Circulating plasminogen activator inhibitor-1 activity: a biomarker for resectable non-small cell lung cancer?

PURPOSE

Plasminogen activator inhibitor-1 (PAI-1) participates in thrombotic, fibrinolytic, inflammatory and metabolic cascades. Since previous studies have focused on tissue and blood level concentrations, our goal was to investigate for the first time the independent relationship between plasma PAI-1 activity in resectable non small cell lung cancer (NSCLC) taking into consideration its several interfaces and study its diagnostic and prognostic potential.

METHODS

In an adequately powered case-control study, plasma PAI-1 activity, metabolic parameters, classic adipokines, hemostatic, inflammatory and tumor biomarkers were measured in 110 consecutive patients with resectable NSCLC and 110 healthy subjects matched on age, sex and date of blood draw.

RESULTS

NSCLC patients exhibited significantly higher PAI-1 activity compared to controls (p<0.001). In NSCLC cases, PAI-1 activity correlated with somatometric variables, insulin, WBC, antithrombin III, protein C, plasminogen, IL-6 and tumor size (p<0.05). Plasma PAI-1 activity was independently associated with NSCLC beyond risk factors associated with NSCLC (OR:6.9, 95%CI:2.9-16.6, p<0.001). Plasminogen activity and body mass index emerged as independent predictors of PAI-1 activity in cases. Due to its high specificity, PAI-1 activity could represent a potentially useful parameter in ruling out NSCLC, alone or in combination with serum tumor markers associated with NSCLC.

CONCLUSIONS

PAI-1 activity, reflecting PAI-1 functionality, may represent a potentially useful biomarker in NSCLC associated with thrombotic, tumor-promoting and metabolic networks. More clinical studies are needed to explore whether PAI-1 activity may be a practical biomarker in the risk assessment of NSCLC, at the crossroads of hemostasis and metabolism.

Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes.

Single-center experience of transplantation for polycystic liver disease

BACKGROUND

Polycystic liver disease (PLD) may lead to massive hepatomegaly, abdominal distension, pain, and various degrees of dyspnea. The surgical treatment of this entity remains controversial.

METHODS

We report our experience from a retrospective analysis of 23 patients suffering from PLD who were treated with liver transplantation (LT) in our institution.

RESULTS

Liver transplantation for PLD patients with extensive hepatic involvement offers excellent symptoms relief. The actuarial 1-, 3-, and 5-year survival rate after transplantation was 86%.

CONCLUSIONS

Our experience demonstrates that PLD patients with extensive hepatic involvement and who are treated with LT have good long-term prognosis and excellent symptoms relief. LT might be considered in severe PLD cases where conventional surgery is not a curative option, and it must be balanced against the risks of LT and lifelong commitment to immunosuppression.

Intrahepatic cholangiocarcinoma: An international, multi-institutional analysis of prognostic factors and lymph node assessment

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Background: Intrahepatic cholangiocarcinoma (ICC) is a rare and poorly understood primary liver cancer. The role of routine lymphadenectomy at the time of surgical resection remains poorly defined. We sought to identify factors associated with outcome following surgical management of ICC and examine the impact of lymph node (LN) assessment on survival.

Methods: 411 patients who underwent curative intent surgery for ICC between 1973-2010 were identified from an international multi-institutional database. Clinical and pathologic data were evaluated using uni- and multivariate analyses.

Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (55%) and no evidence of vascular invasion (64%). Resection involved ≥hemi-hepatectomy (74%) and margin status was R0 (82%). Overall median survival was 28 months and 5-year survival was 32%. Factors associated with adverse prognosis included positive margin status (HR=3.11; p<0.001), multiple lesions (HR=2.16; p=0.007) and vascular invasion (HR=2.13; p=0.01). Tumor size was not a prognostic factor (HR=1.05; p=0.08). Lymphadenectomy was performed in 233 (57%) patients; 87 (37%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0 39 months vs. N1 21 months; p=0.02). Preoperative factors such as tumor size, number, and morphologic subtype did not predict presence of LN metastasis (all p>0.05); however, vascular invasion did (OR=2.24; p=0.003).

Conclusions: While tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. Presence of LN metastasis cannot be predicted using preoperative tumor features. Lymphadenectomy should be routinely performed for ICC as up to one-quarter of patients will have LN metastasis.

No significant financial relationships to disclose.

Results of Kidney Transplantation With Simultaneous Implantation of Vascular Graft

BACKGROUND

Arteriosclerosis and calcification of iliac arteries are common in patients on dialysis. This study sought to evaluate the outcome after kidney transplantation and simultaneous implantation of vascular grafts.

PATIENTS AND METHODS

In a single center study we evaluated donor and recipient data among 443 kidney transplantations in adults performed between January 2002 and October 2006. In 11 recipients (2.5%) a vascular graft (Gore-Tex) was implanted due to severe arterioscleroses of the iliac vessels.

RESULTS

Reconstruction of the lower limb blood supply was performed with an ileofemoral Gore-Tex-Bypass in 9 of 11 patients, with an aortofemoral bypass in 1 patient, and with a femoroiliac crossover bypass in 1 patient. Overall, 8 of 11 patients (73%) had an uneventful postoperative course. Six of 11 patients had primary graft function.

CONCLUSIONS

This analysis demonstrated that vascular reconstruction during kidney transplantation has to be performed rarely but has a strong impact on further life and kidney function. In 8 of 11 patients, kidney function at 6 months was good. Severe arteriosclerosis is usually not a contraindication for kidney transplantation. However, training in vascular surgery seems to be important to achieve satisfying results. In this series, simultaneous implantation of vascular prosthetic grafts was safe since there were no infectious complications of the graft itself.

Two cases of cutaneous leishmaniasis presenting to the emergency department as chronic ulcers

With the increasing numbers of travelers and immigrants coming to the United States from tropical areas where Leishmaniasis is endemic, it is important to be familiar with its common cutaneous manifestations. Leishmaniasis is a parasitic infection caused by the obligate intracellular protozoa Leishmania and is transmitted by the bite of the sandfly. It can appear as a nonhealing lesion on exposed skin in patients and is often misdiagnosed, delaying treatment. We present two cases of patients who presented to the Emergency Department with chronic, nonhealing ulcers that were ultimately found to have Leishmaniasis.

Cold injury from pressurized liquid ammonia: a report of two cases

Patients exposed to pressurized liquids or gases present unique diagnostic and treatment challenges to the Emergency Physician. The potential for injury depends upon the properties of the chemical in addition to the thermodynamic effects from exposure to a pressurized substance. We present two cases of exposure to pressurized ammonia during an industrial accident. One patient's symptoms were consistent with an ammonia alkali burn, whereas the other patient's symptoms were more characteristic of a significant thermal injury caused by the rapid expansion and evaporation of a pressurized liquid.

Incorporating patient preferences into practice guidelines: management of children with fever without source

STUDY OBJECTIVE

To evaluate parent preferences for the therapy of young children with fever without source.

PARTICIPANTS

Consecutive parents, not in a medical profession, of children less than 36 months old.

SETTING

Pediatric clinic of a university teaching hospital.

DESIGN

During individual interviews at the time of their child's clinic visit, parents were presented with a case scenario and two treatment options and the risks, outcomes, and cost associated with each.

MAIN OUTCOME MEASURE

Parent preferences for alternative treatment strategies.

RESULTS

All parents correctly identified the management strategy with the higher probability of an adverse outcome. Seventy-one percent chose the option with less testing and treatment and the greater risk of an adverse outcome. Parents' reasons for this choice were fewer painful tests and procedures (36%), less time waiting (32%), smaller chance of unnecessary antibiotics (23%), and ability to return if their child's condition deteriorated (22%). Thirty-two percent of parents indicated that cost was a factor in their decision. Age, gender, education, and/or number of children was not associated with parents' treatment preferences.

CONCLUSION

Parents' preferences may be considered when determining how to manage febrile infants and children.