Modulation of IFNAR1 mRNA expression in multiple sclerosis patients

Interferon-beta receptor (IFNAR) is composed of 2 subunits, IFNAR1 and IFNAR2, the latter of which is expressed as functional (IFNAR2.2), non-functional (IFNAR2.1) and soluble (IFNAR2.3) isoform. Real-Time PCR analysis of mRNA for all IFNAR components in multiple sclerosis patients na?ve for therapy and undergoing long-term treatment with interferon-beta shows that IFNAR1 mRNA level is lower than in healthy controls. If long-term treated patients are divided according to the production of mRNA for Myxovirus protein-A, a marker of interferon-beta bioactivity, IFNAR1 mRNA reaches the values observed in controls only in Myxovirus protein-A-induced patients. Since chronic cell stimulation by interferon-beta induces IFNAR protein down-regulation, we suggest that the increase of IFNAR1 mRNA might serve as a mechanism for counterbalancing the loss of protein receptor, enhancing, at least in this sub-group of patients, cell responsiveness to interferon-beta.     

Emerging perspectives in epidermal growth factor receptor targeting in head and neck cancer

The epidermal growth factor receptor (EGFR) has been shown to be a promising therapeutic target in head and neck cancer. Cetuximab, a monoclonal antibody against EGFR, has been approved in the United States for use with radiotherapy for head and neck squamous cell carcinoma. However, the role of EGFR targeting agents in other therapeutic modalities, such as combined chemoradiotherapy or induction chemotherapy, remains to be defined. Although results from several clinical trials have demonstrated the therapeutic potentials of EGFR targeting agents in these settings, further studies are necessary before definitive conclusions can be made. The concurrent targeting of EGFR along with other pathways important in carcinogenesis may hold significant therapeutic potential. In particular, several clinical trials are studying the effects of combining agents that target the vascular endothelial growth factor with EGFR inhibitors. Last, studies are ongoing to elucidate the predictive and correlative biomarkers in anti-EGFR therapy to allow for proper patient selection. In the case of cetuximab, these correlative biomarkers may include elements of the immune system in addition to the signal transduction proteins involved in EGFR pathway.     

Can biomarkers play a role in the decision about treatment of the clinically negative neck in patients with head and neck cancer?

For most patients with head and neck squamous cell cancer, a treatment decision concerning the neck is required. Since detection of small metastases in lymph nodes is difficult, many of the patients with no detectable metastases receive elective treatment of the neck. Additional information on the metastatic potential of the primary tumor before treatment may be useful to reduce the number of these elective procedures. Biomarkers may supply such information. Molecules involved in several pathways have been studied, but the complexity of the metastatic process makes it unlikely that a single marker for metastasis can de identified. Techniques allowing the study of many factors simultaneously seem to be the most promising ones. In recent years, microarray expression profiling and comparative genomic hybridization studies have yielded interesting results. If these results can be confirmed in larger studies, they may play a role in future clinical decision making on treatment of the clinically N0 neck.     

Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy

BACKGROUND: The purpose of this study was to determine the influence of weight loss on outcome in patients with head and neck cancer undergoing concomitant chemoradiotherapy (CCRT): treatment interruption, infections, mortality, and hospital readmission rate. METHODS: Forty patients with head and neck cancer were enrolled. All patients were counseled to follow a nutritional program during CCRT. Body weight was evaluated at baseline, at the end, and 30 days after radiochemotherapy. RESULTS: Ninety percent of compliant patients with nutritional program maintained body weight (mean, 1 +/- 2.4 kg) and 100% of noncompliant patients continued to lose weight (mean, -9 +/- 4 kg; p < .001). A reduction greater than 20% of prediagnosis weight significantly correlated with treatment interruption (p = .003), infections (p = .002), early mortality (p = .011), hospital readmission rate (p = .001), and survival (log-rank test: z = -2.722, p = .006). CONCLUSION: In patients with head and neck cancer undergoing CCRT, the early nutritional management reduces weight loss and improve outcome.     

Use of StarClose for brachial artery closure after percutaneous endovascular interventions

The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.     

Efficacy and safety of quetiapine treatment for delusional parasitosis: experience in an elderly patient

Delusional parasitosis is an unusual psychiatric disorder characterized by the false and persistent belief of being infested by parasites. Treatments include haloperidol, pimozide, and at present, olanzapine and risperidone. We report a case of delusional parasitosis in an elderly man, in which the treatment with low doses of quetiapine induced the complete remission of the syndrome, without any considerable side effects. No such report has been described before.     

Heart transplantation in a child with LGMD2I presenting as isolated dilated cardiomyopathy

Limb-girdle muscle dystrophy type 2I is associated with mutations in the gene encoding Fukutin-related protein. Clinical phenotypes are heterogeneous, ranging from isolated hyperCkemia to severe congenital muscular dystrophy. Affected patients frequently develop dilated cardiomyopathy, depending on evolution of their skeletal myopathy. We report on an 8 years-old boy presenting a severe dilated cardiomyopathy requiring heart transplantation. The child harbored a homozygous p.Leu276Ile mutation in Fukutin-related protein gene (FKRP). At the current age of 20 years, the patient shows persistent hyperCKemia but no clinical muscle weakness, CT scan showing very mild features of muscle involvement. Our findings add to the array of clinical presentations of FKRP mutations.     

Methods to avoid gamma nail complications

Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.     

Charcot's joint secondary to neurologic complications of epidural anaesthesia: a case report

Neurogenic arthropathy or Charcot's Joint is an articular pathology that can strike patient with neurological effects or can be the result of a neurological lesion with deficit of the superficial and deep sensitivity. In this article we introduce one case Charcot's Joint of the hip, caused by an epidural anaesthesia performed for a surgery of the other hip.