1/15. Phase I trial of the angiogenesis inhibitor TNP-470 for progressive androgen-independent prostate cancer.Clinical and laboratory observations support the view that angiogenesis is necessary for prostate cancer progression. The angiogenesis inhibitor TNP-470 has demonstrated in vivo antitumor activity in a series of clinical models. To evaluate a possible therapeutic clinical value, we conducted a Phase I dose escalation trial of alternate-day i.v. TNP-470 in 33 patients with metastatic and androgen-independent prostate cancer. The patients were evaluated during therapy for evidence of neurological toxic effects. An assay of endothelial and vascular proliferation "markers" and a sequential assay of serum prostate-specific antigen concentration were performed. The effects of TNP-470 could be evaluated in 32 of the 33 patients. The maximum tolerated dose was 70.88 mg/m(2) of body surface area. The dose-limiting toxic effect was a characteristic neuropsychiatric symptom complex (anesthesia, gait disturbance, and agitation) that resolved upon cessation of therapy. The times to clinical recovery of neurological side effects were 6, 8, and 14 weeks. No definite antitumor activity of TNP-470 was observed; however, transient stimulation of the serum prostate-specific antigen concentration occurred in some of the patients treated. Additional studies of TNP-470 should be conducted using an alternate-day i.v. injection of 47.25 mg/m(2) body surface area and should focus on understanding and overcoming the neurological toxic effects. In addition, valid intermediate end points that reflect the status of tumor-associated neovascularity are needed to facilitate effective development of treatment strategies.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/15. Experience with radiofrequency ablation in the treatment of pelvic recurrence in rectal cancer: report of two cases.PURPOSE: The aim of this study was to assess the efficacy of radiofrequency ablation in the treatment of pelvic recurrent rectal cancer. methods: Computed tomography-guided percutaneous radiofrequency ablation was performed by placing a LeVeen needle electrode into the tumor. Radiofrequency ablation was performed on three lesions in two patients with pelvic recurrent rectal cancer, where the tumors were unresectable and associated with poorly controllable pain despite local treatment consisting of chemoradiotherapy. RESULTS: There were no major complications during the radiofrequency ablation procedure, although one patient complained of a sensation of warmth in the pelvic region, which was reasonably tolerated. Case 1: Each of two lesions of pelvic recurrence, 3 or 4 cm in diameter, was treated once by radiofrequency ablation with placement of a needle electrode into the tumor mass. After the procedure, magnetic resonance imaging confirmed nearly complete necrosis of the tumors, and there was a sufficient relief of pain enabling discontinuation of an opioid. serum carcinoembryonic antigen returned to normal and there was no evidence of relapse six months after the treatment. Case 2: Radiofrequency ablation was performed by placing a needle electrode at two sites of a recurrent tumor 6 cm in diameter. Postradiofrequency ablation imaging showed viable tissue remnants along the tumor margin, but the treatment produced relief of pain. The procedure was effective in opioid dosage reduction and pain control within a limited time span. CONCLUSION: Radiofrequency ablation is a relatively readily maneuverable and safe local treatment for pelvic recurrence in rectal cancer and is considered a procedure worth applying with further accumulation of experience in clinical cases.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
3/15. scleritis as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.PURPOSE: To describe a case of scleritis with choroidal detachment as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation. DESIGN: Interventional case report. methods: review of clinical records. RESULTS: A 50-year-old man developed symptoms of mild dry eye syndrome 20 days after receiving a one-antigen-mismatched allogenic bone marrow transplant. Five days later, he developed orbital pain, moderate visual loss, and a sterile orbital abscess on the left side. The orbital inflammatory collection was drained, and symptoms improved. On day 41 after bone marrow transplantation, the patient developed severe ocular pain and scleral thickening with secondary choroidal detachment and glaucoma in the right eye. The patient had no systemic signs of graft-versus-host disease at this time. The ocular symptoms and signs responded remarkably well to intravenous corticosteroids. Six months after bone marrow transplantation, while receiving low-dose oral methylprednisolone, the patient developed a skin rash. A biopsy of the involved skin confirmed the diagnosis of graft-versus-host disease. CONCLUSION: scleritis can be the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
4/15. osteoporosis with underlying connective tissue disease: an unusual case.A 44-year-old male was initially seen by dermatologists, who noted an erythematous rash on sun-exposed areas, the back, shoulders, and upper arms. There was associated muscle weakness and significant weight loss. Investigation revealed mildly raised aspartate and alanine transaminases but normal creatine kinase. Inflammatory indices and antinuclear antibodies (ANAs) were normal. biopsy of the rash was reported as consistent with either dermatomyositis (DM) or acute lupus erythematosus. A diagnosis of DM was made, and prednisolone was given with improvement of the rash but deteriorating myopathy. The patient was referred to the rheumatology department, and further history revealed multiple vertebral fractures after falling from standing height; these had occurred six months prior to starting steroids. Besides smoking he had no other risk factors for osteoporosis. Examination showed normal muscle strength, no muscle tenderness, and no joint abnormality. Repeat muscle enzymes were normal, and ANAs were now 1 : 100, but dsDNA antibodies and extractable nuclear antigens were normal. Investigations for osteoporosis revealed a hypergonadotrophic hypogonadism picture. Further examination indicated scanty pubic and auxiliary hair, small testicles, and mild gynecomastia. He is married, though has no children of his own. The hormonal profile raised the possibility of Klinefelter's syndrome, which was subsequently confirmed with karyotyping of 47 XXY. hypogonadism has been established as a cause of osteoporosis in males, and in this case would explain the occurrence of fractures in the absence of other major risk factors. Systemic lupus erythematosus has been recognized in association with Klinefelter's syndrome; in view of the normal muscle enzymes, his rash is most likely due to acute discoid lupus with androgen deficiency causing muscle weakness.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
5/15. Early-onset hemochromatic arthropathy in a patient with idiopathic hypermobility syndrome.hemochromatosis is a genetic disease related to human leukocyte antigen (HLA) A3, B7, and B14 histocompatability antigens resulting in increased iron absorption from the gastrointestinal tract and deposition of iron in tissues. Arthropathy is not uncommon in the late stage of disease. Characteristic radiologic findings are commonly observed in the wrists and metacarpophalangeal joints as well as the hips, knees, and ankle joints. Presented here is a 34-year-old male with hemochromatosis and bilateral shoulder, knee, and ankle pain. Radiologic examination revealed osteoarthritic findings in both ankle joints and chondrocalcinosis in the knee joints. All the major criteria of hypermobility syndrome were observed on physical examination. The early-onset arthropathy seen with this hemochromatosis is thought to result from hypermobility syndrome.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/15. Painful diffuse osteosclerosis after intravenous drug abuse.PURPOSE: We identify a new syndrome of acquired painful diffuse osteosclerosis associated with past intravenous drug abuse in two adults. methods: A 28-year-old white woman and a 38-year-old black man with a history of non-A, non-B chronic active hepatitis were referred to us for increasing bone pain that was especially severe in their lower extremities. They were studied at our clinical research center. RESULTS: Skeletal radiographs documented progressive generalized osteosclerosis. Increased bone mass was confirmed by dual-energy radiography, and bone scintigraphy showed diffusely increased radionuclide accumulation. serum biochemical studies revealed elevated alkaline phosphatase activity and osteocalcin levels, mild to moderately increased 1,25-dihydroxyvitamin D concentrations, and normal parathyroid hormone levels. In urine, hydroxyproline excretion was elevated, whereas calcium levels were reduced. Iliac crest histomorphometry showed increased rates of bone formation. hematology, renal function, serum protein electrophoresis, and screening for fluorosis as well as vitamin a and heavy metal poisoning were all normal. family histories were negative. Both patients were seropositive for antibody against hepatitis c virus as well as against Epstein-Barr virus (antiviral capsid antigen IgG but not IgM). Each subject was seronegative for cytomegalovirus, human immunodeficiency virus (HIV) 1 and 2, and human T-cell lymphotropic virus (HTLV) 1 and 2. Assay for reverse transcriptase in lymphocyte co-culture fluid and polymerase chain reaction studies using hiv-1 primers on peripheral monocyte dna were negative. Treatment with synthetic salmon calcitonin in both individuals rapidly led to decreased bone pain and to a decline in biochemical parameters of accelerated bone turnover. CONCLUSION: Painful diffuse osteosclerosis can follow intravenous drug abuse and is possibly caused by parenteral transmission of a virus that in some way stimulates bone formation.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
7/15. The painful purple digit: an alarming complication of candida albicans antigen treatment of recalcitrant warts.candida albicans (CA) antigen immunotherapy for recalcitrant warts is a novel treatment that has had much success in the recent past. Although several side effects are well documented in the literature, we report a new adverse reaction to CA antigen immunotherapy for verruca vulgaris of the distal fingertip. Our patient received an intradermal injection of CA antigen solution into periungual warts located on the distal left thumb and distal subungual area of the left index finger. Within 24 hours, the patient reported pain, edema, and a purple hue to only the index finger. Incision of the finger demonstrated no hematoma or compartment syndrome. Although the etiology is unknown, we believe the condition was most likely due to edema and vascular compromise secondary to a vigorous delayed-type hypersensitivity reaction, possibly leading to cyanosis of the distal index finger. We report this case to make physicians who use intralesional CA antigen aware of a new possible complication at this anatomic location.- - - - - - - - - - ranking = 4keywords = antigen (Clic here for more details about this article) |
8/15. Whipple's disease with unusual clinical, bacteriologic, and immunologic findings.A middle-aged man was found to have Whipple's disease after episodes of nephritis and arthralgia. While on antibiotic therapy, and in the absence of worsening of the histologic appearances of the jejunum, aortic valve endocarditis developed, presumably due to Whipple's disease. Observations during the course of his illness included the isolation of corynebacterium bovis from an inguinal lymph node, and detection of circulating antibodies against material within the characteristic abnormal macrophages present in the gastrointestinal mucosa. This antigen-antibody reaction was specifically blocked by the monosaccharide rhamnose, a component of the polysaccharide surface coat of many bacteria, including C. bovis.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
9/15. graves disease presenting as painful thyroiditis.hyperthyroidism associated with subacute (painful, viral) thyroiditis is well-recognized as a clinical entity; the thyroid gland in graves disease is minimally, if ever, tender and painful. We describe a 10-year-old girl with hyperthyroidism whose initial clinical presentation was predominantly a painful, tender goiter. graves disease was established by high uptake of 131I with a diffuse pattern of distribution of radioactivity on scan and the presence of thyroid-stimulating antibody. thyrotropin-binding inhibiting IgG and antibody to thyroid microsomal antigen were both positive. She responded well to treatment with propylthiouracil and had spontaneous regression of her thyroid pain. The cause of the severe pain and tenderness remains speculative.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
10/15. Cat scratch disease: an unusual cause of acute parotid pain (a case report with a literature review).CSD is a well recognised cause of cervical lymphadenopathy, and parotid involvement occurs in 3 per cent of cases. Parotid lymphadenopathy is usually asymptomatic or tender but acute parotid pain treated successfully by surgery is previously undescribed. In our case excision of the primary lesion with parotid biopsy provided an immediate diagnosis and decompression of the parotid capsule resulted in dramatic relief of the patient's pain. We would therefore recommend that, in all cases of obscure cervical lymphadenopathy, CSD should be considered and a documentation of domestic pets actively sought. We would also advise that in those cases of parotid CSD in which either the diagnosis is equivocal, CS antigen is unavailable or intense parotid pain is a predominant feature, excision of the primary lesion together with surgical decompression of the parotid capsule should be performed.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
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