The endothelial dysfunction associated with vascular endothelial
growth factor pathway inhibitors (VPIs) would seem
to be the most plausible explanation for such events:
it causes thromboembolic events and cardiovascular
complications.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Adjuvant Treatment of Pancreatic Cancer - August 2018Amr Sakr
This document summarizes the history and results of several major clinical trials evaluating different adjuvant treatment strategies for pancreatic cancer after surgical resection. It finds that adjuvant chemotherapy provides a survival benefit compared to observation alone. Specifically, gemcitabine alone and gemcitabine plus capecitabine were found to improve overall and disease-free survival compared to older regimens or observation. Most recently, a modified FOLFIRINOX regimen was shown to provide the longest median and 3-year survival compared to gemcitabine alone, establishing it as the new standard first-line adjuvant treatment for resectable pancreatic cancer when tolerability allows.
1) The study compared outcomes for 156 patients with liver metastases from colorectal cancer who were randomly assigned to receive either hepatic arterial infusion of chemotherapy plus systemic chemotherapy or systemic chemotherapy alone after liver resection.
2) At two years, the combined therapy group had a higher rate of overall survival (86% vs 72%), a higher rate of survival free from hepatic recurrence (90% vs 60%), and a higher rate of progression-free survival (57% vs 42%).
3) The combined therapy of hepatic arterial infusion and systemic chemotherapy improved outcomes at two years for patients who underwent resection of liver metastases from colorectal cancer.
Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor.
This study evaluated the roles of adjuvant chemoradiotherapy and chemotherapy in patients with resected pancreatic cancer. 541 patients were randomized to one of four groups: chemoradiotherapy, chemotherapy, both, or observation. The results showed no survival benefit for adjuvant chemoradiotherapy, with a median survival of 15.5 months compared to 16.1 months without chemoradiotherapy. However, there was evidence of a survival benefit for adjuvant chemotherapy, with a median survival of 19.7 months compared to 14 months without chemotherapy. This study provided evidence that adjuvant chemotherapy may improve survival for patients with resected pancreatic cancer, but did not show a benefit for chemoradiotherapy.
This document summarizes the case of a patient with a metastatic gastrointestinal stromal tumor (GIST) who was treated with STI571, a tyrosine kinase inhibitor. Key points:
- The patient's GIST was resistant to chemotherapy and other treatments. STI571 treatment resulted in a significant reduction in tumor size on MRI scans over 8 months with no new lesions.
- PET scans also showed elimination of abnormal glucose uptake in liver and kidney tumors after one month of STI571.
- Biopsies of a liver metastasis showed a marked decrease in tumor cell density, myxoid degeneration, and no signs of proliferation or necrosis, indicating inhibition of tumor growth.
- STI
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
Marcellus Simadibrata Kolopaking MD PhD
Department of Medical Education
Division Gastroenterology Department of Internal Medicine
Faculty of Medicine University Indonesia
Dr.Cipto Mangunkusumo Hospital Jakarta
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Adjuvant Treatment of Pancreatic Cancer - August 2018Amr Sakr
This document summarizes the history and results of several major clinical trials evaluating different adjuvant treatment strategies for pancreatic cancer after surgical resection. It finds that adjuvant chemotherapy provides a survival benefit compared to observation alone. Specifically, gemcitabine alone and gemcitabine plus capecitabine were found to improve overall and disease-free survival compared to older regimens or observation. Most recently, a modified FOLFIRINOX regimen was shown to provide the longest median and 3-year survival compared to gemcitabine alone, establishing it as the new standard first-line adjuvant treatment for resectable pancreatic cancer when tolerability allows.
1) The study compared outcomes for 156 patients with liver metastases from colorectal cancer who were randomly assigned to receive either hepatic arterial infusion of chemotherapy plus systemic chemotherapy or systemic chemotherapy alone after liver resection.
2) At two years, the combined therapy group had a higher rate of overall survival (86% vs 72%), a higher rate of survival free from hepatic recurrence (90% vs 60%), and a higher rate of progression-free survival (57% vs 42%).
3) The combined therapy of hepatic arterial infusion and systemic chemotherapy improved outcomes at two years for patients who underwent resection of liver metastases from colorectal cancer.
Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor.
This study evaluated the roles of adjuvant chemoradiotherapy and chemotherapy in patients with resected pancreatic cancer. 541 patients were randomized to one of four groups: chemoradiotherapy, chemotherapy, both, or observation. The results showed no survival benefit for adjuvant chemoradiotherapy, with a median survival of 15.5 months compared to 16.1 months without chemoradiotherapy. However, there was evidence of a survival benefit for adjuvant chemotherapy, with a median survival of 19.7 months compared to 14 months without chemotherapy. This study provided evidence that adjuvant chemotherapy may improve survival for patients with resected pancreatic cancer, but did not show a benefit for chemoradiotherapy.
This document summarizes the case of a patient with a metastatic gastrointestinal stromal tumor (GIST) who was treated with STI571, a tyrosine kinase inhibitor. Key points:
- The patient's GIST was resistant to chemotherapy and other treatments. STI571 treatment resulted in a significant reduction in tumor size on MRI scans over 8 months with no new lesions.
- PET scans also showed elimination of abnormal glucose uptake in liver and kidney tumors after one month of STI571.
- Biopsies of a liver metastasis showed a marked decrease in tumor cell density, myxoid degeneration, and no signs of proliferation or necrosis, indicating inhibition of tumor growth.
- STI
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
Marcellus Simadibrata Kolopaking MD PhD
Department of Medical Education
Division Gastroenterology Department of Internal Medicine
Faculty of Medicine University Indonesia
Dr.Cipto Mangunkusumo Hospital Jakarta
- The document summarizes key landmark clinical trials investigating treatments for metastatic gastric cancer.
- The ToGA trial found that adding trastuzumab (Herceptin) to standard chemotherapy (cisplatin and fluoropyrimidine) significantly improved overall survival and progression-free survival in patients with HER2-positive metastatic gastric cancer compared to chemotherapy alone. Median overall survival was 13.8 months with chemotherapy plus trastuzumab versus 11.1 months with chemotherapy alone.
- The REAL-2 trial demonstrated that cisplatin plus capecitabine was as effective as cisplatin plus fluorouracil for advanced gastric cancer, with less toxicity. Cisplatin plus capecitabine has since
This document discusses sickle cell nephropathy and provides information over several slides. It begins with basic renal anatomy and physiology concepts. It then covers the pathophysiology of sickle cell nephropathy including hyperfiltration, albuminuria, tubular abnormalities, and hematuria. Epidemiology statistics for sickle cell nephropathy are presented. Clinical manifestations such as hematuria, nocturia, polyuria, acute kidney injury, chronic kidney disease, and nephrotic syndrome are outlined. Methods for diagnosis including basic tests, glomerular filtration rate equations, and newer biomarkers are reviewed. Treatment options are explored including hydroxyurea, ACE inhibitors, blood transfusions, erythropoies
1. GISTs were historically misdiagnosed and poorly treated, but advances in molecular genetics and targeted therapies have transformed management.
2. Imatinib revolutionized treatment by specifically targeting KIT and PDGFRA mutations in most GISTs, achieving high response rates and prolonged disease control.
3. Continuous long-term imatinib treatment is now standard for advanced/metastatic GIST due to the near-universal risk of rapid progression upon treatment cessation.
1. Neuroendocrine tumors (NETs) are increasing in incidence and are often metastatic at diagnosis. They originate from neuroendocrine cells and secrete hormones.
2. Somatostatin analogues are first-line treatment for symptomatic control in NETs but resistance can develop. Chemotherapy has limited efficacy except in high-grade tumors.
3. Emerging biomarkers and molecular targeted therapies such as inhibitors of angiogenesis are improving outcomes beyond traditional approaches.
This document provides the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Neuroendocrine and Adrenal Tumors. It was last updated in January 2019 and is authored by an expert panel assembled by NCCN. The guidelines provide evidence-based recommendations for diagnosis, staging, treatment and surveillance of neuroendocrine tumors and adrenal tumors. The key updates from the previous version include expanding the name to include adrenal tumors, preferring gallium-68 dotatate PET/CT for somatostatin receptor imaging, and adding peptide receptor radionuclide therapy with lutetium-177 as a treatment option.
11.[27 30]hepatoid adenocarcinoma of the stomach - copyAlexander Decker
This case report describes a rare case of hepatoid adenocarcinoma of the stomach in a 16-year-old girl. Histological examination of a biopsy from a gastric mass found features suggestive of hepatoid adenocarcinoma. Further tests after surgery confirmed the diagnosis and found metastasis to lymph nodes and liver. Hepatoid adenocarcinoma is a rare subtype of gastric cancer characterized by production of alpha-fetoprotein and resemblance to hepatocellular carcinoma. It typically has a poor prognosis due to frequent metastasis even in early stages. This represents an unusually early presentation of this disease.
11.[27 30]hepatoid adenocarcinoma of the stomachAlexander Decker
This case report describes a rare case of hepatoid adenocarcinoma of the stomach in a 16-year-old girl. Histological examination of a biopsy from a gastric mass showed features suggestive of hepatoid adenocarcinoma. Further tests found elevated AFP levels and liver metastases. The patient underwent gastrectomy and chemotherapy, but hepatoid adenocarcinoma typically has a poor prognosis due to frequent liver or lymph node metastases even in early stages. This young patient presented an unusual case of this rare gastric cancer subtype.
This document describes a case report of a rare type of gastric adenocarcinoma called hepatoid
adenocarcinoma that was diagnosed in a 16-year-old girl. Hepatoid adenocarcinoma is characterized by
features resembling hepatocellular carcinoma and alpha-fetoprotein production. The patient presented with
abdominal pain and weight loss. Testing found a stomach tumor and high alpha-fetoprotein levels. A
surgery was performed but liver metastases were discovered. The prognosis for hepatoid adenocarcinoma is
generally poor due to frequent metastases. This case highlights the rare occurrence of this tumor subtype in
an adolescent.
This document summarizes a case report of a mature ovarian teratoma with malignant transformation into a sebaceous gland carcinoma in a 55-year-old woman. Malignant transformations are rare but can occur in the ectodermal, mesodermal, or endodermal tissues of a teratoma. Squamous cell carcinoma and adenocarcinoma are the most common malignant tumors derived from a cystic teratoma. The pathological examination in this case confirmed a sebaceous gland carcinoma in the ovarian teratoma. No metastatic lesions were found and the patient was diagnosed with stage Ia disease. The mechanism of malignant transformation is unclear but may involve human papillomavirus infection or genetic factors.
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
The document discusses past, present, and future applications of endoscopic ultrasound (EUS)-guided anti-tumor therapy. It outlines how EUS can be used for diagnosis, local drug delivery, and ablation of pancreatic cysts and cancers. Current techniques include ethanol ablation, fiducial placement, brachytherapy, and vascular interventions. Future areas of research may involve photodynamic therapy, radiofrequency ablation, high intensity focused ultrasound, and combining EUS with natural orifice transluminal endoscopic surgery.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
This document discusses recent updates in treating metastatic colorectal cancers. It presents several case studies of patients diagnosed with colorectal cancer and large metastatic tumors. It then reviews the epidemiology of colorectal cancer in India, including rising incidence rates. The document outlines different classifications and treatment approaches for patients with metastatic disease, including the goal of increasing overall survival. It also discusses the increasing number of treatment options and challenges of personalizing therapy based on a patient's molecular profile.
This document summarizes the results of the PRODIGE 7 trial, which compared cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery alone for patients with metastatic colorectal cancer and peritoneal carcinomatosis. The trial found no significant difference in overall survival between the two treatment groups. Patients who received HIPEC had higher rates of postoperative complications and longer hospital stays. For patients with 11-15 peritoneal lesions, HIPEC showed a potential survival benefit. However, given the lack of overall survival benefit and increased risks, the addition of HIPEC to standard treatment requires reconsideration.
This document summarizes a presentation on controversies in hepatobiliary pancreatic surgery. It discusses 4 topics: 1) Whether resectable hilar cholangiocarcinoma should be resected or treated with orthotopic liver transplantation, 2) How to treat node-positive intrahepatic cholangiocarcinoma, 3) Options for unresectable intrahepatic cholangiocarcinoma, and 4) Managing large hepatocellular carcinoma in early cirrhosis. For each topic, one or more case examples are described and various treatment approaches are outlined and discussed. Supporting data from studies on outcomes with different strategies are also presented.
The document summarizes highlights from the 11-ICML Lugano conference in 2011, including:
1) Studies showing the impact of the tumor microenvironment in lymphoma prognosis and the predictive value of increased macrophages in Hodgkin's lymphoma biopsies.
2) High response rates to antiviral treatment in patients with indolent B-cell lymphoma associated with HCV infection.
3) A PET-based approach can effectively guide treatment for limited-stage diffuse large B-cell lymphoma.
4) R-CHOP induction followed by rituximab maintenance improves survival over R-FC induction for elderly patients with mantle cell lymphoma.
This document summarizes targeted therapies for ovarian cancer, including anti-angiogenic agents and PARP inhibitors. It discusses several studies evaluating bevacizumab, an anti-VEGF monoclonal antibody, in the first-line and recurrent platinum-sensitive settings. The GOG218 and ICON7 trials showed improved progression-free survival when bevacizumab was added to first-line chemotherapy. The OCEANS trial demonstrated significantly longer progression-free and overall survival with the addition of bevacizumab to chemotherapy for platinum-sensitive recurrent ovarian cancer. Adverse events with bevacizumab were consistent with its known safety profile.
Oncology is the branch of medicine which deals with cancer and tumor related problems. Austin Oncology Case Reports is an open access, peer review journal publishing the case reports covering all fields of Oncology. We follow double blind review process & the published case reports can be accessed by readers across the world without subscription and registration.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Bowel Perforation in COVID-19 Patient Treated With Dexamethasonesuppubs1pubs1
The treatment and management for COVID-19 continues to evolve as we have gained more experience with infected patients over the past year of this pandemic. The goal of the medical team is to optimize the care and balance the risk and benefits of each intervention and treatment. Currently, guidelines include starting dexamethasone therapy for patients requiring supplemental oxygen or mechanical ventilation. However, each treatment and intervention comes with risks. Here, we discuss the case of a 76-year old male who presented to the ED with dyspnea and cough after being diagnosed with COVID-19 three days prior.
- The document summarizes key landmark clinical trials investigating treatments for metastatic gastric cancer.
- The ToGA trial found that adding trastuzumab (Herceptin) to standard chemotherapy (cisplatin and fluoropyrimidine) significantly improved overall survival and progression-free survival in patients with HER2-positive metastatic gastric cancer compared to chemotherapy alone. Median overall survival was 13.8 months with chemotherapy plus trastuzumab versus 11.1 months with chemotherapy alone.
- The REAL-2 trial demonstrated that cisplatin plus capecitabine was as effective as cisplatin plus fluorouracil for advanced gastric cancer, with less toxicity. Cisplatin plus capecitabine has since
This document discusses sickle cell nephropathy and provides information over several slides. It begins with basic renal anatomy and physiology concepts. It then covers the pathophysiology of sickle cell nephropathy including hyperfiltration, albuminuria, tubular abnormalities, and hematuria. Epidemiology statistics for sickle cell nephropathy are presented. Clinical manifestations such as hematuria, nocturia, polyuria, acute kidney injury, chronic kidney disease, and nephrotic syndrome are outlined. Methods for diagnosis including basic tests, glomerular filtration rate equations, and newer biomarkers are reviewed. Treatment options are explored including hydroxyurea, ACE inhibitors, blood transfusions, erythropoies
1. GISTs were historically misdiagnosed and poorly treated, but advances in molecular genetics and targeted therapies have transformed management.
2. Imatinib revolutionized treatment by specifically targeting KIT and PDGFRA mutations in most GISTs, achieving high response rates and prolonged disease control.
3. Continuous long-term imatinib treatment is now standard for advanced/metastatic GIST due to the near-universal risk of rapid progression upon treatment cessation.
1. Neuroendocrine tumors (NETs) are increasing in incidence and are often metastatic at diagnosis. They originate from neuroendocrine cells and secrete hormones.
2. Somatostatin analogues are first-line treatment for symptomatic control in NETs but resistance can develop. Chemotherapy has limited efficacy except in high-grade tumors.
3. Emerging biomarkers and molecular targeted therapies such as inhibitors of angiogenesis are improving outcomes beyond traditional approaches.
This document provides the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Neuroendocrine and Adrenal Tumors. It was last updated in January 2019 and is authored by an expert panel assembled by NCCN. The guidelines provide evidence-based recommendations for diagnosis, staging, treatment and surveillance of neuroendocrine tumors and adrenal tumors. The key updates from the previous version include expanding the name to include adrenal tumors, preferring gallium-68 dotatate PET/CT for somatostatin receptor imaging, and adding peptide receptor radionuclide therapy with lutetium-177 as a treatment option.
11.[27 30]hepatoid adenocarcinoma of the stomach - copyAlexander Decker
This case report describes a rare case of hepatoid adenocarcinoma of the stomach in a 16-year-old girl. Histological examination of a biopsy from a gastric mass found features suggestive of hepatoid adenocarcinoma. Further tests after surgery confirmed the diagnosis and found metastasis to lymph nodes and liver. Hepatoid adenocarcinoma is a rare subtype of gastric cancer characterized by production of alpha-fetoprotein and resemblance to hepatocellular carcinoma. It typically has a poor prognosis due to frequent metastasis even in early stages. This represents an unusually early presentation of this disease.
11.[27 30]hepatoid adenocarcinoma of the stomachAlexander Decker
This case report describes a rare case of hepatoid adenocarcinoma of the stomach in a 16-year-old girl. Histological examination of a biopsy from a gastric mass showed features suggestive of hepatoid adenocarcinoma. Further tests found elevated AFP levels and liver metastases. The patient underwent gastrectomy and chemotherapy, but hepatoid adenocarcinoma typically has a poor prognosis due to frequent liver or lymph node metastases even in early stages. This young patient presented an unusual case of this rare gastric cancer subtype.
This document describes a case report of a rare type of gastric adenocarcinoma called hepatoid
adenocarcinoma that was diagnosed in a 16-year-old girl. Hepatoid adenocarcinoma is characterized by
features resembling hepatocellular carcinoma and alpha-fetoprotein production. The patient presented with
abdominal pain and weight loss. Testing found a stomach tumor and high alpha-fetoprotein levels. A
surgery was performed but liver metastases were discovered. The prognosis for hepatoid adenocarcinoma is
generally poor due to frequent metastases. This case highlights the rare occurrence of this tumor subtype in
an adolescent.
This document summarizes a case report of a mature ovarian teratoma with malignant transformation into a sebaceous gland carcinoma in a 55-year-old woman. Malignant transformations are rare but can occur in the ectodermal, mesodermal, or endodermal tissues of a teratoma. Squamous cell carcinoma and adenocarcinoma are the most common malignant tumors derived from a cystic teratoma. The pathological examination in this case confirmed a sebaceous gland carcinoma in the ovarian teratoma. No metastatic lesions were found and the patient was diagnosed with stage Ia disease. The mechanism of malignant transformation is unclear but may involve human papillomavirus infection or genetic factors.
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
The document discusses past, present, and future applications of endoscopic ultrasound (EUS)-guided anti-tumor therapy. It outlines how EUS can be used for diagnosis, local drug delivery, and ablation of pancreatic cysts and cancers. Current techniques include ethanol ablation, fiducial placement, brachytherapy, and vascular interventions. Future areas of research may involve photodynamic therapy, radiofrequency ablation, high intensity focused ultrasound, and combining EUS with natural orifice transluminal endoscopic surgery.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
This document discusses recent updates in treating metastatic colorectal cancers. It presents several case studies of patients diagnosed with colorectal cancer and large metastatic tumors. It then reviews the epidemiology of colorectal cancer in India, including rising incidence rates. The document outlines different classifications and treatment approaches for patients with metastatic disease, including the goal of increasing overall survival. It also discusses the increasing number of treatment options and challenges of personalizing therapy based on a patient's molecular profile.
This document summarizes the results of the PRODIGE 7 trial, which compared cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery alone for patients with metastatic colorectal cancer and peritoneal carcinomatosis. The trial found no significant difference in overall survival between the two treatment groups. Patients who received HIPEC had higher rates of postoperative complications and longer hospital stays. For patients with 11-15 peritoneal lesions, HIPEC showed a potential survival benefit. However, given the lack of overall survival benefit and increased risks, the addition of HIPEC to standard treatment requires reconsideration.
This document summarizes a presentation on controversies in hepatobiliary pancreatic surgery. It discusses 4 topics: 1) Whether resectable hilar cholangiocarcinoma should be resected or treated with orthotopic liver transplantation, 2) How to treat node-positive intrahepatic cholangiocarcinoma, 3) Options for unresectable intrahepatic cholangiocarcinoma, and 4) Managing large hepatocellular carcinoma in early cirrhosis. For each topic, one or more case examples are described and various treatment approaches are outlined and discussed. Supporting data from studies on outcomes with different strategies are also presented.
The document summarizes highlights from the 11-ICML Lugano conference in 2011, including:
1) Studies showing the impact of the tumor microenvironment in lymphoma prognosis and the predictive value of increased macrophages in Hodgkin's lymphoma biopsies.
2) High response rates to antiviral treatment in patients with indolent B-cell lymphoma associated with HCV infection.
3) A PET-based approach can effectively guide treatment for limited-stage diffuse large B-cell lymphoma.
4) R-CHOP induction followed by rituximab maintenance improves survival over R-FC induction for elderly patients with mantle cell lymphoma.
This document summarizes targeted therapies for ovarian cancer, including anti-angiogenic agents and PARP inhibitors. It discusses several studies evaluating bevacizumab, an anti-VEGF monoclonal antibody, in the first-line and recurrent platinum-sensitive settings. The GOG218 and ICON7 trials showed improved progression-free survival when bevacizumab was added to first-line chemotherapy. The OCEANS trial demonstrated significantly longer progression-free and overall survival with the addition of bevacizumab to chemotherapy for platinum-sensitive recurrent ovarian cancer. Adverse events with bevacizumab were consistent with its known safety profile.
Oncology is the branch of medicine which deals with cancer and tumor related problems. Austin Oncology Case Reports is an open access, peer review journal publishing the case reports covering all fields of Oncology. We follow double blind review process & the published case reports can be accessed by readers across the world without subscription and registration.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Bowel Perforation in COVID-19 Patient Treated With Dexamethasonesuppubs1pubs1
The treatment and management for COVID-19 continues to evolve as we have gained more experience with infected patients over the past year of this pandemic. The goal of the medical team is to optimize the care and balance the risk and benefits of each intervention and treatment. Currently, guidelines include starting dexamethasone therapy for patients requiring supplemental oxygen or mechanical ventilation. However, each treatment and intervention comes with risks. Here, we discuss the case of a 76-year old male who presented to the ED with dyspnea and cough after being diagnosed with COVID-19 three days prior.
A 25-year-old female presented with abdominal pain, repeated fits and profuse vaginal bleeding after delivering a dead baby at home. She was diagnosed with HELLP syndrome based on her symptoms and lab results. She was treated aggressively in the intensive care unit with magnesium sulfate to control seizures, blood transfusions, evacuation of retained placenta, antihypertensives, and hemodialysis. Her condition improved over several days and she was discharged after 10 days on oral medications. The case illustrates the importance of early detection and rapid treatment by a multidisciplinary team for successful management of HELLP syndrome.
Docetaxel Versus Docetaxel/Cisplatin in NSCLCJames Hilbert
This study compared docetaxel alone versus docetaxel plus cisplatin as frontline treatment for advanced non-small cell lung cancer. 302 patients were randomly assigned to receive either docetaxel alone (146 patients) or the docetaxel/cisplatin combination (156 patients). The overall response rate was significantly higher for the combination at 36% versus 18% for docetaxel alone. However, median survival time, time to disease progression, and 1-year survival rates were similar between the two groups. Toxicity was higher with the combination therapy. Both regimens showed similar effectiveness in terms of survival, though the combination resulted in a higher response rate and more toxicity.
This document reports a case study of a 64-year-old female patient who developed late onset tracheal stenosis after receiving an 125Iodine seed esophageal stent to treat advanced esophageal carcinoma. The patient experienced progressive stenosis of the lower trachea at 6, 26, and 47 days post-operatively. The causes of stenosis are believed to include direct pressure from the stent, tumor proliferation, pressure from the aortic arch, and complications from other therapies such as radiation treatment. Due to its short clinical use, 125Iodine seed stents may present some fatal complications, and more study is needed on their long-term efficacy.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...daranisaha
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesion
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC.
Similar to Aortic dissection after ramucirumab infusion dz 2019 (12)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. 118 Zenoni D, et al. Eur J Hosp Pharm 2020;27:117–120. doi:10.1136/ejhpharm-2019-001879
Case report
Figure 1 Computed tomography (CT) shows the dissection flap marked there by the red arrow.
insertion of a central venous catheter port, adjuvant systemic
chemotherapy was started in March 2017 in combination with
FOLFOX412–14
of which, in August 2017, the first seven cycles
were completed, and were well tolerated by the patient.
Given the absence of suspicious signs of disease progres-
sion after the thorax-abdominal CT/PET scans performed in
September 2017, treatment was continued, completing 11
/12 cycles of the initially established treatment regimen, until
November 2017, when treatment was interrupted at the patient's
request.
The chest-abdomen CT on 2 February 2018 did not show
pulmonary nodules, mediastinal adenopathies, visceral metas-
tasis or detectable abdominal locations, but reported hydrouret-
eronephrosis on the left, with kinking and ureteral strincture in
the distal tract.
The PET scan (January 2018) showed unchanged shades
and dubious mediastinal lymph nodes, with no other detect-
able hyper-accumulations in particular in the pulmonary and
abdominal-pelvic area. In the absence of evident signs of disease
progression and of hyper-accumulations in the pelvic-abdominal
area despite the CT scan, the tomographic data were again
checked after a short interval, repeating the chest-abdomen CT
scan 3 months later.
Examination (April 2018) showed a marked worsening of
hydronephrosis on the left side, with the presence of hydro-
ureteronephrosis also on the right side and a conglobate aspect
of the ileal loops. The cancer antigen CA 19.9 level was 142.
The patient was evaluated by a urologist, who having observed
a retained renal function, excluded nephrostomy, instead
suggesting creatinine monitoring and renal dilatation ultra-
sound. Taking into account the documented peritoneal progres-
sion, the patient's good general health, the previous treatments
and the biomolecular profile, and excluding the need to perform
nephrostomies, first-line systemic treatment with a combination
of cisplatin (CDDP) with 75% dosage + 5-fluorouracil (5FU) was
performed. On August 2018, three cycles had been completed,
the first and third of which were complicated by gastrointestinal
toxicity g.3 (Common Terminology Criteria for Adverse Events
CTCAE).15
Taking into account the reported toxicities, before restarting
treatment, restaging was anticipated; the thorax-abdominal CT
performed on September 2018 reported substantial stability of
the pathological para-aortic tissue infiltration, again with uret-
eral infiltration on the left side, even if with lower hydrouretero-
nephrosis. However, the CA 19.9 level was markedly increased
(472). The renal function parameters were within normal limits.
Given the patient's good general condition and their mediocre
tolerance of the previous treatment schedule, a new systemic
therapy line with paclitaxel + ramucirumab was planned, the
initial administration of which was completed on the end of
September 2018. The day after the therapy, the patient arrived
in the emergency room with epigastric pain with retrosternal
and interscapular irradiation, which was subsequently associated
with pallor, cold sweating and hypotension with lipothymia. An
electrocardiogram showed left axial deviation, incomplete right
bundle branch block, and non-specific repolarisation disorders.
Thorax-abdominal CT with and without contrast medium
excluded signs of pulmonary thromboembolism, but a Standford
type A AD2
[figure 1] was documented, with a diameter of around
6.5 cm and dissection flap originating in the ascending aorta
below the brachiocephalic trunk with no apparent involvement
of the aortic valvular plane, extended to the whole descending
aorta to the carrefour; the epiaortic trunks, the celiac tripod, the
superior mesenteric artery, the common iliac arteries and both
renal arteries appeared to originate from the true lumen, while
the inferior mesenteric artery originated from the false lumen.
INVESTIGATIONS
Through MEREAFaPS 5.0 project (Monitoraggio degli Eventi e
delle Reazioni Avverse da farmaci in Ambito Poli-Specialistico),
an active pharmacovigilance project conducted in North Italian
onFebruary24,2020atICP.Protectedbycopyright.http://ejhp.bmj.com/EurJHospPharm:firstpublishedas10.1136/ejhpharm-2019-001879on14June2019.Downloadedfrom
3. 119Zenoni D, et al. Eur J Hosp Pharm 2020;27:117–120. doi:10.1136/ejhpharm-2019-001879
Case report
Hospitals, integrated with the pharmacovigilance system of
ASST Bergamo Est Hospital, an adverse drug reaction was found
following administration of a biological drug. The analysis of
causality and interactions was carried out by means of the Soft-
ware Intercheck Web managed by ‘Mario Negri’ Pharmacolog-
ical Research Centre. Micromedex and Codifa were consulted as
data banks. The physician was interviewed and the clinical folder
was analysed in order to collect more information.
TREATMENT
Evaluated by the vascular surgeon, and considering the extension
of the dissection and the prognosis, the patient was not subjected
to further intervention; no signs of cardiocirculatory or respira-
tory decompensation were documented, and an antalgic therapy
associated with deep sedation with morphine hydrochloride
subcutaneously (induction 4 mg), midazolam intravenous (15
mg/day) and haloperidol (2–4 mg/day) was performed.
Outcome and follow-up
The patient was hospitalised in the Department of Medicine in
order to stabilise the clinical and haemodynamic parameters;
during the subsequent hours there were episodes of vomiting
followed by loss of consciousness, hypotension and oligo-anuria.
Death was recorded during the night of hospitalisation.
DISCUSSION
The pharmacodynamic characteristics of multiple vascular endo-
thelial growth factor pathway inhibitors (VPIs), now widely used
in the treatment of many solid neoplasms in adults, are associ-
ated with toxicity risks, especially in the cardiovascular system,16
with modalities and recurrence rates widely observed in the
recorded studies for each different molecule.
VEGF, in fact, plays a key role in the growth and functional
maintenance of the vascular system, whose integrity is essen-
tial for cardiocirculatory function.16
Hypertension, sometimes
severe, is the most common adverse event for this pharmaco-
logical class.8 17 18
For this reason, it is always advisable, and is
routinely applied, to carry out a careful monitoring of blood
pressure before the administration of ramucirumab, and during
the treatment period, as well as for other anti-angiogenics. A
Japanese retrospective study, performed on the basis of the Japa-
nese Adverse Drug Event Report (JADER), revealed a potential
direct correlation between VPIs use and AD. The reported study
documented the adverse reactions that occurred following the
use of various VPIs, and therefore the associated cardiovascular
risk would represent a class effect related to the mechanism of
action of these drugs.
The endothelial dysfunction associated with these drugs
would seem to be the most plausible explanation for such events:
it causes vasoconstriction, atherosclerosis, platelet aggregation
and coagulation, all factors favouring arterial thromboembolic
events and cardiovascular complications.16
Analysing the spontaneous reports of adverse drug reac-
tions between April 2004 and October 2015, it emerged that
out of 16 441 subjects with malignant neoplasms treated with
a systemic VPIs drug, 49 (0.3%) developed AD, 25 (51%) of
which presented with hypertension, while out of 74 614 patients
presenting with malignant neoplasms not treated with VEGF
inhibitors, 10 (0.01%) developed AD.19
In the literature there are case reports that associate AD with
the anti-angiogenic tyrosine kinase inhibitor, sunitinib20 21
or with
the anti-VEGF monoclonal antibody, bevacizumab;22
however,
ramucirumab-related cases are not reported in the literature,
perhaps due to the small number of case series compared with
the other VPIs. To date, there are no reports of AD in the RNF
(National Pharmacovigilance Network) related to ramucirumab
administration in Italy. The assessment of a causal link between
ramucirumab and AD was calculated using the Naranjo algo-
rithm, a probability scale consisting of 10 questions that assigns,
based on the answers, a score that allows the establishment of a
category of probability (certain ≥9, probable 5–8, possible 1–4,
doubtful <1).23
The probable correlation (score of 5) is related
to the lack of dechallenge and rechallenge data. However, the
temporal correlation data remain strong. Although the hyperten-
sive picture, a highly correlated factor with AD, was known in
the months before the patient commenced treatment, during the
access to Emergency Room (ER) and just before ramucirumab
administration, the blood pressure was always well controlled by
antihypertensive treatment performed at home (nebivolol and
hydrochlorothiazide); conversely, no traumatic events that could
have facilitated the event were detected.
We believe that ramucirumab may have contributed to DA
manifestation in a patient who presented with predisposing
factors, comprising arterial hypertension and atherosclerotic
vasculopathy.
We hypothesise that hypertension can be a side effect that
also occurs in the short-medium term; for hypertensive patients
in therapy with VPIs, although blood pressure compensated,
therefore we believe that intensive monitoring of blood pres-
sure (Holter) can be useful, at least in the days before treatment
commences and after first administration.
The authors have not declared a specific grant for this research from any funding
agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
ORCID iD
Davide Zenoni http://orcid.org/0000-0002-1060-5252
References
1 Pino PG, Rigo Fausto, Moreo Antonella, et al. Linee Guida ANMCO – Associazione
Nazionale Medici Cardiologi Ospedalieri: “Sindromi Aortiche Acute”.Available: http://
www.anmco.it/uploads/u_cms/media/2017/5/0a72636960d9f1532f3f76dee7b2134f.
pdf
2 Kamalakannan D, Rosman HS, Eagle KA, et al.Acute aortic dissection. Crit Care Clin
2007;23:779–800.
3 Criado FJ.Aortic dissection: a 250-year perspective. Tex Heart Inst J
2011;38:694–700.
4 Olsson C,Thelin S, Ståhle E, et al.Thoracic aortic aneurysm and dissection: Increasing
prevalence and improved outcomes reported in a nationwide population-based study
of more than 14,000 cases from 1987 to 2002. Circulation 2006;114:2611–8.
5 Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet
2015;385:800–11.
6 Golledge J, Eagle KA, et al.Acute aortic dissection. Lancet 2008;372:55–66.
7 Fuchs CS,Tomasek J,Yong CJ, et al. Ramucirumab monotherapy for previously
treated advanced gastric or gastro-oesophageal junction adenocarcinoma (regard):
an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet
2014;383:31–9.
8 European Medicines Agency (EMA). European public assessment reports CYRAMZA
(Ramucirumab).Available: https://www.ema.europa.eu/medicines/human/EPAR/
cyramza
9 AIFA – Agenzia Italiana del FarmacoAggiornato in data 18/10/2018.Available:
https://view.officeapps.live.com/op/view.aspx?src=http://www.aifa.gov.it/sites/
default/files/Registri_PT_attivi_16.10.2018.ods
10 Sanchez-Gastaldo A, Gonzalez-Exposito R, Garcia-Carbonero R, Garcia-Carbonero R,
et al. Ramucirumab clinical development: an emerging role in gastrointestinal tumors.
Target Oncol 2016;11:479–87.
11 Lu D, Shen J,Vil MD, et al.Tailoring in vitro selection for a picomolar affinity human
antibody directed against vascular endothelial growth factor receptor 2 for enhanced
neutralizing activity. J Biol Chem 2003;278:43496–507.
onFebruary24,2020atICP.Protectedbycopyright.http://ejhp.bmj.com/EurJHospPharm:firstpublishedas10.1136/ejhpharm-2019-001879on14June2019.Downloadedfrom
4. 120 Zenoni D, et al. Eur J Hosp Pharm 2020;27:117–120. doi:10.1136/ejhpharm-2019-001879
Case report
12 Nardi M,Azzarello D, Maisano R, et al. FOLFOX-4 regimen as fist-line chemotherapy
in elderly patients with advanced gastric cancer: a safety study. J Chemother
2007;19:85–9.
13 Liu Z-F, Guo Q-S, Zhang X-Q, et al. Biweekly oxaliplatin in combination with
continuous infusional 5-fluorouracil and leucovorin (modified FOLFOX-4 regimen) as
first-line chemotherapy for elderly patients with advanced gastric cancer. Am J Clin
Oncol 2008;31:259–63.
14 Catalano Vet al.A phase II study of modified FOLFOX as first-line chemotherapy for
metastatic gastric cancer in elderly patients with associated diseases. Gastric Cancer
2012;16:411–9.
15 Common Terminology Criteria for Adverse Events (CTCAE). U.S. Department of Health
and Human Services. National Institutes of Health National Cancer Institute, May 28,
2009(v4.03: June 14, 2010).
16 Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing numerical rating scales,
verbal rating scales, and visual analogue scales for assessment of pain intensity in
adults: a systematic literature review. J Pain Symptom Manage 2011;41:1073–93.
17 Iwai M, Ito D,Asano H, et al. Evaluation of the safety of ramucirumab in Japanese
patients with advanced gastric cancer. Pharmazie 2018;73:309–12.
18 Yen C-J, Muro K, Kim T-W, et al. Ramucirumab safety in East Asian patients: a meta-
analysis of six global, randomized, double-blind, placebo-controlled, phase III clinical
trials. J Glob Oncol 2018;4:1–12. Jul.
19 Oshima Y,Tanimoto T,Yuji K, et al.Association between aortic dissection and systemic
exposure of vascular endothelial growth factor pathway inhibitors in the Japanese
Adverse Drug Event Report database. Circulation 2017;135:815–7.
20 Formiga MNdaC, Fanelli MF.Aortic dissection during antiangiogenic therapy with
sunitinib.A case report. Sao Paulo Med J 2015;133:275–7.
21 Edeline J, Laguerre B, Rolland Y, et al.Aortic dissection in a patient treated by sunitinib
for metastatic renal cell carcinoma. Ann Oncol 2010;21:186–7.
22 Aragon-Ching JB, Ning Y-M, Dahut WL.Acute aortic dissection in a hypertensive
patient with prostate cancer undergoing chemotherapy containing bevacizumab. Acta
Oncol 2008;47:1600–1.
23 Linee Guida Nella Valutazione del causality assessment.Available: http://www.
farmacovigilanza.asl3.liguria.it/pdf/linee_guida_valutazione_causality_assessment.
pdf [Accessed 19/10/2018].
onFebruary24,2020atICP.Protectedbycopyright.http://ejhp.bmj.com/EurJHospPharm:firstpublishedas10.1136/ejhpharm-2019-001879on14June2019.Downloadedfrom