Is chemotherapy always required for cancer in pregnancy? An observational study.

BACKGROUND: Cancer in pregnancy is relatively rare, but the incidence is increasing. Several studies show that cytotoxic agents are safe to use in pregnancy from the second trimester onwards. AIMS: This study assesses the maternal and foetal outcomes of cancers diagnosed during pregnancy. In particular, it focuses on a subset of women who elected to defer systemic chemotherapy until after delivery. This study examines if all cancers need to be treated during pregnancy or if, in certain cases, treatment can be safely deferred until after full-term delivery. METHODS: This is a retrospective observational study of women diagnosed with cancer during pregnancy in an Irish cancer centre over a 27-year period. All women diagnosed with cancer during pregnancy who were referred to the medical oncology department for consideration of chemotherapy were included in this study. Medical and pharmacy records were extensively reviewed. RESULTS: Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology for consideration of systemic chemotherapy. Sixteen women (64%) commenced chemotherapy during pregnancy, seven women (28%) did not receive chemotherapy while pregnant, but commenced treatment immediately after delivery, and two (8%) did not receive any systemic chemotherapy at all. Of the seven women who commenced chemotherapy after delivery, six (85.7%) were diagnosed before 30/40 gestation. There were three cases of Hodgkin's lymphoma, two breast cancers and one ovarian cancer. After a median follow-up of 12 years, all six mothers remain disease-free. CONCLUSIONS: This study identified a select cohort of patients that did not receive chemotherapy during pregnancy. There were no adverse outcomes to mothers due to delayed treatment.

Primary bone lymphoma: single institution case series.

BACKGROUND: Primary bone lymphoma (PBL) is a rare condition and accounts for less than 2% of adult lymphomas and 3% of all primary bone malignancies. Because of the rarity of this disease, there is a lack of prospective randomised clinical trials and hence optimal treatment is uncertain. AIM: We report on our experience of treating PBL over 20 years. METHODS: Using our hospital database, we identified all patients with PBL, their treatment, and long-term follow-up. RESULTS: From January 1989 to July 2007, we identified 12 patients with PBL. Long extremity bones were the most common presenting sites. Multifocal disease was present in three cases. Treatment modalities included surgery, chemotherapy, and radiotherapy. Median follow-up was 8 years (range 0.5-18.5 years), and overall survival was 100%. CONCLUSIONS: Combined modality therapy, i.e. chemotherapy followed by radiotherapy, is the preferred treatment option unless adverse neurology or an unstable fracture presents first.

Targeting of VEGF-mediated angiogenesis to rat myocardium using ultrasonic destruction of microbubbles.

Myocardial angiogenesis mediated by human vascular endothelial growth factor 165 (hVEGF165) cDNA was promoted in rat myocardium using an in vivo-targeted gene delivery system known as ultrasound-targeted microbubble destruction (UTMD). Microbubbles carrying plasmids encoding hVEGF165, or control solutions were infused intravenously during ultrasonic destruction of the microbubbles within the myocardium. Biochemical and histological assessment of gene expression and angiogenesis were performed 5, 10, and 30 days after UTMD. UTMD-treated myocardium contained hVEGF165 protein and mRNA. The myocardium of UTMD-treated animals showed hypercellular foci associated with hVEGF165 expression and endothelial cell markers. Capillary density in UTMD-treated rats increased 18% at 5 days and 33% at 10 days, returning to control levels at 30 days (P<0.0001). Similarly, arteriolar density increased 22% at 5 days, 86% at 10 days, and 31% at 30 days (P<0.0001). Thus, noninvasive delivery of hVEGF165 to rat myocardium by UTMD resulted in significant increases in myocardial capillary and arteriolar density.

Urinary leukotriene levels are increased during exacerbation of atopic eczema/dermatitis syndrome. Relation to clinical status.

BACKGROUND: Leukotrienes are potent mediators of allergic inflammation and their role in the pathogenesis of allergic disorders, particularly asthma, is well established. Their importance in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS) is still unclear. We aimed to compare urinary cysteinyl leukotriene (Cys-LT) levels during exacerbation and remission of AEDS in relation to clinical status, IgE levels, and eosinophil counts. METHODS: Urinary Cys-LTs were measured by direct enzyme immunoassay in 17 adult patients with AEDS and in 17 healthy controls in whom atopy had been excluded. Cys-LTs were compared during exacerbation and remission of AEDS in relation to the clinical status measured by SCORAD. Total IgE levels were measured by enzyme-linked immunoassay (ELISA). RESULTS: Mean clinical score during the exacerbation was 64.3 +/- 3.1 and during remission 22.4 +/- 4 (P < 0.01). Cys-LTs levels were significantly higher during the exacerbation of AEDS than in the control group (230.9 +/- 20.8 vs 123.2 +/- 9.9 pg/mg creatinine; P < 0.005). During the remission, the difference between AEDS patients and the control group was not significant (96.3 +/- 8.7 vs 123.2 +/- 9.9 pg/mg creatinine; P = 0.8). During AEDS exacerbation Cys-LTs levels were significantly correlated with the clinical status (rS = 0.73, P < 0.01) and with eosinophil counts (r = 0.86; P < 0.01) but not with the duration of the disease, age of patients, or IgE levels. CONCLUSIONS: Our results point to enhanced biosynthesis of Cys-LTs during the AEDS exacerbations. Inflammatory cells, e.g. eosinophils are the most probable source of Cys-LTs. A strong correlation between Cys-LT levels and clinical status may in part explain preliminary clinical observations of efficacy of leukotriene antagonists in alleviating symptoms of AEDS.

[Comparison of clinical status and long-term outcome of patients with angina pectoris and normal coronary vessels in coronary angiography or insignificantly narrowed coronary arteries]. / Porównanie obrazu klinicznego i rokowania odleglego chorych z dusznica bolesna i z prawidlowymi tetnicami wiencowymi w koronarografii oraz chorych z przysciennymi zmianami miazdzycowymi.

UNLABELLED: Among patients investigated with coronary angiography because of effort chest pains, 8-30% are found to have insignificantly narrowed coronary arteries. In this group there are patients with angiographically normal coronary arteries and patients with hemodynamically insignificant atherosclerotic plaques. The aim of this study was to compare clinical status and long-term outcome of patients with effort angina whose epicardial coronary arteries were angiographically normal (Group 1) and patients with luminal diameter stenoses of maximum 30% (Group 2). Between III'91 and IV'97 we identified 230 patients who underwent coronary angiography in the Department of Coronary Artery Disease in Cracow. At the end of the follow-up the patients were asked to complete the self-report questionnaires which evaluated the course of the disease after discharge from the Department and present symptoms. On the basis of the medical records from the hospitalization in the Department and returned questionnaires data of 142 patients (Group 1: 89 patients, 46 men and 43 women, mean age 48.10 +/- 9.2 years; Group 2: 53 patients, 36 men and 17 women, mean age 52.51 +/- 9.6 years) were analyzed. Group 2 patients were older (p = 0.007), with higher prevalence of men (p = 0.05). The mean follow-up was 3.47 +/- 1.7 years for Group 1 and 2.85 +/- 1.7 years for group 2 (p = NS). Left ventricle contractility was normal in both groups. The occurrence of atherosclerosis risk factors was more frequent in Group 2 patients and didn't change significantly over the observation period. There were no deaths or new myocardial infarctions during the observation. Unstable angina occurred in 4 (2.8%) of patients. 33 patients (23.2%) reported hospital treatment for chest pain with mean frequency 0.13 +/- 0.3 hospitalizations/year in Group 1 and 0.09 +/- 0.17 in Group 2 (p = NS). Before coronary angiography this index was significantly higher -0.57 +/- 0.8 hospitalizations/year in group 1 and 0.51 +/- 0.7 in group 2 (p < 0.001 for both groups). Anginal symptoms improved significantly over the observation period. Before coronary angiography majority of patients (60.5% Group 1 patients and 58.3% of Group 2 patients) defined their angina as severe comparing to respectively 7.1% and 2.1% of patients at the end of follow-up (p < 0.05 for both groups). Only 8 (5.6%) of patients remained entirely asymptomatic at the end of the study. During the observation 7 (4.9%) of patients returned to work while 30 (21.1%) of patients retired for medical reasons out of which 25 (17.6%) were due to heart disease. During the follow-up there were no differences between the groups in the professional activity of patients. Group 2 patients were receiving more cardiac medications (mean 2.63 +/- 0.8 vs 2.18 +/- 0.9 at the discharge from the Department; p. = 0.05 and mean 2.52 +/- 0.9 vs 2.02 +/- 1.0 at the end of follow-up; p = 0.04). Group 2 patients were more frequently taking nitrates (86.3% vs 53.7% at the discharge from the Department; p < 0.001 and 77.1% vs 60.9% at the end of the study; p = 0.05) and diuretics. CONCLUSIONS: 1. During follow-up (mean 3.4 years) there were no differences between the groups in the presence of symptoms, frequency of hospitalizations and occurrence of acute coronary events. 2. In both groups severity of anginal symptoms and frequency of hospitalizations decreased significantly. 3. The persistence of cardiac symptoms might have been caused by the presence of atherosclerosis risk factors during the follow-up.

[Self-estimation of the quality of life in adult patients after surgical correction of atrial septal defect type II (ASD II)]. / Samoocena jakosci zycia doroslych po chirurgicznej korekcji ubytku w przegrodzie miedzyprzedsionkowej typu II (ASD II).

Health estimation was performed in 134 patients (where 67% were women), aged 17-70, mean 42 years, 2-3 years after surgical correction of atrial septal defect type II (ASD II). The study consists of clinical examination and self-estimation of the quality of life with help of a mall questionnaire, with return ratio of 90%. The improvement of health status was declared by 80% of patients, where 23% stated considerable improvement. While 15% did not confirm any significant changes and 5% noticed worsening quality of life status (mainly connected with postoperative pain). The physical condition improved similarly, with range of tolerable physical effort doubled. The frequency of dyspnea, chest pain and palpitation decreased from 72%, 67% and 87% to 47%, 43% and 47%, respectively, as well as their intensity. More over, the frequency of anxiety decreased from 70% to 62% with reduction of its intensity. Both, before and after surgery, the environmental estimation and self-estimation was very good (77% versus 78%, 78% versus 89%) respectively, and predominant were optimistic attitudes. Post-operative improvement of the quality of life correlating to the clinical state, confirms the suitableness of surgical correction of ASD II, independent of age.