scholarly journals Angiosarcoma of the Bladder: Case Report and Review of the Literature

2008 ◽  
Vol 8 ◽  
pp. 508-511 ◽  
Author(s):  
Steve K. Williams ◽  
Rita L. Romaguera ◽  
Bruce Kava
Keyword(s):  
English Language ◽  
Clinical Course ◽  
Radical Surgery ◽  
Survival Rates ◽  
Multimodality Treatment ◽  
Multimodal Approach ◽  
Term Survival ◽  
Medline Search ◽  
Therapeutic Radiation

Our objective was to present a new case of angiosarcoma of the bladder after therapeutic radiation of the prostate, and discuss the treatment and clinical course of this rare tumor; the role of multimodality treatment is also discussed. We report a case of angiosarcoma of the bladder. Presentation, clinical course, and treatment were outlined and discussed. A MEDLINE search of all reported cases of angiosarcoma in the English language literature was performed. Thirteen previous cases of bladder angiosarcoma have been reported and three previous cases have been reported after therapeutic radiation. Hematuria was the most common presentation. Overall survival is poor, with 5-year survival rates at 35%. Longer-term survival has been demonstrated in patients who have had a multimodal approach to treatment, which combines radical surgery with chemotherapy and radiotherapy. Angiosarcoma of the bladder is a rare disease with overall poor prognosis. Optimal treatment has not been defined, but multimodality approaches appear to have a survival benefit.

scholarly journals Macrophages in Organ Transplantation

2020 ◽  
Vol 11 ◽  
Author(s):  
Farideh Ordikhani ◽  
Venu Pothula ◽  
Rodrigo Sanchez-Tarjuelo ◽  
Stefan Jordan ◽  
Jordi Ochando
Keyword(s):  
Immune Response ◽  
Organ Transplantation ◽  
Survival Rates ◽  
Adaptive Immune Response ◽  
Phagocytic Cells ◽  
Term Survival ◽  
Vast Number ◽  
Monocytes And Macrophages

Current immunosuppressive therapy has led to excellent short-term survival rates in organ transplantation. However, long-term graft survival rates are suboptimal, and a vast number of allografts are gradually lost in the clinic. An increasing number of animal and clinical studies have demonstrated that monocytes and macrophages play a pivotal role in graft rejection, as these mononuclear phagocytic cells recognize alloantigens and trigger an inflammatory cascade that activate the adaptive immune response. Moreover, recent studies suggest that monocytes acquire a feature of memory recall response that is associated with a potent immune response. This form of memory is called “trained immunity,” and it is retained by mechanisms of epigenetic and metabolic changes in innate immune cells after exposure to particular ligands, which have a direct impact in allograft rejection. In this review article, we highlight the role of monocytes and macrophages in organ transplantation and summarize therapeutic approaches to promote tolerance through manipulation of monocytes and macrophages. These strategies may open new therapeutic opportunities to increase long-term transplant survival rates in the clinic.

scholarly journals Role of Radiotherapy in Modern Treatment of Hodgkin's Lymphoma

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Kheng-Wei Yeoh ◽  
N. George Mikhaeel
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Survival Rates ◽  
Hodgkin's Lymphoma ◽  
Ongoing Research ◽  
Modern Treatment ◽  
Modality Approach ◽  
Therapeutic Radiation ◽  
Modern Radiotherapy

Hodgkin's Lymphoma was incurable until the advent of effective therapeutic radiation around the first half of the 20th century. As survival rates improved, the long-term toxicities from radiotherapy began to emerge. This together with the availability of effective chemotherapy has encouraged a combined modality approach for early-staged disease and the omission of radiotherapy in advanced-staged disease. The differing toxicities of radiotherapy and chemotherapy has promoted ongoing research to identify the utility of each of these modalities in the modern management of Hodgkin's Lymphoma. This article will provide a critical review of the developments and indications for modern radiotherapy, in context with advances in chemotherapy, for the treatment of Hodgkin's Lymphoma.

scholarly journals Long-Term Survival of Campylobacter jejuni at Low Temperatures Is Dependent on Polynucleotide Phosphorylase Activity

2009 ◽  
Vol 75 (23) ◽  
pp. 7310-7318 ◽  
Author(s):  
Nabila Haddad ◽  
Christopher M. Burns ◽  
Jean Michel Bolla ◽  
Hervé Prévost ◽  
Michel Fédérighi ◽  
...  
Keyword(s):  
Campylobacter Jejuni ◽  
Low Temperatures ◽  
Survival Rates ◽  
Polynucleotide Phosphorylase ◽  
Wild Type ◽  
Term Survival ◽  
Poultry Products ◽  
Bacterial Gastroenteritis

ABSTRACT Campylobacter jejuni is a leading cause of bacterial gastroenteritis worldwide. Infection generally occurs after ingestion of contaminated poultry products, usually conserved at low temperatures. The mechanisms promoting survival of C. jejuni in the cold remain poorly understood despite several investigations. The present study provides insight into the survival mechanism by establishing the involvement of polynucleotide phosphorylase (PNPase), a 3′-5′ exoribonuclease with multiple biological functions in cold survival. The role of PNPase was demonstrated genetically using strains with altered pnp genes (which encode PNPase) created in C. jejuni F38011 and C. jejuni 81-76 backgrounds. Survival assays carried out at low temperatures (4 and 10°C) revealed a difference of 3 log CFU/ml between the wild-type and the pnp deletion (Δpnp) strains. This did not result from a general requirement for PNPase because survival rates of the strains were similar at higher growth temperatures (37 or 42°C). trans-Complementation with plasmid pNH04 carrying the pnp gene under the control of its natural promoter restored the cold survival phenotype to the pnp deletion strains (at 4 and 10°C) but not to the same level as the wild type. In this study we demonstrate the role of PNPase in low-temperature survival of C. jejuni and therefore attribute a novel biological function to PNPase directly related to human health.

scholarly journals Fifty Years of Experience with Propylthiouracil-Associated Hepatotoxicity: What Have We Learned?1

1997 ◽  
Vol 82 (6) ◽  
pp. 1727-1733 ◽  
Author(s):  
Katherine V. Williams ◽  
Sunil Nayak ◽  
Dorothy Becker ◽  
Jorge Reyes ◽  
Lynn A. Burmeister
Keyword(s):  
Liver Transplantation ◽  
Pediatric Patient ◽  
Clinical Evaluation ◽  
Thyroid Disease ◽  
Patient Management ◽  
English Language ◽  
Optimal Management ◽  
Exact Test ◽  
Medline Search

Abstract The aim of this study was to determine the optimal management of patients with propylthiouracil (PTU) hepatotoxicity. A MEDLINE search for English language cases of PTU hepatotoxicity between 1966 and April 1996 was performed, and additional cases were cross-referenced. Twenty-seven cases were selected based on the availability of information on patient management after the onset of hepatotoxicity. Eighty-five percent of the selected cases met this criterion. A detailed summary of the management of two cases of PTU hepatotoxicity at our institutions is also provided. Although most patients recovered once PTU was stopped, seven patients died. Patients with PTU hepatotoxicity who survived were more likely to have received 131I during the course of their illness than those who died (P < 0.03, by Fisher’s exact test). In our two patients, hyperbilirubinemia was linearly associated with progressively decreasing T4 levels (r = 0.91; P < 0.001) despite the presence of clinical thyrotoxicosis in one of the patients. These findings demonstrate the need for appropriate clinical evaluation and treatment of thyroid disease during the course of hepatotoxicity. Additionally, we report the first pediatric patient with PTU hepatotoxicity to undergo liver transplantation. The emerging role of liver transplantation in these patients is discussed.

scholarly journals The Role of Ganciclovir for the Management of Cytomegalovirus Retinitis in HIV Patients: Pharmacological Review and Update on New Developments

1996 ◽  
Vol 7 (3) ◽  
pp. 183-194 ◽  
Author(s):  
Alice Tseng ◽  
Michelle Foisy
Keyword(s):  
English Language ◽  
Data Extraction ◽  
Clear Understanding ◽  
Medical Subject Headings ◽  
Aids Patients ◽  
Intravenous Ganciclovir ◽  
Medline Search ◽  
Advantages And Disadvantages ◽  
Cmv Retinitis

OBJECTIVE: To review the pharmacology and pharmacokinetics of intravenous, oral and intraocular ganciclovir, and to discuss the role of these various formulations in the management of cytomegalovirus (CMV) retinitis in AIDS patients.DATA SOURCES: A MEDLINE search (1987 through November 1995) of English-language literature using the main medical subject headings ‘ganciclovir’ and ‘cytomegalovirus’, and the subheading ‘acquired immunodeficiency syndrome’. Relevant articles were also selected from references of identified articles. Abstracts from recent medical conferences of infectious diseases, pharmacology and human immunodeficiency virus were screened for additional data.STUDY SELECTION AND DATA EXTRACTION: All articles and abstracts discussing the use of ganciclovir for the management or prophylaxis of CMV retinitis in AIDS patients were considered for inclusion. Pertinent information, as judged by the authors, was selected and synthesized for discussion.DATA SYNTHESIS: Ganciclovir has demonstrated virustatic activity against CMV, and is often administered 5 mg/kg intravenously every 12 h as first-line therapy for CMV retinitis. Intravenous maintenance therapy at 5 mg/kg daily is usually effective at delaying retinitis progression for approximately 60 to 70 days. Neutropenia and thrombocytopenia are observed frequently, often necessitating interruption or discontinuation of therapy. Local drug administration may delay disease progression even further, and may be considered for patients who are intolerant to or failing intravenous therapy. However, systemic ganciclovir should be encouraged to reduce the risk of developing contralateral eye or end-organ CMV disease. Oral ganciclovir at 1 g tid is almost as effective as intravenous ganciclovir 5 mg/kg/day in delaying retinitis progression and is associated with fewer line-related complications. Absorption, drug interactions, cost and compliance should also be considered.CONCLUSIONS: Until recently, ganciclovir was available only for intravenous use. Recent developments allow for intraocular and oral administration of this agent. A clear understanding of the advantages and disadvantages of these new formulations is required in order to select the most appropriate product for managing CMV retinitis in AIDS patients.

scholarly journals Targeted therapy of brain metastases: latest evidence and clinical implications

2017 ◽  
Vol 9 (12) ◽  
pp. 781-796 ◽  
Author(s):  
Rodica Di Lorenzo ◽  
Manmeet S. Ahluwalia
Keyword(s):  
Targeted Therapy ◽  
Brain Metastases ◽  
Survival Rates ◽  
Multimodality Treatment ◽  
Term Survival ◽  
Primary Tumors ◽  
Poor Prognostic Factor ◽  
Patients With Cancer ◽  
Whole Brain Radiation ◽  
Multiple Metastases

Brain metastases (BM) occur in 20–40% of patients with cancer and 60–75% of patients with BM become symptomatic. Due to an aging population and advances in the treatment of primary cancers, patients are living longer and are more likely to experience complications from BM. The diagnosis of BM drastically worsens long-term survival rates, with multiple metastases being a poor prognostic factor. Until recently, the mainstay of treatment consisted of stereotactic radiosurgery (SRS), surgical resection, whole brain radiation therapy (WBRT), or a combination of these modalities. Systemic chemotherapy has been felt largely ineffective in the treatment of BM due to the presence of the blood–brain barrier (BBB), which includes efflux pumps on brain capillaries. Over the past decade however, researchers have identified therapeutic agents that are able to cross the BBB. These findings could make a multimodality treatment approach possible, consisting of surgery, radiation, immunotherapy, and targeted therapy, which could lead to better disease control in this patient population and prolong survival. In this review, we discuss present evidence on available targeted therapies and their role in the treatment of BM from primary tumors with the highest prevalence of central nervous system (CNS) involvement, specifically non-small cell lung cancer (NSCLC), breast cancer melanoma, and renal cell carcinoma.

scholarly journals Enteral Nutrition and Acute Pancreatitis: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
B. W. M. Spanier ◽  
M. J. Bruno ◽  
E. M. H. Mathus-Vliegen
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
English Language ◽  
Tube Feeding ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Nasogastric Feeding ◽  
Medline Search ◽  
Nasogastric Tube Feeding

Introduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP.Methods. A MEDLINE search of the English language literature between 1999–2009.Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of pancreatic rest less probable. Enteral nutrition has a beneficial influence on the outcome of AP and should probably be initiated as early as possible (within 48 hours). Supplementation of enteral formulas with glutamine or prebiotics and probiotics cannot routinely be recommended.Conclusions. Nutrition therapy in patients with AP emerged from supportive adjunctive therapy to a proactive primary intervention. Large multicentre studies are needed to confirm the safety and effectiveness of nasogastric feeding and to investigate the role of early nutrition support.

The Role of Vasopressin in the Treatment of Vasodilation in Shock States

2000 ◽  
Vol 34 (2) ◽  
pp. 250-254 ◽  
Author(s):  
Vitalina Rozenfeld ◽  
Judy WM Cheng
Keyword(s):  
English Language ◽  
Case Reports ◽  
Small Scale ◽  
Vasodilatory Shock ◽  
Medline Search ◽  
Language Studies ◽  
Study Selection ◽  
End Stage ◽  
Β Adrenergic Receptors

OBJECTIVE: To review the role of vasopressin in the treatment of vasodilatory shock. DATA SOURCES: A MEDLINE search on published reports (1966–April 1999) was conducted. STUDY SELECTION: English-language studies and case reports were selected and evaluated based on quality of review of vasopressin in the treatment of vasodilatory shock. DATA SYNTHESIS: In patients with end-stage vasodilatory shock, baroreceptor reflex is impaired and vasopressin stores are depleted. Persistent elevation of catecholamines may lead to down-regulation of β-adrenergic receptors and reduces smooth-muscle response to catecholamines, leading to inability of maintaining organ perfusion. Small-scale studies and case reports have demonstrated vasopressin's efficacy in maintaining blood pressure in patients with septic shock, cardiac arrest, and end-stage heart failure, refractory to other vasopressor therapies. CONCLUSIONS: Vasopressin may be a reasonable alternative for patients in vasodilatory shock. However, larger-scale controlled clinical trials are warranted before its routine use can be recommended.

Recurrent angiosarcoma of scalp with opsoclonus myoclonus syndrome: role of salvage treatment

2021 ◽  
Vol 14 (6) ◽  
pp. e241824
Author(s):  
Kannan Periasamy ◽  
Namrata Das ◽  
Divya Khosla ◽  
Rakesh Kapoor
Keyword(s):  
Clinical Course ◽  
Locally Advanced ◽  
Multimodality Treatment ◽  
Best Supportive Care ◽  
Paraneoplastic Neurological Syndrome ◽  
Active Management ◽  
Objective Clinical Response ◽  
First Recurrence ◽  
Opsoclonus Myoclonus Syndrome

Cutaneous angiosarcoma is a type of rare and locally aggressive malignancy requiring individualised treatment owing to paucity of randomised trials. We present the case of a middle-aged cancer survivor with locally advanced angiosarcoma of scalp managed with surgery, radiotherapy, chemotherapy and targeted therapy over a course of 6 years for two recurrences. The first recurrence was preceded by opsoclonus myoclonus syndrome, a type of paraneoplastic neurological syndrome (PNS), rarely reported in sarcomas. The second recurrence had a rapid clinical course, which led to a therapeutic dilemma of best supportive care versus active management. A trial of weekly paclitaxel was started that was continued for a total of 12 cycles with good objective clinical response. Presently, he is tolerating maintenance pazopanib well and is symptom free for 6 months. In cutaneous angiosarcoma patients, PNS may be a harbinger of recurrence and aggressive, multimodality treatment helps prolong survival.

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