ABSTRACT
BACKGROUND & AIMS: A "microbrachytherapy" was developed as treatment option for inoperable tumours by direct intratumoral injection of radioactive holmium-166 ( 166 Ho) microspheres (MS). 166 Ho emits ß-radiation which potentially enables a high, ablative, radioactive-absorbed dose on the tumour tissue while sparing surrounding tissues. MATERIALS & METHODS: Safety and efficacy of 166 Ho microbrachytherapy were evaluated in a prospective cohort study of 13 cats with inoperable oral squamous cell carcinoma without evidence of distant metastasis. RESULTS: Local response rate was 55%, including complete response or partial response (downstaging) enabling subsequent marginal resection. Median survival time was 113 days overall, and 296 days for patients with local response. Side effects were minimal. Tumour volume was a significant predictor of response. DISCUSSION: Response rate may be further improved by optimizing the intratumoral spatial distribution of 166 Ho MS. CONCLUSION: 166 Ho microbrachytherapy has potential as a minimally invasive, single procedure radio-ablation treatment of unresectable tumours with minimal morbidity.
Subject(s)
Brachytherapy/veterinary , Carcinoma, Squamous Cell/veterinary , Cat Diseases/radiotherapy , Holmium/therapeutic use , Mouth Neoplasms/veterinary , Radioisotopes/therapeutic use , Animals , Brachytherapy/methods , Carcinoma, Squamous Cell/radiotherapy , Cats , Female , Holmium/administration & dosage , Injections/methods , Injections/veterinary , Male , Microspheres , Mouth Neoplasms/radiotherapy , Prospective Studies , Radioisotopes/administration & dosageSubject(s)
Catheter-Related Infections/microbiology , Environmental Exposure/adverse effects , Gram-Negative Bacterial Infections/microbiology , Kidney Failure, Chronic/therapy , Peritonitis/microbiology , Sphingobacterium/isolation & purification , Anti-Bacterial Agents/administration & dosage , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/etiology , Humans , Injections, Intravenous , Male , Middle Aged , Peritonitis/drug therapy , Peritonitis/etiology , RNA, Bacterial/analysis , Soil Microbiology , Sphingobacterium/genetics , Tobramycin/administration & dosageABSTRACT
The case history of a 56-year-old man is described who suffered from severe adrenocorticotrophic hormone (ACTH)-dependent Cushing's syndrome. The clinical course was complicated by simultaneous infections with Pneumocystis carinii, Staphylococcus aureus, Candida albicans, Aspergillus fumigatus and Herpes simplex, which proved to be fatal. A study of the literature shows that opportunistic infections in endogenous Cushing's syndrome are associated with severe cortisol excess and carry a high mortality. Opportunistic infections are most prevalent in the ectopic ACTH syndrome explained by the very high plasma cortisol concentrations in this condition. Infections with Aspergillus species, Cryptoccus neoformans, Pneumocystis carinii and Nocardia asteroides predominated. Cushing's syndrome with a very high plasma cortisol concentration causes a severe immunocompromized state. Prompt evaluation of the cause of the hypercortisolism, initiation of cortisol lowering therapy, primary prophylaxis for Pneumocystis carinii infection when plasma cortisol exceeds 2500 nmol L-1 and a search for concomitant infectious disease is recommended.
Subject(s)
Cushing Syndrome/complications , Opportunistic Infections/pathology , Adrenocorticotropic Hormone/blood , Anti-Infective Agents/therapeutic use , Cushing Syndrome/blood , Fatal Outcome , Humans , Hydrocortisone/blood , Male , Middle Aged , Opportunistic Infections/drug therapyABSTRACT
We describe a 39-year-old woman with an 8-month history of abdominal pain, diarrhea, and weight loss. Clinical and laboratory evaluation indicated the presence of a malabsorption syndrome. Endoscopy revealed multiple gastric ulcerations and an abnormal "picture" of the duodenal mucosa. At duodenal biopsy, necrosis confined to the distal parts of the enteric villi and a polymorphonuclear leukocyte response were found. Further evaluation revealed intestinal ischemia as a result of mesenteric atherosclerosis. After a revascularization procedure was performed, the symptoms disappeared. The macroscopic and microscopic picture of the bowel normalized. In our search for risk factors of atherosclerosis, we found a substantially increased basal plasma homocysteine concentration. This case suggests that hyperhomocysteinemia may have a causal role in the development of symptomatic, premature atherosclerosis of the mesenteric circulation.
Subject(s)
Duodenal Ulcer/complications , Homocysteine/blood , Intestines/blood supply , Ischemia/complications , Malabsorption Syndromes/etiology , Stomach Ulcer/complications , Adult , Chronic Disease , Duodenal Ulcer/pathology , Female , Humans , Intestines/pathology , Ischemia/pathology , Malabsorption Syndromes/pathology , Splanchnic Circulation , Stomach Ulcer/pathologyABSTRACT
An elevated plasma homocysteine level may result from various environmental and genetic factors. Herediatary causes of severe hyperhomo-cysteinaemia are very rare and usually lead to disease in childhood or adolescence. Common pathology consists of early atherosclerotic vascular changes, arterioocclusive complications and venous thrombosis. Mildly elevated genetically determined plasma homocysteine levels are observed in 5% of the general population. In the last two decades research has shown mild hyperhomocysteinaemia to be linked to an increased risk of premature atherosclerosis, pregnancies complicated by neural tube defects and early pregnancy loss, and venous thrombosis. Homozygosity for thermolabile MTHFR deficiency has been identified as one important genetic factor, which expression is modified by dietary folate intake. Although mild hyperhomocysteinaemia can easily be treated by vitamin supplementation the beneficial effects of such treatment remains to be shown.
Subject(s)
Homocysteine/blood , Homocystinuria/physiopathology , Metabolism, Inborn Errors/blood , Oxidoreductases/deficiency , 5,10-Methylenetetrahydrofolate Reductase (FADH2) , Arteriosclerosis/epidemiology , Arteriosclerosis/etiology , Female , Homocystinuria/blood , Homocystinuria/drug therapy , Homocystinuria/genetics , Homozygote , Humans , Lyases/deficiency , Metabolism, Inborn Errors/etiology , Metabolism, Inborn Errors/genetics , Metabolism, Inborn Errors/physiopathology , Methylenetetrahydrofolate Reductase (NADPH2) , Neural Tube Defects/epidemiology , Neural Tube Defects/etiology , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Thrombophlebitis/epidemiology , Thrombophlebitis/etiologyABSTRACT
A 57 year-old woman was seen after a three-week period of upper abdominal pain, nausea, fever, headache and exertional dyspnoea. Laboratory examination showed an elevated ESR and serum gamma-GT activity. The chest X-ray showed cardiomegaly resulting from a pericardial effusion as was demonstrated by echocardiography. An abdominal CT-scan disclosed multiple hypodense lesions in the liver and spleen and lymphadenopathy along the hepatoduodenal ligament. Liver biopsy showed a necrotising granulomatous hepatitis. A recent infection with Bartonella, presumably B. henselae, was demonstrated serologically. The patient was treated with clarithromycin and recovered.