Calf pseudohypertrophy in a patient with double neurogenic pathology

A pseudohypertrophy of the calf can be rarely associated with neurogenic pathologies as S-1 radiculopathy, poliomyelitis, spinal muscular atrophy, traumatic lesions of peripheral nerves, intraspinal neurinoma. The causes of this particular phenomenon are unknown. The authors present the case of a 52-year-old man with an enlargement of the left calf suffering from a mild form of spinal paralytic poliomyelitis in the early childhood and episodes of severe left sciatica in the last four years. Electromyography demonstrated a pattern of denervation in both legs and an H-reflex absent when the left tibial nerve was stimulated. An open muscle biopsy of the left calf was performed. Light microscopic and ultrastructural examination of the muscle confirmed the presence of a pattern of "neurogenic type" pseudohypertrophy. Our results could be interesting for the understanding of the mechanism of neurogenic pseudohypertrophy. This case suggests that timing of stimulus or "dose" of denervation may be important factors in such a phenomenon.

Transtympanic steroids in refractory sudden hearing loss. Personal experience

The treatment of choice for sudden sensorineural hearing loss is still lacking. Many drugs have been used over the years, with varying results and steroids have proven to be effective in clinical trials, albeit systemic administration is associated with untoward side-effects and cannot be used in all patients. The transtympanic approach presents two main advantages: first, it allows higher concentrations in the inner ear environment and, second, it minimizes systemic absorption. Aim of the present investigation was to establish the effectiveness of transtympanic steroid treatment for sudden sensorineural hearing loss in patients in whom conventional treatment had failed. For this purpose, a prospective, non-randomized study was designed to evaluate hearing improvement in sudden sensorineural hearing loss patients treated with transtympanic steroids. A solution of methyl-prednisolone and sodium bicarbonate was administered, via a transtympanic injection, in 10 patients. Hearing levels were evaluated before treatment and on days 1, 7 and 30, thereafter. Improvement in hearing was observed in 70% of patients, moreover, in patients not usually considered amenable to this kind of treatment. Transtympanic steroid treatment is an effective and safe option for patients with sudden sensorineural hearing loss when conventional treatment regimens have failed. Further studies are needed to define the optimal dosage, route of administration and type of steroids.

Pegylated liposomal doxorubicin in combination with gemcitabine in elderly women with locally advanced or metastatic breast cancer: Safety and activity results of our clinical experience

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Background: Elderly breast cancer patients have an increased risk of toxicity from chemotherapy, especially from anthracycline-based regimens. Pegylated liposomal doxorubicin (PLD) has shown a better tolerability profile also in combination with gemcitabine (GEM), as evidenced in several phase II trials. The aim of this study is to retrospectively evaluate the safety and activity of this combination in chemo-naïve or pre-treated elderly patients with advanced breast cancer. Methods: From January 2006 to March 2008, 39 patients (pts) with age ≥ 65 received, at our institution, PLD 25 mg/m2 (day 1, q21) and GEM 800 mg/m2 (days 1 and 8, q21). Median age was 72 (range, 65–79). ECOG PS was 0/1/2 in 14/23/2 pts, respectively. 12 pts (31%) were chemo-naïve, 20 (51%) received prior adjuvant anthracycline-based regimens, and 7 (18%) received other chemotherapies. PLD-GEM combination was administered as first line in 35 pts (90%). Median left ventricular ejection fraction (LVEF) at baseline was 61% (range, 50%-75%). 28 patients (72%) had metastatic disease: 10 in liver, 6 in lung, 2 in skin, and 10 in multiple sites. Estrogen receptor was positive in 32 pts (82%); HER-2+ in 5 pts; 7 pts were triple negative. Results: A total of 206 cycles were administered with a mean number of cycles per patient of 5.2 (range, 3–12). Grade 3–4 neutropenia occurred in 4 (10%) and 3 patients (8%), respectively; grade 3 anemia in two pts (5%). Non-hematological toxicity was mild, with 5 cases (13%) of grade 3 mucositis, and 2 cases (5%) of grade 2 palmar-plantar erythrodysesthesia syndrome. No modifications in LVEF or toxic deaths were documented. We observed 1 CR (2.5%) and 11 PR (28.2%). Eighteen (44%) patients experienced SD for 16 weeks and an overall clinical benefit of 76.8%. Conclusions: The combination of PLD and GEM has a favorable tolerability and a safety profile with an evident clinical benefit and should represent an interesting treatment option in elderly women with advanced breast cancer.

No significant financial relationships to disclose.

[Use of dermo-adipose grafts in facial morphology restoration in cases of progressive partial lipodystrophy]

Two cases of partial progressive lipodystrophy syndrome with extensive soft tissue atrophy of the face and of the upper part of the trunk, with kidney and blood alteration, are presented. On the basis of the psysical examination and pathological history of the patients, blood and instrumental tests have been performed in both cases. The diagnosis of partial progressive lipodystrophy syndrome has been made and a surgical treatment with dermal fat graft from the inguinal region was proposed to the patients after several information and was performed to improve the facial contour. After a follow up of 18 months a resorption of 50% of dermal fat graft was found according to surgeons' expectations with a good esthetic improvement of the face.

Surgical approach to a rare case of Beckwith Wiedemann syndrome with left thigh hyperplasia

Thigh lift surgery is generally performed in patients with severe weight loss outcomes, particularly those undergoing bariatric surgery. However, there are other congenital malformation conditions that may require the same treatment, such as Beckwith Wideman syndrome.

Ultrasound measurement of detrusor thickness in bladder instability in women

– Ultrasound was used to measure the detrusor thickness in 20 women with urodynamically-proved detrusorial instability. In 95% of the cases, detrusor thickness is greater than or equal to 5 mm. Comparison with a control group confirms the reliability of these results.

A case of pregnancy in a patient suffering from the Behcet syndrome: immunological aspects

A case of pregnancy in a patient with Behçet syndrome is described. The immunological aspects have been thoroughly investigated during and after gestation and an explanation is given in regards to clinical remission during pregnancy.

[Embolism in an elderly diabetic patient following hyperosmolar coma]

The authors report a case of hemiballismus in an old patient with diabetes and hypertension, developed after a non ketotic hyperosmolar coma episode. In agreement with the recent literature, the syndrome is not always caused by a single Luys body lesion, but also by complex scattered lesions demonstrable only by RMN. A possible pathogenetic role of the recent non ketotic hyperosmolar diabetic coma and the good prognosis indicate that the vascular aetiology, even if prevalent, could not be the only one. The role of institutionalization of the patient during the development of the syndrome has also been discussed.

Hyaluronic acid fillers in lip augmentation procedure: a clinical and histological study

Several approaches have been proposed for soft tissue augmentation using injectable materials for lip and soft-tissue augmentation due to their physical and biological properties. Hyaluronic acid represents a natural component of the connective tissues, related to wound healing and skin regeneration. The aim of this research was to investigate the clinical and histological effectiveness of cross-linked hyaluronic acid for lip augmentation. A total of 8 patients were treated for lip augmentation with a clinical follow up of 60 days. After this period a histological evaluation was performed to evaluate the healing of the treated regions. The healing phase reported no inflammatory response, tissue contractions and no local flogistic evidence in the treated areas, where the filling volume appeared maintained. The 60 days histological evaluation showed evidence of filler resorption with few infiltrated inflammatory cells. The clinical and histological findings suggested that cross-linked hyaluronic acid represents a safe and effective tool for lip augmentation.

[Sister chromatid exchanges induced in human lymphocyte chromosomes by trifluralin, atrazine and simazine]

Many epidemiological and experimental "in vivo" studies have proved in recent years the carcinogenic properties of herbicides. In order to evaluate the "in vitro" action on the human DNA of Trifluralin, Atrazine and Simazine (active principles of herbicides Treflan and Fogard S respectively) the authors have studied the rates of SCE in cultures of human lymphocytes exposed to different concentrations of a solution 1 ppm of the substances. Trifluralin and Simazine, but not Atrazine, increase SCE per cell, with statistical significance, in the cultures with the highest concentrations of these substances. (SCE per cell: Trifluralin 5.27 +/- 1.38, Simazine 5.09 +/- 1.19, Control 3.51 +/- 1.14).

Abstract P6-17-02: Ado-trastuzumab emtansine (T-DM1) is effective against established HER2-positive breast cancer brain metastases in mice

Background: Brain metastases represent a major problem in the treatment of HER2-positive breast cancer (1). The antibody-drug conjugate ado-trastuzumab emtansine (T-DM1) has shown efficacy in trastuzumab-resistant systemic breast cancer. Here, we tested the hypothesis that T-DM1 could overcome trastuzumab resistance in murine models of brain metastases.

Methods: We used previously established animal models of HER2-positive breast cancer brain metastases and organotypic brain slice cultures that recapitulate clinical scenarios (2). We treated mice bearing HER2-positive breast cancer brain metastases with trastuzumab or T-DM1 at equivalent or equipotent doses. Using intravital imaging, molecular techniques and histological analysis we determined tumor growth, mouse survival, cancer cell apoptosis and proliferation, tumor drug distribution, gene expression, and HER2 downstream signaling.

Results: T-DM1 significantly delayed the growth of HER2-positive breast cancer brain metastases compared to trastuzumab. These findings were consistent between HER2-driven and PI3K-driven breast tumors. The activity of T-DM1 resulted in a striking survival benefit compared to trastuzumab (median survival for BT474 tumors: 28d for trastuzumab vs 112d for T-DM1, HR=6.2, P<0.001). A comparison of T-DM1 with trastuzumab revealed no difference in their tumor distribution, HER2 downstream signaling inhibition or immune cell enrichment. T-DM1, however, led to a significant increase in tumor cell apoptosis. Electron microscopy studies revealed increased numbers of abnormal mitotic figures in brain tumors treated with T-DM1. Whole-transcriptome microarray analysis of BT474 brain tumors treated with trastuzumab or T-DM1 showed an enrichment of genes that are associated with mitotic catastrophe in the group treated with the antibody-drug conjugate. These mechanistic studies support the hypothesis that the efficacy of ado-trastuzumab emtansine in the brain microenvironment is mediated through the cytotoxic chemotherapeutic effect of the DM1 component.

Conclusions: Our findings suggest that T-DM1 can overcome resistance to HER2-targeted therapies in the CNS, and warrants clinical investigation for the effective treatment of HER2-positive breast cancer brain metastases.

References:

1. Kodack DP, Askoxylakis V, Ferraro GB, et al. Emerging strategies for treating brain metastases from breast cancer. Cancer Cell 2015, 27(2):163-175.

2. Kodack DP, Chung E, Yamashita H, et al. Combined targeting of HER2 and VEGFR2 for effective treatment of HER2-amplified breast cancer brain metastases. Proc Natl Acad Sci U S A 2012, 109(45):E3119-3127.

Citation Format: Askoxylakis V, Ferraro G, Kodack D, Badeaux M, Jain R. Ado-trastuzumab emtansine (T-DM1) is effective against established HER2-positive breast cancer brain metastases in mice. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-17-02.

Synergisms between different activation pathways in adult and aged human lymphocytes

The present report investigates the synergistic effects of different agents (phytohaemoagglutinin (PHA), anti-CD3, phorbol-12-myristate-13-acetate (PMA) and Ionomycin on T cell activation. Results indicate that in normal lymphocytes PMA causes a dose-dependent decrease of PHA-induced blastogenesis and a marked enhancement of anti-CD3-induced 3H-thymidine uptake. There is positive synergism when cells are costimulated with PMA and the calcium ionophore Ionomycin. These data show that phorbol esters can exert either positive or negative synergisms depending on the experimental conditions. We also studied the simultaneous stimulation with PHA and anti-CD3 which gives an addictive effect for the minimal doses of the two stimuli, and an appreciable negative synergism for their highest concentrations. In order to evaluate T lymphocyte functions in the age-associated immune defect, PHA plus anti-CD3 and PMA plus Ionomycin costimulation assays were applied to a population of healthy elderly subjects. An additive effect is found after costimulation with the highest doses of PHA and anti-CD3, at variance with the negative synergism found in younger adult controls. Following costimulation with PMA plus Ionomycin, elderly subjects also display an impaired response, as compared to adult controls. No correlation was found with PHA-, anti-CD3- and PMA plus Ionomycin-induced T cell proliferation. These results underline the complexity of age-associated immune defects and suggest that alterations in different mechanisms of lymphocyte activation are responsible for the immune deficiency of aging.