Cardiac safety of adjuvant pegylated liposomal doxorubicin with concurrent trastuzumab: a randomized phase II trial.

BACKGROUND: The cardiac safety of trastuzumab concurrent with pegylated liposomal doxorubicin (PLD) in an adjuvant breast cancer treatment regimen is unknown. PATIENTS AND METHODS: Women with resected node-positive or intermediate-risk node-negative HER2 overexpressing breast cancer and baseline left ventricular ejection fraction (LVEF)≥55% were randomized (1:2) to doxorubicin 60 mg/m2 (A)+cyclophosphamide 600 mg/m2 (C) every 21 days (q21d) for four cycles or PLD 35 mg/m2+C q21d+trastuzumab 2 mg/kg weekly (H) for 12 weeks. Both groups then received paclitaxel (Taxol, T) 80 mg/m2 with H for 12 weeks followed by H to complete 1 year. The primary end point was cardiac event rate or inability to administer 1 year of trastuzumab. RESULTS: Of 181 randomized patients, 179 underwent cardiac analysis. The incidence of cardiac toxicity or inability to administer trastuzumab due to cardiotoxicity was 18.6% [n=11; 95% confidence interval (CI) 9.7% to 30.9%] with A+C→T+H and 4.2% (n=5; 95% CI 1.4% to 9.5%) with PLD+C+H→T+H (P=0.0036). All events, except one, were asymptomatic systolic dysfunction or mildly symptomatic heart failure. Mean absolute LVEF reduction at cycle 8 was greater with doxorubicin (5.6% versus 2.1%; P=0.0014). CONCLUSION: PLD+C+H→T+H is feasible and results in lower early cardiotoxicity rates compared with A+C→T+H.

A young female with a cholangiocarcinoma in the past: is pregnancy allowed?

BACKGROUND: A 28-year-old woman developed a cholangiocarcinoma after using oral contraceptives for eight years. The common bile duct and the gallbladder were removed and four hepaticojejunostomies were performed. RESULTS: Seven years after surgery no evidence of disease recurrence is detectable and the patient wants advice regarding her wish for pregnancy. CONCLUSION: The possible role of oestrogens in the development of cholangiocarcinoma makes it difficult to give an adequate advice. As in patients with breast cancer in the past, it seems reasonable to admit pregnancy in our patient, because of a disease-free interval of longer than five years.

PIP: Long-term oral contraceptive (OC) use has been implicated as a possible factor in the development of hepatocellular carcinoma and cholangiocarcinoma. Presented, in this paper, is the case of a 35-year-old Dutch woman who developed a cholangiocarcinoma at 28 years of age after 8 years of OC use. The common bile duct and gall bladder were removed and 4 hepaticojejunostomies were performed. Seven years after surgery, with no evidence of disease recurrence, this woman sought advice regarding the feasibility of pregnancy. The possible role of estrogens in cholangiocarcinomas makes this a difficult question. The only such case reported in the literature involved a woman with inoperable cholangiocarcinoma who became pregnant with no evidence that the pregnancy stimulated tumor growth. Most studies of the interactive effects of pregnancy and recurrent malignancies have involved breast cancer. Recommended, for breast cancer patients, is postponement of pregnancy until a disease-free interval of 3-5 years has been achieved. In the absence of specific guidelines for cholangiocarcinoma survivors, it seems advisable to adhere to this same principle.

Nephroptosis: a considerable cause of renovascular hypertension.

Four females were admitted with hypertension. Other causes of hypertension were excluded on clinical grounds. Digital substraction angiography performed in 3 patients revealed no stenosis of the renal arteries. The 99mTc-Mag3 renogram showed diminished perfusion and excretion on the affected side. Right-sided nephropexy was performed in all 4 cases via lumbotomy after which all 4 patients became normotensive. We conclude that nephroptosis is a considerable cause of renovascular hypertension and deserves particular attention in cases of possible renovascular hypertension when angiography shows no stenosis. We also conclude that renography is the preferred diagnostic method in the diagnosis of renovascular hypertension due to nephroptosis.

Relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings.

Fifty cases admitted to the urological clinics of Turkish State Railways Hospital, Ankara, were examined by scrotal ultrasonography in order to find the relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings. In the measured 5-6 mm spermatic vein diameters palpable varicocele and venous regurgitation were found in 100%, in the measured 3-4 mm diameters palpable varicocele was found in 50% and venous regurgitation in 64.5%, and in the measured 1-2 mm diameters palpable varicocele was found in 16% and venous regurgitation in 24%.