Pre- and post-treatment evaluation of non-Hodgkin's lymphoma

Once the diagnosis of a non-Hodgkin's lymphoma (NHL) has been established three critical steps in patient management must follow. The first is the pre-treatment evaluation and staging to identify prognostic factors (the subject of another chapter in this volume), impending problems, such as ureteral obstruction, spinal cord compression, biliary or vena caval obstruction. This assessment directs the best therapeutic approach, and also provides a baseline against which to assess response. The second step is the treatment itself. Third, conscientious follow-up after completion of therapy to monitor for disease recurrence as well as for long-term sequelae of therapy. A careful history and physical examination are the most important components of patient evaluation. Whereas some evaluation procedures have become standard practice (e.g. chest radiographs, CT scans, gallium scan, blood chemistry and assessment of hepatic and renal function), the role of other studies is still being defined (e.g. PET scan). The increased use of systemic therapies has somewhat reduced the requirement for precise staging to determine treatment strategies, but will become more critical to identify early patients with resistant disease and those with minimal residual disease following treatment so that novel therapies can be introduced at that point.     

Preferential killing of PTEN-null myelomas by PI3K inhibitors through Akt pathway

We recently reported that internal deletion of PTEN tumor suppressor gene in OPM2 and Delta47 myeloma lines led to high Akt activation. Re-expression of PTEN induced strong apoptosis and growth inhibition. To understand the biologic importance of the phosphatidylinositol 3 kinase (PI3K)/Akt activation affected by PTEN deletion, we analysed apoptosis and growth inhibition by applying PI3K inhibitors to myeloma lines and by expressing Akt constructs. The PI3K inhibitors preferentially suppressed PTEN-null myeloma growth to those expressing PTEN, indicating that PI3K activation is more critical for growth and survival of those lines with PTEN mutations than others expressing a functional PTEN gene. Since PTEN-null myeloma lines exhibited much stronger Akt activation than PTEN-expressing cells in response to insulin-like growth factor I stimulation, we determined whether Akt could be responsible for PI3K-mediated cell survival and growth of PTEN-null myeloma lines. Expression of an active Akt, but not its kinase dead mutant, reversed wortmannin- and dexamethasone-induced apoptosis and growth inhibition in PTEN-null myeloma lines, suggesting that Akt lies downstream of PI3K for PTEN-null myeloma survival and dexamethasone resistance. In summary, we have provided evidence that PTEN-null myeloma cells are stringently dependent on the PI3K/Akt activation for cell survival. These results may provide a basis to treat myeloma patients with PI3K and Akt inhibitors.     

Acute necrotizing encephalopathy associated with parainfluenza virus in a Caucasian child

Acute necrotizing encephalopathy is a severe parainfectious disorder with a clear racial predilection for Oriental children living in the Far East. The prognosis was originally reported as grave; however, a mild form of the disease has recently been described. A case of parainfluenza virus-associated acute necrotizing encephalopathy in a Caucasian child with a mild clinical course and excellent prognosis is presented. In this patient, the initial clinical picture was not very impressive, and the diagnosis was delayed until the third week of the illness, when neuroimaging was performed. Two months later, clinical and neuroimaging findings had almost completely resolved. Suggested criteria for a benign prognosis, such as normal liver function and cerebrospinal fluid protein levels, asymmetric thalamic lesions, and no brainstem involvement, were relevant in the present case. An extended diagnostic work-up for metabolic, vascular, coagulation, and infectious diseases was negative apart from a seroconversion for parainfluenza virus. To our knowledge, this is the first reported case of acute necrotizing encephalopathy associated with parainfluenza virus infection. Acute necrotizing encephalopathy, especially in the mild form, might not be fully recognized and could be underdiagnosed in Europe, where the reported incidence of the syndrome is very low.     

Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement

Objectives

This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR).

Hemorrhagic cerebral infarct and ulcerative colitis. A case report

We report the occurrence of a cerebral ischemic infarct in a young normotensive woman suffering from ulcerative colitis. One week later, clinical neurological deterioration corresponded with hemorrhagic transformation of the previously ischemic region and white matter edema. Extensive laboratory investigation excluded other possible causes for stroke mechanism and rather supported a cerebral vasculitic process, while significant improvement both on neurological and bowel function was observed under prednisone therapy. This report provides some additional support to the possible association between ulcerative colitis and cerebrovascular complications.     

Polymyositis in a patient with recurring ovarian cancer and history of unrelated breast cancer

Background Polymyositis (PM) is an idiopathic inflammatory myopathy. Occasionally, it may present as a paraneoplastic syndrome and it is strongly associated with ovarian and weakly with breast cancer. We present here a case of a 60-year-old patient with sequential breast and ovarian (second primary) carcinomas followed by PM as a paraneoplastic disorder. Case report The patient had been diagnosed with stage I breast carcinoma 3 years ago and had been treated with conservative surgery followed by radiotherapy and six cycles of chemotherapy (CMF). One and a half year later an ovarian carcinoma was diagnosed for which the patient underwent abdominal hysterectomy oophorectomy and omentectomy. The pathological report characterized it as second primary. Adjuvant chemotherapy with carboplatin and taxol was administered. Fourteen months after the initial laparotomy, the patient was re-operated due to ovarian carcinoma recurrence which was involving all lesser pelvis organs. After a successful radical removal of the recurrence the patient developed a fully expressed PM. This case serves to remind that this disease can occur as a paraneoplastic disorder.