719 research outputs found

    Clinical evidence for overcoming capecitabine resistance in a woman with breast cancer terminating in radiologically occult micronodular pseudo-cirrhosis with portal hypertension: a case report

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    <p>Abstract</p> <p>Introduction</p> <p>We report a case of stage IV breast cancer terminating in an unusual picture of radiologically occult micronodular pseudo-cirrhosis. Contrast-enhanced computed tomography showed no evidence of metastatic breast cancer within the liver. Unlike the few previously reported cases of intrasinusoidal spread of breast cancer, our patient was palliated with a transjugular intrahepatic portosystemic shunt along with salvage chemohormonal therapy. In addition, our patient demonstrated proof of the principle of the dependence of capecitabine (Xeloda) efficacy on dose scheduling as predicted by laboratory studies based on Gompertzian tumor growth and the Norton-Simon hypothesis.</p> <p>Case presentation</p> <p>We report the case of a 52-year-old Caucasian woman who developed radiological signs of portal hypertension without radiological evidence of hepatic metastasis five years after being diagnosed with metastatic breast cancer. She was receiving chemotherapy for stage IV breast cancer initially thought to be metastatic only to the bones. During salvage therapy with high-dose estradiol (Estradiol valerate), vinorelbine (Navelbine) and bevacizumab (Avastin), she suddenly developed signs of portal hypertension confirmed on computed tomography and by portal and systemic venous pressure measurements. Drug toxicity due to bevacizumab (Avastin) was initially and incorrectly entertained as a cause. The patient underwent palliative transjugular intrahepatic portosystemic shunt and transhepatic venous liver biopsy, which revealed the presence of rapidly progressive and uncontrolled metastatic breast cancer. The new discovery of radiologically occult intrasinusodal hepatic metastases with secondary micronodular cirrhosis was found to be the cause of her sudden onset portal hypertension. The patient's resistance to capecitabine (Xeloda) was reversed by changing the schedule of medication to biweekly 7/7 (7 days ingesting drug alternating with 7 days off drug) from the 14/7 (14 days ingesting drug alternating with a 7 day rest period) day schedule approved by the US Food and Drug Administration.</p> <p>Conclusion</p> <p>This case report demonstrates an unusual presentation of radiographically occult hepatic metastasis from breast cancer palliated with transjugular intrahepatic portosystemic shunt. All patients with advanced breast cancer developing unexpected portal hypertension should be considered candidates for liver biopsy despite normal computed tomography of the liver imaging results. This is the first report of a reversal of clinical resistance to capecitabine (Xeloda) by changing from the schedule of 14/7 day to a biweekly 7/7 day schedule. This suggests that a biweekly schedule may be best for some patients.</p

    Matter effects in long baseline experiments, the flavor content of the heaviest (or lightest) neutrino and the sign of Delta m^2

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    The neutrinos of long baseline beams travel inside the Earth's crust where the density is approximately rho = 2.8 g cm^-3. If electron neutrinos participate in the oscillations, matter effects will modify the oscillation probabilities with respect to the vacuum case. Depending on the sign of Delta m^2 an MSW resonance will exist for neutrinos or anti-neutrinos with energy approximately E_nu(res) = 4.7 |\Delta m^2|/(10^-3 eV^2) GeV. For Delta m^2 in the interval indicated by the Super-Kamiokande experiment this energy range is important for the proposed long baseline experiments. For positive Delta m^2 the most important effects of matter are a 9% (25%) enhancement of the transition probability P(nu_mu -> nu_e) for the KEK to Kamioka (Fermilab to Minos and CERN to Gran Sasso) beam(s) in the energy region where the probability has its first maximum, and an approximately equal suppression of P(antinu_mu -> antinu_e). For negative Delta m^2 the effects for neutrinos and anti-neutrinos are interchanged. Producing beams of neutrinos and antineutrinos and measuring the oscillation probabilities for both (nu_mu -> nu_e) and (antinu_mu -> antinu_e) transitions can solve the sign ambiguity in the determination of Delta m^2.Comment: Latex, 28 pages, 12 postscript figure

    Giant secreting adrenal myelolipoma in a man: a case report

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    <p>Abstract</p> <p>Introduction</p> <p>Adrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting. It develops within the adrenal gland and is composed of mature adipose tissue with elements of the hematopoietic series. We describe the case of what is, to the best of our knowledge, one of the largest secreting adrenal myelolipomas reported in the literature.</p> <p>Case presentation</p> <p>A 52-year-old Caucasian man of medium build who had had moderate hypertension for three years presented to our hospital. He had no other significant symptoms. His hypertension was pharmacologically treated. He came to our hospital to undergo abdominal ultrasonography during a clinical checkup. The ultrasound scan showed the presence of a voluminous hyperechoic mass interposed between the spleen and the left kidney. It was reported as a myelolipoma of the left kidney on the basis of its structural characteristics and position. Computed tomography confirmed our diagnosis. All preoperative biochemical tests were normal, with the exception of high serum cortisol, which was being overproduced by the lesion and was probably responsible for the patient's hypertension. He underwent successful surgery, and his postoperative course was uneventful. The pathologic examination of the lesion confirmed the diagnosis of adrenal myelolipoma. The patient's blood pressure returned to within the normal range.</p> <p>Conclusions</p> <p>The "incidental" discovery of an adrenal mass requires careful diagnostic study to plan adequate therapeutic management. Both of the primary investigations at our disposal, ultrasound and blood tests (adrenal hormones), helped in rendering the diagnosis and allowed us to move toward the most appropriate treatment, taking into account the size of the tumor and its probable hormonal production.</p

    Do national resources have to be centrally managed? Vested interests and institutional reform in Norwegian fisheries governance

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    Corporatism -with its privileged access, restricted participation and centralized structures - has a long history in Norwegian fisheries governance. Co-management – understood as a decentralized, bottom-up and more inclusive form of fisheries governance - has not been considered a relevant alternative.. Why does corporatism still prevail in a context where stakeholder status in fisheries governance globally – both in principle and practice - has been awarded environmental organizations, municipal authorities and even consumer advocacy groups? Why then have alternatives to the corporatist system of centralized consultation and state governance never been seriously considered in Norway, in spite of the growing emphasis on fish as a public resource and fisheries management as human intervention in geographically confined and complex ecosystems? We suggest that thismay have to do with the fundamental assumptions behind Norwegian fisheries governance that since fish is a national resource, it must be centrally managed. We argue that this is an assumption that may be contested

    Atmospheric neutrino flux from 3-dimensional simulation

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    The atmospheric muon and neutrino flux have been simulated using the same approach which successfully accounted for the recent secondary proton, electron and positron flux measurements in orbit by the AMS experiment. For the muon flux, a good agreement is obtained with the CAPRICE and HEAT data for altitudes ranging from sea level up to about 38 km. The general features of the calculated atmospheric neutrino flux are reported and discussed. The flux obtained at the Super-Kamiokande experiment location are reported and compared with other calculations. For low neutrino energies the flux obtained is significantly smaller than that used in the data analysis of underground experiment. The simulation results for the SOUDAN experiment site are also reported.Comment: 33 pages, 27 figures, 12 tables, final version for Phys. Rev.

    Lepton Masses from a TeV Scale in a 3-3-1 Model

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    In this work, using the fact that in 3-3-1 models the same leptonic bilinear contributes to the masses of both charged leptons and neutrinos, we develop an effective operator mechanism to generate mass for all leptons. The effective operators have dimension five for the case of charged leptons and dimension seven for neutrinos. By adding extra scalar multiplets and imposing the discrete symmetry Z9Z2Z_9\otimes Z_2 we are able to generate realistic textures for the leptonic mixing matrix. This mechanism requires new physics at the TeV scale.Comment: RevTex, 13 pages. Extended version to be published in Physical Review

    Neutrino Physics at the Turn of the Millenium

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    Recent solar & atmospheric nu-data strongly indicate need for physics beyond the Standard Model. I review the ways of reconciling them in terms of 3-nu oscillations. Though not implied by data, bi-maximal nu-mixing models emerge as a possibility. SUSY with broken R-parity provides an attractive way to incorporate it, opening the possibility of testing nu-anomalies at high- energy colliders such as the LHC or at the upcoming long-baseline or nu- factory experiments. Reconciling, in addition, the LSND hint requires a fourth, light sterile neutrino, nus. The simplest are the most symmetric scenarios, in which 2 of the 4 neutrinos are maximally-mixed and lie at the LSND scale, while the others are at the solar scale. The lightness of nus, the nearly maximal atmospheric mixing, and the solar/atmospheric splittings all follow naturally from the assumed lepton-number symmetry and its breaking. These basic schemes can be distinguished at neutral-current-sensitive solar & atmospheric neutrino experiments such as SNO. However underground experiments have not yet proven neutrino masses, as there are many alternatives. For example flavour changing interactions can play an important role in the explanation of solar and contained atmospheric data and could be tested e.g through \mu \to e + \gamma, \mu-e conversion in nuclei, unaccompanied by neutrino-less double beta decay. Conversely, a short-lived numu might play a role in the explanation of the atmospheric data. Finally, in the presence of a nus, a long-lived heavy nutau could delay the time at which the matter and radiation contributions to the energy density of the Universe become equal, reducing density fluctuations on smaller scales, thus saving the standard CDM scenario, while the light nue, numu and nus would explain the solar & atmospheric data.Comment: Invited talk at 2nd International Conference on Non-Accelerator New Physics (NANP-99), Dubna, June 28 - July 3, 199

    Solution structure of a repeated unit of the ABA-1 nematode polyprotein allergen of ascaris reveals a novel fold and two discrete lipid-binding sites

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    Parasitic nematode worms cause serious health problems in humans and other animals. They can induce allergic-type immune responses, which can be harmful but may at the same time protect against the infections. Allergens are proteins that trigger allergic reactions and these parasites produce a type that is confined to nematodes, the nematode polyprotein allergens (NPAs). These are synthesized as large precursor proteins comprising repeating units of similar amino acid sequence that are subsequently cleaved into multiple copies of the allergen protein. NPAs bind small lipids such as fatty acids and retinol (Vitamin A) and probably transport these sensitive and insoluble compounds between the tissues of the worms. Nematodes cannot synthesize these lipids, so NPAs may also be crucial for extracting nutrients from their hosts. They may also be involved in altering immune responses by controlling the lipids by which the immune and inflammatory cells communicate. We describe the molecular structure of one unit of an NPA, the well-known ABA-1 allergen of Ascaris and find its structure to be of a type not previously found for lipid-binding proteins, and we describe the unusual sites where lipids bind within this structur

    Self-Collected Mid-Turbinate Swabs for the Detection of Respiratory Viruses in Adults with Acute Respiratory Illnesses

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    BACKGROUND: The gold standard for respiratory virus testing is a nasopharyngeal (NP) swab, which is collected by a healthcare worker. Midturbinate (MT) swabs are an alternative due to their ease of collection and possible self-collection by patients. The objective of this study was to compare the respiratory virus isolation of flocked MT swabs compared to flocked NP swabs. METHODS: Beginning in October 2008, healthy adults aged 18 to 69 years were recruited into a cohort and followed up for symptoms of influenza. They were asked to have NP and MT swabs taken as soon as possible after the onset of a fever or two or more respiratory symptoms with an acute onset. The swabs were tested for viral respiratory infections using Seeplex® RV12 multiplex PCR detection kit. Seventy six pairs of simultaneous NP and MT swabs were collected from 38 symptomatic subjects. Twenty nine (38%) of these pairs were positive by either NP or MT swabs or both. Sixty nine (91%) of the pair results were concordant. Two samples (3%) for hCV OC43/HKU1 and 1 sample (1%) for rhinovirus A/B were positive by NP but negative by MT. One sample each for hCV 229E/NL63, hCV OC43/HKU1, respiratory syncytial virus A, and influenza B were positive by MT but negative by NP. CONCLUSIONS: Flocked MT swabs are sensitive for the diagnosis of multiple respiratory viruses. Given the ease of MT collection and similar results between the two swabs, it is likely that MT swabs should be the preferred method of respiratory cell collection for outpatient studies. In light of this data, larger studies should be performed to ensure that this still holds true and data should also be collected on the patient preference of collection methods
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