The hypoxia-inducible factor 1alpha (HIF-1alpha) plays a major role in cancer progression. The role of this transcription factor in prostate cancer development and its transition to a metastatic and androgen refractory state remains to be elucidated. Previous reports have identified the existence of single nucleotide polymorphisms (SNPs) in the oxygen-dependent degradation domain of the HIF-1alpha gene in renal cell carcinoma, head and neck squamous cell carcinoma, and androgen-independent prostate cancer (AIPC). Studies in prostate cancer, however, are variable and limited in the number of cases assessed. Herein we further investigate these SNPs, specifically C1772T (which results in an amino acid change from proline 582 to serine) and G1790A (alanine 588 to threonine). The frequency of these polymorphisms was evaluated in a population of individuals with metastatic AIPC and compared to a set of healthy control subjects. The distribution of HIF-1alpha genotypes for C1772T in 196 AIPC patients was 161 C/C (82.1%), 29 C/T (14.8%), and 6 T/T (3.1%). The genotype distribution in 196 controls was 179 C/C (91.3%), 14 C/T (7.1%), and 3 T/T (1.5%). Our results demonstrate a significant difference in genotype distribution between AIPC patients and control subjects only for the C1772T polymorphism (p = 0.024). The association of the incidence of the polymorphism with overall survival was determined to be not statistically significant (p = 0.93) by the Mantel-Haenszel (log-rank) test. These results suggest that the C1772T polymorphism in HIF-1alpha may confer susceptibility to AIPC and contribute to the progression or metastasis of this disease.

Intravenous immunoglobulin (IVIG) with high titers to West Nile virus was used as an adjuvant therapy for a patient with West Nile virus encephalitis that did not respond to supportive care. We present this case report and review the evidence supporting the use of high-titer IVIG.

200 mg/day and estramustine was given three times a day at 1, 2, 3, 8, 9, 10, 15, 16 and 17 days. RESULTSIn the mice, thalidomide with docetaxel plus estramustine reduced tumour volume by 88% at 17 days vs the control treatment ( p = 0.001). The combination of docetaxel, estramustine and thalidomide nearly eradicated the signal from the luciferaseexpressing PC3M cells in the metastasis model. Clinically, the progression-free time was 7.2 months with this combination; 18 of 20 patients had a decline of half or more in prostate-specific antigen level and two of 10 patients with soft-tissue lesions had a partial response on computed tomography. There were 24 grade 3 and two grade 4 complications associated with this combination. There was a statistically significant association between overall survival and the CYP1B1*3 genotype ( P = 0.013). CONCLUSIONDocetaxel-based chemotherapy is now regarded as a standard regimen for metastatic AIPC. The combination of estramustine, docetaxel and thalidomide is an advantageous treatment in pre-clinical models of prostate cancer and is a safe, tolerable and active regimen in patients with AIPC.

Malignant pericardial disease is a serious and common problem seen in patients with cancer. It is usually due to metastatic spread of the underlying malignancy or a complication of radiation therapy. The patient may have a mild, subtle presentation, as is often seen in the early stages of pericardial effusion, or may experience dramatic hemodynamic compromise, as is seen with cardiac tamponade and constrictive pericarditis. There are many treatment options available that range from simple drainage to thoracic surgery. It is essential that the treating physician choose a treatment plan in the context of the cancer stage and the patient's prognosis. This article discusses the incidence, pathophysiology, clinical presentation, diagnosis, and treatment options in the various types of malignant pericardial disease.