Lentigo Maligna/Lentigo Maligna Melanoma: Current State of Diagnosis and Treatment

BACKGROUND: Lentigo maligna (LM) is a subtype of melanoma in situ that typically develops on sun-damaged skin. Presentation may be quite subtle and delayed diagnosis is common. Clinical margins are often ill defined. Histologic evaluation can be difficult due to the widespread atypical melanocytes that are present in the background of long-standing sun damage. Recurrence following standard therapies is common. OBJECTIVE: To review the clinical features, histopathology, and treatment options for LM. Emphasis is placed on recent advances in the treatment of LM. METHODS AND MATERIALS: Literature review. RESULTS: The estimated lifetime risk of LM progressing to LM melanoma is 5%. Standard excision of LM with 5 mm margins is insufficient in 50% of cases. The recurrence rate with standard excision ranges from 8 to 20%. Mohs surgery and staged excision may offer better margin control and lower recurrence rates (4-5%). Estimates of recurrence rates following nonsurgical therapies such as cryosurgery, radiotherapy, electrodessication and curettage, laser surgery, and topical medications range from 20 to 100% at 5 years. CONCLUSIONS: Adequate treatment of LM requires a comprehensive knowledge of the diagnostic features, histopathology, and treatment options. Surgical modalities with meticulous evaluation of tissue margins appears to offer the lowest rates of disease recurrence.     

Embolic Control of Massive Haematobilia After Liver Biopsy

Life threatening haematobilia following liver biopsy was successfully treated by percutaneous transcatheter embolization of the right hepatic artery. Complications of liver biopsy and aspects of their treatment are discussed.     

Emergence of fluoroquinolone‐resistant clonal group A: clonal analysis of Norwegian and Russian E. coli isolates

Strand L, Jenkins A, Grude N, Allum A‐G, Mykland H‐C, Nowrouzian FL, Kristiansen B‐E. Emergence of fluoroquinolone‐resistant clonal group A: clonal analysis of Norwegian and Russian E. coli isolates. APMIS 2010; 118: 571–77. We describe a study of urinary tract and intestinal isolates of Escherichia coli from Norway and Russia using automated ribotyping, single nucleotide polymorphism analysis for clonal group A (CgA) supplemented with phylogrouping, virulence gene profiling and resistance profiling. CgA comprised 19% of the Norwegian UTI isolates from 2001. Two highly multiresistant fluoroquinolone‐resistant CgA isolates were found. Ribotypes clustered into four major and six minor groups (ribogroups). Fluoroquinolone‐resistant isolates and phylogroups A and B1 were associated with ribogroup ^RA. Ribogroup ^RB predominated among Russian UTI isolates and was predominantly phylogroup A and depleted in P‐fimbriae. Ribogroup ^RC predominated among Norwegian UTI isolates and was rich in virulence factors (S‐fimbriae, haemagglutinin and haemolysin) and predominantly phylogroup B2 and D. Ribogroup ^RG was associated with CgA and predominantly phylogroup D. Ribogroups ^RD, ^RE and ^RF had too few members for statistical analysis. The correlation between ribotype and phylogenetic group was not as strong as reported in other studies.     

COMBINED HAMARTOMA OF THE RETINA AND RPE: AN UNUSUAL CAUSE OF THE DRAGGED DISC APPEARANCE

Combined hamartoma of the retina and retinal pigment epithelium (RPE) is a rare, benign, congenital fundal lesion which contains a mixture of glial tissue, blood vessels and pigment epithelium. Such turnours are variably pigmented and may be wrongly diagnosed as malignant melanoma or retinoblastoma. We report two cases which were located in the periphery of the fundus and which produced a dragged disc appearance.     

Acquired Anti Factor VIII inhibitors following pregnancy: a report of two cases responding to treatment

Summary Anti Factor VIII antibodies, usually detected in the post-partum period, are a recognized complication of pregnancy. They are associated with a high morbidity and mortality and should therefore be treated actively whenever possible. We report two cases of acquired haemophilia arising in the puerperium and responding to treatment with prednisolone. We recommend this approach which is simple, cheap and effective.     

Antibodies Against the β-Subunit of Ovine Luteinizing Hormone Can Decrease the Clearance of Human Chorionic Gonadotropin in Rhesus Monkeys*

ABSTRACT: Contraceptive vaccines based on active immunization against gonadotropic hormones are being investigated in humans and other primates. Immunization against the β-subunit of ovine luteinizing hormone (oLHβ) reduces fertility in rhesus monkeys by inducing inadequate luteal phases and preventing corpus luteum rescue by rhesus chorionic gonadotropin (rhCG). These effects result from the cross-reactions of the oLHβ-antibodies with rhCG and rhLH. We used human CG (hCG), which also cross-reacts strongly with anti-oLHβ to examine how the circulating oLHβ-antibodies affect the metabolic clearance rates (MCR) of hCG in rhesus monkeys. ¹²⁵I-hCG was injected into four nonimmunized and seven immunized monkeys and blood was collected at frequent intervals over 7 days. Total and immunoprecipitable radioactivity did not differ significantly, suggesting that the radioactivity in the plasma consisted almost entirely of ¹²⁵I-hCG. This was confirmed by column chromatography. The MCR (mean ± SE) was significantly lower (p < 0.001) in six immunized monkeys (0.35 ± 0.06 liters/day) as compared to controls (1.19 ± 0.09 liters/day). The hCG disappearance curve in control monkeys was best described by a two-compartmental system (slow and fast) while an additional third (intermediate) compartment of distribution was typical for immunized animals. The half-lives of hCG for the two exponentials corresponding to the slow and fast components of distribution were not significantly different between the two groups. One immunized monkey had a MCR (1.44 liters/day) that was much greater than the MCR of the other six. This monkey cleared a significantly smaller proportion of hCG in the slow and a higher proportion in the intermediate compartment and unlike the others, formed a circulating immune complex capable of binding hCG that was significantly larger than the antibody-hCG complexes found in the other six immunized animals. We conclude that circulating antibodies to oLHβ reduced the MCR of hCG in six of seven monkeys. The decreased MCR found in immunized monkeys is associated with a shift in clearance from the “fast” to the “slow” compartment as well as the addition of an intermediate compartment of distribution. Plasma disappearance rates of hCG depend on the size of the antibody hCG complex.     

MONOCYTE ADHESION TO FIBRONECTIN IN PSORIASIS

Background. After vascular extravasation, mononuclear cells (MNC) undergo chemotaxis and adhesion to extracellular matrix proteins, resulting in their differentiation into macrophages. Although endothelial adhesion and chemotaxis are altered in psoriasis, MNC adhesion to extracellular matrix proteins has not been previously studied in the disease. Since MNC adhesion to endothelial cells is abnormally regulated in psoriasis by TGF-beta, we tested they hypothesis that in psoriasis substance P also regulates the adhesion of monocytes to the extracellular matrix protein fibronectin. Methods. Monocytes from 16 normal controls and 11 psoriatic individuals were isolated and purified using a two-step gradient centrifugation procedure. Adhesion to fibronectin was studied by plating monocyte suspensions onto fibronectin-precoated microtiter plates. The number of adherent cells was quantified by measuring their hex-osaminidase activity. Results. Although statistically significant differences in the basal (unstimulated) adhesion or in the substance P-stimulated adhesion between normal control monocytes and those obtained from psoriatic individuals were not observed, a subpopulation of psoriatics was identified who responded to substance P. Furthermore, this in vitro response to substance P was correlated with the clinical status of the subpopulation which was characterized by unstable psoriasis triggered by stressful life events. Conclusions. The results of this study indicate that priming of monocytes by the extracellular matrix protein fibronectin or by elevated levels of substance P are not critical steps in the pathogenesis of stable, chronic psoriasis. Substance P may contribute to the appearance of new lesions in some individuals with unstable psoriasis.     

A TECHNIQUE FOR THE LABORATORY EVALUATION OF THE SPEED OF ONSET OF I.V. ANAESTHESIA

A method is described for the evaluation of the speed of onsetof i.v. anaesthesia in mice. The technique involves (a) determinationof the median hypnotic dose (HD50) by plotting the probit valueof the percentage of mice sleeping, against dose on a logarithmicscale, (b) plotting mean induction time over a range of dosesagainst the logarithm of the dose and (c) comparison of inductiontimes at 1.25 HD50. All doses were given over 1 s or 10 s. A1–s injection was thought to be of most value in the evaluationof structure activity effects whereas the 10–s injectionproduced results similar to those which have been reported inman. With this technique, and using 1–s injection times,induction times were found to be similar with thiopentone andAlthesin. Those following methohexitone, etomidate and propanididwere marginally longer whereas ketamine and pentobarbitone wereobviously slower in onset.