily for 3 days and every 3 weeks until progression. The study was closed after 18 months because of poor accrual. There were no responses seen among the 10 patients accrued. The toxicity was primarily hematologic. There was no evidence of activity of etoposide in thyroid carcinoma, although this study lacked significant power because of the poor accrual.     

Laparoscopic biliary surgery

The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. The differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about whether access to the main biliary path should be achieved through the cystic conduct or whether, on the contrary, a choledochotomy should be performed.     

Duodenal gangliocytic paraganglioma

We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histological study showed that it was a duodenal gangliocytic paraganglioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.     

Nutritional factors in high blood pressure

Metabolism of Na+, Ca+ and Zn+ cations is clearly disturbed and involved in the development and maintenance of a hypertensive condition. These changes are closely related to each other; therefore, when their effects on primary hypertension (PH) are studied, they should always be globally (and not separately) considered. These changes of the aforementioned electrolytes in PH maintain a close, but unclear, relationship with various hormonal systems, mainly with the renin-angiotensin-aldosterone system. Daily control in the intake of these electrolytes (especially Na+ and Ca++) remains a cornerstone in the adjuvant treatment of PH. Na+ dietary restriction is indicated in hypertensives showing higher sensitivity to salt; in most cases they have low (70%) plasma renin activity (PRA) and belong to one of the following five groups: black, elderly, obese or diabetic (type 2) patients, and mixed blood young people from our community with low levels of PRA and serum ionic calcium. For best results, this moderate Na+ restriction (4-6 g of NaCl) should always be accompanied by an oral calcium supplement, or at least the assurance that the subject takes an appropriate amount of Ca++ (>800 mg/day) in his/her diet. Hypertensives with low PRA exhibit obvious changes of their calcium metabolism. We do not know the role of Zn++ in the development of PH; however, older hypertensives with very low PRA have high urinary excretion of Zn++ with low serum levels, a factor that could contribute to Zn++ depletion in these hypertensive patients. The oral administration of calcium corrects the Zn++ changes by a still unclear mechanism.     

Intraoperative cell salvage with autologous transfusion in liver transplantation

Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.