Modifying the course of chronic obstructive pulmonary disease: looking beyond the FEV1.

COPD is defined by airflow limitation that is not fully reversible and is usually progressive. Thus, airflow obstruction (measured as FEV(1)) has traditionally been used as the benchmark defining disease modification with therapy. However, COPD exacerbations and extrapulmonary effects are common and burdensome and generally become more prominent as the disease progresses.

Length of adjuvant imatinib therapy in GIST: weighing benefits, side effects and costs.

A recent large randomized clinical trial showed a survival advantage with 36 vs 12 months of adjuvant imatinib in patients with resected gastrointestinal stromal tumors (GISTs). However, there was a higher therapy discontinuation rate with the longer duration of treatment. Preferences of individual GIST patients and the imatinib risk/benefit ratio should always be sought before employing this agent in adjuvant setting for longer than 12 months.

Bevacizumab in lung cancer: lackluster performance and unjustified expense?

A recent retrospective analysis of a large cohort of patients aged 65 and older with advanced non-small cell lung cancer failed to demonstrate any improvement in survival with the addition of bevacizumab to the platinum doublet in the first-line therapy. A few points have to be made: 1) a vast majority of patients with lung cancer are 65 and older; 2) important including fatal toxicity can occur with the use of bevacizumab; and 3) costs of bevacizumab are significant. Integrating the conclusions of this study into clinical practice and further analysis of underlying physical, psychosocial, and economic hurdles of bevacizumab use in lung cancer patients are certainly justified.

Immune alterations and emerging immunotherapeutic approaches in lung cancer.

Introduction: Subjects with lung cancer were shown to present a variety of immune abnormalities including cellular immune dysfunction, cytokine alterations, and antigen presentation defects. As discouraging results are commonly seen with the existing therapies in lung cancer, more innovative treatment strategies are needed.

Areas Covered: The authors review comprehensively the immune abnormalities in individuals with lung cancer, describe the lung cancer immunotherapy candidates that are most advanced in their clinical development, and summarize recent data from clinical trials of these agents.

Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study.

Background: Sciatic nerve block when combined with femoral nerve block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial nerve block in the popliteal fossa would avoid complete peroneal motor block.

Methods: Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial nerve block in the popliteal fossa or a sciatic nerve block proximal to its bifurcation in combination with femoral nerve block as part of a multimodal analgesia regimen.

Cardiovascular toxicity associated with small molecule tyrosine kinase inhibitors currently in clinical use.

Introduction: Tyrosine kinase inhibitors (TKIs) have changed the concepts of systemic therapy for a variety of advanced solid and hematologic malignancies. However, their toxicity can be significant, and includes both cardiac and non-cardiac effects.

Areas Covered: The authors evaluate comprehensively the adverse cardiovascular portfolio of small molecule TKIs, postulate their underlying mechanisms and offer recommendations regarding prevention and therapy of these toxicities.

Hair repigmentation associated with the use of lenalidomide: graying may not be an irreversible process!

We report the first case of progressive hair repigmentation associated with the use of lenalidomide in an elderly patient with multiple myeloma. The influence of lenalidomide on follicular melanogenesis may involve removing the inhibitory influences of some cytokines such as IL-1, IL-6 and TNF-α. In addition, certain endocrine effects of lenalidomide on the hypophyseal-adrenal axis could explain its action on hair pigmentation.

Emerging therapeutic options for advanced enteropancreatic neuroendocrine tumors.

Introduction: Several chemotherapy agents and combinations have proven effective in the therapy of advanced enteropancreatic neuroendocrine tumors (EP-NETs). However, their toxicity can be significant. Recent understanding of the molecular mechanisms of these tumors, especially the central role of tumor angiogenesis, has led to the identification of new therapeutic targets and agents directed at the molecular level.

Immune alterations in untreated and treated multiple myeloma.

The incidence of second malignancies was shown to be increased in patients with multiple myeloma. Although a shared genetic predisposition or common environmental carcinogens may account for the occurrence of both myeloma and additional cancers, multiple immune defects encountered in myeloma might play an important role in this regard. This review explores the impairments in both cellular and humoral mediated immunity in multiple myeloma, linking them with increased susceptibility to infections and additional cancers.

Decreasing the local anesthetic volume from 20 to 10 mL for ultrasound-guided interscalene block at the cricoid level does not reduce the incidence of hemidiaphragmatic paresis.

Background And Objectives: This prospective, randomized, double blind study was designed to determine whether reduction in volume from 20 to 10 mL of ropivacaine 0.5% for ultrasound-guided interscalene block might decrease the incidence of diaphragmatic paresis and preserve pulmonary function.

Method: Thirty patients scheduled for arthroscopic shoulder surgery were randomized to receive either 10 or 20 mL of ropivacaine 0.

Emerging pharmacotherapeutic strategies for cholangiocarcinoma.

Introduction: Although of limited clinical benefit, chemotherapy represents the cornerstone of management for patients with inoperable cholangiocarcinoma. The literature on chemotherapy in advanced cholangiocarcinoma is difficult to interpret because of the heterogeneity of cholangiocarcinoma, the use of various chemotherapeutic agents in different combinations and dosing regimens, and the small size of existing patient cohorts.

Areas Covered: The authors discuss the major advances in the therapy of cholangiocarcinoma over the past decade.

Newer developments in adult T-cell leukemia/lymphoma therapeutics.

Introduction: Adult T-cell leukemia/lymphoma (ATL) is a rare disease with a unique geographic distribution. Conducting controlled randomized trials to assess the effective therapeutic strategies has therefore been a significant challenge to date.

Areas Covered: This review explores the natural history and diagnostic evaluation of ATL, followed by a focused review of existing studies on the most potent individual pharmaceutical agents and combinations used in the therapy of this malignancy.

Newer developments in the therapeutics of the transitional cell carcinoma of renal pelvis.

Many of the risk factors and pathogenesis of urothelial carcinoma of the renal pelvis are similar to the ones of the more common urothelial bladder cancer. In addition, two endemic nephropathies and two inherited syndromes have been linked with the development of upper urologic cancer. Multiple synchronous or metachronous lesions throughout urinary tract are rather common and should always be sought in the management of this entity.

Targeting macrophages in classical Hodgkin's lymphoma may seem rational, but is it safe?

A few reports have linked increased numbers of tissue macrophages with treatment failure and reduced lifespan in classical Hodgkin's lymphoma (HL) patients. Some investigators even suggested to target the macrophages in HL with biologic therapy, thus eliminating them from the tumor microenvironment. This review explores the risk: benefit equation of such approach as well as what the author believes is the driving force behind the 'great' migration of macrophages in HL.

Accuracy of colon tumor localization: Computed tomography scanning as a complement to colonoscopy.

Aim: To determine the utility of computed tomography (CT) scanning in localizing colon tumors.

Methods: At a single tertiary care teaching hospital, a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006. One hundred and four charts containing all of the following data were reviewed: preoperative colonoscopy report, preoperative CT report, surgical operative report, tumor pathology report.

Etiology and treatment of overactive bladder in women.

Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency with or without urinary incontinence and often have urinary frequency and nocturia.

Vulvar pain after spondylosyndesis procedure: a presentation of 2 cases.

Vulvar pain can be a difficult and frustrating problem for patients and practitioners. Often, no specific etiology can be determined for these symptoms. Treatment can be long and difficult as well.