Treatment approach in patients with hyperbilirubinemia secondary to liver metastases in gastrointestinal malignancies: a case series and review of literature

BACKGROUND: Treatment of patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastases of gastrointestinal (GI) cancer is challenging. Regimen of oxaliplatin and fluoropyrimidine (FP)/folinic acid (FA) ± a monoclonal antibody (moAb), represents a feasible option considering the pharmacokinetics. Clinical data on the respective dosage and tolerability are limited and no recommendations are available. METHODS: Consecutive patients with severe hyperbilirubinemia [>2 × upper limit of the normal range (ULN) and >2.4 mg/dl] due to liver metastases of GI cancer without options for drainage receiving oxaliplatin, FP/FA ± moAb were analyzed. To collect further data a review of the literature was performed. RESULTS: A total of 12 patients were identified between 2011 and 2015. At treatment start, median bilirubin level was 6.1 mg/dl (>5 × ULN, range 2.7-13.6). The majority of patients (n = 11) received dose-reduced regimen with oxaliplatin (60-76%) and FP/FA (0-77%), rapidly escalating to full dose regimen. During treatment, bilirubin levels dropped more than 50% within 8 weeks or normalized within 12 weeks in 6 patients (responders). Median overall survival was 5.75 months (range 1.0-16.0 months) but was significantly prolonged in responders compared to nonresponders [9.7 and 3.0 months, p = 0.026 (two-sided test); 95% confidence interval (CI): 1.10-10.22]. In addition, case reports or series comprising a further 26 patients could be identified. Based on the obtained data a treatment algorithm was developed. CONCLUSION: Treatment with oxaliplatin, FP/FA ± moAb is feasible and may derive relevant benefits in patients with severe liver dysfunction caused by GI cancer liver metastases without further options of drainage.

Lichtheimia Infection in a Lymphoma Patient: Case Report and a Brief Review of the Available Diagnostic Tools

We describe the case of a patient with a T-lymphoblastic lymphoma whose disseminated mucormycosis was diagnosed with delay, and we address the diagnostic and therapeutic decision-making process and review the diagnostic workup of patients with potential IFD. The diagnosis was delayed despite a suggestive radiological presentation of the patient's pulmonary lesion. The uncommon risk profile (T-lymphoblastic lymphoma, short neutropenic phases) wrongly led to a low level of suspicion. The diagnosis was also hampered by the lack of indirect markers for infections caused by Mucorales, the low sensitivity of both fungal culture and panfungal PCR, and the limited availability of species-specific PCR. A high level of suspicion of IFD is needed, and aggressive diagnostic procedures should be promptly initiated even in apparently low-risk patients with uncommon presentations. The extent of the analytical workup should be decided on a case-by-case base. Diagnostic tests such as the galactomannan and β-D-glucan test and/or PCR on biological material followed by sequencing should be chosen according to their availability and after evaluation of their specificity and sensitivity. In high-risk patients, preemptive therapy with a broad-spectrum mould-active antifungal agent should be started before definitive diagnostic findings become available.

Slavery and the remedy, or, Principals and suggestions for a remedial code ; with a review of the decision of the supreme court in the case of Dred Scott.

Mode of access: Internet.

A review of the case of the civil servants of the Crown : with reference to the question of their superannuation and salaries /

Mode of access: Internet.

Why Pope Pius XI asked prayers for Russia on March 19, 1930 : a review of the facts in the case together with proofs of the international program of the Soviet government /

Cover title.

Channelization of streams and rivers in Illinois : procedural review and selected case studies /

"Printed: January 1991."

Review of the case of the free bridge between Boston and Charlestown : in which the expediency and constitutionality of that measure are considered : with a statement of the legislative proceedings upon it at the late January session, including the public documents.

Mode of access: Internet.

Review, of the report of the case of the Commonwealth versus David Lee Child, for publishing in the Massachusetts Journal a libel on the honorable John Keyes.

At head of title: (From the Concord (Middlesex) Gazette.).

Review of a report to the House of Representatives of the Commonwealth of Massachusetts, on the case of William Vans. With observations upon the dispensing power of the Legislature, and upon a decision of the Supreme Judicial Court, "nullifying" the said power.

"Postscript by William Vans": p. [13]-15 at end.

A further illustration of the case of the Seneca Indians in the state of New York : in a review of a pamphlet entitled "An appeal to the Christian community, &c., by Nathaniel T. Strong, a chief of the Seneca tribe."

"Printed by direction of the Joint Committees on Indian Affairs, of the four Yearly Meetings of Friends of Genesee, New York, Philadelphia, and Baltimore."

National rights and state rights : a review of the case of Alexander McLeod : recently determined in the Supreme Court of Judicature of the state of New York /

"Reprinted from The law reporter."

Factual brief, submitted on behalf of the Industrial Commissioner, in the matter of the petitions of certain affected persons, firms, and corporations, for a review of the validity or reasonableness of Directory order number 7, governing minimum wage standards in the retail trade industry, promulgated under Article 19 of the Labor law. Case no. 2828-45, et al.

Cover title.

Histoplasmosis in Australia: A report of a case with a review of the literature

Histoplasmosis is a rare but serious fungal infection commonly presenting as mucosal ulceration of the oral cavity. It is increasingly recognized in Australia but the source of infection remains obscure and it is likely to be under-diagnosed. We report a case of chronic mucosal ulceration which failed to fully respond to periodontal therapy. Histology and culture of a gingival biopsy was consistent with histoplasmosis, and the patient responded favourably to treatment with oral itraconazole. Histoplasmosis may present to general dental practitioners as chronic mucosal ulceration and should be considered in the differential diagnosis of such lesions. Diagnosis is best made by culture and histology of biopsy specimens.