The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site.

BACKGROUND: We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS: We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS: As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS: Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.

Simulating muscular thin films using thermal contraction capabilities in finite element analysis tools.

In this study, new techniques for approximating the contractile properties of cells in biohybrid devices using Finite Element Analysis (FEA) have been investigated. Many current techniques for modeling biohybrid devices use individual cell forces to simulate the cellular contraction. However, such techniques result in long simulation runtimes. In this study we investigated the effect of the use of thermal contraction on simulation runtime. The thermal contraction model was significantly faster than models using individual cell forces, making it beneficial for rapidly designing or optimizing devices. Three techniques, Stoney׳s Approximation, a Modified Stoney׳s Approximation, and a Thermostat Model, were explored for calibrating thermal expansion/contraction parameters (TECPs) needed to simulate cellular contraction using thermal contraction. The TECP values were calibrated by using published data on the deflections of muscular thin films (MTFs). Using these techniques, TECP values that suitably approximate experimental deflections can be determined by using experimental data obtained from cardiomyocyte MTFs. Furthermore, a sensitivity analysis was performed in order to investigate the contribution of individual variables, such as elastic modulus and layer thickness, to the final calibrated TECP for each calibration technique. Additionally, the TECP values are applicable to other types of biohybrid devices. Two non-MTF models were simulated based on devices reported in the existing literature.

HIF1A expression in localized prostate cancer treated with dose escalation radiation therapy.

PURPOSE: To analyze the expression of hypoxia inducible factor 1 alpha (HIF1A) and its correlation with clinical outcome in men with localized prostate cancer (PC) treated with dose escalation radiotherapy (RT) and androgen deprivation (AD). METHODS: Between 1996 and 2004, 129 PC patients who had diagnostic biopsies pre-treatment and 24-36 months following RT were enrolled in this study. Median follow-up was 129 months. Suitable archival diagnostic tissue was obtained from 86 patients. Correlation analysis was done to assess association between HIF1A expression and clinical outcome. RESULTS: HIF1A expression was observed in 25/86 (29%) of diagnostic biopsies, and in 5/14 (36%) of post-RT biopsies. No significant association was noted between HIF1A expression and clinical and treatment parameters. We also failed to show a significant correlation between HIF1A overexpression and outcome. A borderline significant relationship was observed between expression of HIF1A and overall survival (OS) (HR 0.03, p=0.08). CONCLUSION: To our knowledge this is the first study assessing the pattern of change of HIF1A staining in biopsies of patients prior and following treatment. While we did not find significant variations in the expression of HIF1A following radio-hormone therapy, a high HIF1A expression was unexpectedly associated with a borderline improved OS.

Conocimiento sobre lactancia materna en embarazadas que acudieron a consulta prenatal: Hospital Dr. Patrocinino Peñuela Ruiz. San Cristóbal, Venezuela / Knowledge about breastfeeding in pregnant mothers who attended antenatal consultation: Hospital Dr. Patrocinio Peñuela Ruiz. San Cristóbal-Venezuela

Introducción: La lactancia materna exclusiva proporciona un aporte nutricional, inmunológico y emocional necesario para el crecimiento y desarrollo durante los primeros seis meses de vida. Se planteó como objetivo evaluar el conocimiento sobre la lactancia materna que tiene la embarazada que acude a la consulta prenatal. Métodos: Estudio comunitario exploratorio, prospectivo, transversal realizado en la consulta prenatal del Servicio de Obstetricia, del hospital IVSS Dr. Patrocinio Peñuela Ruiz. A las embarazadas se les aplicó una encuesta de diez preguntas. Resultados: La mayoría de las embarazadas respondieron que han recibido información sobre lactancia materna y quieren amamantar a su hijo. Sin embargo se pudieron observar dudas en el conocimiento sobre lactancia, como características del calostro, preparación de la mama, alimentación y solución de algunos problemas que se pueden presentar. Discusión: La promoción y difusión acerca de la importancia de la lactancia materna se está arraigando en las mentes de las futuras madres, sin embargo hay que mejorar la preparación y el conocimiento para lograr que la lactancia no tenga inconvenientes. La consulta prenatal es un espacio ideal para impulsar programas de educación a las futuras madres.

Introduction: Exclusive breastfeeding provides a necessary nutritional, immunological and emotional contribution to the growth and development during the first six months of life. He said intended to observe the knowledge on breastfeeding that pregnant women who attend antenatal consultation. Methods: A community study went conducted in the prenatal consultation of obstetrics service of Dr. Patrocinio Peñuela Ruiz, IVSS hospital. Applied to pregnant a survey of ten questions. Results: The majority of pregnant women responded that they have received information on breastfeeding and want to breastfeed her child. However observed doubts the knowledge about breastfeeding, as features of colostrum, breast, feeding and solving some problems that may occur. Discussion: The promotion and dissemination about the importance of breastfeeding is taking root in the minds of moms, however it must improve preparedness and knowledge to achieve that breast-feeding does not have problems. The prenatal consultation is an ideal space to promote programs of education to futures mothers.

Predictive value of PAK6 and PSMB4 expression in patients with localized prostate cancer treated with dose-escalation radiation therapy and androgen deprivation therapy.

PURPOSE: The present study analyzed the expression by immunochemistry of the novel markers P21-activated protein kinase 6 (PAK6) and proteasome beta-4 subunit (PSMB4) in men with localized prostate cancer (PC) who were treated with dose-escalation radiotherapy (RT) and androgen deprivation therapy. MATERIALS AND METHODS: Between 1996 and 2004, a cohort of 129 patients with PC who underwent diagnostic biopsies pretreatment and 24 to 36 months following RT were enrolled in this study. Suitable archival diagnostic tissue was obtained from 89 patients. Median follow-up was 129 months (48-198). Correlation analysis was done to assess association between PAK6 and PSMB4 expression and clinical outcome. RESULTS: PAK6 and PSMB4 were expressed in the cytoplasm in 62% and 96.7% of diagnostic biopsies, respectively. Increased staining for PAK6 was significantly (P = 0.04) correlated with higher Gleason scores. In the multivariate analysis, the intensity of PSMB4 staining was an independent predictor of local relapse (hazard ratio = 8.6, P = 0.04). CONCLUSIONS: To our knowledge, this is the first description of PAK6 and PSMB4 expression in the diagnostic specimens of men with PC who were treated with RT. If confirmed by further studies, increased expression of these genes could be used to identify patients at a high risk of developing local failure following high-dose RT, thus better tailoring treatments for the individual patient.

[The Alliance for the Prevention of Colorectal Cancer in Spain. A civil commitment to society]. / Alianza para la Prevención del Cáncer de Colon en España: un compromiso cívico con la sociedad.

Colorectal cancer (CRC) is the most common malignant tumor in Spain, when men and women are considered together, and the second leading cause of cancer death. Every week in Spain over 500 cases of CRC are diagnosed, and nearly 260 people die from the disease. Epidemiologic estimations for the coming years show a significant increase in the number of annual cases. CRC is a perfectly preventable tumor and can be cured in 90% of cases if detected in the early stages. Population-based screening programs have been shown to reduce the incidence of CRC and mortality from the disease. Unless early detection programs are established in Spain, it is estimated that in the coming years, 1 out of 20 men and 1 out of 30 women will develop CRC before the age of 75. The Alliance for the Prevention of Colorectal Cancer in Spain is an independent and non-profit organization created in 2008 that integrates patients' associations, altruistic non-governmental organizations and scientific societies. Its main objective is to raise awareness and disseminate information on the social and healthcare importance of CRC in Spain and to promote screening measures, early detection and prevention programs. Health professionals, scientific societies, healthcare institutions and civil society should be sensitized to this highly important health problem that requires the participation of all sectors of society. The early detection of CRC is an issue that affects the whole of society and therefore it is imperative for all sectors to work together.

Post-treatment prostate biopsies in the era of three-dimensional conformal radiotherapy: what can they teach us?

BACKGROUND: The ability to discriminate between therapeutic success and failure after radiotherapy (RT) for prostate cancer (PCa) remains a clinical challenge. Post-treatment biopsies would seem ideal for evaluating innovations such as dose escalation protocols or combination treatments involving brachytherapy or hormones. OBJECTIVE: Correlate post-treatment biopsy results with prostate-specific antigen (PSA) and clinical outcome in PCa patients treated with three-dimensional conformal radiotherapy (3DCRT) in a dose-escalation study. DESIGN, SETTING, AND PARTICIPANTS: This study included 160 patients with clinical stage T1c to T3b PCa treated between 1995 and 2005 in Hospital Universitario la Princesa with 3DCRT who consented to and underwent a transrectal ultrasound (TRUS)-guided prostate biopsy 24-36 mo after RT. The median follow-up was 78 mo (range 27-171 mo). INTERVENTION: The median radiation dose was 74 gray (Gy; range 66.0-84.1). Risk-adapted short-term androgen deprivation (STAD) and long-term androgen deprivation (LTAD) were associated in 25 and 106 patients, respectively. Right and left systematic biopsies were carried out by the same urologist and were examined by a genitourinary pathologist. MEASUREMENTS: Biochemical disease-free survival (bDFS) according to American Society for Therapeutic Radiology and Oncology (ASTRO) 1997 and Phoenix definition criteria as well as histologic control using post-treatment prostate biopsies. RESULTS: Twenty-one percent of patients (34 of 160) had post-treatment-positive biopsies (PB). The 5-yr bDFS according to the Phoenix definition was 87%, 65%, and 92% for the whole series (PB and negative biopsies [NB] patients, respectively [p<0.001]). Multivariate analysis showed that biopsy status at 24-36 mo was an independent predictor of bDFS (p<0.0005) and of clinical failure-free survival (p=0.043). CONCLUSION: The results of the present study show a strong correlation between a post-treatment PB and the 5-yr probability of bDFS, confirming that PSA control can be an adequate surrogate for local control, as assessed by post-treatment biopsies.

[Primary systemic amyloidosis with exclusive involvement of the tongue as an exceptional cause of dysphagia]. / Amiloidosis primaria AL con afección exclusiva de la lengua como causa excepcional de disfagia.

We present a 73-year-old woman with progressive dysphagia and dysarthria over two years associated with systemic symptoms including weight loss, asthenia and dyspnoea. Biopsy of the tongue demonstrated amyloid AL deposits. The immunohistochemical study showed a notable positiveness to antibodies for L-kappa chains. The patient died 6 months after diagnosis.

Amiloidosis primaria AL con afección exclusiva de la lengua como causa excepcional de disfagia / Primary systemic amyloidosis with exclusive involvement of the tongue as an exceptional cause ofdysphagia

Se presenta el caso de una mujer de 73 años de edad con disfagia progresiva asociada a disartria de 2 años de evolución, con síntomas sistémicos que incluían disnea, astenia y pérdida de peso. Se realizó biopsia de la lengua que mostró amiloidosis primaria AL. En el estudio inmunohistoquímico se obtuvo una marcada positividad con anticuerpos frente a cadenas ligeras kappa. La paciente falleció a los 6 meses del diagnóstico (AU)

We present a 73-year-old woman with progressive dysphagia and dysarthria over two years associated with systemic symptoms including weight loss, asthenia and dyspnoea. Biopsy of the tongue demonstrated amyloid AL deposits. The immunohistochemical study showed a notable positiveness to antibodies for L-kappa chains. The patient died 6 months after diagnosis (AU)

Chordoid glioma of the third ventricle attached to the optic chiasm. Successful removal through a trans-lamina terminalis approach.

Chordoid glioma of the third ventricle constitutes a rare, very recently recognized histological entity. Most reports of this neoplasm, focused on its distinct histological features, have hypothesized about a probable origin of the lesion at the third ventricle floor and/or the lamina terminalis. We report on a new case, presenting neuroradiological and intraoperative pictorial evidences of the tumoral attachment, limited to the chiasm-lamina terminalis junction. A 53-year-old woman debuted with acute symptoms of obstructive hydrocephalus, visual disturbances and confusion. MRI investigation showed a large solid-cystic third ventricle mass bulging through the lamina terminalis and ventricular floor. After placing a ventriculoperitoneal shunt, the tumor was completely removed through a trans-lamina terminalis approach. A tight tumoral attachment to the junction of the posterior chiasm to the lamina terminalis was identified and dissected. No other adhesions to the third ventricle boundaries were found. A chordoid glioma was diagnosed on histological examination. One year after the surgical procedure the patient does not present new neurological deficits, and there are no signs of tumoral regrowth on the follow-up postoperative MRI. Chordoid glioma should be included in the differential diagnosis of third ventricle tumors. Preoperative neuroradiological suspicion of this lesion should alert the neurosurgeon about the presence of a tight tumoral adherence at the level of the chiasm-lamina terminalis junction. The trans-lamina terminalis approach provides a suitable route for an early control of this attachment under direct vision, allowing a safe dissection of the mass from the third ventricle.

Undifferentiated carcinoma arising from the Stensen's duct: a case report and review of the literature.

Primary carcinoma arising in Stensen's duct is an extremely rare and poorly understood tumor. A 38-year-old man was referred with a malignant lesion situated in the right cheek. The patient was treated by local resection, total parotidectomy, and modified radical neck dissection. Microscopic examination revealed tumor cells of basaloid pattern with squamous differentiation in some areas. The tumor showed a very aggressive behaviour with early local recurrence and metastatic disease. The histological and radiological findings suggest the origin from the Stensen's duct. Primary carcinoma of Stensen's duct should be histologically consistent with epidermoid, mucoepidermoid, or undifferentiated carcinoma. The diagnosis of true Stensen's duct carcinoma can be performed on the basis of clinical presentation, radiological findings, and tumor histology. Criteria for determination of origin in the duct are revised and compared with this case.

High molecular response rate and clinical correlation in patients with follicular lymphoma treated with cyclophosphamide-vincristine-prednisone plus interferon alpha 2b.

PURPOSE: The role of molecular monitoring of minimal residual disease (MRD) in low-grade non-Hodgkin's lymphoma is controversial. We have performed a prospective study of the molecular behavior of 35 patients with follicular non-Hodgkin's lymphoma who received cyclophosphamide-vincristine-prednisone chemotherapy in conjunction with IFN-alpha 2b. EXPERIMENTAL DESIGN: Bcl-2 and clonal immunoglobulin heavy chain (IgH) gene rearrangements were assayed at diagnosis by PCR in lymph node and bone marrow (BM) and sequentially after treatment. RESULTS: Molecular markers were detected in BM of 29 (83%) patients at diagnosis: Bcl-2 rearrangement in 20 patients (90% major breakpoint and 10% minor cluster) and clonal IgH rearrangement in 9 of 15 patients negative for Bcl-2. Molecular and clinical response was noted in 25 (86%) patients after induction treatment. Progression-free survival at 5 years was 78.1 +/- 8%. A correlation between clinical and molecular response was found in 24 patients with molecular markers in BM at diagnosis and >2 years of follow-up: 94% of patients with undetectable MRD showed continuous clinical remission, whereas 50% of patients who reverted back to positive molecular markers relapsed (P < 0.05). CONCLUSIONS: The rate of molecular response is high in patients treated with cyclophosphamide-vincristine-prednisone and IFN and MRD sequential analysis is useful for disease surveillance.

Hemangioma cavernoso laríngeo del adulto

Los hemangiomas cavernosos laríngeos son lesiones benignas y poco frecuentes, cuya presentación es todavía más rara en la edad adulta. En éstos, aparecen fundamentalmente en la supraglotis y la práctica totalidad de los pacientes afectos son varones. La sintomatología es escasa y de largo tiempo de evolución, predominando la disfonía. Su histología es característica y permite diferenciarlos de otras lesiones de aspecto clínico similar. El método de tratamiento de elección para la mayoría de los autores es la resección quirúrgica. La hemorragia no siempre está presente, pero hay que tenerla en cuenta. Presentamos el caso de un gran hemangioma cavernoso de presentación supraglótica en un varón de 35 años. La resección se realizó por vía endoscópica, previa traqueotomía. No hubo problemas hemorrágicos (AU)

Experimental mandibular regeneration by distraction osteogenesis with submerged devices: preliminary results of a canine model.

The authors describe a new technique for reconstruction of mandibular body defects. The feasibility of distraction osteogenesis with submerged (internal) devices for reconstruction of segmental mandibular defects is investigated in an experiment with five adult dogs. A segmental mandibulectomy was performed on the horizontal ramus. The bony defect was regenerated using distraction osteogenesis (bone transport) at a rate of 1 mm daily. The animals were killed after the consolidation period. Complete bone regeneration of the surgically created gap was successful in three of five dogs. Two animals failed to create new bone. In these two cases, the screws did not offer proper stability to the bony fragments, and this caused a lack of ossification. This experimental study demonstrates the possibility to use internal distraction devices to reconstruct segmental mandibular defects in a canine model. Internal devices show enormous advantages in comparison with the external ones. This method with no donor-site morbidity may become a very useful option in human mandibular reconstruction.