Posible especificidad de los síntomas tipo pánico inducidos por inhalantes: a propósito de un caso

La intoxicación aguda por inhalantes produce distintos síntomas psiquiátricos y se ha documentado daño orgánico cerebral por exposición crónica a los mismos. Describimos la aparición de un subgrupo específico de síntomas tipo pánico, tras la exposición a solventes volátiles, en una mujer de 36 años con historia de exposición profesional y adicción a los solventes volátiles que posteriormente desarrolló un trastorno de pánico comórbido con escasa respuesta al tratamiento antidepresivo. La paciente se evaluó mediante la administración del SCL-90-R, el WAIS y el test de Rorschach; también se le realizó RM de medio contraste. No se encontraron datos sólidos de daño cerebral, aunque sus síntomas de ansiedad cumplen criterios para el subtipo neurobiológico de trastorno de pánico no relacionado con miedo a asfixia. Este subgrupo de síntomas de ansiedad se atribuye al mecanismo de acción de los solventes volátiles, es decir, la neurotransmisión gabaérgica

Carboxylesterase Isoform 2 mRNA Expression in Peripheral Blood Mononuclear Cells Is a Predictive Marker of the Irinotecan to SN38 Activation Step in Colorectal Cancer Patients

AbstractPurpose: Irinotecan (CPT11) is a prodrug activated in humans mainly by carboxylesterase 2 (CES2) generating the SN38 metabolite responsible for the drug efficacy and toxicity. The interpatients variability in CPT11 activation step could cause unpredictable toxicity. To identify a predictive molecular marker for CPT11 activation in cancer patients, we investigated the CES2 mRNA expression in peripheral blood mononuclear cells (PBMC) and correlated it to CPT11 activation rate, toxic effects, and response.Experimental Design: Forty-five colorectal cancer patients were treated with a CPT11-including regimen (FOLFIRI). CES2 mRNA expression in PBMC was quantified by reverse transcription-PCR in real time. Plasma concentrations of CPT11, SN38, and SN38-glucuronide were determined by high-performance liquid chromatography and the pharmacokinetic variables calculated adopting the noncompartmental model. Toxicity was evaluated by the National Cancer Institute Common Toxicity Criteria scale and response by the WHO criteria.Results: A high interindividual variability in CES2 mRNA relative expression was observed (median, 1.45; range, 0.01-28.21). CES2 mRNA expression level was significantly associated with CPT11 activation ratio [(AUCSN38 + AUCSN38G)/AUCCPT11]. Patients with CES2 mRNA expression above the median cutoff value presented an activation ratio higher (median, 0.25; range, 0.15-0.42) than those with CES2 mRNA below the median (median, 0.20; range, 0.10-0.40; P = 0.013). This was associated with a nonsignificant trend of 1.34-fold increase of SN38 AUC in the group of patients with high CES2 mRNA expression (mean, 1.03 ± 0.62 versus 0.77 ± 0.32 μmol/L hour). Eight of 23 high CES2 mRNA–expressing patients (34.8%) developed grade 3 to 4 neutropenia or diarrhea compared with 2 of 22 (9.1%) in the low CES2-expressing group (P = 0.071).Conclusion: Our data support a predictive power of CES2 mRNA expression in PBMC for the activation rate of CPT11

Lack of Activity of Docetaxel in Soft Tissue Sarcomas: Results of a Phase II Study of the Italian Group on Rare Tumors

Purpose. The prognosis of advanced soft tissue sarcoma is poor, only a few drugs showing some activity with response rates around 15– 25%. Consequently drug development seems mandatory to improve treatment outcome. Following previous favourable EORTC experience, the Italian Group on Rare Tumors started a phase II study with docetaxel to confirm the activity of this drug in soft tissue sarcoma

Posible especificidad de los síntomas tipo pánico inducidos por inhalantes: a propósito de un caso

La intoxicación aguda por inhalantes produce distintos síntomas psiquiátricos y se ha documentado daño orgánico cerebral por exposición crónica a los mismos. Describimos la aparición de un subgrupo específico de síntomas tipo pánico, tras la exposición a solventes volátiles, en una mujer de 36 años con historia de exposición profesional y adicción a los solventes volátiles que posteriormente desarrolló un trastorno de pánico comórbido con escasa respuesta al tratamiento antidepresivo. La paciente se evaluó mediante la administración del SCL-90-R, el WAIS y el test de Rorschach; también se le realizó RM de medio contraste. No se encontraron datos sólidos de daño cerebral, aunque sus síntomas de ansiedad cumplen criterios para el subtipo neurobiológico de trastorno de pánico no relacionado con miedo a asfixia. Este subgrupo de síntomas de ansiedad se atribuye al mecanismo de acción de los solventes volátiles, es decir, la neurotransmisión gabaérgica

Mesenchymal chondrosarcoma of the spleen: report of a case.

BACKGROUND: Chondrosarcoma is a malignant tumor of chondrogenic origin and the mesenchymal type is a very rare finding. Mesenchymal chondrosarcoma tends to develop mostly in the skeleton but may also occur as a primary tumor in periosteal nervous and muscular tissues, the anterior cerebral falx, meninges, brain, maxillary sinus, eyelid, thyroid, pleura and mediastinum, while in the abdomen the most frequent locations are the kidney, retroperitoneum and even the perineum and the anogenital area. Apparently, the only splenic mesenchymal chondrosarcoma in the literature occurred in a dog. METHODS AND STUDY DESIGN: Our paper reports the case of a patient who had a diagnosis of mesenchymal chondrosarcoma of the spleen. Results. We adopted surgery as the main therapeutic procedure without achieving complete recovery but preserving a good quality of life for our patient, minimizing the repercussions of the disease on her working and relational life. CONCLUSIONS: The absence of important or invalidating symptoms and the persistence of good general conditions before and after each surgical operation encouraged us to adopt the surgical option as the most rational

Trattamento del carcinoma del retto localmente avanzato mediante chemio-radioterapia preoperatoria in combinazione con radioterapia intraoperatoria (IORT)

Object: The use of aggressive multimodality treatment including preoperative chemo-radiation, surgery, and intraoperative radiotherapy (IORT) has been shown to impact on relapse and survival in patients with unresectable and recurrent rectal cancer. The aim of this study was to determine the outcome of this approach in locally advanced primary rectal cancer. Patients and methods: The study cohort comprised 53 patients (38 men and 15 women; median age 65 years, range 40-80) with clinical T3-4NxM0 adenocarcinoma of the rectum who received preoperative chemo-radiation, radical surgery (40 low anterior resection and 13 abdominoperineal resection), and IORT at our Institution between January 2000 and December 2005. Median distance of the tumor from the anal verge was 5 cm (range 2-13). According to the cTNM staging system 13 (25%) of the tumors were cT4 and 13 (25%) were cN positive. Univariate and multivariate analysis for disease free survival (DFS) and overall survival (OS) were performed. Results: Median follow-up was 54 months (range 10-111), and 5-year DFS and OS were 67,0% and 78,7% respectively. Univariate analysis of survival showed that DFS and OS were 76,7% and 86,7% in patients with cT3 tumors and 38,8% and 55,5% in patients with cT4 tumors (P<0,01). At multivariate analysis of survival cT, cN, and tumor regression grade (TRG) were independent prognostic factors. Postoperative morbidity and mortality rate were 33,9% and 3,8% respectively. Conclusions: Multimodality treatment including IORT is highly effective in locally advanced rectal cancer. Due to its toxicity this approach should be balanced with the risk of local recurrence

FOLFOX4 in the treatment of metastatic colorectal cancer in elderly patients: A prospective study

Elderly patients constitute a subpopulation with special characteristics that differ from those of the general population and have been under-represented in clinical trials. We, prospectively, analyzed the toxicity and efficacy of the original FOLFOX4-regimen in the treatment of elderly patients affected by metastatic (m) colorectal cancer (CRC). Thirty-six consecutive patients aged 67-82 years (median age 72 years), 22 males and 14 females, with mCRC and measurable disease, were enrolled in the study. The primary site of metastases was the liver (36.1% of patients). The median ECOG Performance Status (PS) was 1. The main hematological and extra-hematological (grade 3 or 4) toxicities were neutropenia (38.9%) and neurological (13.9%), respectively. A total of 36 patients, aged 67-82 years were included. Twenty-two and 14 patients were male and female, respectively. The median age was 72 years (range 67-82). The primary site of metastases was the liver (36.1% of patients). The median ECOG Performance Status (PS) was 1. The overall response rate (ORR) was 44.4% and similar to original study. Median progression-free survival (PFS) was 7.5 months and median overall survival (OS) was 16 months. The main hematological and extra-hematological (grade 3 or 4) toxicities were neutropenia (38.9%) and neurological (13.9%), respectively. Tolerability, however, was manageable and no toxic death occurred. FOLFOX4-regimen maintains its efficacy, and safety ratio in elderly patients with mCRC and good performance status. It would be considered the treatment of choice in the treatment of this particular setting of patients. (C) 2010 Elsevier Ireland Ltd. All rights reserved