Large Mediastinal Teratoma Originating from the Aortic Adventitia
Many mediastinal tumors do not cause local symptoms, so they are discovered incidentally upon thoracic imaging. We present the case of a patient who had a large, mature, cystic, mediastinal teratoma. The primary tumor arose from the ascending aortic adventitia and was in a highly unusual location—the medial mediastinum. The teratoma, which was diagnosed in our patient on thoracic computed tomography for follow-up evaluation of empyema, was resected completely. To our knowledge, such a teratoma, arising from the adventitia of the ascending aorta in the medial mediastinum, has not previously been reported in the English medical literature.
We review diagnostic methods and therapeutic approaches to such mediastinal tumors. We conclude that surgical resection is the method of choice for treating these tumors, because it enables radical therapy and tissue diagnosis after extirpation.
Key words: Magnetic resonance imaging, mediastinal cyst, mediastinal neoplasms/diagnosis/surgery, radiography, thoracic, surgical resection, teratoma/diagnosis/surgery, tomography, X-ray computed, tumor markers, biological/blood/diagnostic use
Heart and stroke death rates steadily decline; risks still too high
In an appropriate prelude to American Heart Month, which is just ahead in February, new mortality data from the Centers for Disease Control and Prevention (CDC) shows that, since 1999, coronary heart disease and stroke age-adjusted death rates are down by 25.8 percent and 24.4 percent, respectively. This means that the American Heart Association’s 2010 strategic goal for reducing deaths from coronary heart disease has been achieved, and for stroke nearly achieved – ahead of time. However, potential problems loom for the future, as all of the major risk factors for these leading causes of death are still too high and several are actually on the rise. If this trend continues, death rates could begin to rise again in years ahead.
In 1999, the American Heart Association set a strategic goal of reducing the death rates from coronary heart disease and stroke, and reducing the risk factors for these diseases by 25 percent by 2010. The new CDC data notes early success in meeting the coronary heart disease death rate goal, and shows that success is near for the 25 percent reduction in stroke. However, American Heart Association president Dan Jones, M.D., said the victory could be short-lived if the risk factors that lead to heart disease and stroke are not also reduced.
“This progress in the reduction of death rates is a landmark achievement, and has come about as a result of tremendous efforts from many partners in research, healthcare, government, business and communities,” Jones said.
New therapeutic target for treatment of multiple sclerosis
An international research team, led by a scientist from the Centre hospitalier de l’Université de Montréal (CHUM), has identified new therapeutic targets for the treatment of multiple sclerosis (MS). In the February issue of Nature Immunology, the team provides fresh answers concerning the role of novel adhesion molecules in the pathogenesis of MS, a chronic autoimmune disease of the nervous system that affects approximately 55,000 young adults in Canada.
Conducted by Dr. Alexandre Prat, a CHUM neurologist and researcher and a professor at the Université de Montréal’s Faculty of Medicine, the study included collaborators from McGill University (Dr. S. David), the Université de Montréal (Dr. N. Arbour), the National Research Council of Canada (Dr. D. Stanimirovic) and University of Zürich (Dr. B. Becher). The team found that the adhesion molecule dubbed ALCAM (Activated Leukocyte Cell Adhesion Molecule), or CD166, plays a major role in the migration of certain types of leukocytes to the brain.
Findings Suggest Link Between Vitamin E and Subsequent Decline in Physical Function for Older Adults
Low serum concentration of vitamin E, an indication of poor nutrition, is associated with physical decline for older persons, according to a study in the January 23 issue of JAMA.
“The decline in physical function that occurs with aging often represents the early stage of a continuum leading to disability and other important adverse outcomes such as institutionalization,” the authors write. Understanding the mechanisms associated with this process has been identified as a priority. The potential harmful effect of poor nutrition on physical function in older persons is not well understood.
Benedetta Bartali, R.D., Ph.D., of Yale University School of Medicine, New Haven, Conn., and colleagues conducted a study to determine whether a low concentration of specific micronutrients is associated with subsequent decline in physical function.
Combination Therapy Improves Survival For Certain Prostate Cancer Patients
Men with localized prostate cancer who were treated with male hormone suppression therapy and radiation treatment had longer survival, but those with moderate to high levels of other illnesses did not experience this effect, according to a study in the January 23 issue of JAMA.
Several studies have documented increased survival when androgen (male sex hormone) suppression therapy (AST) is combined with external beam radiation therapy (RT) compared with RT alone in the treatment of unfavorable localized and locally advanced prostate cancer. However, comorbid (co-existing) illnesses may increase the negative effects of specific anti-cancer treatments such as AST, altering the survival benefit observed when AST is added to RT.
Anthony V. D’Amico, M.D., Ph.D., of Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, and colleagues performed an analysis of overall survival of 206 men with localized but unfavorable–risk prostate cancer in subgroups defined by their level of comorbidity at the time of their randomization to AST and RT vs. RT alone. During a median follow-up of 7.6 years, 74 deaths occurred.
