Intramedullary spinal cord metastasis in a patient with colon cancer: a case report.

INTRODUCTION: Intramedullary spinal cord metastasis (ISCM) is both a rare and devastating event, since it is clinically evident in 0.1-0.9% of cancer patients and the mortality rate at 3-4 months is 80%. MATERIALS AND METHODS: We present the case of a woman with colon cancer who developed ISCM while on chemotherapy for metastatic disease. The patient presented with paralysis of both legs, weakness in the upper arms, and urinary retention. RESULTS: The diagnosis of ISCM at the level of C6-C7 was made with magnetic resonance imaging of the whole spine. Due to the fact that the patient had an established lower limb paralysis and a poor overall clinical status, external beam radiotherapy (RT) was administered, achieving stabilization of symptoms. CONCLUSIONS: ISCM should be diagnosed and managed as early as possible, since this may result in improvement of neurological deficits. RT is the treatment of choice in most cases, with surgery reserved for selected patients. Recent published data suggest that surgery may result in an improved survival. However, no firm recommendations can be made due to the lack of controlled comparative clinical trials.

Potential value of PTEN in predicting cetuximab response in colorectal cancer: an exploratory study.

BACKGROUND: The epidermal growth factor receptor (EGFR) is over-expressed in 70-75% of colorectal adenocarcinomas (CRC). The anti-EGFR monoclonal antibody cetuximab has been approved for the treatment of metastatic CRC, however tumor response to cetuximab has not been found to be associated with EGFR over-expression by immunohistochemistry (IHC). The aim of this study was to explore EGFR and the downstream effector phosphatase and tensin homologue deleted on chromosome 10 (PTEN) as potential predictors of response to cetuximab. METHODS: CRC patients treated with cetuximab by the Hellenic Cooperative Oncology group, whose formalin-fixed paraffin-embedded tumor tissue was available, were included. Tissue was tested for EGFR and PTEN by IHC and fluorescence in situ hybridization (FISH). RESULTS: Eighty-eight patients were identified and 72 were included based on the availability of tissue blocks with adequate material for analysis on them. All patients, except one, received cetuximab in combination with chemotherapy. Median follow-up was 53 months from diagnosis and 17 months from cetuximab initiation. At the time of the analysis 53% of the patients had died. Best response was complete response in one and partial response in 23 patients. In 16 patients disease stabilized. Lack of PTEN gene amplification was associated with more responses to cetuximab and longer time to progression (p = 0.042). CONCLUSION: PTEN could be one of the molecular determinants of cetuximab response. Due to the heterogeneity of the population and the retrospective nature of the study, our results are hypothesis generating and should be approached with caution. Further prospective studies are needed to validate this finding.

A multi-resistant Acinetobacter baumannii outbreak in a general intensive care unit.

In an Intensive Care Unit, three patients were found infected and two colonized with multiresistant Acinetobacter baumannii within a period of one week. To identify the outbreak source, two surveillance studies were performed concerning patients and the environment. Genotyping of isolates was performed by random amplification of polymorphic DNA analysis (RAPD). Environmental sampling failed to yield A. baumannii, with the exception of a single sample from a trunking. RAPD-fingerprinting yielded identical patterns for all patient isolates including the trunking isolate, thus confirming the suspected cluster. Since the strain from the trunking had a susceptibility pattern and a RAPD pattern identical to that of the strains isolated from the patients, we believe that this was the likely source of the outbreak. In conclusion, A. baumannii outbreaks may be quickly controlled by appropriate action of the hospital infection staff. RAPD-fingerprinting may provide a useful and rapid identification technique for the epidemiological investigation of a hospital outbreak.