The Hematologic Toxicity of Methotrexate in Patients with Autoimmune Disorders

The incidence of auto-immune diseases is increasing nowa- days. Despite of the development of diagnosis and management of diseases, they remained chronic diseases.

The patient’s lifespan expansion requires long-term treatment with harmful agents, such as Methotrexate or other immuno-suppressive drugs. The Methotrexate toxicities are based on the duration and cumulative dosing of drug, and the combination with other drugs.

Myelosuppression and consequent pancytopenia is the most frequent hematologic toxicity, which occur mostly later during low dose methotrexate administration. We demonstrate three cases of low dose Methotrexate toxicity in older patients with rheumatoid arthritis and psoriasis.

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Interaction between Polyunsaturated Fatty Acids and Genetic Variants in Relation to Breast Cancer Incidence

Experimental evidence suggests that higher ω-3 relative to ω-6 could reduce mammary carcinogenesis through mechanisms related to inflammation, oxidative stress, and estrogen metabolism.

Breast Cancer

A recently published meta-analysis of population based prospective cohort studies reported an approximately null association for dietary intake of polyunsaturated fatty acids (PUFAs) among studies that were conducted using populations from the United States (U.S.). This is inconsistent with findings from studies conducted in Asia that show risk reductions for ω-3 intake. PUFAs may affect carcinogenesis via multiple biologic pathways. Thus, we hypothesized that interactions with biologically relevant genetic polymorphisms with breast cancer may help to clarify the biologically plausible association with PUFAs. We further hypothesized that consideration of the ratio of ω-3 to ω-6 intake (ω-3:ω-6) may enhance our examination of interactions with breast cancer, given the two PUFA subgroups compete for the same metabolic enzymes. 

Paraplegia Following A Failed Spinal Anesthesia: Case Report And Literature Review

Intradural spinal cord tumors are uncommon with an incidence of about 3-10 per 100,000 individuals. These tumors occur predominately in the third and fourth decades of life.

Paraplegia

Ependymomas, a subset of intradural spinal cord tumors, are the most common gliomas of the lower cord, conus and filum terminale, and approximately 40% of all spinal ependymomas arise within the proximal intradural filum terminale. Back pain is the most common presenting symptom, with neurological compromise rare secondary to the adaptive compressibility of the surrounding structures. Mork and Loken report that in 82% of patients with spinal ependymoma, symptoms were present for more than 1 year before the diagnosis was achieved. Spinal ependymomas can originate from either the ependymal lining of the central canal of the spinal cord, ependymal cell clusters in the terminal filum, or from ependymal rests left during embryonic development. Read more>>>>>

Pleomorphic Adenoma of Ectopic Salivary Gland Tissue in the Upper Neck

Pleomorphic adenoma also known as “mixed tumor” is the most common neoplasm in major salivary glands. It is a benign tumor arises from the parotid gland in 84% ofcases and represents 45% of parotid gland tumors. Only 6.5% are found in the minor salivary glands.

Neck Cancer

Salivary gland tumors occurring in ectopic sites are rare and poorly understood; sometime we can find heterotopic tissue arising from an aberrant salivary gland in external auditory canal, nasal cavity, tongue, tonsils and neck. The presence of pleomorphic adenoma in the upper neck, along the anterior border of the sternocleidomastoid muscle is extremely rare. Only five cases of ectopic mixed salivary gland tumors in the upper neck in adult patients have been reported. This article describes another case of pleomorphic adenoma occurring in the upper neck followed by a literature review in order to identify the major characteristics and differential diagnosis of such a rare disease.

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The Hematologic Toxicity of Methotrexate in Patients with Autoimmune Disorders

The incidence of autoimmune diseases increased to the end of twenty centuries. Despite of the development of diagnosis and therapy in medicine, autoimmune diseases remainedincurable.

Autoimmune Disorders

Only long-term treatment with harmful agents is available for these patients, such as methotrexate or other immuno-suppressive drugs. Methotrexate, a synthetic antifolate was developed in the 1950’s after the discovery that dietary folic acid deficiency resulted in decreased blast cell count in leukemic patients. This drug has been extensively investigated and used successfully to treat solid tumors as well as hematological malignancies. It has been used, in much lower doses, in autoimmune diseases including rheumatoid arthritis, psoriasis, lupus, sarcoidosis, and eczema. By inhibiting several enzymes of the folic acid pathway MTX blocks purine and pyrimidine biosynthesis, leading to impaired DNA replication and cell proliferation.

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Tumor Lysis Syndrome Following a Single Atezolizumab Infusion for Metastatic Urothelial Carcinoma Involving Both Upper and Lower Tract

Tumor lysis syndrome is a potentially fatal complication of oncological therapy. Atezolizumab is a recently-approved agent for the treatment of advanced urothelial carcinoma and, to the best of our knowledge, tumor lysis syndrome has never been reported after atezolizumab therapy for urothelial carcinoma.

We present the case of a 77-year-old female who developed acute renal failure and tumor lysis syndrome after a single infusion of atezolizumab for metastatic urothelial carcinoma involving both upper and lower tract.

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Solitary Muscular Recurrence of Nasopharyngeal Carcinoma

Angiosarcoma of breast or chest wall is a rare recognized side effect in breast cancer survivors secondary to Adjuvant radiation.

The treatment of angiosarcoma of the breast is carried out in number of ways. We would like to report the case of a 50-year old woman.

She developed an angiosarcoma of the breast following adjuvant radiation to her conserved breast and was successfully treated with classical Cyclophosphamide, Methotrexate, and 5- fluorouracil (CMF) chemotherapy leading to a successful local surgical salvage.

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