Dietary-derived agents, such as the flavonoids, are of particular interest for prostate cancer (PCa) chemoprevention as they may offer a favourable safety and side-effect profile. An agent that demonstrates action on the androgen receptor (AR) axis may have value for preventing or treating castrate-resistant PCa. Four main flavonols – quercetin, myricetin, kaempferol, and fisetin – have been demonstrated in laboratory studies to have chemopreventive action in both castrate-resistant and castrate-sensitive PCa models. Mechanisms of flavonol action on the AR axis in PCa have been proposed to be inhibition of the 5α-reductase enzymes, direct androgen competition, suppression of the AR complex and transactivation by coregulators such as c-Jun, Sp1, and the PI3K/Akt pathway. It is, however, still unclear with current levels of evidence whether AR axis-mediated effects can fully account for the flavonols’ chemopreventive action.

Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.

Background Inferior vena cava (IVC) tumour thrombus in children with Wilms tumour is typically managed with neoadjuvant chemotherapy with the intention of achieving thrombus regression in order to minimize the risks associated with complex vascular surgery. Methods A systematic review of Medline and Embase databases was undertaken to identify all eligible studies with reference to thrombus viability in Wilms tumour index cases with caval/cardiac extension. A meta-analysis of proportions was utilized for pooled thrombus viability data across studies. Logistic regression was used to analyse the relationship between thrombus viability and duration of chemotherapy. Results Thirty-five eligible observational studies and case reports met inclusion criteria describing a total of 236 patients with thrombus viability data. The pooled proportion of patients with viable tumour thrombus after neoadjuvant chemotherapy was 0.53 (0.43–0.63). Logistic regression analysis of 54 patients receiving either a standard (4–6 weeks) or extended (more than 6 weeks) course of neoadjuvant chemotherapy resulted in an odds ratio of 3.14 (95 per cent c.i. 0.97 to 10.16), P = 0.056, with extended course therapy trending towards viable tumour thrombus. Conclusion Preoperative chemotherapy is successful in achieving non-viability of caval and cardiac thrombi in around 50 per cent of children, without added benefit from extended cycles of neoadjuvant chemotherapy. Risks versus benefits of extirpative vascular surgery must be considered, therefore, for these high-risk patients.

A 53-year-old Cambodian woman presented with nodular masses on the right arm suggestive of a sarcoma-type malignancy. The masses were excised and identified as multiple benign eccrine poromas. The patient re-presented after two years with large relapsed tumours and axillary lymph node involvement. A forequarter amputation was undertaken. Histology confirmed the diagnosis of a porocarcinoma, which was likely to be due to malignant transformation of the original poromas. The size and multiplicity of the tumours represents a highly unusual presentation of these rare eccrine neoplasms.

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