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Open Journal of Rheumatology and Autoimmune Diseases 2014年第3期4卷 146-152页

作者： damien mikael hansra Mario Ponce Francisco Socola Maria Helena Restrepo Department of Hematology/Oncology Sylvester Comprehensive Cancer Institute Jackson Memorial Hospit-al/University of Miami Miami Florida USA Department of Hematology/Oncology Sylvester Comprehensive Cancer Institute University of Miami Miami Florida USA Department of Medicine Jackson Memorial Hospital/University of Miami Miami Florida USA

A Pleural mass biopsy was performed showing an invasive thymoma. Computed tomography (CT) scan of the chest performed on admission revealed a left sided pleural mass, anterior mediastinal mass, lymphadenopathy and pericardial effusion. Pleural mass biopsy showed an invasive thymoma. Due to her clinical presentation, a complete work-up was performed revealing paraneoplastic systemic lupus erythematous (SLE), myasthenia gravis (MG) and hypogammaglobulinemia. We reviewed the literature regarding thymoma and its relationship with paraneoplastic SLE, MG and hypogammaglobulinemia.

关键词： Thymoma Paraneoplastic Systemic Lupus Erythematosus Myasthenia Gravis Hypogammaglobulinemia

Patient with Metastatic Breast Cancer Achieves Stable Disease for 5 Years on Graviola and Xeloda after Progressing on Multiple Lines of Therapy

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Advances in Breast Cancer Research 2014年第3期3卷 84-87页

作者： damien mikael hansra Orlando Silva Ashwin Mehta Eugene Ahn Department of Hematology and Oncology Sylvester Comprehensive Cancer Center at the University of Miami Miami USA

Breast cancer (BC) is the most common malignancy in women and is second to lung cancer in terms of cancer mortality. Treatment of BC remains a challenge as current therapies are limited by toxicity and drug resistance. Graviola (Annona muricata) is a tree that grows in the tropics of North and South America. Traditionally, the leaves and stems from the graviola tree have been used for a wide range of human diseases including cancer.?In vitro?and?in vivo?studies demonstrate anticancer activity in BC however clinical studies are lacking. We present the first case demonstrating clinical benefit without side effects using graviola in a patient with BC whose disease was refractory to multiple lines of chemotherapy including anthracyclines and taxanes.

关键词： Breast Cancer Graviola Therapy

Evaluation of Tobacco Use and Her-2 Receptor Expression in Breast Cancer in an Ethnically Diverse Inner-City Population

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Open Journal of Epidemiology 2014年第2期4卷 84-88页

作者： damien M. hansra Judith Hurley Sylvester Comprehensive Cancer Center at the University of Miami Miami USA

Background: Tobacco is linked to most cancers however despite overwhelming biological plausibility and decades of epidemiological studies, no association has been established between tobacco and breast cancer. Although estrogen receptor status has been looked at as a variable there has been no evaluation of the role of Her-2 and smoking in breast cancer. Methods: Review of records from patients treated at the University of Miami/Jackson Memorial Hospital from 1998-2012. The incidence of smoking and Her-2 expression in1255 women was evaluated. Data was analyzed by age, race, ethnic group, menopausal status, tumor stage, and ER/PR/Her-2 receptor status. Results: 1255 charts were analyzed with 1094 having full information. Overall rate of Her-2 expression 18.1%. The rate of Her-2 expression was 21.4% in smokers and 17.0% in non-smokers (p = 0.10). The rate of Her-2 expression was 10.8% in Caucasian smokers and 9.8% in Caucasian non-smokers (p = 0.88);24.5% in smokers of African descent and 17.3% in non-smokers of African descent (p = 0.24);22.9% in Latino smokers and 17.4% in Latino non-smokers (p = 0.10). The rate of Her-2/ER expression was 9.4% in smokers and 7.9% in non-smokers (p = 0.42);5.4% in Caucasian smokers and 4.9% in Caucasian non-smokers (p = 0.916);12.2% in smokers of African descent and 5.9% in non-smokers of African descent (p = 0.11);9.5% in Latin smokers and 8.8% in Latin non-smokers (p = 0.77). Conclusions: We found non-statistically significant positive associations in all analyses between Her-2 expression with or without ER expression and tobacco exposure when analyzed by ethnicity.

关键词： HER-2 Breast Cancer Tobacco

Novel ACLV1 Mutation Identified in Late Onset Hereditary Hemorrhagic Telangiectasia

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International Journal of Otolaryngology and Head & Neck Surgery 2016年第4期5卷 157-173页

作者： Cory Patrick Kaitlin McIntyre Jeremy Ramidial Sano Joa Vijaykumar Dinsukhlal Zaveri damien hansra Miller School of Medicine University of Miami Miami FL USA Jackson Memorial Hospital Miami FL USA Mercy Hospital Miami FL USA Oncology and Radiation Associates Miami FL USA

Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder with variable expressivity. We present a 62-year-old patient with a rare, late-onset disease course featuring a novel mutation in ACVRL1, a... 详细信息

关键词： Hereditary Hemorrhagic Telaniectasia Osler-Weber-Rendu Syndrome Anemia Mutation

Rare Case of a Patient Presenting with Parathyroid Hormone-Related Peptide Mediated Hypercalcemia and IgG Heavy Chain Disease: Case Report and Review of Literature

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Open Journal of Blood Diseases 2015年第3期5卷 31-38页

作者： damien hansra Diaz Liege Victoria Sujoy Ikpatt Offiong Chris Wunsch James E. Hoffman Oncology and Radiation Associates Miami USA Department of Internal Medicine University of Miami/Jackson Memorial Hospital Miami USA Department of Pathology and Laboratory Medicine University of Miami/Jackson Memorial Hospital Miami USA Sylvester Comprehensive Cancer Center Miami USA

IgG Heavy Chain Disease (γHCD) is a rare plasma cell disorder. Hypercalcemia related to plasma cell dyscrasias is related to non-PTHrP related mechanisms. Here we describe the first case of a patient with γHCD and PTHrP related hypercalcemia. Methods: Patient case derived from chart review from 2011 to 2015. Literature review performed searching PubMed 1968-current. Results: The patient was diagnosed with hypercalcemia with elevated PTHrP and exclusion of other etiologies of hypercalcemia. She was diagnosed with (γHCD) by M-spike 0.64 g/dL, IFE showing a broad band of IgG heavy chain, without associated light chains and severe depression of the non-mono-clonal IgG. Serum immunoglobulins demonstrated elevated IgG (2110 mg/dL), normal IgA (46 mg/dL) and decreased IgM (<21 mg/dL). Bone marrow biopsy showed 5% PCs, non-clonal by kappa/lambda, but exclusive for IgG by IHC, without any staining for IgA or IgM. The patient was started on therapy with improved hypercalcemia and PTHrP levels. Conclusions: This is the first reported case of γHCD presenting with PTHrP related hypercalcemia. Given that skeletal involvement is uncommon in γHCD, hypercalcemia secondary to γHCD may at times be a PTHrP driven phenomenon and we recommend that this test be ordered in such cases.

关键词： Hypercalcemia Parathyroid Hormone-Related Peptide (PTHrP) Franklin Disease Heavy Chain Myeloma

Effects of Obesity and Smoking on Survival in Non-Small Cell Lung Cancer

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Open Journal of Epidemiology 2016年第2期6卷 128-139页

作者： damien M. hansra Tulay Koru-Sengul Wei Zhao Feng Miao Alicia P. Monedero Stacey L. Tannenbaum David J. Lee Judith Hurley Margaret M. Byrne University of Miami/Jackson Memorial Hospital Miami FL USA Department of Public Health Sciences and Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine Miami FL USA

Background: Obesity is an emerging leading cause of morbidity and mortality in the US and the relationship between obesity, tobacco, and survival in NSCLC is unclear. Methods: Data (n = 87,631) were obtained from linkage of the 1996-2007 Florida Cancer Data System to the Agency for Health Care Administration database providing procedure and diagnoses codes. Survival time was calculated from date of diagnosis to date of death. Smoking status was categorized as never, current, and former. Obesity (yes/no) = ICD9 code BMI > 30 kg/m2, cachexia = ICD9 code “wasting syndrome”, & non-obese = non-obese & non cachectic. Cox proportional regression models used to predict survival;demographic, clinical, treatment factors, & comorbidities were included in adjusted models with smoking status and obesity as the main factors. Results: The majority of patients (pts) were either former (49%) or current (40%) smokers, & non-obese (88%). 6.8% of pts were obese & 4.8% of pts were cachectic. There were significant differences between survival curves and median survival (months) for obese vs. non-obese vs. cachectic pts. (20 vs 10 vs. 7.9;P < 0.001). Former and current smokers had shorter median survival than never smokers (10.8 & 9.2 vs. 11.9;P < 0.001). Survival rates (%) at 1-yr (60.1 vs. 45.2 vs. 37.7;P < 0.001), 5-yr (30.3 vs. 15.4 vs. 9.5;P < 0.001), 10-yr (18.1 vs. 7.6 vs. 2.7;P < 0.001) were better for obese vs. non-obese and cachectic pts respectively. Independent predictor of worse survival in the unadjusted model was former (HR 1.08;P < 0.001) and current (HR 1.20;P < 0.001) smokers compared to never. Obese and non-obese pts had better survival vs. cachexia pts. (HR 0.52;P < 0.001 and HR 0.80, p < 0.001 respectively) and obese had better survival than Non-obese pts (HR 0.65, p < 0.001). In the adjusted model, controlling for extensive variables and comorbidities, former (HR 1.11;P < 0.001) and current (HR 1.19;P < 0.001) smokers still had significantly worse survival vs. never

关键词： Lung Cancer Non-Small Cell Lung Cancer Tobacco Smoking Obesity