Efficacy of paclitaxel in the treatment of Kaposi sarcoma

OBJECTIVE

Kaposi sarcoma is an angioproliferative disease. Kaposi sarcoma is clinicopathologically classified into four subgroups based on epidemiological data. For its systemic treatment, in addition to some chemotherapeutics, taxanes have also been used during the recent years for their anti-angiogenic properties. In this study, we aimed to compare paclitaxel and non-paclitaxel chemotherapeutic regimens in terms of efficacy and side effects.

PATIENTS AND METHODS

In our center, demographical, clinical and histopathological characteristics of a total of 13 patients diagnosed with Kaposi sarcoma who received therapy were retrospectively recorded based on their medical files

RESULTS

Among these subjects, 7 have been treated with paclitaxel and 6 with non-paclitaxel therapies. Eleven patients were male. Twelve patients were found to have classical type of Kaposi Sarcoma. The recurrence was observed in 2 patients treated with paclitaxel and in 1 patient treated with non-paclitaxel therapy. No statistically significant difference was found between the therapeutic modality, the stage of the disease and the percentage of the recurrence. Neuropathy developed in 3 patients treated with paclitaxel, whereas there was no neuropathy in the other group. Although the recurrence-free survival was worse in the patients treated with paclitaxel, there was no statistically significant difference.

CONCLUSIONS

Cytotoxic chemotherapy is effective in treating patients with Kaposi Sarcoma, although it is palliative. Taxanes have demonstrated effectiveness against AIDS-associated Kaposi Sarcoma. The experience suggests that paclitaxel is an effective alternative in the treatment of classical form Kaposi's sarcoma. There was no difference in efficacy between paclitaxel and non-paclitaxel therapies whereas difference in occurrence of neuropathy which is one of the side effects, showed borderline statistical significance.

Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

Background and purpose

Patients with symptomatic internal carotid artery (ICA) occlusion constitute a small proportion of stroke/transient ischaemic attack patients who are at increased risk of early stroke recurrence and poor outcome. The optimal medical treatment for patients with symptomatic ICA occlusion who are ineligible for thrombolysis or thrombectomy is unknown.

Methods

Consecutive patients presenting at a single center with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) were retrospectively reviewed. Those treated with intravenous thrombolysis or intra‐arterial thrombolysis/thrombectomy were excluded. Patients were divided into two groups based on whether they experienced recurrent in‐hospital stroke.

Results

The selected study population (n = 33) represented a small (20.4%) proportion of all newly symptomatic carotid occlusions, who nevertheless had an elevated risk of recurrent stroke during admission (24.2%). Of the variables examined (age, gender, admission National Institutes of Health Stroke Scale score, vascular risk factors, atrial fibrillation, prior stroke/transient ischaemic attack and anticoagulation within 48 h of presentation), only anticoagulation was significantly associated with a lower risk of in‐hospital recurrent stroke. Anticoagulated patients showed a decreased incidence of stroke recurrence within the first week (6.7% vs. 38.9%, P = 0.032) and fewer strokes or deaths at 1 month (13.3% vs. 47.1%, P = 0.040). Hemorrhagic transformation was not observed in any patient. On follow‐up imaging, ICA recanalization was significantly more frequent in anticoagulated patients (46.2% vs. 9.1%, P = 0.047).

Conclusion

Patients with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) represent a small but high risk subgroup of patients with carotid occlusion. Early anticoagulation was associated with fewer recurrent strokes and increased ICA recanalization. Larger scale prospective studies may be justified.

New method for estimating the volume and volume fractions of the nasal structures in the goose (Anser anser domesticus) using computed tomography images

1. The conchae within the nasal cavity of poultry are important for water and energy conservation, but have not been experimentally evaluated. The aim of the present study was to determine the accuracy of volume and volume fraction estimates of the conchae, nasal septum and nasal cavity. 2. The nasal cavities of 7 adult goose heads were scanned using computed tomography (CT), with images sampled randomly at a 1/5 sampling fraction. Physical sections were obtained from the same samples, using an electric saw that had an adjustable section range, and provided 14 to 15 sections with a thickness of 2.5 mm. The section surface areas of the nasal cavity, nasal septum and conchae were estimated using the Cavalieri principle. Results obtained using the CT and physical section images were compared. Volumes and volume fractions obtained from the physical sections were accepted as the gold standard and differences in the CT images were determined. 3. Multiplication of the data obtained on the CT images with the deviation percentage of the physical sections produced normalised values. No differences were observed between the gold standard data and the CT images. While it was possible to normalise the obtained data using the gold standard values, the raw data could also be used for comparative studies because the deviations from normal would be similar for all groups. 4. Our study showed that the nasal structures could be estimated in vivo using CT images.

PTEN, Akt, MAPK, p53 and p95 expression to predict trastuzumab resistance in HER2 positive breast cancer

PURPOSE

Mutations that activate the PIK3CA oncogene and inhibit the tumor suppressor gene PTEN action are commonly found in breast tumors. Akt is a key activator of cell survival. p53 is frequently found mutated in human tumors, and mutant p53 protein actively contributes to tumorigenesis. In selected cases of breast cancer, trastuzumab (TZMB) is incorporated in the primary treatment in the adjuvant and metastatic settings. Many studies have reported that selected patients are resistant to TZMB due to the presence of p95 HER2 fragments. To address this, we analysed PTEN, Akt, MAPK, p53 and p95 expression in breast cancer patients treated with TZMB.

METHODS

Out of 90 patients histologically diagnosed with breast cancer between 2004 and 2011, analysed were 25 patients with HER2 positive, and estrogen (ER) and progesterone receptors (PR) negative, metastatic or locally advanced disease. All 25 patients were treated with TZMB and resistance to TZMB was assessed. All patients were on anthracycline-and taxane-containing regimens. Tissue samples were obtained from paraffin blocks and evaluated immunohistochemically for PTEN, Akt, MAPK, p53, and p95 expression.

RESULTS

TZMB resistance was detected in 5 (20%) patients. Akt expression was positive in 2 patients (8%) and MAPK, p95, and p53 expression was positive in 1 patient (4%); PTEN expression was negative in 3 patients (12%). No significant differences were found between TZMB resistance and PTEN, Akt, MAPK, p53, and p95 expression. Subgroup analysis was carried out in the neoadjuvant treatment group. Complete pathologic response was detected in 3 patients (21.4%). Statistically significant differences were not found between the complete response rate and PTEN, Akt, MAPK, and p95 expression. There was a statistically significant correlation between p53 expression and complete pathologic response (p=0.02).

CONCLUSION

No statistically significant correlation between TZMB resistance and the expression of these biomarkers was noted. In patients with HER2-positive breast cancer that were treated with 4 dose-dense sequential cycles of doxorubicin and cyclophosphamide, followed by TZMB and paclitaxel combination therapy in the neodjuvant setting, p53 expression could predict complete response to chemotherapy.

Nurse-assisted education and exercise decrease the prevalence and morbidity of lymphedema following breast cancer surgery

PURPOSE

To evaluate an educational and exercise program for the prevention and progression of post-mastectomy lymphedema of the arm and shoulder.

METHODS

Fifty-five patients who had undergone mastectomy and axillary lymph node dissection between June 2009 and January 2010 were included in this study. The patients were informed by a trainer nurse about the precautions they should take to prevent the development of lymphedema. The patients were also trained for the appropriate exercises and were given written educational material prepared by the investigators.

RESULTS

Among the participants, 96.4% underwent modified radical mastectomy (MRM) and 3.6% breast-conserving (BCS) surgery. The mean postoperative follow-up period was 9.87 ± 17.55 months. The degree of lymphedema was found lower, even within 6 months, in the patients that exercised as compared to the patients that did not (p<0.05).

CONCLUSIONS

The results indicate that the risk of development and progression of mastectomy-related lymphedema was reduced with education and exercise provided by trained nurses at an early stage.

Estimation of nasal cavity and conchae volumes by stereological method

BACKGROUND

Studies evaluating the mean volumes of nasal cavity and concha are very rare. Since there is little date on the mentioned topic, we aimed to carry out the presented study to obtain a volumetric index showing the relation between the nasal cavity and concha.

MATERIAL AND METHODS

The volumes of the nasal cavity and concha were measured in 30 males and 30 females (18-40 years old) on computed tomography images using stereological methods.

RESULTS

The mean volumes of nasal cavity, concha nasalis media, and concha nasalis inferior were 5.95 ± 0.10 cm(3), 0.56 ± 0.22 cm(3), and 1.45 ± 0.68 cm(3); 7.01 ± 0.18 cm(3), 0.67 ± 0.31 cm(3) and 1.59 ± 0.98 cm(3) in females and males, respectively. There were statistically significant differences in the volume of the nasal cavity and concha nasalis media (p 〈 0.05) between males and females, except for concha nasalis inferior (p 〉 0.05).

CONCLUSIONS

Our results could provide volumetric indexes for the nasal cavity and concha, which could help the physician to manage surgical procedures related to the nasal cavity and concha.

The estimation of the volume of sheep mandibular defects using cone-beam computed tomography images and a stereological method

OBJECTIVE

The Cavalieri principle of stereological methods is widely used to estimate the volume of structures. Recently in clinical practice, it has become common to use this approach for daily routine purposes. The Cavalieri principle provides quantitative and unbiased volume estimates which are independent of the observer. In the present study, the efficacy of using the Cavalieri principle to estimate the volume of sheep mandibular defects on cone beam CT (CBCT) scans was tested.

METHODS

24 differently sized defects were created on 4 sheep mandibles. Before the defects were created, the outer boundaries of the defects were determined using plaster casts. CBCT scans of the defects were taken. The scans were reconstructed in the coronal plane and sections of 0.2 mm thickness with 0.2 mm and 0.4 mm intervals were obtained. The volume of each defect was estimated using the Cavalieri principle. The models were created using light-body silicone for the estimation of the actual volume of each defect. They were immersed in water using a pycnometer and the actual volumes were obtained on the basis of the Archimedean principle. The actual and estimated volumes of the defects were compared using the Wilcoxon signed-rank test.

RESULTS

The results showed that the volumes from the Cavalieri estimates did not differ from the actual volumes of the defects (P > 0.05).

CONCLUSION

We concluded that the volume of mandibular defects can be accurately estimated using the Cavalieri principle on images from a CBCT scan.

Endoscopic treatment of biliary disorders in patients with Roux-en-Y hepaticojejunostomy via a permanent access loop

The management of biliary disorders in patients with Roux-en-Y hepaticojejunostomy anastomosis is challenging and remains controversial. Our aim is to share our experiences of endoscopic treatment via a permanent access loop in 5 patients. Endoscopic treatment via a permanent access loop is an invaluable procedure for the management of stenotic hepaticojejunostomy anastomosis, anastomotic leakage, and hepatolithiasis. It may even be life-saving for some patients.

Mucormycosis-associated fungal infections in patients with haematologic malignancies

Among patients with haematologic disorders, mucormycosis most commonly occurs in those with acute leukaemia or lymphoma who have developed neutropenia due to malignancy or to chemotherapy, and in transplanted patients receiving immunosuppressive treatment. Here, we aim to present a retrospective study conducted over a 5-year period (2001-2005). The study included 20 patients with haematologic malignancies with a proven mucormycosis admitted in Medical Oncology Divisions in Cukurova University Hospital. The most frequent sites of infection were paranasal sinuses (95%) and lung (5%). Antifungal treatment was empirically administered in 18 (90%) patients; 18 patients underwent radical surgical debridement (90%). The therapy was successful for only eight patients (40%). Eleven patients died within 1 months of the diagnosis of fungal infection: the cause of death was only by mucormycosis in four patients (36.6%), mucormucosis and systematic inflamatuar response syndrome (SIRS) in two patients (18.2%) and progression of haematologic disease in five patients (45.5%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: amphotericin B treatment, neutrophil recovery from postchemotherapy aplasia. At multivariate analysis, the factors that significantly correlated with recovery from infection were the liposomal amphotericin B treatment (p = 0.026), doses of L-AmB (p = 0.008) and the length of the treatment (p = 0.01), respectively. It seems to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients.

Epiphytic algae on mosses in the Altindere Valley National Park (Maçka-Trabzon/Turkey)

Species composition and abundance of epiphytic algae on mosses growing in the Altindere Valley National Park were investigated in March 2008. The epiphytic algae identified in these samples were 27 species in total, 15 of the Bacillariophyta, 7 of the Cyanophyta, 4 of the Chlorophyta and a single of the Euglenophyta species. The members of the Bacillariophyta were more frequently found among these epiphytic algae on mosses. Netrium digitus (Ehrenb.) Itzigs and Rothe var. curtum (Borge) Willi Krieg. was recorded for the first time in the desmids flora of Turkey. The epiphytic algal flora on mosses at the submerged habitat was the richest of the three habitats.

Comparison of four methods for the estimation of intracranial volume: a gold standard study

Investigators can infer how much reduction in volume has occurred since brain volume was at its peak, by combining measures of brain volume with measures of intracranial volume (ICV). Several methodologies have been proposed to asses the ICV. However, we have not seen a gold-standard study evaluating the results of the methodologies for the assessment of ICV. In the present study, the actual intracranial volume of 20 dry skulls was measured using the water-filling method, using this as a gold standard. Anthropometry, cephalometry, point-counting, and planimetry techniques were applied to the same skulls to estimate the ICV. Anthropometric and cephalometric measurements were carried out directly on skulls and roentgenograms, respectively. Consecutive computed tomography sections at a thickness of 10 mm were used to estimate the ICV of the skulls by means of the point-counting and planimetry methods. The mean (+/-SD) of the actual ICV measured by the water-filling method was 1,262.0 +/- 160.4 cm(3) (1,389.5 +/- 96.5 cm(3) for males and 1,134.5 +/- 94.3 cm(3) for females, respectively). Our results showed that the estimated values obtained by all four methods differed from the actual volumes of the skulls (P < 0.05). The data obtained by anthropometry resulted in overestimation. However, cephalometry, point-counting, and planimetry methods produced underestimation. After calibration, there were no significant differences between the actual volumes and the results of the four methods (P > 0.05). While the anthropometric method is easy and quick to apply, its result may deviate from the actual values. The optimized stereological techniques of point-counting and planimetry methods may provide unbiased ICV results since they take the third dimension of the structures into account.

Topoisomerase-II, c-erb B2, c-kit and bcl-2 expression in non-small cell lung cancer treated with docetaxel and gemcitabine based threapy

18212

Background: This study was conducted to determine the expression of the topoisomeras-II, c-erb B2, c-kit and bcl-2 in patients with non-small cell lung cancer (NSCLC). Material-methods: These factors expression were identified by immunohistochemical method in 62 NSCLC patients pathologically verified on before therapy. Results: 3 patients were in stage-II, 10 in stage-IIIA, 21 in stage-IIIB and 28 in stage-IV. 14 patients had refused therapy, 12 were undergone to surgery alone and 36 recieved multimodality therapy. 27 patients recieved docetaxel-cisplatin therapy and 7 had recieved gemcitabine-cisplatin therapy. Of those docetaxel treated patients 14 received radiation therapy and others undewent surgery in combination therapy. In 31 patients topoisomerase-II was +2 (50%), +1 in 3 patients, +3 in 27 patients and in 1 patient the expression was negative. c-erb B2 was negative in 1, +1 in 2, +2 in 14 and +3 in 45 patients. bcl-2 was negative in 9, +1 in 16, +2 in 22 and +3 in 15 patients. c-kit was negative in 9, +1 in 26, +2 in 15 and +3 in 12 patients. Statistical analysis was done by SPSS- 14 software program. The disease stage, received therapies and the expression of the these proteins was correlated, median survival time and possible prognostic factors were identified. There were statistically significant between stage and patient status (P=0.000), either with therapy or no therapy (p=0.003), bcl-2 (p=0.09) and c-kit (p=0.022), respectively. There were statisticaly significant between stage and bcl-2 (p=0.023), bcl-2 and c-kit (p=0.001), respectively. At the end of the follow-up time, 38 (61.3%) patients were alive. The median survival was 37.2 months. There were not any prognostic values for topoisomerase-II (p=0.7), c-erb B2 (p=0.6), bcl-2 p=0.15) and c-kit (p=0.118) expression. Conclussion: In conclussion, we suggested that the treatment modality of patients with NSCLC should be combination therapy. The patients received docetaxel based therapy had long median survival time. In addition there was no prognosticeffect of the expression of the topoisomeras-II, c- erb B2, c-kit and bcl-2 in patients with non-small cell lung cancer (NSCLC).

No significant financial relationships to disclose.

Early decision for precut sphincterotomy: is it a risky preference?

The aim of this prospective study was to evaluate the results and the complications at a tertiary referral center which frequently uses precutting techniques for biliary cannulation. Four hundred seventy patients with naive papilla for whom biliary intervention was planned were included in the study. If the selective cannulation was not achieved after a few trials, precutting sphincterotomy was performed. The results were evaluated for the frequency, success, and complication rates of precutting. Precutting was performed on 238 (50.6%; 117 male, 121 female; mean age, 58.5 +/- 16.2 years) of 470 patients. Total success rate of endoscopic retrograde cholangiopancreatography (ERCP) was 99.2% (236/238). The rate of complications in patients with versus without precutting was 7 (2.9%) versus 3 (1.3%) for pancreatitis, 2 (0.8%) versus 1 (0.4%) for perforation, and 7 (2.9%) versus 3 (1.3%) for bleeding. The differences between the rates were not significant. Early precutting can be preferable in prolonged cannulation trials of therapeutic ERCP.