Trousseau's syndrome (cancer-associated thrombosis) is the second leading cause of death in cancer patients, after death from cancer itself. The risk of a venous thromboembolism is 4-to 7-fold higher in patients with cancer than in those without cancer. The causes of this impaired coagulation are associated with general patient-related risk factors, and other factors that are specific to the particular cancer or treatment. It is important to assess the risk of thrombotic events in cancer patients and administer effective prophylaxis and treatment. Effective prophylaxis and treatment of venous thromboembolism reduces morbidity and mortality, and improves patients' quality of life. Low molecular weight heparin is the first-line treatment for venous thromboembolism, as an effective and safe means for prophylaxis and treatment, according to guidelines released by international scientific societies. Oral anticoagulation therapy with warfarin is preferable to no therapy. However, warfarin has low efficacy and is associated with high rates of recurrence. If low molecular weight heparin is unavailable, some guidelines recommend the use of vitamin K antagonists that have a target international normalized ratio in the range of 2-3, as acceptable alternatives. Novel oral anticoagulants that directly inhibit factor Xa or thrombin are promising for the prophylaxis of high-risk cancer patients and in the long-term treatment of venous thromboembolism. However, to date, there is insufficient evidence to support the use of these new anticoagulants.

Reciprocal Ia inhibition from ankle flexors to extensors was studied during voluntary tonic isometric dorsiflexion and plantar flexion in five normal subjects. The Ia inhibition was examined as the short-latency suppression of the soleus H-reflexes by stimulation of the low-threshold afferents in the common peroneal nerve (Mizuno et al. 1971). At rest, weak Ia inhibition was demonstrated in four subjects out of five, the maximal amount being 14.1 +/- 5.0% suppression of the control H-reflex. The absolute amount of inhibition, which was calculated by subtracting the mean size of the conditioned H-reflex from that of the control H-reflex and expressed as a percentage of the maximal M-response, increased during ankle dorsiflexion, and decreased or disappeared during plantar flexion in parallel with the amount of contraction. The neural mechanisms for facilitation of the Ia inhibitory pathway during dorsiflexion were considered to support the hypothesis of "alpha-gamma-linkage in reciprocal inhibition", i.e. combined facilitatory effects on the Ia inhibitory interneuron from the supraspinal centers directly and indirectly via the gamma motoneuron--Ia afferent route. The mechanism for inhibition of the pathway during plantar flexion was considered to be inhibition of the Ia interneuron of the flexor side by Ia interneuron of antagonist extensors. A quantitative aspect of activity in the reciprocal Ia inhibitory pathway on the performance of voluntary movement is revealed in this study.

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A 56-year-old woman, a never-smoker, had postoperative recurrence of anaplastic lymphoma kinase rearranged lung cancer. She achieved a partial response to treatment with an anaplastic lymphoma kinase tyrosine kinase inhibitor, crizotinib. After the tumor regrowth, crizotinib was switched to alectinib; once again a partial response was observed. At the second recurrence, transbronchial needle aspiration of the right paratracheal node was performed, which revealed cytological findings of small-cell carcinoma. While treatment with cisplatin-irinotecan chemotherapy made reduction of some tumor shadows, including the biopsied mediastinal lymph nodes, new, small, nodular shadows, highly suggestive of pulmonary metastases, were detected in both lung fields. This case may show proof of the transformation to small-cell lung cancer as a mechanism of resistance to anaplastic lymphoma kinase tyrosine kinase inhibitors in anaplastic lymphoma kinase rearranged tumor. However, this transformation may also be only one part of the resistance mechanism of the heterogeneous tumor.

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