[Meningeal carcinomatosis in breast cancer: from diagnosis to treatment]

The appearance of meningeal carcinomatosis in breast cancer is an event that is being reported increasingly more frequently in the literature. It seems to be related with the lengthening of the patients' lives, improved sensitivity to diagnostic imaging and impermeability of the blood-brain barrier to the chemotherapeutic agents. It is an evolutionary form that affirms the metastatic invasion of the subarachnoidal space and is correlated with limited survival. Its diagnosis is difficult, due to the lack of specificity of the clinical signs dominated by headaches, cognitive disorders and possible signs and symptoms of progressive focal lesions. Magnetic resonance imaging of the brain and the spinal cord interpreted by a specialist in neuro-oncology is the preferred examination in this indication, in the search for an increase in meningeal enhancement. Biological analysis of the cerebrospinal fluid is an essential element in the diagnosis. In addition to the biochemical study, the presence of neoplastic cells is in itself enough to confirm the diagnosis. False negatives are very common and represent an important diagnostic problem that entails the need to repeat the lumbar punctures. The therapeutic methods are standard, often invasive, dominated by intrathecal chemotherapy and are based on low-level scientific evidence. This study analyses the epidemiology, the prognostic factors, the diagnostic tools, currently available treatments and the possible future therapies of meningeal carcinomatosis in breast cancer.

FOLFOX as Perioperative Chemotherapy of localized Gastric Cancer: Efficacy and Tolerance

BACKGROUND

Use of perioperative chemotherapy had significantly improved prognosis of localized gastric cancer. Two studies have validated this approach using cisplatin based chemotherapy despite important toxicities. We conducted this study with the aim to evaluate efficacy and toxicity of FOLFOX regimen in this setting.

MATERIAL AND METHODS

This is a retrospective study including patients followed for gastric cancer in the Oncology Department of the military hospital Mohamed V in Rabat, Morocco over a period of 7 years from 2007 to 2013. Patients received 4 cycles of mFOLFOX as perioperative regimen. Assessment of tumor response after completion of preoperative chemotherapy was granted by comparative CT scan, tumor markers measurements and R0 surgery rate.Adverse events were graded according to classification of the National Cancer Institute Common Toxicity Criteria version 4.0.

RESULTS

Thirty-one patients were included in this study. Use of preoperative chemotherapy showed partial response in fourteen patients (45.1%), stabilization in fifteen patients (48.4%). Tumor markers CEA and CA 19- 9 were significantly decreased. R0 resection rate was 83.87%. Only 2 (6.45%) cases of grade 3/4 hematologic toxicity were reported in our study. Achieving programmed postoperative chemotherapy was possible in 72.41% of patients.

CONCLUSIONS

Our study is limited by the retrospective design and small sample size but FOLFOX chemotherapy seems effective and well tolerated in this setting and its place deserves to be studied in a larger study.

Endometrial stromal sarcoma: prognostic factors and impact of adjuvant therapy in early stages

BACKGROUND AND OBJECTIVES

Endometrial stromal sarcomas (ESS) are rare uterine neoplasms. surgery remains the cornerstone of treatment for early stages and consists of an abdominal hysterectomy with bilateral salpingo-oopherectomy. Despite appropriate surgical treatment, relapse rates are high (18% to 45%) and the value of adjuvant therapies is not clear. We evaluated prognostic factors and the impact of adjuvant treatment on localized ESS (stages I and II).

DESIGN AND SETTING

Retrospective, case-control study conducted at the National Institute Of Oncology in Rabat, Morocco over 10 years from 2000 to 2009.

PATIENTS AND METHODS

twenty-one cases of localized ESS were included in the analysis.

RESULTS

standard surgery was performed in 71.4% of our patients. Myometrial invasion was noted in 57.1% of cases. Mitotic activity was considered high in five patients. Adjuvant treatment was given to 52.3% of patients: endocrine therapy in five patients and radiotherapy in six. Survival was significantly longer in the group of patients who underwent standard surgical treatment (P=.0007), in the absence of deep myometrial invasion (P=.0248) in cases with a low mitotic index (P<.0001) and in patients who received adjuvant therapy (hormone or radiotherapy) (P=.0048). In a multivariate analysis independent risk factors for monitoring were inadequate surgical treatment and absence of adjuvant treatment.

CONCLUSIONS

Myometrial invasion and mitotic index appear to be important prognostic factors. the reference surgery is hysterectomy with bilateral salpingo-oopherectomy. Lymph node dissection does not appear to provide a benefit. finally adjuvant treatment may carry a significant survival benefit.

[Cardiac safety of trastuzumab in adjuvant: a review across 53 observations]

Trastuzumab has been a revolution in the treatment of breast cancer overexpressing HER. Its use as an adjuvant for a period of 1 year is currently an international standard. Its major toxicity is cardiac, where the systematic monitoring of the LVEF before and during treatment. To evaluate the cardiac safety for our patients, we conducted this retrospective case-control study. The average in LVEF before the start of trastuzumab was 62.5% (51-80), and at the end of treatment 60.55 (40-77), a decrease in absolute value by 2%. This difference is statistically significant with P<0.001. Eighty-three percent of our patients have completed treatment, of whom 26.4% with a provisional arrest because of a regressive fall in LVEF. A final arrest has been made in 17% cases due to either a nonregressive reduction in LVEF or the appearance of symptomatic heart failure found in two patients. Analysis of risk factors toxicity found in this group of patients with a cardiotoxicity persisting an average age and average number of treatments received anthracyclines higher than the rest of our sample, and diminished baseline LVEF. But all these differences were not statistically significants. During the period of monitoring of these patients, six (67%) had spontaneous recovery of their LFEV 5 months ± 2.01 after discontinuation of trastuzumab. For two cases of symptomatic heart failure, they had a clinical improvement under medical treatment in February but is still less than 40%. The cardiac safety in our study seems comparable with the literature data but located in the upper range of levels of toxicity. The lack of statistical power of our study does not exclude a greater cardiac toxicity of trastuzumab among Moroccan women and should prompt a more cautious use of this drug and the achievement of larger studies that could answer this question.

Lawn mower-related injuries to children

Lawn mower-related injuries to children are relatively common and can result in severe injury or death. Many amputations during childhood are caused by power mowers. Pediatricians have an important role as advocates and educators to promote the prevention of these injuries.

Vasodilatory effects of lidocaine on epicardial porcine coronary arteries

To investigate the mechanism of lidocaine's effect to cause vasorelaxation, swine epicardial mid-right coronary arterial rings were placed under constant (5 g) tension in a muscle bath, precontracted with 35 mmol/l KCl and exposed to increasing concentrations of lidocaine (3-2,000 micrograms/ml). At a concentration of 10 micrograms/ml, mild vasoconstriction occurred, increasing tension 1.9 +/- 0.1% above baseline. Vasodilation began to occur at 30 micrograms/ml and was maximal at 2,000 micrograms/ml, reducing tension 97.5 +/- 0.2% below baseline. Vasodilation was not altered significantly by removal of endothelium or by pretreatment with propranolol or indometacin.

Are toy guns too dangerous?

Toy guns with projectiles may injure young children. A study was undertaken to assess the danger posed by these toys and the regulations governing them. US Consumer Product Safety Commission (CPSC) data indicate that toy guns with projectiles cause relatively few injuries, mostly to young boys. The magnitude of the problem is smaller than that of nonpowder and powder firearms. Most often, toy gun injuries are to the face and eyes. Of the estimated 818 injuries in 1980 and 1981, 2.9% required hospitalization. More than 400 days were lost from school and work, and there were nearly 3,000 days of restricted activity due to these toy gun injuries. The hazard posed by toy guns with projectiles can be reduced through the legitimate regulatory authority of the Consumer Product Safety Commission with minor impact on retail cost, toy industry sales, and the play value of the toys. The yearly cost to consumers from increased regulation would probably be similar to the annual cost of the injuries. Regulation is warranted to protect young children who use these toys.

Childhood injuries caused by nonpowder firearms

Motivated by four penetrating brain injuries to children caused by BBs, a study was undertaken to (1) assess the danger posed by nonpowder guns and rifles and (2) evaluate current regulations pertaining to these products. Data from the US Consumer Product Safety Commission indicate that there are many nonpowder firearm injuries, predominantly among males aged 5 to 24 years. Nonpowder firearm injuries are close in prevalence to those caused by powder firearms and include fatalities. More than one fourth of reported nonfatal injuries are to the eye, face, head, or neck. Despite the hazard they pose, nonpowder firearms are regulated loosely, such that young teens can legally purchase and use the products in most jurisdictions. We propose stricter regulations and other means to prevent serious and fatal nonpowder firearm injuries.