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Ethylenediamine hydrochloride (EDA) is a very common sensitizer from use in topical or systemic drugs. However, allergic sensitivity is unusual from occupational exposure to it. A 46-year-old nurse working in the pulmonary department, developed eczematous lesions on the hands, and systemic urticaria. She was patch tested with the standard series which showed a strong plosive reaction to 1% EDA. The history excluded personal use of topical or systemic drugs with EDA as stabilizers, but for many years, she had prepared and administrated injectable therophylline, containing EDA, preparations for treatment of asthma.

BACKGROUND Lymphedema (LE) is a common complication of breast cancer (BC) treatments conditioning disability that affects quality of life. Decongestive therapy is the most popular treatment but it determines only a transient advantage, while pharmacologic therapy didn't impact on LE. On the basis of clinical observations of LE regression in patients treated with sorafenib with antitumoral intent, we hypothesized that sorafenib could have an anti-LE activity through inhibition of vascular permeability by suppressing VEGFRs. METHODS We conducted a single-arm, monoistitutional phase II study in BC patients with treatment-acquired LE of the arm. Major or uncontrolled cardiological disease, brain metastasis, history of thromboembolism were exclusion criteria. Concomitant chemo or hormonal therapy was allowed. Pts received sorafenib 200 mg daily for a maximum of 8 weeks. The primary end-point was to evaluate the efficacy of sorafenib as reduction of LE, defined by the percentage reduction (PR) of the difference between the total arm circumference (measured as the sum of the circumference at 12 points) of the affected and the controlateral arm (Starritt, Peterk JA Cancer 2001-10): [(Initial Difference - Final Difference)/Initial Difference] x 100. Secondary end-points were safety and duration of response (DOR). The study was designed to test the null hypothesis that the PR of edema observed with this therapy was at most 20% versus the alternative hypothesis that the PR obtained by this regimen was ≥ 40%. RESULTS From May 2009 to April 2011, 36 BC pts were enrolled. All pts underwent axillary dissection and 29 pts had received adjuvant radiotherapy, but none on the axilla. Median time from primary breast surgery and from occurrence of edema to study enrollement was 65 and 49 months, respectively. All pts are evaluable for efficacy and toxicity. Most common toxicities included grade 1-2 gastralgia (17%), hypertension (17%) and rash (43%); one patient experienced grade 3 hand-foot syndrome. Twenty-five pts completed the planned 8 weeks of therapy, 11 (31%) had early treatment discontinuation after 2 (n = 6), 4 (n = 4) and 6 (n = 1) weeks of treatment due to recurrent grade 2 toxicity or to relapse of disease (n = 1). The median PR of the difference between the two arms was 34% (range, 2-100), 14 pts (39%) experienced a LE reduction ≥ 40%. Among 25 pts who completed therapy, 12 (48%) achieved a PR ≥ 40%. The median difference of total circumferences between the LE and controlateral arm was significantly reduced after treatment: 37 cm (range 8-88) vs 25 cm (range 1-62) (p = 0.006). Best response was achieved after a median of 5 weeks of therapy (range 1- 6) and the median DOR was 8 weeks (range 4-15). Reduction of LE was associated with improvement of related symptoms. After discontinuation of study drug 84% pts presented a progressive increase of total circumference of LE arm and returned to values similar to baseline after a median of 7 weeks (range 2-11). CONCLUSIONS: Low dose of sorafenib has a good toxicity profile and exerts a significant anti-LE activity in BC patients. The early but transient effect observed in this study suggests exploring different schedule of administration. Further studies are warranted in order to obtain a durable benefit in term of reduction of LE and quality of life. [ABSTRACT FROM AUTHOR]

Background: We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity., Methods: We reviewed BC patients treated with anthracyclines who underwent CT before (CT-t 0 ) and after (CT-t 1 ) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU., Results: Thirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t 0 and CT-t 1 , EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t 0 to CT-t 1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627)., Conclusions: EAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism., (© 2021. The Author(s).)

Background: Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time., Methods: After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection., Results: Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values., Conclusions: mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims.2020.04.05). FS reports he has received research grants from and he is member of the speakers’ bureau for General Electric, Bayer, and Bracco; he is also member of the Bracco Advisory Group. The other authors have no conflicts of interest to declare., (2020 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Summary: The number of patients with uncontrolled asthma is growing especially in young people. Although current therapies improve the disease management, the heterogeneity of clinical outcomes results in patients whose asthma is refractory to standard therapies. To understand not responsive phenotypes, we instituted a web-registry aimed to collect real life data of adolescent and adult patients. One-hundred and five Italian medical Centers are part of the network. Participants above 14 years and affected by severe asthma will be included in the study. Demographic and clinical data will be collected for 5 years on a dedicated electronic database. For the first time in Italy, our study will provide information on epidemiological, clinical and therapeutic aspects related to the natural course of the disease, filling the gap between adolescents and adults.

Objective: The effectiveness of palonosetron without delayed dexamethasone dosing against emesis was investigated in patients scheduled to receive the corticosteroid-containing combination of doxorubicin and paclitaxel (AT) for 3 cycles., Methods: Chemo-naïve women with breast cancer receiving doxorubicin (60 mg/m(2)) and paclitaxel (200 mg/m(2)) were eligible. Patients received palonosetron 0.25 mg intravenously before chemotherapy, however, all patients also received a premedication consisting of prednisone (25 mg orally the evening before therapy) and hydrocortisone (250 mg intravenously just before paclitaxel). The primary end point was complete control (CC; no vomiting, no rescue anti-emetics, and no more than mild nausea) during the overall phase (days 1-5) following cycle 1., Results: Seventy-six patients were enrolled and evaluable (median age 50 years). Fifty-six patients (74%; 95% CI 62-83%) achieved overall CC. Acute (day 1) and delayed (days 2-5) CC rates were 78 and 74%, respectively. No vomiting rates for the acute, delayed and overall phases were 85, 85 and 83%, respectively. An exploratory analysis showed only a small decrease in the probability of achieving CC between cycle 1 (74%) and cycle 3 (66%)., Conclusion: The dexamethasone-sparing strategy prevented emesis in more than 70% of breast cancer patients receiving their initial cycle of AT chemotherapy., (Copyright © 2013 S. Karger AG, Basel.)

Sequential doxorubicin/paclitaxel (AT) followed by CMF treatment was shown to be an active neoadjuvant chemotherapy regimen in the first European Cooperative Trial in Operable Breast Cancer (ECTO I trial). The aim of the current study (ECTO II) is to assess the complete pathological response (pCR) rate following three different anthracycline and taxane-containing neoadjuvant chemotherapy regimens, with or without capecitabine (X). Patients with operable, invasive breast cancer > 2.0 cm in diameter, were randomized to AT→CMF, AT→CMX or AC→TX regimens in two parallel, randomized, open-label, phase II trials (within a single study) in patients with estrogen receptor negative (ER-) and estrogen receptor positive (ER+) diseases, respectively. Exemestane was delivered concomitantly with neoadjuvant chemotherapy in ER+ tumors. Achievement of pCR was more common in ER- than ER+ women (45.3 vs. 10.4%). Capecitabine was only associated with a higher frequency of pCR in ER+ patients receiving AT→CMX. Overall response rates (ORR) ranged from 88 to 97%, and this translated into high rates of breast-conserving surgery (67% of ER- patients and 72% of ER+ patients). All three regimens were well tolerated. Febrile neutropenia and gastrointestinal effects were the most common grade ≥ 3 adverse events. As expected, the ECTO II study showed higher pCR rates in patients with ER- disease. Substituting capecitabine for fluorouracil (± methotrexate) in anthracycline/taxane-containing regimens appeared to be beneficial only in ER+ tumors. Translational studies investigating interactions between therapeutic agents and tumor biology are warranted to refine patient selection and improve the results of neoadjuvant chemotherapy.

Trastuzumab has an established role for the treatment of HER2-positive early-stage breast cancer because of the success of this agent in the adjuvant setting. Several key questions about the value of trastuzumab for the treatment of breast cancer, however, still need to be answered. Various differences in patient characteristics and treatment regimens were present in the randomized trials discussed in this Review; therefore, the details of trastuzumab use need clarification. For example, the optimum timing, the ideal administration schedule, and the appropriate length of treatment are not known. Cardiotoxicity is major concern even though the results of all randomized trials have shown that the degree of cardiotoxicity with trastuzumab is acceptable -- the incidence of cardiac damage caused by trastuzumab ranged from 0.4% to 4.1% in the different trials (cumulative incidence of congestive heart failure, New York Heart Association class 3-4). Current data do not support the use of trastuzumab for more than 1 year. The analysis of 2-year treatment with trastuzumab is expected to be available in 2009.

Echocardiograms were performed on 111 prosthetic porcine valves in mitral position and 25 in aortic position. Satisfactory tracings were obtained in 68% of the mitral and in 80% of the aortic prosthesis. The characteristic appearance of the porcine prosthesis consists of two lines parallel to each other which represent the stent; the valve cusps reflect much thinner echoes with a box-like pattern similar to that of the normal aortic valve. The distance between the cusps varied from 12 to 17 for the mitral prosthesis and from 11 to 15 for the aortic prosthesis. The range of these values as well as the range of other parameters which were measured varies widely. We suggest therefore that a post-operative echocardiogram should be performed to get a baseline pattern useful for comparison with following controls.