May 2008 - bcps

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JOURNAL OF BANGLADESH COLLEGE OFPHYSICIANS AND SURGEONSVol. 26, No. 2, Page 58-111 <strong>May</strong> <strong>2008</strong>CONTENTSEDITORIALNew Management Strategies of Hormone Refractory Prostate Cancer (HRPC) 58Prof. M.A. SalamORIGINAL ARTICLESSerum Apoprotein ( ApoA1 and ApoB) in Myocardial infarction 62KA Jhuma, MM HoqueProblems and Immediate Outcome of Infants of Diabetic Mothers 67CB Mahmood, MI KayesRadioiodine (131i) Therapy for Thyrotoxicosis Patients and their Outcome: Experience 73at Center for Nuclear Medicine & Ultrasound, BarisalSK Biswas, N Jahan, KBMA RahmanCo-relation between Sepsis Score and Blood Culture Report in Neonatal Septicaemia 79S Afroza, F BegumREVIEW ARTICLESJuvenile Idiopathic Arthritis Essential Elements of Care 83MR AlamApproach to Subclinical Thyroid Disease 91SR SutradharCASE REPORTSGonadoblastoma: Primary Amenorrhoea with Gonadal Dysgenesis 97H Begum, S Khaton, S JahanHenoch-Schonlein Purpura in an Elderly Women Presenting with Severe GI Bleeding: 100A Case ReportMAJ Chowdhury, SM Arafat, Abed HussainMalignant Melanoma of the Vagina - A Case Report 103N Sultana, CM Ali, RA Khanam, M KhatunCOLLEGE NEWS106
EDITORIALNew Management Strategies of Hormone RefractoryProstate Cancer (HRPC)Carcinoma prostate is the commonest cancer in menand recognized as the commonest killer of men.Prostate cancer incidence is increasing in Bangladeshas the detection technology and people are servingslonger. Prostate cancer progression ends up atHormone Refractory Prostate Cancer (HRPC) orstage D3 status where no endocrine manipulation iseffective. The median survival at this stage of prostatecancer is usually less than 10 months. World wide lifeof the most of the prostate cancer patients areterminated at this stage.Hormone Refractory Prostate Cancer (HRPC) mayoccur due to the fact that prostate cancer cell escapefrom androgen withdrawal-induced apoptosis. In thisdevelopment, enhancement of growth factorstimulation has an essential role in the up regulationof survival signals and constitutive proliferation 1 .The principle of treatment for advanced prostatecancer is endocrine manipulation which includesandrogen deprivation. Unfortunately, at this stage ofprostate cancer most of men become resistant tohormonal manipulation, developing what is definedas hormone-refractory prostate cancer (HRPC). Adecade ago, most clinicians find no answer and felthelples*ecause no Chemotherapy was considered tobe ineffective and associated with unacceptabletoxicity. A review of 26 chemotherapy-based trialsrevealed an overall response rate of 8.7% with amedian survival ranging from. 6 to 10 mo 2 . For thisreason, it was established that a median expectedsurvival for patients with HRPC is 10 months.Therefore, novel therapeutic strategies that target themolecular basis of androgen resistance were required.Role of chemotherapy in HRPC was emphasized In2004. Two pivotal trials of Docitaxel-basedchemotherapy were reported and, for the first time, asurvival benefit was observed for chemotherapy inHRPC. The results from the Southwest OncologyGroup (SWOG )99-16 and TAX327 studies changed theexpectations of treatment outcome these patients 7,8 .Also these trials demonstrated the need forcombination therapies in patients with HRPC.The combination of Docitaxel with estramustineincreases the thrombo embolic risk and necessitates aprimary prophylaxis 7,8 . New combination modelsusing Docitaxel may represent an excitinginvestigational field 9 . In particular, less toxicregimens, provided that the activity can bemaintained, are more attractive.Recently, Di Lorenzo et al 9 presented an interestingproposal using a combination of docetaxel,vinorelbine, and zoledronic acid as first-linetreatment in patients with HRPC. Vinorelbine is avinca alkaloid that inhibits the microtubular apparatusin malignant cells and has shown activity in HRPC 9 .The synergism of docetaxel and vinorelbine has beenconfirmed in preclinical studies and human trials 9 .Moreover, the use of docetaxel in a weekly scheduleappears to minimize myelo suppression and has beenassociated with moderate toxicity 9 .Most HRPC develops bone metastases thatt areresponsible for pain and morbility. Bisphosphonatesshowed an inhibitory effect on prostate cancer bonemetastases by blocking proteolytic activity of thematrix, cell adhesion, and possibly cancer cellgrowth 9 . Multicentric randomised trials of HRPCwith bone metastases showed a significant reductionin skeletal related events using zoledronic acid 9 .Di Lorenzo et al 9 developed a phase 2 study toevaluate the impact of weekly docetaxel andvinorelbine and monthly zoledronic acid on PSAresponse, pain improvement, and toxicity profile in40 men with HRPC. Complete and partial response(PSA reduction) were observed in 18% and 32% ofcases, respectively.The objective of this editorial is to emphasizes twopossible strategies: the first, specifically targeted tothe role of the neuro endocrine (NE) system in
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Page 4 and 5: Introduction:The introduction will
Page 8 and 9: Journal of Bangladesh College of Ph
Page 10 and 11: ORIGINAL ARTICLESSerum Apoprotein (
Page 12 and 13: Serum Apoprotein ( ApoA1 and ApoB)
Page 14 and 15: Serum Apoprotein ( ApoA1 and ApoB)
Page 16 and 17: Problems and Immediate Outcome of I
Page 22 and 23: Radioiodine (131i) Therapy for Thyr
Page 28 and 29: Co-relation between Sepsis Score an
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Page 32 and 33: Juvenile Idiopathic Arthritis Essen
Page 40 and 41: Approach to Subclinical Thyroid Dis
Page 46 and 47: Gonadoblastoma: Primary Amenorrhoea
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Page 50 and 51: Henoch-Schonlein Purpura in an Elde
Page 52 and 53: Malignant Melanoma of the Vagina -
Page 54 and 55: COLLEGE NEWS(J Bangladesh Coll Phys
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College NewsRoll No. Name of candid
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College NewsContinuing Professional
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