Ectopic Murmurs
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Official Publication of the FAR EASTERN UNIVERSITY Dr Nicanor Reyes Jr School of Medicine Alumni Foundation ECTOPIC MURMURS Volume 24 Number 3 March 2013 Opinions and articles published herein are those of the authors and do not necessarily reflect that of the FEUDNSM Alumni Foundation MEET US IN LAS VEGAS (PRESIDENT’s Tenderly Yours ) NOLI GUINIGUNDO MD 62 The Board Trustees, past and The price given to us kept on present officers of the changing; hence the decision FEUDNRSM to go to Monte Carlo Casino Alumni and Resort. Foundation will We hope for a good convene this attendance. We also hope for a Saturday, good show inspite of the ever March 16, rising price of the airline 2013, in Las tickets. We probably do not NOLI C POPE FRANCIS, Welcome! GUINIGUNDO MD Vegas for its have much choice but to take Spring the quoted price of the meeting. different airlines. The venue this year is the To date, we do not have a Monte Carlo Casino and Resort. Pope. His Holiness, Pope especially if his health is We apologize for the earlier Benedict XVI, resigned on involved and at risk. announced venue in Treasure February 28, 2013. Our Archbishop of Manila, Island. The Las Vegas hotel He is the first Pope to resign Luis Antonio Cardinal Tagle is failed to communicate with Dr from office in more than 600 one of those being considered to Oscar Tuazon who made the years. But, he probably has all become Pope, Papabili . The arrangement for the meeting. the valid reasons for doing so, continue on page 11 MARCH IMAGE Some of the FEUDNRSM Alumni Foundation scholars in white uniform outfit are shown with alumni, from left, Drs Frank Rabadam, Grace Rabadam, Farida Chua, Arsenio Martin, Melinda Fabito, Daniel Fabito and Philip Chua. SEQUESTRATION FROM ASHES ON PECHAY ULYSSES M CARBAJAL MD on Medical Care 61 TO ASHES CESAR D CANDARI, MD 62 Introduction. Pechay is a CELSO DEL MUNDO MD leafy vegetable plant with Sequestration is the budget We’re all God’s cuts which will slash $1.2 symmetrically creations arranged trillion from coming from federal leaves. Each the ashes, leaf, which is spending over With His the next a verdant power, He widening decade. It has gave us life taken more CELSO DEL sheet, is fused MUNDO MD with the ULYSSES M with the than a year of human form, CARBAJAL MD tapered top of CESAR D anticipation We have all immortal souls CANDARI MD about whether a concave succulent stalk. within this pile of ashes, From the time of planting, a Congress and At the end of life we will go President Barack Obama would pechay plant matures within back to earth except our two to three months. If left strike a compromise, however, crying souls. finally it kicked-off March 1. alone longer, the plant sometimes bears a cluster of Enumerable articles have been Alive we are all dancing above written on these subjects. I have yellowish flowers. The tiny the troubled water, summarized them in tidbits for In the beginning we are solid everyone to make your own masses with immortal souls, take. In the first place the act Time will come when the was considered a last resort that physical being will turn to would force Congress and the crumpled ashes, Obama administration to reach From ashes to ashes we an agreement on federal deficit dissipate except our loosened reduction in order to avert large soul, cuts to defense and non-defense programs. Don’t waste time for solid mass What is its impact to that give heat like a burning Medical care? An up-to-date ember, statement from Massachusetts Let the ashes give the rays of Medical Society (MMS): More light to all the corners of the than a billion dollars in disaster world, relief, more than $350 million From when the ashes turn into for the Centers for Disease ashes, we have life no more, petals are finally shed, each Control and Prevention, and Just a pile of dusts, going back leaving a tiny fruit, which more than $133 million for the to earth where we all are consists mostly of a single seed. Food and Drug Administration from. A variety that is commonly are among the scheduled cuts. grown in school gardens and Mental health services, AIDS/ more so in farms is one which HIV prevention and treatment, had been introduced from and food safety programs are China. This is most commonly also to be reduced, as are used in Chinese restaurants. payments to health care May I now recount three providers. lessons in life, associated with Under the current sequester planting and harvesting pechay . rules, Medicare will be cut by A Lesson on Fairness. $100 billion over the next 10 From ashes to ashes When I was in grade one, continue on page 9 continue on page 7 CLINICAL IMAGE SSS A CURE IN TRIPLE-NEGATIVE BREAST DUCTAL CARCINOMA? These images are from a 41- (Figure 1 ), highlighted on confirmed a high-grade ductal year old woman who presented mammogram as a bright dense, carcinoma, Nottingham score with a palpable left breast irregular, poorly circumscribed 3+3+2=8 (acinar formation, nodule immediately posterior to and poorly demarcated mass in nuclear pleomorphism, and the nipple with periareolar the center of the left breast mitotic figures, respectively), inflammatory cutaneous tissue ( Figure 2). without basaloid features. The changes. Figure 3 , clockwise, ( A) the negative immunostain Ultrasound affirmed a 2.0- stereotatic-guided vacuum- represents (B) 0% estrogen cm tumor underneath the nipple assisted core-needle biopsy receptor, (C) 0% progesterone receptor and (D) under- expressed HER2; ( E) 90% p53, and ( F) 30% Ki-67. In addition, S-phase and DNA molecular evaluation showed aneuploid. The final results signified a triple-negative high-grade ductal carcinoma associated with unfavorable p53, Ki-67 and aneuploid DNA. The patient was administered with systemic chemotherapy of gemcitabine, nab -paclitaxel, and bevacizumab once every other week for seven months with significant improvement. The regimen was followed Figure 1 Figure 2 by bilateral modified radical mastectomies which microsco- pically were negative for residual malignancy. No new tumor in either breast was also noted. The mastectomy surgical margins were negative for malignancy. BCD Two sentinel lymph nodes A excised were negative for metastasis. Breast reconstruction was done shortly thereafter, and follow-up for 5½ -year, to date, showed no recurrence or metastasis. COMMENTS and LITERATURE REVIEW. F E Triple-negative breast cancer (TNBC) is defined as tumors Figure 3 that neither express hormone Patients with metastatic overall survival compared with receptors nor overexpress TNBC exhibit progressively patients with residual invasive human epidermal growth factor shorter response durations to disease. receptor 2 (HER2)/ Neu gene successive lines of therapy. Less than 10% develop a amplification. In a retrospective series of distant recurrence at 5 years, TNBC tumors account for 111 patients with TNBC, 14% and equivalent to that for approximately 15% of breast of whom presented with patients with other breast cancer cancers. metastatic disease at diagnosis, subtypes who experience a Clinically, they are highly the median duration of response pathologic complete resolution. aggressive and dispropor- was only 12 weeks (range, 0– Those patients with TNBC tionately affects young women 73.1 weeks) to first-line who do not experience a under 40, African American, therapy, 9 weeks (range, 0– pathologic complete remission and women who have a genetic 120.9 weeks) to second-line with the same chemotherapy mutation called BRCA1. chemotherapy, and 4 weeks have a much poorer prognosis The risk of recurrence is (range, 0–59 weeks) to third- — an observation that has higher than other breast cancer line chemotherapy. sometimes been referred to as types within the first 3 years. There is still an unattained the triple-negative paradox . Distant recurrences in the clinical need for effective FINAL DIAGNOSIS. brain and visceral metastases therapies that prolong survival Triple negative, high-grade are more common than in for patients with metastatic infiltrating ductal carcinoma hormone receptor-positive TNBC. Stage IA in complete tumors. In the absence of possibly remission for 5½ years. Therapeutically, despite curative therapies for metastatic A list of REFERENCES is being highly chemosensitive, disease, the goal of therapy is available upon request. their progression-free time is primarily palliative in nature, by CESAR V REYES MD 68 generally short; and there is leveraging systemic treatment about 25% of patients treated with minimal toxicity during with standard pre-mastectomy remission and at the same time chemotherapy achieve complete enhance quality of life by remission. delaying the onset of cancer- COMMENTS Chemotherapy-wise, related symptoms. Editorials, news releases, anthracyclines and taxanes are The patient illustrated here is letters to the editor, column useful drugs; and high response an instance in Stage IA TNBC proposal and manuscripts rates have been described for treated with first-line are invited. the combination of ixabepilone- combination chemotherapy capecitabine and platinums. consisting of nab-paclitaxel, Email submission, including The addition of antiangio- bevacizumab, and gemcitabine figures or pictures, genic drugs has also proven every other week. After only 5 is preferred. useful. weeks and 2 infusions, the A group of new drugs, poly- patient experienced mass size (ADP-ribose)-polymerase decrease and symptom relief. ECTOPIC inhibitors, showed favorable Following seven months of results in TNBC tumors with treatment, the patient achieved a MURMURS BRCA mutation. complete remission that, with There are also currently continuous therapy, persisted Deadline for the several ongoing studies with for 5½ years to date. April 2013 issue new drugs including epidermal Overall, patients who growth factor receptor experience a pathologic April 15, 2013 inhibitors, c-kit inhibitors, Raf/ complete response with Mek/ Map kinase inhibitors and neoadjuvant chemotherapy have Please address submissions mTOR inhibitors.