Gaurav Goel, Mayank Jauhri, Anita Negi, Shyam Aggarwal
on 14/06/2010 07:53:00 BACKGROUND: At present, there is no standard regimen for the treatment of gastroesophageal cancer. Docetaxel, cisplatin and fluorouracil (DCF) has been shown to be an effective regimen; however, toxicity is an area of concern in the palliative case setting. Capecitabine and oxaliplatin have been shown to be as effective as fluorouracil and cisplatin, respectively. To reduce the toxicity of DCF while maintaining efficacy, we conducted this study to evaluate the efficacy of docetaxel, oxaliplatin and capecitabine (DOX) combination in advanced gastroesophageal cancer. PATIENTS AND METHODS: Patients with histologically confirmed metastatic or locally advanced adenocarcinoma of the stomach or gastroesophageal junction received docetaxel 25 mg/m2 and oxaliplatin 50 mg/m2 on days 1 and 8 with capecitabine 625 mg/m2 twice daily from day 1-14, in 21-day cycles. The primary endpoint was overall response rate (ORR). RESULTS: Of 21 patients, there were 16 males and 5 females with a median age of 57 years, range 37-80 years. The primary tumor was located at the gastroesophageal junction in 7 patients and in other parts of the stomach in the remaining 14 patients. One patient had locally advanced tumor without distant metastases and 20 patients presented with metastatic disease. Grade 3/4 toxicities included diarrhea (24%), hand-foot syndrome (5%) and febrile neutropenia (5%). The ORR was 29%. The median survival was 8.4 months. At the time of analysis, 5 of the 21 patients (24%) were alive. CONCLUSIONS: The DOX combination is tolerable, active and a promising day-care regimen for advanced gastroesophageal cancer. Protein C levels in beta-thalassemia major patients in the east Nile delta of Egypt ================================================================================Tamer H. Hassan, Rabab M. Elbehedy, Doaa M. Youssef, Ghada E. Amr
on 14/06/2010 08:18:00 BACKGROUND AND OBJECTIVES: Thalassemic patients have an increased risk for thromboembolic complications. To determine if this might be due to a deficiency in protein C, we investigated the status of the protein C anticoagulant pathway in thalassemia major patients and its relationship to the hypercoagulable state. PATIENTS AND METHODS: Fifty patients with beta-thalassemia major (30 non-splenectomized and 20 splenectomized) and 20 healthy children as a control group were tested for levels of serum ferritin, liver enzymes, serum albumin, fibrinogen, protein C and protein S, thrombin antithrombin complex (TAT) and D-dimer. RESULTS: Thalassemic patients had lower levels of protein C and S and higher levels of D-dimer and TAT than the control group. These findings were more obvious in splenectomized patients and in those with infrequent blood transfusion. CONCLUSIONS: Protein C plays a major role in the hypercoagulable state in thalassemic patients. These findings raise the issue as to whether it would be cost-beneficial to recommend prophylactic antithrombotic therapy in high-risk thalassemic patients. A wider prospective study is necessary to delineate under which circumstances therapy might be needed, and at what level of protein C deficiency to start prophylactic antithrombotic therapy. Human G-protein gamma 7 in extrahepatic cholangiocarcinoma and its clinicopathological significance ================================================================================Mei Wang, Biao Gong, Yongmei Li, Yajie Wang
on 14/06/2010 08:36:00 BACKGROUND AND OBJECTIVES: Several studies have found a down-regulated G-g 7 gene in gastrointestinal tract cancers. We evaluated the expression and clinicopathological significance of the human G protein g 7 (G-g 7) in human extra-hepatic cholangiocarcinoma (EHCC). METHODS: The expression of G-g 7 expression was studied in 21 patients with EHCC. G-g 7 mRNA expression was tested by using RealTime reverse transcription polymerase chain reaction (RT-PCR).To visualize the localization of G-g 7, an immunohistochemistry study was also performed. The G-g 7 expression was compared among cancer tissues, peri-cancerous bile duct tissues and normal bile duct tissues. The clinicopathological significance of G-g 7 expression was also studied. RESULTS: Expression of G-g 7 mRNA and protein were significantly lower in EHCC tissue than in peri-cancerous bile duct tissue and normal bile duct tissues. G-g 7 mRNA and protein expression were significantly lower in poorly differentiated EHCC tissues than in moderate differentiated and well differentiated EHCC tissues (P Systemic thromboembolic complications after laparoscopic splenectomy for idiopathic thrombocytopenic purpura in comparison to open surgery in the absence of anticoagulant prophylaxis ================================================================================Said Yousuf Mohamed, Ibrahim Abdel-Nabi, Ahmed Inam, Mohammad Bakr, Khaled El Tayeb, Abu Jafar M. Saleh, Hazaa Alzahrani, Said H. Abdu
on 14/06/2010 09:08:00 BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) in adults has a chronic course and may necessitate splenectomy. The current study was undertaken to study the systemic thromboembolic complications of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with ITP at two large referral hospitals. PATIENTS AND METHODS: We conducted a retrospective analysis of 49 patients who underwent splenectomy (21 LS and 28 OS) for primary/relapsing refractory ITP between June 1995 and November 2004. Clinically and/or radiologically confirmed deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were assessed within 2 weeks before and after splenectomy. None had prophylactic anticoagulants immediately after surgery. Follow up of those who developed complications continued for at least 2 additional years to assess for contributing factors that may have been masked at the time of occurrence. RESULTS: Two (9.5%) LS group had acute PE within 5 days of LS and their platelet count reached 500×103/µL within 4 days and 1000×103/µL within 7 days after surgery. Three conversions to OS occurred; none had VTE. DVT occurred in 3 patients (10.7%) in the OS group; none were life threatening. There were no deaths. CONCLUSION: Life-threatening venous thromboembolic events are serious complications after LS and OS for ITP patients if prophylactic anticoagulants are not administered. Patients at risk are those who both have an exponential rise of the platelet count, although factors other than the platelet count may be contributing in OS. Postsplenectomy, ITP should be considered as a thrombophilic condition and studies of additional measures to prevent such events are warranted. The impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center ================================================================================Hikmat Abdel-Razeq, Shadi Hijjawi, Hazem Abdulelah, Rula Amarin, Majid Asawaeer, Haitham Shaheen
Issam Hamadah, Yousef Binamer, Saad Alajlan, Amr Nassar, Abu Jafar M. Saleh
on 14/06/2010 09:48:00 Allogeneic hemopoietic stem cell transplantation (HSCT) has been considered a curative treatment option for many hematological and non-hematological disorders. Despite the use of advanced methods of tissue typing and new therapies, graft versus host disease (GVHD) remains a major obstacle. Secondary malignancies are also among the most serious long-term complications after HSCT including leukemia, lymphomas, and to a lesser extent, solid tumors. The most commonly observed solid tumor is squamous cell carcinoma (SCC). We report two cases of SCC of the lower lip diagnosed several years after HSCT. Both cases were complicated with GVHD prior to the development of SCC and had a successful outcome with minimal surgical intervention. Successful treatment of biphasic metaplastic sarcomatoid carcinoma of the breast by evaluation of immunohistochemical markers ================================================================================Tsai-Ju Chien, Jung-Mao Chou, Ting-An Chang, Che-Pin Lin
on 14/06/2010 09:58:00 Biphasic metaplastic sarcomatoid carcinoma (MSC) of the breast is rare and aggressive. Patients with metaplastic breast carcinomas tend to have poor outcomes with a high risk of recurrence following primary surgery. Most reports have shown that systemic therapy appears to be less effective. We report a case of a 42-year-old female who presented with a large (14 cm) cauliflower breast mass. Biopsy revealed a poorly differentiated sarcoma. Initially, neo-adjuvant concurrent chemoradiotherapy with a sarcoma regimen was prescribed, and the tumor regressed to a large ulcer. Subsequent biopsy showed invasive ductal carcinoma (estrogen receptor, progesterone receptor stained weakly, 5%, Her2:2+) and disappearance of the sarcomatous component. Second-line neoadjuvant therapy was designed according to the histologic features of infiltrating ductal carcinoma, which led to nearly a complete response. A modified radical mastectomy of the right breast and axillary dissection was performed followed by monoclonal antibody (trastuzumab) therapy for 6 months due to the surgical specimen showing Her2:3+. The treatment course went smoothly with a good response. The patient had no evidence of disease at 18 months. Granulocytic sarcoma of the stomach: relapse after hematopoietic stem-cell transplantation for chronic myeloid leukemia ================================================================================Antonio Vaz Macedo, Izabela F. Freitas, Fábio M. Oliveira, Clarissa C. Resende, Cláudia Maria C. Mendes, Ana Karine Vieira, Lúcia P. Castro, Eduardo M. Rego, Nelma Cristina D. Clementino, Henrique Bittencourt
Woei Chung-Lo, Ching-Yun Hsieh, Chang-Fang Chiu, Li-Yuan Bai
Keyvan Gohari Moghadam, Bahareh Marghoob, Kamran Alimoghadam, Shapour Shirani, Ardeshir Ghavamzadeh
on 14/06/2010 11:15:00 To the Editor: One of the most important causes of morbidity and mortality after hematopoietic stem cell transplantation (HSCT) is bronchiolitis obliterans (BO), which sometimes