Samer El-Safadi

Management of adult primary vulvar Langerhans cell histiocytosis: review of the literature and a case history

Primary vulvar Langerhans cell histiocytosis (LCH) is extremely rare and there are no standard treatment options. This review of the published literature with a case report aimed to clarify the optimal treatment for patients with this condition. Medline and PubMed were searched and all cases of primary vulvar LCH reported as single case reports or small case series were reviewed. A patient with vulvar LCH treated in this department is also reported. Twenty-seven cases, including the reported case, were reviewed. First-line treatments included surgery, radiotherapy, chemotherapy, thalidomide and local treatment. The mean follow-up time was 21.1±17.7 months. Although no patient died from the disease, recurrence rates were high (62%) and the mean time to relapse was 10.9±11.8 months (range 1-36 months). Treatment with thalidomide was successful, resulting in long-lasting remission. Disease recurrence is likely after surgery and or radiotherapy, and these treatments together with chemotherapy affect the patients wellbeing adversely. Although definitive conclusions await further work, thalidomide has minimal adverse effects, is easy to administer and should be considered as a first-line treatment or as maintenance therapy in some patients.

Complementary and alternative medicine in obstetrics: a survey from Iran.

PurposeThis survey assessed the use of complementary and alternative medicine (CAM) methods by obstetricians in the Islamic Republic of Iran.MethodsObstetricians in the province of Tehran were identified using the “Ketabe 118 Mashaghel” (2008), a source of medical department information. A survey on the use of CAM methods during childbirth and the reasons behind their application was conducted on site.ResultsCAM methods are by in 37.3% (62/166) of the obstetricians. Acupressure, massage, and phytotherapy were found to be the most frequently used methods. Use of CAM was influenced by the employment status of the midwives and inversely correlated with the number of deliveries in the hospital.ConclusionsCAM methods are used in Iran to some extent. With evidence-based medicine in mind it is interesting to note that in Iran mainly CAM methods which already have some proven benefit are used.

Erlaubt die Dunkelfeldmikroskopie nach Enderlein die Diagnose von Krebs? Eine prospektive Studie

Hintergrund: Die Dunkelfeldmikroskopie nach Enderlein behauptet, eine drohende oder beginnende Krebserkrankung im Blut frühzeitig entdecken zu können. In Deutschland und den USA wird diese Methode von einer steigenden Anzahl von Ärzten und Heilpraktikern angewendet, da hier ein einfacher Test eine sofortige Auskunft über die mögliche Erkrankung von Patienten ergeben soll. Fragestellung: Besteht die Möglichkeit, Krebserkrankungen mit der Dunkelfeldmikroskopie sicher zu erkennen? Material und Methoden: Im Rahmen einer prospektiven Studie zur Iridologie/Irisdiagnostik wurde 110 Patienten Blut für die Dunkelfeldmikroskopie abgenommen. Ein Heilpraktiker mit langjähriger Erfahrung führte die Untersuchung ohne Vorinformationen an verhüllten Patienten durch. Ergebnis: Von den 12 Patienten mit einem metastasierten Tumor, der durch radiologische Diagnose (CT, MRT, Sonographie) gesichert war, wurden 3 Patienten richtig erkannt. Die Analyse von Sensitivität (0,25), Spezifität (0,64), positiv prädiktivem Wert (0,09) und negativ prädiktivem Wert (0,85) erbrachte unbefriedigende Ergebnisse. Schlussfolgerung: Mit der Dunkelfeldmikroskopie ist es scheinbar nicht möglich, das Vorhandensein einer Krebserkrankung sicher zu erkennen. Die Methode sollte in der klinischen Praxis nicht eingesetzt werden, bevor weitere Untersuchungen vorliegen.

Primary Signet Ring Cell Mucinous Ovarian Carcinoma: A Case Report and Literature Review

A 24-year-old female patient presented with an extremely rare primary signet cell carcinoma of the right ovary 1 year after surgery for a mucinous borderline tumour of the left ovary. Relaparotomy was carried out with right adnexectomy, appendectomy and partial omentectomy. Surgery was followed by 6 courses of paclitaxel/carboplatinum chemotherapy. After an initial response, the patient again developed increasing ascites. The patient was transferred to our hospital and a re-relaparotomy was carried out, completing the operation. After 3 courses of pegylated doxorubicin/trabectedin, the clinical course showed a positive response and a decline of the tumour marker CEA in peripheral blood. After 5 months, ascites developed in the retroperitoneum so that the chemotherapy had to be changed. In spite of a positive response with the new chemotherapy, the patient died of a very rare pulmonary complication after 1 month within 2 days.

Nutritive Supplements – Help or Harm for Breast Cancer Patients?

Considerable numbers of patients and physicians believe that micronutrients may be useful with respect to prevention and treatment of breast cancer. However, the analysis of the literature shows that basic information on nutritional demands in cancer patients is lacking. It is unknown whether there is an increased demand of micronutrients in cancer patients in general and if there is an even more increased demand during the various types of treatment. As a result, there are only limited positive findings. Higher calcium intake in premenopausal women and higher intake of vitamin D seem to be able to lower breast cancer incidence. Vitamin E (800 IU per day) was found to have a modest effect on hot flashes during tamoxifen treatment. However, there are potential side effects especially when micronutrients are administered in high or very high doses. There is increasing evidence that dose-effect relationships are not linear but U-shaped. It seems that two thresholds exist for adverse effect, one at low doses for undersupply, and another at high doses for toxicity. Thus, arbitrary high-dose administration of micronutrients should be avoided. Supplementation of normal doses seems to be safe and acceptable from the medical point of view.

Long-Lasting Response to Trabectedin in a Patient with Metastatic Uterine Leiomyosarcoma: A Case Report

Background: Uterine leiomyosarcoma (uLMS) is a rare tumor that accounts for 1% of all uterine malignancies. In spite of adequate surgical resection of uLMS, even in the early stage, patients remain at high risk for local and distant recurrence. Therefore, the treatment of advanced uLMS represents a considerable challenge. Methods: We report the case of a 47-year-old woman who presented with uLMS with abnormal vaginal bleeding. Results: The patient underwent a total hysterectomy and bilateral adnexectomy, which was followed by 1 year progression-free survival without adjuvant therapy. Thereafter, new lung metastases and local progression at the vaginal stump were observed. Chemotherapy with ifosfamide and doxorubicin was administered. However, after 4 cycles, a CT scan revealed disease progression in the lung metastases. Subsequently, the patient was treated with trabectedin at a dose of 1.5 mg/m2 for 6 cycles resulting in complete remission of the lung metastases as well as partial remission of the mass in the vaginal stump after 9 cycles of trabectedin. The patient is currently on maintenance therapy with trabectedin and has no recurrence. Conclusion: Trabectedin seems to be an efficient option for patients with uLMS as demonstrated by a long-lasting response in a pretreated patient with an acceptable safety profile with no signs of cumulative toxicity.