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Ortiz D.,University of Illinois at Chicago | Alvikas J.,University of Illinois at Chicago | Riker A.I.,Advocate Cancer Institute
Ochsner Journal | Year: 2015

Background: Allergic reactions including anaphylaxis resulting from isosulfan blue dye are rare but warrant a thorough review given that lymph node mapping has become an increasingly common procedure, putting more patients at risk. Case Report: Our patient was an 82-year-old female who underwent elective excision of a right forearm melanoma and right axillary sentinel lymph node mapping and suffered an anaphylactic reaction approximately 15 minutes after injection of isosulfan blue dye. The procedure was aborted. She was intubated; diphenhydramine and dexamethasone were administered; her blood pressure was stabilized with phenylephrine, epinephrine, and intravenous fluids; and she was transferred to the intensive care unit. She was extubated on postoperative day 1 and discharged home on postoperative day 2. Conclusion: Sentinel lymph node biopsy is the standard of care for staging several cancers, and isosulfan blue is the dye most commonly used for this procedure. Reactions to the dye occur in some patients; however, we recommend the continued use of isosulfan blue dye for lymph node mapping given the low incidence of adverse effects, with no reported mortalities. Physicians should be prepared for the potential risk of anaphylactic shock. © Academic Division of Ochsner Clinic Foundation.


Riker A.I.,Advocate Cancer Institute
Breast disease: Comprehensive management | Year: 2015

Breast Disease: Comprehensive Management provides a clear, concise source of information in order to make real-life, evidence-based decisions for all aspects of breast disease, both benign and malignant. The volume provides the latest breakthroughs in breast cancer research, ranging from paradigm shifts in the surgical management of the axilla, the changing role of adjuvant and neoadjuvant chemotherapy, the impact of molecular medicine in decision-making and the controversial role of prophylactic mastectomy in our era. Within select chapters, “How I do it” clinical scenarios are supplied and described in very practical terms. Also included at the end of each chapter are synoptic questions with detailed answers, akin to the self-assessment (SESAP) format questions and answers. These questions provide a basis for continuous medical education (CME) for the practicing physician and surgeon, further in surgical oncology and breast surgery, medical oncologists, radiation oncologists, and breast radiologists enhancing a focused approach to the management of breast disease in preparation for the American Board of Surgery certification and re-certification for the general surgeon. Breast Disease: Comprehensive Management is of great value to general surgeons, breast surgeons, surgical oncologists, general surgery residents, and fellows. © Springer Science+Business Media New York 2015.


Glynn K.M.,Advocate Christ Medical Center | Riker A.I.,Advocate Cancer Institute
Ochsner Journal | Year: 2015

Background: Formerly, anesthetized patients who received intraoperative radiation therapy (IORT) had to be transported from the operating room (OR) to the location of the linear accelerator. With the advent of mobile accelerators, therapy is delivered directly to the patient in the OR, presenting specific challenges for the anesthesiologist.Methods: We review the uses and benefits, operative and anesthetic challenges, and unique issues associated with IORT.Results: Patient safety and precise delivery of the radiation dose are the primary goals of IORT. The anesthesiologist’s role in ensuring the success of these two outcomes includes selecting the optimal anesthetic technique to prevent patient movement and permit sentinel node mapping, monitoring the patient’s vital signs throughout the procedure, and ensuring that the sterile field is maintained in the OR.Conclusion: Although keeping patients in the OR has simplified the process of providing IORT, the anesthesiologist must be aware of potential problems and plan accordingly. © Academic Division of Ochsner Clinic Foundation.


Gao L.,Harbin Medical University | Gao L.,University of South Alabama | Gao Y.,Harbin Medical University | Li X.,University of South Alabama | And 8 more authors.
Molecular Oncology | Year: 2012

The integral membrane channel protein aquaporin (AQP) is aberrantly expressed with oncogenic characteristics in various human cancers. In this study, we analyzed the expression pattern of all subtypes of AQPs, and found that 8 out of 13 AQPs expressed in melanoma cells. To understand the role of aberrant expression of AQP in this disease, we over-expressed AQP3 and AQP9 in human melanoma WM266.4 cells and found that both AQPs significantly increased the chemoresistance of WM266.4 cells to arsenite. Functional studies showed that AQP3 and AQP9 can inhibit cell apoptosis induced by arsenite through down-regulating p53 and up-regulating Bcl-2 and XIAP. Our data suggest the implication of APQ in melanoma progression and that the over-expression of AQP3 and AQP9 contributes to the chemoresistance of melanoma to arsenite. © 2011 Federation of European Biochemical Societies.


Benjamin M.A.,University of Illinois at Chicago | Riker A.I.,Advocate Cancer Institute
Ochsner Journal | Year: 2015

Male breast cancer (MBC) is an uncommon malignancy with an incidence that accounts for about 1% of all breast cancer cases. It commonly presents as a locally advanced tumor that has already spread to the regional nodal basin. Similar to female breast cancers, MBC gene expression profiling and tumor studies help to detect molecular subtypes of tumors that correlate with clinical outcome and mortality rates. Case Report: We report a relatively uncommon case of a 64-year-old male with a BRCA1+ gene mutation that is also found to be HER2+ on receptor analysis. Initial diagnostic studies with mammography and ultrasound revealed a left-sided hypoechoic mass measuring 2.3 cm, located at the 11 o’clock position adjacent to the nipple-areolar complex. Whole body positron emission tomography-computed tomography scan revealed a hypermetabolic retroareolar left breast mass and enlarged, hypermetabolic left axillary lymph nodes. Final pathology revealed an infiltrating ductal carcinoma with a Nottingham histologic score of 3 (mitotic count score, 3; nuclear pleomorphism score, 3). Of the 19 lymph nodes examined, 15 had evidence of macrometastatic disease. Conclusion: This report highlights a novel case of MBC with a rare genotypic presentation. A need exists to further explore this disease process because the literature is scant with information regarding the long-term treatment and outcomes of MBC, especially in the genotypic form presented here. Subsequent studies in the long-term outcomes of various MBC cases will need to be pursued to better understand the optimal screening and treatment strategies for this disease. © Academic Division of Ochsner Clinic Foundation.


PubMed | Peoples Hospital of Anqiu City, Beijing 307 hospital, Beijing Institute of Transfusion Medicine and Advocate Cancer Institute
Type: Journal Article | Journal: PloS one | Year: 2015

Progestagen-associated endometrial protein (PAEP) is a glycoprotein of the lipocalin family that acts as a negative regulator of T cell receptor-mediated activation. However, the function of tumor-derived PAEP on the human immune system in the tumor microenvironment is unknown. PAEP is highly expressed in intermediate and thick primary melanomas (Breslows 2.5mm or greater) and metastatic melanomas, correlating with its expression in daughter cell lines established in vitro. The current study investigates the role of melanoma cell-secreted PAEP protein in regulating T cell function. Upon the enrichment of CD3+, CD4+ and CD8+ T cells from human peripheral blood mononuclear cells, each subset was then mixed with either melanoma-derived PAEP protein or PAEP-poor supernatant of gene-silenced tumor cells. IL-2 and IFN- secretion of CD4+ T cells significantly decreased with the addition of PAEP-rich supernatant. And the addition of PAEP-positive cell supernatant to activated lymphocytes significantly inhibited lymphocyte proliferation and cytotoxic T cell activity, while increasing lymphocyte apoptosis. Our result suggests that melanoma cell-secreted PAEP protein immunosuppresses the activation, proliferation and cytotoxicity of T lymphocytes, which might partially explain the mechanism of immune tolerance induced by melanoma cells within the tumor microenvironment.


PubMed | Advocate Christ Medical Center and Advocate Cancer Institute
Type: Journal Article | Journal: The Ochsner journal | Year: 2016

Formerly, anesthetized patients who received intraoperative radiation therapy (IORT) had to be transported from the operating room (OR) to the location of the linear accelerator. With the advent of mobile accelerators, therapy is delivered directly to the patient in the OR, presenting specific challenges for the anesthesiologist.We review the uses and benefits, operative and anesthetic challenges, and unique issues associated with IORT.Patient safety and precise delivery of the radiation dose are the primary goals of IORT. The anesthesiologists role in ensuring the success of these two outcomes includes selecting the optimal anesthetic technique to prevent patient movement and permit sentinel node mapping, monitoring the patients vital signs throughout the procedure, and ensuring that the sterile field is maintained in the OR.Although keeping patients in the OR has simplified the process of providing IORT, the anesthesiologist must be aware of potential problems and plan accordingly.


PubMed | Advocate Lutheran General Hospital, Capital Medical University and Advocate Cancer Institute
Type: Journal Article | Journal: The Ochsner journal | Year: 2016

Imiquimod is a topical cream approved by the US Food and Drug Administration for treatment of superficial basal cell carcinoma, actinic keratosis, and genital-perianal warts. Its successful use in patients with persistently positive margins of melanoma in situ (MIS) after surgical excision has been previously reported.A 75-year-old female presented with a primary melanoma that was removed through an elliptical excision with 1 cm margins. Pathology revealed 3 involved margins with residual MIS without an invasive component. After a second operation removed an additional 1 cm margin, pathology revealed 2 positive margins with residual MIS. Rather than undergoing a third excision, the patient decided to pursue a nonsurgical approach with topical imiquimod, and at the 4-month follow-up examination, the incision was completely healed with no clinical evidence of tumor recurrence.A nonsurgical approach with 5% topical imiquimod cream applied along the incision was utilized. In specific patient populations, the use of imiquimod is a reasonable alternative approach for the management of persistently positive MIS margins. Long-term follow-up is necessary to assess for evidence of recurrence and the ultimate success of this nonsurgical approach.


PubMed | University of Illinois at Chicago and Advocate Cancer Institute
Type: Journal Article | Journal: The Ochsner journal | Year: 2016

Male breast cancer (MBC) is an uncommon malignancy with an incidence that accounts for about 1% of all breast cancer cases. It commonly presents as a locally advanced tumor that has already spread to the regional nodal basin. Similar to female breast cancers, MBC gene expression profiling and tumor studies help to detect molecular subtypes of tumors that correlate with clinical outcome and mortality rates.We report a relatively uncommon case of a 64-year-old male with a BRCA1+ gene mutation that is also found to be HER2+ on receptor analysis. Initial diagnostic studies with mammography and ultrasound revealed a left-sided hypoechoic mass measuring 2.3 cm, located at the 11 oclock position adjacent to the nipple-areolar complex. Whole body positron emission tomography-computed tomography scan revealed a hypermetabolic retroareolar left breast mass and enlarged, hypermetabolic left axillary lymph nodes. Final pathology revealed an infiltrating ductal carcinoma with a Nottingham histologic score of 3 (mitotic count score, 3; nuclear pleomorphism score, 3). Of the 19 lymph nodes examined, 15 had evidence of macrometastatic disease.This report highlights a novel case of MBC with a rare genotypic presentation. A need exists to further explore this disease process because the literature is scant with information regarding the long-term treatment and outcomes of MBC, especially in the genotypic form presented here. Subsequent studies in the long-term outcomes of various MBC cases will need to be pursued to better understand the optimal screening and treatment strategies for this disease.


PubMed | Advocate Christ Medical Center, University of Illinois at Chicago and Advocate Cancer Institute
Type: Journal Article | Journal: The Ochsner journal | Year: 2016

Desmoid tumors are relatively uncommon tumors, and those occurring sporadically and in an intraabdominal location are especially rare. Although desmoid tumors have a benign histologic appearance and lack the ability to metastasize, they can invade locally, often aggressively, grow to large sizes, and recur repeatedly.We present the case of a symptomatic, giant mesenteric desmoid tumor discovered incidentally during workup for the patients previous history of lung cancer. The patient elected to undergo palliative resection of the tumor because of persistent and unrelenting abdominal pain.Because of the rarity of the disease, no clear evidence-based guidelines exist for the treatment of sporadic mesenteric desmoid tumors. Review of the available literature suggests that surgical resection with negative margins is a reasonable approach for patients with symptomatic tumors.

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