A rare case of acral amelanotic melanoma,nodular type

Amelanotic melanoma is a rare melanoma subtype, and it is even more rare when it occurs at an acral site. We here present a case of a nodular amelanotic acral melanoma (NAAM) occurring on the heel of an 83‐year old female. It presented as an ulcerated pink nodular growth on the heel, which clinically mimicked other nodular non‐pigmented lesions, causing a delay in diagnosis until it was biopsied. This case is a demonstration of the critical importance to include NAAM in the differential diagnosis of nodular non‐pigmented skin lesions as to avoid delay in diagnosis and disease progression, in which early detection can provide the most modifiable prognostic factor.     

Marjolin ulcer: an overlooked entity

Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.     

Accuracy of Intraoperative Frozen Section Diagnosis of Borderline Ovarian Tumors by Hospital Type

Study Objective

To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital—academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists—and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.

Low-affinity uptake of the fluorescent organic cation 4-(4-(dimethylamino)styryl)-N-methylpyridinium iodide (4-Di-1-ASP) in BeWo cells

Understanding the mechanisms of transport processes in the placenta can improve the safety and efficacy of drug delivery during pregnancy. Functional studies of organic cation transporters (OCTs) are usually carried out using radioactivity, and a fluorescent marker would add flexibility to experimental methods. As a published substrate for OCT1 and OCT2, the fluorescent compound 4-(4-(dimethylamino)styryl)-N-methylpyridinium iodide (4-Di-1-ASP) was chosen as a candidate for studying placental OCT function in BeWo cells. The expression of OCT1 and OCT2 was also investigated in BeWo cells, an established human choriocarcinoma trophoblastic cell line frequently used as an in vitro model of the rate-limiting barrier for maternal-fetal exchange of drugs and nutrients within the placenta. 4-Di-1-ASP was taken up into BeWo cells by a low-affinity, carrier-mediated process exhibiting a Km of 580+/-110 microM and Vmax of 97+/-9 nmol/mg protein/30 min, and asymmetric transport was observed, with greater permeability in the apical to basolateral (maternal-to-fetal) direction. However, RT-PCR revealed no expression of OCT1 or OCT2 in either BeWo cells or primary cultured human cytotrophoblast cells, and OCT substrates such as TEA and choline did not inhibit the uptake of 4-Di-1-ASP. Although the uptake of this fluorescent compound in BeWo cells is not mediated by an OCT, the colocalization experiments with fluorescence microscopy and inhibition studies confirmed significant mitochondrial uptake of 4-Di-1-ASP. Transport of 4-Di-1-ASP into the nuclear region of BeWo cells was also observed, which is likely mediated by a nucleoside transporter.     

Self-reported oral parafunctions and pain intensity in temporomandibular disorder patients

AIM: To examine the relationship between different types of self-reported oral parafunctions and pain intensity in patients with temporomandibular disorders (TMD). METHODS: Two cohorts of TMD pain patients, 1 comprising 303 patients and the other comprising 226 patients, completed a 12-item oral parafunctions questionnaire as well as the Research Diagnostic Criteria Axis II questionnaire, which includes a characteristic pain intensity score (CPI). Relationships between oral parafunctions and CPI were examined; age and gender were controlled for. The effects of phrasing of the oral parafunction questions were also examined. For 1 cohort, the questions were directed at the mere occurrence of the parafunctions; in the other, the questions addressed the perceived stressfulness of parafunctional behavior to the jaw. RESULTS: A principal component analysis of the responses to the questionnaires led to 3 factors (scales) in both cohorts: (1) a BRUX scale for bruxism activities; (2) a BITE scale for biting activities (eg, chewing gum, nails); and (3) a SOFT scale for soft tissue activities (eg, tongue, lips). Statistical significance was reached for 2 of the 6 relationships studied (P < .05), but with a very low explained variance (approximately 3.5%). CONCLUSION: No clinically relevant relationships were found between different types of self-reported oral parafunctions and TMD pain complaints.     

Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: translation efforts and reliability assessments in The Netherlands

AIMS: To outline the steps taken to conduct and to culturally adapt Dutch translations of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) history questionnaire, clinical examination form, and verbal instructions to the patients, and to assess the reliability of the clinical examination. METHODS: For the linguistic translation from English into Dutch, the forward and back-translation approach was followed. For cultural adaptation, an expert panel reviewed the translation, and a pretest was performed on a small clinical sample. Examiner training and calibration were carried out, and the clinical reliability of a "gold standard examiner" and 3 clinicians was assessed on 18 symptomatic TMD patients and 6 asymptomatic controls. The order of the examinations was based on a quasi-random Latin square design. Intraclass correlation coefficients (ICCs) were calculated to assess the overall interexaminer reliability of the clinical examination. RESULTS: A linguistically valid and culturally equivalent translation of the RDC/TMD into Dutch resulted from the above-outlined procedure. As for the clinical reliability, the ICC values obtained could mostly be considered "excellent" or, less frequently, as "fair to good." Poor reliability was found only for some of the palpation tests. For uncommon diagnoses (disc displacement without reduction and without limited mouth opening; osteoarthritis), no reliable ICC value could be calculated. CONCLUSION: The mode described by the authors for preparing clinical sites for RDC/TMD-based research is a feasible one.     

Dissolution of weak acids under laminar flow and rotating disk hydrodynamic conditions: application of a comprehensive convection-diffusion-migration-reaction transport model

A steady-state mass transfer model that incorporates convection, diffusion, ionic migration, and ionization reaction processes was extended to describe the dissolution of weak acids under laminar flow and a rotating disk hydrodynamics. The model accurately predicted the experimental dissolution rates of benzoic acid, 2-naphthoic acid, and naproxen in unbuffered and monoprotic buffers within the physiological pH range for both hydrodynamic systems. Simulations at various flow rates indicated a cube root dependency of dissolution rate on the flow rate for a given bulk pH value for the laminar hydrodynamic system, as proposed earlier by Shah and Nelson (1975. J Pharm Sci 64(9):1518-1520) for neutral compounds. The model has limitations in its ability to accurately predict the dissolution of weak acids under certain conditions that imposed steep concentration gradients, such as high pH values, and for polyprotic buffer systems that caused the numerical solution to be unstable, suggesting that alternative numerical techniques may be required to obtain a stable numerical solution at all conditions. The model presents many advantages, most notably the ability to successfully predict the complex process under physiological conditions without simplifying assumptions, and therefore accurately representing the system in a comprehensive manner.