Obesity and Breast Cancer: Molecular and Epidemiological Evidence
Pages 30-42
Nehad M. Ayoub and Amal Kaddoumi

DOI: http://dx.doi.org/10.6000/1929-2279.2015.04.01.3

Published: 19 February 2015

Abstract: Carcinoma of the breast is a leading cause of cancer deaths among women world-wide. Obesity is recognized as a well-established risk factor for epithelial tumors including the mammary epithelium. Adipose tissue is considered to be metabolically active organ with the ability to secrete a wide range of biologically active adipokines. Multiple studies have evaluated the potential mechanisms correlating obesity to increased risk of breast cancer. Altered circulating levels of adipokines or changed adipokine signaling pathways are now increasingly recognized to be associated with breast cancer development and progression. Leptin and adiponectin were the main adipokines that have been investigated in the context of breast cancer in both preclinical and epidemiological studies. Obesity is also believed to promote inflammatory response and induce activity of key enzymes like aromatase, leading to higher risk of breast cancer development. The goal of this review is to provide recent insights into the potential molecular mechanisms linking adipokines to the etiopathogenesis of breast cancer including recently identified adipokines and trying to correlate these molecular mechanisms to more established metabolic and hormonal dysregulations of obesity. A better understanding of the interplay between adipokines and other deregulated mechanisms in obesity is important for the development of preventive strategies with therapeutic potential against breast cancer in obese patients.

Perioperative Management in a Child with Familial Bilateral Pheochromocytoma
Pages 43-46
Saurabh Joshi, Chetan Saraya, Shri Prakash Singh, Jasbir Singh Khanuja and Umesh Kumar Valecha

DOI: http://dx.doi.org/10.6000/1929-2279.2015.04.01.4

Published: 19 February 2015

Abstract: Purpose: Diagnosis and perioperative management of bilateral adrenal pheochromocytoma with a successful outcome is an apt combination of clinical knowledge and anaesthetic skills. Detailed history, meticulous physical examination, relevant laboratory investigations along with good preoperative pharmacological optimization and fluid resuscitation plays an important role in the perioperative period. Genetic testing and counseling should be offered to all the family members of patients suspected of familial predisposition. We report the anesthetic management of 10 year old male child with bilateral adrenal pheochromocytoma with family history of disease.

Clinical Features: A10-year old male, presented to our pediatric outpatient clinic with gradually increasing holocranial headache, blurring of vision, sweating, photophobia, progressive quietness in nature and poor performance in school, increased thirst and urine output for one week along with pain over bilateral lower limbs and difficulty walking without support for 20days. Parents also reported two episodes of generalized convulsions with one episode of opisthotonic posturing and up rolling of eyes, which was sustained for 50 min. Family history of three sudden deaths, and father, a known case of pheochromocytoma along with clinical presentation, raised the suspicion of familial pheochromocytoma.

Conclusion: Though pheochromocytomas are rare tumours, a high level of suspicion in paediatric age group, where patients don’t present with classical symptoms, leads to early diagnosis and management and prevents catastrophic events. Young patients with bilateral disease and positive family history should be offered genetic testing. Preoperative catecholamine blockade and meticulous anaesthetic and surgical management are the keys to successful perioperative management of bilateral pheochromocytoma.