Relationship between survival and PET measurements of tumour blood flow, in patients with metastatic colorectal cancer

20021

Background: There are conflicting reports on the relationship between tumour blood flow and patient survival. Poor flow is associated with tumour hypoxia and has been associated with a poor outcome (Lehtio et al 2004;Int J Radiat Oncol Biol Phys:59, 971–982). However, good flow is associated with angiogenesis which drives tumorigenesis, and has also been linked with a poor prognosis (Hermans 200 Int J Radiat Oncol Biol Phys:57, 1351–6). In this study, we examined the relationship between PET measurements of blood flow in liver metastases, and survival, in patients with colorectal cancer. Methods: Thirty seven patients with metastatic colorectal cancer, with a range of previous treatments, were studied. Regional perfusion was measured in liver metastases using H2[15O] or C[15O]2 PET. Blood flow was correlated with overall survival from the time of PET scan. Relationship between outcome and flow was analysed separately for patients with 1 or >1 metastatic sites; a recent meta-analysis of patient with metastatic colorectal cancer showed number of metastatic sites to be an independent prognostic factor (Kohne et al 2002; Ann Oncol. 13, 308–317). Results: There was no significant relationship between survival and metastasis blood flow when the data were taken as a whole. However, when the data were corrected for number of metastatic sites, there was a trend for high flow to be associated with shorter survival (p = 0.063). Specifically, for patients with multiple metastatic sites, median survival times for patients with high flow (n = 9) was 171 days [95% CI 25–317] compared with 441 days [95% CI 12–870] for patients with low flow (n = 7) (p = 0.026). Conclusions: In patients with multiple sites of metastasis, high tumour blood flow is a poor prognostic factor. This may be due to angiogenesis, which promotes tumorigenesis.

No significant financial relationships to disclose.

When used in animals, a neem (Azadirachta indica)-based ectoparasiticide performs better than a synthetic one

Finding alternate ways to relieve animals from the ectoparasites is one of the most important aspects under One-Health concept. Herbal ectoparasiticides offer a promising alternate to chemical ectoparasiticides. The present study was designed to evaluate the ectoparasiticide efficacy of Nimboliâ (Neem: Azadirachta indica extract) in various animal species, keeping in view the objectives of One-Health. The ectoparasiticide efficacy of Nimboliâ was also compared with a commercial chemical ectoparasiticide Tagafon (Hydroxyethyl Phosporic Acid). Various animals infested with ticks, fleas, lice, flies, and maggots and presented at clinics were treated with Nimboliâ(n=36)and Tagafon (n=19). Mean time taken by each ectoparasiticide to knock-down various ectoparasites was recorded. The present study suggested significantly higher efficacy of Nimboliâ against ticks, fleas, lice, flies and maggots as compared with Tagafon. The mean time taken by Nimboli® to knockdown various ectoparasites of same and different kinds and their larvae was also less compared to the mean time taken by Tagafon. The present study indicated that Nimboliâ is an eco-friendly ectoparasiticide that is safe-to-use both for animals and their handlers, hence can replace chemical ectoparasiticides. The present study highlights the importance of herbal ectoparasiticides, especially those containing neem in the treatment and control of ectoparasites in animals. This information have special relevance for countries that have native neem trees such as Sri Lanka, Pakistan, India, Indonesia, Malaysia, Myanmar, Senegal, and Thailand. Since herbal ectoparasiticides are biodegradable, they offer an added advantage of maintaining ecological health.

Somatostatin Receptor Imaging with [18F]FET-βAG-TOCA PET/CT and [68Ga]Ga-DOTA-Peptide PET/CT in Patients with Neuroendocrine Tumors: A Prospective, Phase 2 Comparative Study

There is a clinical need for 18F-labeled somatostatin analogs for the imaging of neuroendocrine tumors (NET), given the limitations of using [68Ga]Ga-DOTA-peptides, particularly with regard to widespread accessibility. We have shown that [18F]fluoroethyl-triazole-[Tyr3]-octreotate ([18F]FET-βAG-TOCA) has favorable dosimetry and biodistribution. As a step toward clinical implementation, we conducted a prospective, noninferiority study of [18F]FET-βAG-TOCA PET/CT compared with [68Ga]Ga-DOTA- peptide PET/CT in patients with NET. Methods: Forty-five patients with histologically confirmed NET, grades 1 and 2, underwent PET/CT imaging with both [18F]FET-βAG-TOCA and [68Ga]Ga-peptide performed within a 6-mo window (median, 77 d; range, 6-180 d). Whole-body PET/CT was conducted 50 min after injection of 165 MBq of [18F]FET-βAG-TOCA. Tracer uptake was evaluated by comparing SUVmax and tumor-to-background ratios at both lesion and regional levels by 2 unblinded, experienced readers. A randomized, blinded reading of both scans was also then undertaken by 3 experienced readers, and consensus was assessed at a regional level. The ability of both tracers to visualize liver metastases was also assessed. Results: A total of 285 lesions were detected on both imaging modalities. An additional 13 tumor deposits were seen in 8 patients on [18F]FET-βAG-TOCA PET/CT, and [68Ga]Ga-DOTA-peptide PET/CT detected an additional 7 lesions in 5 patients. Excellent correlation in SUVmax was observed between both tracers (r = 0.91; P < 0.001). No difference was observed between median SUVmax across regions, except in the liver, where the median tumor-to-background ratio of [18F]FET-βAG-TOCA was significantly lower than that of [68Ga]Ga-DOTA-peptide (2.5 ± 1.9 vs. 3.5 ± 2.3; P < 0.001). Conclusion: [18F]FET-βAG-TOCA was not inferior to [68Ga]Ga-DOTA-peptide in visualizing NET and may be considered in routine clinical practice given the longer half-life and availability of the cyclotron-produced fluorine radioisotope.

A commercial monovalent canine parvovirus vaccine performs better than a commercial combination vaccine in puppies

Thirty puppies were randomly divided in to 3 groups for comparative evaluation of two commercial CPV vaccines. Each group was further subdivided in to < 6 months and < 3 months -old puppies and either vaccinated with a monovalent vaccine: Primodog, a combination vaccine: Duramune or maintained as a non-vaccinated control. Humoral immune response was determined by Hemagglutination Inhibition (HAI) on 21 and 35 -days after vaccination. The geometric mean titer (GMT) induced by Duramune, 21 and 35 -days post-vaccination was GMT 73.3 and 137.2, respectively. Comparatively, Primodog demonstrated higher GMT on 21 and 35 -days after vaccination: 97.0 and 168.9, respectively. The older puppies (< 6 months old) demonstrated higher seroconversion to both vaccines.

Clinical management of cutaneous bovine papillomatosis in a cow calf: a case report

A Sahiwal breed heifer calf of ~ 5-month age was presented with numerous warts of varying sizes principally on head, face and neck. The history and clinical examination were suggestive of bovine cutaneous papillomatosis. The animal was treated medically with an alternative medicine: Thuja occidentalis 30X. The warts regressed completely after two months of treatment with Thuja occidentalis, suggesting this medicine can be used to treat warts in bovines successfully.

Stevens Johnson syndrome in Pakistan: a ten-year survey

OBJECTIVE

A pre-tested questionnaire-based, retrospective study to highlight the causative factors, mode of presentation, complications and outcome of patients with Stevens Johnson syndrome.

SETTING

Aga Khan University Hospital over a 10 year period.

METHODS

All case records with a diagnosis of Steven Johnson Syndrome in the period 1990 to 2000 were retrospectively reviewed. Data was retrieved on a comprehensive questionnaire. The demographic variatbles and drugs taken within the previous 21 days were noted. Date analysis was done by Epi-Info Version 6.0.

RESULTS

Of the 101 studied patient files, the most common offender was found to be the Penicillins as a group and Sulfadoxine-Pyrimethamine (Fansidar) when considering all drugs individually. Most common complications included electrolyte disturbances (13.9%) and congestive heart failure (6.9%). Mortality rate was high at 10.1%.

CONCLUSION

SJS was found to be a rare condition but having a mortality rate of 10.1%. As it can be induced by a large number of drugs, caution should be practiced while prescribing.