Understanding the pathobiology of chemotherapy-induced nausea and vomiting. Providing a basis for therapeutic progress.

Improved understanding of the physiologic and neuropharmacologic mechanisms underlying chemotherapy-induced nausea and vomiting (CINV) has driven significant progress in the treatment of CINV over the past 2 decades. Recognition of the role of neurotransmitters and their receptors in the process of CINV has been central to this progress. Initial attention focused on dopamine, then on serotonin, and most recently on substance P, which has yielded a useful new class of antiemetic medications known as selective neurokinin-1 receptor antagonists.

Lymphoma-associated paraneoplastic angioedema with normal C1-inhibitor activity: does danazol work?

A patient with splenic marginal zone lymphoma presented with severe, symptomatic acquired angioedema. Unlike previously reported cases, his serum levels of complement and C1 inhibitor (C1-INH) were not decreased. Nonetheless, he responded clinically to treatment with an attenuated androgen and, after therapeutic splenectomy, has been maintained asymptomatic without androgen therapy for 5 years.

Extubation failure: an outcome to be avoided.

Extubation failure is an outcome of increasing importance but nearly all studies have been conducted in academic settings. The article by Seymour and colleagues demonstrates that extubation failure is an outcome to be avoided in the community hospital setting as well. Patients failing extubation experience longer lengths of stay, experience higher intensive care unit mortality, and incur greater hospital costs.

Calcium dyshomeostasis in beta-amyloid and tau-bearing skeletal myotubes.

The relative scarcity of inclusion-affected muscle cells or markers of cell death in inclusion body myositis (IBM) is in distinction to the specific and early intracellular deposition of several Alzheimer's Disease (AD)-related proteins. The current study examined the possible correlation between myotube beta-amyloid and/or Tau accumulations and a widespread mishandling of intracellular muscle calcium concentration that could potentially account for the unrelenting weakness in affected patients. Cultured myogenic cells (C(2)C(12)) expressed beta-amyloid-42 (Abeta(42)) and fetal Tau peptides, as human transgenes encoded by herpes simplex virus, either individually or concurrently.

Chronic respiratory failure after lung resection: the role of pulmonary rehabilitation.

Pulmonary rehabilitation gradually has become the gold standard treatment for patients with severe lung disease, especially COPD. By definition, rehabilitation services are provided to patients with symptoms, most of whom have moderate-to-advanced lung disease. Because new therapeutic strategies, such as lung volume-reduction surgery and lung transplantation, require well-conditioned patients, pulmonary rehabilitation is becoming a crucial component of the overall treating strategy of many patients who heretofore were deemed untreatable.

Spinal epidural hematoma occurrence in the absence of known risk factors: a case series.

Spinal epidural hematoma in the absence of coagulopathy or anticoagulation therapy is an extremely rare occurrence, with a reported incidence of less than 1 in 1 million. We present seven cases of documented epidural hematoma in the absence of coagulopathy or anticoagulation therapy to alert the clinician to consider spinal or epidural hematoma when suspicious signs and symptoms are present after neuraxial block in the absence of coagulopathy or anticoagulation therapy. The need for immediate diagnosis and therapy is emphasized as the only potential for meaningful recovery.

Bronchus-associated lymphoid tissue lymphoma arising in a patient with bronchiectasis and chronic Mycobacterium avium infection.

We describe a 67-year-old woman with bronchiectasis and Mycobacterium avium complex infection who underwent wedge resection of her pulmonary infiltrates because they were progressing despite antibiotic therapy. In addition to the expected granulomatous changes, she was found to have a B-cell lymphoma of bronchus associated lymphoid tissue (BALT). Despite normal bone marrow morphology, marrow involvement was demonstrated by flow cytometry.

New treatment options for chemotherapy-induced nausea and vomiting.

Significant progress has been made in the development of effective, convenient, and well-tolerated means to prevent nausea and vomiting associated with cancer chemotherapy (CINV). Nevertheless, a substantial minority of patients continues to have suboptimal antiemetic control, and additional treatment approaches are needed. One avenue of investigation being pursued involves the evaluation of a new 5-HT(3) receptor antagonist (palonosetron) that differs from available serotonin antagonists in its markedly longer half-life (40 h) and greater binding affinity for the type-three serotonin receptor.

Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches.

Despite advances in the treatment of many side effects associated with chemotherapy, alopecia remains an issue that is difficult to resolve. Chemotherapy-induced alopecia (CIA) is a condition that can have profound psychosocial and quality-of-life consequences, resulting in anxiety, depression, a negative body image, lowered self-esteem, and a reduced sense of well-being. Patients who fear CIA may sometimes select regimens with less favorable outcomes or may refuse treatment.

Differential expression of human Dlg in cervical intraepithelial neoplasias.

Objectives: To evaluate the potential role of human discs large (hDlg) protein in the pathogenesis of cervical neoplasia by examining the changes of hDlg protein expression in normal cervical epithelium as well as various stages of cervical dysplasia.

Materials And Method: Archived formalin-fixed, paraffin-embedded cervical tissue sections with known status of human Papillomavirus (HPV) infection were examined for hDlg expression using immunohistochemical staining by a monoclonal antibody generated against hDlg. The specimens include normal epithelium, low-grade and high-grade squamous intraepithelial lesions, and squamous cell carcinoma.

Hormonal and antihormonal therapy for epistaxis in hereditary hemorrhagic telangiectasia.

Objectives/hypothesis: Objectives were to assess available information on hormonal therapy for bleeding in hereditary hemorrhagic telangiectasia (HHT), to determine whether there is a role for hormonal therapy as an initial therapeutic option, and to report the second known case of response in HHT to antihormonal therapy.

Study Design: Literature review and case report.

Methods: The literature on hormonal and antihormonal therapy for HHT was reviewed.

Spontaneous cholecystocutaneous fistula.

Spontaneous cholecystocutaneous fistula is rarely observed today because of the early diagnosis and management made possible by ultrasonography, broad-spectrum antibiotics, and effective surgical management of biliary tract disease. We present a case of spontaneous cholecystocutaneous fistula due to cholecystitis.

Heat shock protein 70 participates in the neuroprotective response to intracellularly expressed beta-amyloid in neurons.

Intracellular beta-amyloid 42 (Abeta42) accumulation is increasingly recognized as an early event in the pathogenesis of Alzheimer's disease (AD). We have developed a doxycycline-inducible adenoviral-based system that directs intracellular Abeta42 expression and accumulation into the endoplasmic reticulum of primary neuronal cultures in a regulated manner. Abeta42 exhibited a perinuclear distribution in cell bodies and an association with vesicular compartments.

A randomized controlled trial of darbepoetin alfa administered as a fixed or weight-based dose using a front-loading schedule in patients with anemia who have nonmyeloid malignancies.

Background: The effect of using fixed versus weight-based doses for erythropoietic agents has not been reported previously. To investigate this issue, the authors conducted a randomized Phase II study of darbepoetin alfa administered as either a fixed dose or a weight-based dose using an accelerated correction and maintenance dosing regimen (front-loading).

Methods: During the correction phase, patients with anemia (hemoglobin < 11.

Cavernous sinus and leptomeningeal metastases arising from a squamous cell carcinoma of the face: case report.

Objective And Importance: Invasion of trigeminal and facial perineural spaces is a recognized complication of cutaneous malignancies. Centripetal spread along the trigeminal nerve axis and into the cavernous sinus and the gasserian ganglion is rare. Metastasis to the leptomeninges and cauda equina has not been reported.

Effect of tamoxifen on breast tissue density in premenopausal breast cancer.

It has been established that hormone replacement therapy (HRT) increases breast tissue density on mammography in up to 30% of women receiving treatment. The effects of selective estrogen receptor modulators (SERMs) on breast tissue have received limited attention, although there have been several reports of tamoxifen decreasing mammographic tissue density in some women undergoing adjuvant or prophylactic breast cancer treatment. We report a case of a premenopausal woman treated with tamoxifen for 5 years whose mammographic density decreased while on tamoxifen and returned to her baseline density following termination of the drug.

Preoperative interscalene block for elective shoulder surgery: loss of benefit over early postoperative block after patient discharge to home.

Unlabelled: We performed a randomized, prospective, parallel-group, open-label, multicenter trial to compare the effects of pre- versus postoperative interscalene block using levobupivacaine on postoperative pain and analgesic requirements. One-hundred-two outpatients scheduled for elective shoulder surgery were randomized to receive 30 mL of 0.5% levobupivacaine either preoperatively (PRE group) or postoperatively (POST group).

A co-ligand complex anchors Plasmodium falciparum merozoites to the erythrocyte invasion receptor band 3.

In Plasmodium falciparum malaria, erythrocyte invasion by circulating merozoites may occur via two distinct pathways involving either a sialic acid-dependent or -independent mechanism. Earlier, we identified two nonglycosylated exofacial regions of erythrocyte band 3 termed 5ABC and 6A as an important host receptor in the sialic acid-independent invasion pathway. 5ABC, a major segment of this receptor, interacts with the 42-kDa processing product of merozoite surface protein 1 (MSP1(42)) through its 19-kDa C-terminal domain.

The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group.

Purpose: In early clinical trials with patients receiving highly emetogenic chemotherapy, the neurokinin antagonist aprepitant significantly enhanced the efficacy of a standard antiemetic regimen consisting of a type-three 5-hydroxytryptamine antagonist and a corticosteroid. This multicenter, randomized, double-blind, placebo-controlled phase III study was performed to establish definitively the superiority of the aprepitant regimen versus standard therapy in the prevention of chemotherapy-induced nausea and vomiting (CINV).

Patients And Methods: Patients receiving cisplatin > or = 70 mg/m2 for the first time were given either standard therapy (ondansetron and dexamethasone on day 1; dexamethasone on days 2 to 4) or an aprepitant regimen (aprepitant plus ondansetron and dexamethasone on day 1; aprepitant and dexamethasone on days 2 to 3; dexamethasone on day 4).

Human papillomavirus, it's genes...and cancer vaccines.

Genital human papillomavirus (HPV) infection is causally linked to the development of cervical cancer, a leading cause of cancer-related mortality in women worldwide. Recent studies demonstrate the effectiveness of virus-like particle-based vaccines to induce neutralizing antibodies against HPV and prevent cervical intraepithelial neoplasia.