A B S T R A C T PurposeDespite aggressive therapies, median survival for malignant gliomas is less than 15 months. Patients with unmethylated O 6 -methylguanine-DNA methyltransferase (MGMT) fare worse, presumably because of temozolomide resistance. AdV-tk, an adenoviral vector containing the herpes simplex virus thymidine kinase gene, plus prodrug synergizes with surgery and chemoradiotherapy, kills tumor cells, has not shown MGMT dependency, and elicits an antitumor vaccine effect. Patients and MethodsPatients with newly diagnosed malignant glioma received AdV-tk at 3 ϫ 10 10 , 1 ϫ 10 11 , or 3 ϫ 10 11 vector particles (vp) via tumor bed injection at time of surgery followed by 14 days of valacyclovir. Radiation was initiated within 9 days after AdV-tk injection to overlap with AdV-tk activity.Temozolomide was administered after completing valacyclovir treatment. ResultsAccrual began December 2005 and was completed in 13 months. Thirteen patients were enrolled and 12 completed therapy, three at dose levels 1 and 2 and six at dose level 3. There were no dose-limiting or significant added toxicities. One patient withdrew before completing prodrug because of an unrelated surgical complication. Survival at 2 years was 33% and at 3 years was 25%. Patient-reported quality of life assessed with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) was stable or improved after treatment. A significant CD3 ϩ T-cell infiltrate was found in four of four tumors analyzed after treatment. Three patients with MGMT unmethylated glioblastoma multiforme survived 6.5, 8.7, and 46.4 months. ConclusionAdV-tk plus valacyclovir can be safely delivered with surgery and accelerated radiation in newly diagnosed malignant gliomas. Temozolomide did not prevent immune responses. Although not powered for efficacy, the survival and MGMT independence trends are encouraging. A phase II trial is ongoing.

The kidney abscess and/or xanthogranulomatosis pyelonephritis are the result of a lithiasis not treated obstruction that conditions to the appearance of urinary infection and posterior pyonephrosis and or kidney abscess. The not early detection of the kidney abscess conditions to the perforation to retroperitoneal, intra-abdominal and to chest. The early treatment of the abscess (antibiotics and percutaneous drainage) it can avoid the nephrectomy.

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INTRODUCTION: Chronic Lymphocytic Lymphoma (CLL)is the most common form of leukemia in adults. Lung involvement in CLL is rare, once thought to be potentially related to chemotherapy-induced toxicity or from a secondary malignancy. We report a case of pleural effusion as the sole presenting feature of CLL.

PURPOSE: Obesity causes lung restriction and often results in exertional dyspnea. Exercise capacity is reduced in obese subjects, possibly due to impairment in ventilation during exercise. Body Mass Index (BMI) affects exercise capacity (VO2max). Whether BMI affects ventilatory parameters during exercise, thereby contributing to dyspnea has not been studied. The objective of this study was to determine the impact of BMI on ventilatory parameters-maximal voluntary ventilation (MVV), ventilation at maximal exercise (VEmax), Breathing reserve (BR), Respiratory rate (RR) and Tidal volume (VT) at peak exercise during Cardiopulmonary Exercise Testing (CPExT). METHODS: Patients who underwent CPExT for evaluation of dyspnea in our institution over the last 2 years were studied. The following parameters were obtained from their records: age, gender, BMI, VO2max, MVV, RR, VT, VEmax, and BR during CPExT. Correlation between BMI and respectively MVV, VEmax, RR, VT and BR was determined by using Pearson's test for linear correlation. p < 0.05 was deemed statistically significant. RESULTS: Of 84 patients, who underwent CPExT, 58% were females; mean age was 56AE 15 years. Mean BMI was: 28.3AE5.6 kg/sqm; 33% were obese with BMI > 30. Mean values of studied parameters: VO2 max ¼ 71AE5.6 percent predicted (%); MVV ¼ 85 AE23%; VEmax¼65AE17.6 %; BR ¼ 30AE17 percent; RR ¼ 32AE 8 breaths/minute; VT ¼ 3AE12.4L. The correlation between BMI and respective studied parameters and their statistical significance were as follows: