Journal of the Chinese Medical Association

Advances in Combination of Antiangiogenic Agents Targeting VEGF-binding and Conventional Chemotherapy and Radiation for Cancer Treatment

Li-Song Teng, Ke-Tao Jin, Kui-Feng He, Hao-Hao Wang, Jiang Cao, De-Cao Yu — 2010-06-01

Despite great efforts and resources being devoted to treatment, the incidence and mortality of numerous cancers have not decreased in recent decades. This is a result of the resistance of cancer cells to chemotherapeutic agents and radio-therapy. The development of antiangiogenic agents that target vascular endothelial growth factor (VEGF) provides a new option for treatment of cancer. Major advances have been achieved with cancer therapy based on antiangiogenic VEGF-targeted agents in the past few years, and some of the recently approved therapies are now being used in daily clinical practice. A further challenge is finding a more efficacious combination of antiangiogenic VEGF-targeted therapies and conventional radio- and chemotherapies. This review outlines the current preclinical and clinical cancer treatments using optimized combinations of antiangiogenic VEGF-targeted agents and conventional radiochemotherapy and highlights that better scheduling for the combination of radiochemotherapy and antiangiogenic VEGF-targeted agents should be developed to achieve better treatment outcomes.

Magnetic Resonance Venography of Intracranial Venous Diseases

Jiing-Feng Lirng — 2010-06-01

Cetuximab-based Therapy in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma: Experience From an Area in Which Betel Nut Chewing Is Popular

2010-06-01

Background: This study was undertaken to evaluate the efficacy and safety of cetuximab-based therapy in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) in an area in which betel nut chewing is popular. Methods: Twenty-five patients were enrolled in the study from 2004 to 2008, of whom 13 received first-line cetuximab plus chemotherapy and 12 received second-line cetuximab with or without chemotherapy after the failure of cisplatin. Results: In the first-line chemotherapy group, the overall response [complete response (CR) plus partial response (PR)] was 54% and disease control rate [CR + PR + stable disease (SD)] was 62%. In the cisplatin-failure therapy group, the overall response was 16.7% and disease control rate was 50%. Median overall survival (OS) and time to progression (TTP) in the first-line chemotherapy group were 857 days and 147 days, respectively. In the cisplatin-failure therapy group, median OS and TTP were 371 days and 136 days, respectively. The most common grade 3/4 toxicity in both groups of patients was infection/fever (23% in the first-line group, 50% in the cisplatin-failure group), followed by neutropenia (23% in the first-line group, 25% in the cisplatin-failure group). Conclusion: Cetuximab-based therapy is an effective and safe treatment choice for recurrent/metastatic HNSCC in areas where betel nut chewing is popular.

Magnetic Resonance Angiography and Doppler Scanning for Detecting Atherosclerotic Renal Artery Stenosis

2010-06-01

Background: Atherosclerotic renal artery stenosis (ARAS) is a progressive but potentially reversible chronic kidney disease. Although the high sensitivity and specificity of renal Doppler scanning (RDS) for ARAS has been reported in western countries, ARAS has not been detected by RDS. This study used magnetic resonance angiography (MRA) to evaluate the sensitivity and specificity of RDS for detecting ARAS among outpatients at a nephrology clinic, and to calculate the degree of underestimation of ARAS by RDS. Methods: A total of 257 outpatients, aged > 50 years were examined for ARAS by RDS and MRA. Results: Thirty-seven (14.4%) and 139 (54.1%) of 257 patients had stenosis detected by RDS and MRA, respectively. Among the 220 patients whose RDS results were negative, MRA detected stenosis in 111 (50.45%). Multivariate logistic regression analysis showed that age > 65 years, duration of smoking, coronary artery disease, and serum creatinine levels > 354 mmol/L (4 mg/dL) were significant and independent factors that influenced ARAS in patients with negative results by RDS. Conclusion: RDS might still be the diagnostic procedure of choice for screening outpatients for ARAS because it is inexpensive, convenient, able to detect severity, and avoids the use of contrast media. When RDS is negative in aged people who have smoked longer than 20 years, with coronary artery disease or serum creatinine > 4 mg/dL, MRA is recommended for further evaluation of ARAS.

Surgical Outcomes in Resected Non-small Cell Lung Cancer ≤ 1 cm in Diameter

2010-06-01

Background: The goal of this study was to investigate the prognostic factors and patterns of recurrence in patients with resected non-small cell lung cancer (NSCLC) ≤ 1 cm in diameter. Methods: We conducted a retrospective review of the clinicopathological characteristics of 71 patients with NSCLC ≤ 1 cm in diameter in Taipei Veterans General Hospital between 1982 and 2007. Overall survival and its predictors were analyzed. Results: Median follow-up time of the 71 patients was 33.3 months. Complete resection was performed in 68 patients (95.8%) with stage I disease. The 5- and 10-year overall survival rates of patients who underwent complete resections were 81.7% and 44.9%, respectively. There was tumor recurrence in 6 (8.8%) of these 68 patients. Five (9.3%) of 54 patients who underwent standard resection experienced tumor recurrence, but only 1 (7.1%) of 14 patients who received sublobar resection had recurrent disease. The difference was not statistically significant (p = 0.569). Multivariate analysis revealed that sublobar resection (hazard ratio, 5.00; 95% confidence interval, 1.28–20.00; p = 0.020) was a significant predictor for worse overall survival. Conclusion: Survival in patients with NSCLC £ 1 cm in diameter is satisfactory. Sublobar resection, performed in patients unfit for standard resection, is a poor prognostic factor for overall survival.

Newborn Screening for Methylmalonic Aciduria by Tandem Mass Spectrometry: 7 Years' Experience From Two Centers in Taiwan

2010-06-01

Background: The clinical course of methylmalonic aciduria (MMA) is fulminant in neonates and emergency management is necessary to save lives. It is therefore very important to differentiate affected from unaffected neonates immediately when there are abnormal results regarding MMA in newborn screening. Methods: Between January 2002 and December 2008, 598,522 newborns were screened for MMA by 2 neonatal screening centers: the Chinese Foundation of Health and the Taipei Institute of Pathology. A total of 22 newborns were referred to confirmatory medical centers, and 7 were confirmed as having MMA. The initial propionylcarnitine (C3) level, C3/acetylcarnitine (C2) ratio, plasma ammonia, liver function tests, blood pH and bicarbonate were compared between the true-positive and false-positive groups. Results: The C3/C2 ratio and plasma ammonia were markedly higher in the true-positive MMA group (p < 0.0001). Blood gas pH (p = 0.029), bicarbonate (p = 0.019), and aspartate aminotransferase (p = 0.005) also significantly differed between these 2 groups. Conclusion: Referred newborns with elevated plasma C3/C2 ratios > 0.4 or ammonia levels > 200 mg/dL should be highly suspected of having MMA.

Screening for Anti-lipase Properties of 37 Traditional Chinese Medicinal Herbs

Cheng-Dong Zheng, Ya-Qing Duan, Jin-Ming Gao, Zhi-Gang Ruan — 2010-06-01

Background: To find new, crude anti-obesity drugs from natural sources through the inhibition of adsorption of dietary lipids, in vitro porcine pancreatic lipase (PPL; triacylglycerol lipase, EC 3.1.1.3) inhibitory tests were carried out on selected plants with weight-reducing or related potential, used in Chinese traditional medicine. Methods: The methanolic extracts of 37 traditional Chinese herbal medicines of different families were assayed for their in vitro activity against PPL by using spectrophotometry with 2,4-dinitrophenyl butyrate as a synthetic substrate. Coexistent phytochemicals, or those present in high levels, in the 3 most promising Chinese herbs were tested for their anti-lipase activity. Results: Extracts from 2 herbs, Prunella vulgaris L. (Labiatae) and Rheum palmatum L. (Polygonaceae), at a concentration of 200 mg/mL, significantly inhibited PPL—by 74.7% and 53.8%, respectively. Quercetin exhibited better activity (27.4%) than all the other phytochemicals at a final concentration of 25 mg/mL in the assay system, followed by luteolin, with an activity of 17.3%. Conclusion: The results support the view that herbs represent a rich source of anti-lipase compounds. The screening of the methanolic extracts of 37 Chinese medicinal plants in vitro led to the identification of several extracts with potential activity against PPL, in particular, P. vulgaris and R. palmatum. We also found that several monomeric chemicals in these herbs exhibited good or moderate activity against PPL. To the best of our knowledge, these traditional Chinese herbal medicines or phytochemicals have not been previously screened for their lipase inhibitory activity.

Chronic Cervical Perforation by an Intrauterine Device

Semra Oruç Koltan, Aslı Göker Tamay, Yasemin Yıldırım — 2010-06-01

The intrauterine device (IUD) is a widely used, highly effective method of birth control. Uterine perforation is a rare yet serious complication and is usually seen during insertion of the IUD. A regular examination is necessary for follow-up. We present a patient with an IUD that had perforated the cervix. The diagnosis was made during routine gynecological examination, and the patient was treated in a timely manner before any complications such as ectopic pregnancy, intrauterine pregnancy, infection or irreversible harm to the cervix arose. This case stresses the importance of regular visits to maintain health and diagnose possible adverse effects of intrauterine contraceptive methods.

Esophageal Metastasis From Occult Lung Cancer

Po-Kuei Hsu, Sen-Ei Shai, John Wang, Chung-Ping Hsu — 2010-06-01

A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX).

Right Hepatic Artery Pseudoaneurysm Ruptured Into the Gallbladder Demonstrated by Magnetic Resonance Angiography

2010-06-01

Rupture of a right hepatic artery pseudoaneurysm into the gallbladder is very rare. We demonstrated a 20-mm dumbbell-shaped pseudoaneurysm in the gallbladder lumen by using contrast-enhanced magnetic resonance angiography in a 73-year-old man with acute right upper abdominal pain. Inflammation of the gallbladder caused by calculous cholecystitis, which leads to biliary leakage and erodes the right hepatic artery, could have been the cause.

Optical Coherence Tomography in Spontaneous Resolution of Vitreomacular Traction Syndrome

Kuo-Hsuan Hung, Chang-Sue Yang, Tai-Chi Lin, Feng-Lih Lee, Shui-Mei Lee — 2010-06-01

Vitreomacular traction syndrome (VTS) is a vitreoretinal interface abnormality. The disorder is caused by incomplete posterior vitreous detachment with persistent traction on the macula that produces symptoms and decreased vision. Most symptomatic eyes with VTS undergo a further decrease in visual acuity. Spontaneous complete vitreomacular separation occurs infrequently in eyes with VTS. Surgical intervention may be considered if severe metamorphopsia and decreased visual quality occur. Herein, we report 2 typical cases of idiopathic VTS with spontaneous resolution of vitreo-retinal traction demonstrated by optical coherence tomography. Optical coherence tomography is a sensitive and useful tool for the confirmation of diagnosis and for the serial anatomical evaluation of patients with VTS.

Arachnoid Cyst Presenting With Sudden Hearing Loss

Hsuan-Ho Chen, Chin-Kuo Chen — 2010-06-01

Arachnoid cysts can occur at different intracranial sites, including the cerebellopontine angle (CPA). They often occur in childhood, in the posterior fossa. They may present with symptoms such as dizziness, tinnitus and hearing loss, or they may be asymptomatic. Presentation with sudden deafness is very rare. We report the unusual presentation of a 67-year-old male with CPA arachnoid cyst and the complaint of sudden-onset deafness. In this case, the cystic lesion at the CPA was found by magnetic resonance imaging of the brain. Pathology after retromastoid suboccipital craniotomy confirmed an arachnoid cyst. The treatment of this patient is discussed and the possible causes of CPA arachnoid cyst are briefly reviewed.

Erratum

2010-06-01