Mycobacterium malmoense: dissemination causes a popliteal aneurysm in a 74-year-old man.

Mycobacterium malmoense is recognised as an environmental pathogen predominantly affecting populations in Northern Europe. In immuno-competent individuals, isolated pulmonary disease remains the commonest presentation. The authors report a rare case describing a mycotic popliteal aneurysm caused by M malmoense in a 74-year-old man from Hastings, UK with co-existing pulmonary M malmoense disease. Primary pulmonary disease was confirmed by a combination of history, examination and positive radiological and microbiological findings. Tissue analysis of the aneurysm wall during popliteal aneurysm repair confirmed the presence of disseminated M malmoense. Histological analysis of the aneurysm wall showed non-caseating granulomata. The patient completed a 2 year course of rifampicin, ethambutol and clarithromycin which eradicated the organism from his sputum. Further progress has been complicated by the development of an aspergilloma at the site of his eradicated pulmonary M malmoense disease and the need for angioplasty to his bypass grafts 1 year postsurgery.

Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital.

BACKGROUND: Although the distribution of thyroid carcinoma in the Arab Gulf States has been described, no previous study has examined the characteristic clinicopathologic features of thyroid carcinoma cases in the United Arab Emirates. METHODS: The medical records of 135 patients with thyroid carcinoma diagnosed over a 15-year period (1991-2005) at Tawam Hospital, the national referral oncology center in the UAE, were retrospectively studied and the cases classified according to the histologic classification of the World Health Organization (WHO). RESULTS: Seventy-eight patients (58%) were diagnosed before the age of 45 years with an overall peak incidence in the fourth and fifth decades. The female to male ratio was 2.4:1. Eighty-four percent had papillary thyroid carcinoma (PTC), while follicular thyroid carcinoma (FTC), anaplastic thyroid carcinoma and medullary carcinoma comprised 14%, 1.4% and 0.6%, respectively. The conventional classical variant of papillary carcinoma was the most common type. Three-quarters of the papillary carcinomas presented as multinodular goiter, while one-fifth presented as a solitary thyroid nodule. Minimal invasive follicular carcinoma was the most common variant of follicular carcinoma. CONCLUSION: Thyroid carcinoma in the United Arab Emirates seems to be more common among females and female gender may be a risk factor. Age < 45 years can be considered an important prognostic factor as well as a possible risk factor. PTC predominates the histologic pattern of thyroid carcinoma, which is usually associated with an iodide-sufficient area.

Churg-Strauss syndrome presenting as an abdominal mass in a non-asthmatic child.

A 2-year-old boy presented with an abdominal mass and was diagnosed as Churg-Strauss syndrome (CSS). There was no history of asthma. He developed fatal gastro-intestinal disease, despite treatment with corticosteroids and cyclophosphamide. CSS is extremely rare in young children and gastro-intestinal involvement might carry a worse prognosis than in adults.

Could imatinib replace surgery in esophageal gastrointestinal stromal tumor.

Gastrointestinal stromal tumors GISTs are cellular spindle, or epithelioid tumors that occur in the stomach, intestine, and rarely in the esophagus. A 61-year-old man was complaining of resistant dry cough with dysphagia for one month duration. Upper gastrointestinal tract endoscopic examination showed a polypoid mass 30 cm from the incisors obstructing 50% of the lumen, where multiple biopsies were taken. Magnetic resonance imaging MRI showed a mass in the wall of the esophagus extending into the thoracic cavity. Histologically, the stained sections with the routine hematoxylin and eosin as well as the immunohistochemical stains for CD117, CD34, S100, vimentin, and smooth muscle actin confirmed the diagnosis of esophageal GIST. The patient was treated with imatinib, 400 mg/day. There was a dramatic reduction in the size of the tumor with successful improvement of his symptoms after 2 months of treatment, which was confirmed by repeated upper GIT endoscopy, and MRI.

Pharmacokinetic, biochemical and clinical effects of dimethyltriazenoimidazole-4-carboxamide-bischloroethylnitrosourea combination therapy in patients with advanced breast cancer.

We assessed whether split dosing with the methylating agent DTIC is an effective strategy for inactivating the DNA repair protein O6-alkylguanine DNA-ATase in order to decrease tumour resistance to BCNU. ATase levels in PBMCs were used as a surrogate for tumour ATase depletion to determine whether this correlated with either the pharmacokinetics of DTIC and its major metabolite AIC or other clinical sequelae. Two 1 hr infusions of DTIC (400 mg/m(2)) 4 hr apart followed another 4 hr later by BCNU (75 mg/m(2)) were administered every 6 weeks in 7 patients with heavily pretreated advanced breast cancer. The extent and kinetics of ATase depletion and recovery in PBMCs varied not only between patients but also between cycles in the same patient. Serial FNAs showed heterogeneity in tumour ATase expression but no clear pattern of change in ATase activity. DTIC and AIC exhibited biphasic clearance from the blood, consistent with a 2-compartment pharmacokinetic model. The AUC of AIC was strongly correlated with the percentage decrease in PBMC ATase levels. There were no clinical responses, and toxicity in neutrophils and platelets was marked. Split-dose DTIC therefore does not appear to be a clinically effective approach to overcome O(6)-alkylating agent resistance in advanced breast cancer.