Intrapulmonal dislocation of a totally implantable venous access device

BACKGROUND: Totally implantable venous access devices are widely used for infusion of chemotherapy or parenteral nutrition. Device associated complications include technical operative problems, infections, paravasal infusions and catheter or punction chamber dislocation. CASE PRESENTATION: We present the case of a 49-year-old patient with the rare complication of a intrapulmonal catheter dislocation of a totally implantable venous access system. Treosulfane for chemotherapy of metastatic breast cancer was infused via the catheter causing instant coughing and dyspnoea which lead to the diagnosis of catheter dislocation. The intrapulmonal part of the catheter was removed under thoracoscopic control without further complications. CONCLUSION: Intrapulmonal catheter dislocation is a rare complication of a totally implantable venous access device which can not be avoided by any prophylactic measures. Therefore, the infusion system should be tested before each use and each new symptom, even when not obviously related to the catheter should be carefully documented and evaluated by expert physicians to avoid severe catheter-associated complications

همانژیواندوتلیومای اپیتلیویید کبدی بدخیم اولیه، یک مرور جامع از متون تحقیقی با تأکید بر درمان جراحی

زمینه و هدف: همانژیواندوتلیـومای اپیتلیویید کبدی (HEH) بدخیم، یک تومـور عروقی بدخیـم نادر با علت ناشناخته و سیر طبیعی متغیر است. نویسندگان این مقاله، مـرور جامعی از متـون تحقیقی در مـورد HEH را با تمـرکز بر پیامدهای بالینی پس از راهبـردهای درمانی متفاوت، ارائه می‌دهند. مواد و روش‌ها: در این مـرور، تمامی مجمـوعه‌های منتشر شده در مورد بیماران مبتلا به HEH (تعداد 434 بیمـار) از نخستین توصیف این بیمـاران در سال 1984 تا مقالة حاضر مـورد تحلیل قـرار گرفت. پارامتـرهای مرور شده شامل: داده‌های جمعیت ـ شناختی، تظاهـرات بالینی، روش‌های درمانی و پیامـدهای بالینی بود. یافته‌ها: میانگین سنی بیماران مبتلا به HEH، 7/41 سال و نسبت مرد به زن، 2 به 3 بود. شایعترین تظاهـرات بالینی: درد ربع فـوقانی راست شکم، هپاتومگالی و کاهش وزن بود. اغلـب بیماران با تومور چند کانونی که هر دو لـوب را درگیـر کرده، مـراجعه کردند. شایعترین مناطق درگیری خارج کبدی در زمان تشخیص: ریه، صفاق، گـره‌های لنفـاوی و استخوان بود. شایعتـرین تدابیـر درمانی: پیـوند کبد (LTx)‌ (8/44% از بیمـاران)، پیگیـری بدون درمان (8/24% از بیماران)، شیمی درمانی یا پرتو درمانی (21% از بیماران)، و رزکسیـون کبد (LRx) (4/9% از بیمـاران) بود. میـزان بقـای یک و پنـج سالة پس از LTx به ترتیب 96% و 5/54%، پس از عـدم درمان به ترتیب 3/39% و 5/4% پس از شیمـی درمانی یا پرتودرمانی به ترتیب 3/73% و 30% و پس از LRx به ترتیب 100% و 75% بود. نتیجه‌گیـری: LRx درمان انتخـابی برای بیمـاران مبتلا به HEH قابل رزکسیـون است، با این وجـود، به دلیل چند مـرکزی بودن HEH کبـدی، LTx به عنوان درمـان انتخـابی پیشنهـاد شده است. علاوه بر این، LTx گزینة قابل قبـولی برای بیمارانی است که HEH با تظاهـرات خارج کبدی دارند. شاید بتوان بیماران کاملاً گزینش شده را تحت LTx از اهـداء کنندة زنده (با حفـظ منبع اهـداء) قـرار داد. نقش درمان‌های کمکی مختلف برای بیمارن مبتلا به HEH همچنان نامعلـوم است

Double-blind, placebo-controlled first in human study to investigate an oral vaccine aimed to elicit an immune reaction against the VEGF-Receptor 2 in patients with stage IV and locally advanced pancreatic cancer

BACKGROUND: The investigational oral DNA vaccine VXM01 targets the vascular endothelial growth factor receptor 2 (VEGFR-2) and uses Salmonella typhi Ty21a as a vector. The immune reaction elicited by VXM01 is expected to disrupt the tumor neovasculature and, consequently, inhibit tumor growth. VXM01 potentially combines the advantages of anti-angiogenic therapy and active immunotherapy. METHODS/DESIGN: This phase I trial examines the safety, tolerability, and immunological and clinical responses to VXM01. The randomized, placebo-controlled, double blind dose-escalation study includes up to 45 patients with locally advanced and stage IV pancreatic cancer. The patients will receive four doses of VXM01 or placebo in addition to gemcitabine as standard of care. Doses from 10(6) cfu up to 10(10) cfu of VXM01 will be evaluated in the study. An independent data safety monitoring board (DSMB) will be involved in the dose-escalation decisions. In addition to safety as primary endpoint, the VXM01-specific immune reaction, as well as clinical response parameters will be evaluated. DISCUSSION: The results of this study shall provide the first data regarding the safety and immunogenicity of the oral anti-VEGFR-2 vaccine VXM01 in cancer patients. They will also define the recommended dose for phase II and provide the basis for further clinical evaluation, which may also include additional cancer indications. TRIAL REGISTRATION: EudraCT No.: 2011-000222-29, NCT01486329, ISRCTN6880927

Pancreatic cancerrelated cachexia: influence on metabolism and correlation to weight loss and pulmonary function

<p>Abstract</p> <p>Background</p> <p>Dramatic weight loss is an often underestimated symptom in pancreatic cancer patients. Cachexia- defined as an unintended loss of stable weight exceeding 10% – is present in up to 80% of patients with cancer of the upper gastrointestinal tract, and has a significant influence on survival. The aim of the study was to show the multiple systemic effects of cachexia in pancreatic cancer patients, in terms of resection rate, effects on pulmonary function, amount of fat and muscle tissue, as well as changes in laboratory parameters.</p> <p>Methods</p> <p>In patients with pancreatic cancer, clinical appearance was documented, including the amount of weight loss. Laboratory parameters and lung-function tests were evaluated, and the thickness of muscle and fat tissue was measured with computed tomography scans. Statistical analysis, including multivariate analysis, was performed using SPSS software. Survival curves were calculated using Kaplan-Meier analysis and the log-rank test. To test for significant differences between the examined groups we used Student's t-test and the Mann-Whitney U test. Significance was defined as p < 0.05.</p> <p>Results</p> <p>Of 198 patients with a ductal adenocarcinoma of the pancreas, 70% were suffering from weight loss when they presented for operation, and in 40% weight loss exceeded 10% of the stable weight. In patients with cachexia, metastases were diagnosed significantly more often (47% vs. 24%, P < 0.001), leading to a significantly reduced resection rate in these patients. Patients with cachexia had significantly reduced fat tissue amounts. Hence, dramatic weight loss in a patient with pancreatic cancer may be a hint of a more progressed or more aggressive tumour.</p> <p>Conclusion</p> <p>Pancreatic cancer patients with cachexia had a higher rate of more progressed tumour stages and a worse nutritional status. Furthermore, patients with cachexia had an impaired lung function and a reduction in fat tissue. Patients with pancreatic cancer and cachexia had significantly reduced survival. If weight loss exceeded 5% there was a significantly reduced resection rate to detect, but the changes were significantly more substantial if weight loss was 10% or more. We propose that a weight loss of 10% be defined as significant in pancreatic cancer.</p

Major combined electrolyte deficiency during therapy with low-dose Cisplatin, 5-Fluorouracil and Interferon alpha: report on several cases and review of the literature [ISRCTN62866759]

BACKGROUND: Low-dose Cisplatin and Interferon alpha treatment of solid tumors rarely has been associated with severe hypocalcaemia. To the authors knowledge the phenomenon has not been reported previously in patients with pancreatic carcinoma. CASE PRESENTATION: A patient with resected adenocarcinoma of the pancreas was treated with adjuvant radio-chemo-immunotherapy using a combination of low-dose Cisplatin, 5-Fluorouracil and Interferon alpha together with external beam radiation. Severe hypocalcaemia without signs of acute renal failure or electrolyte disturbance occurred within 2 days at the 4th week of treatment and required intensive care treatment. CONCLUSION: Combination of biological and cytotoxic therapies may increase the incidence of severe hypocalcaemia in pancreatic cancer. Oncologists should remain attentive of this problem as more highly active regimes become available

Predictive factors for postoperative pancreatic fistula

The goal of the ISGPF, clearly stated in the title of the article, was to define the complication and to grade its severity but not to provide any prognostic value. Indeed, the data necessary for the grading system cannot be analyzed before one of the events occur or at the end of the course of patient care and therefore, by definition, cannot be of any predictive value. What has to be done now is to analyze the data of several centers, expert and not so expert, to determine the independent predictive factors and then validate the results in another independent population, prospectively.What has to be done now is to analyze the data of several centers, expert and not so expert, to determine the independent predictive factors and then validate the results in another independent population, prospectively