Assessment of severity of suicide attempts. A trial with the dexamethasone suppression test and 2 rating scales

In this study, the dexamethasone suppression test (DST) and 2 rating scales, the 'Echelle d'Evaluation de Risque Suicidaire' and the Pierce modified form of the Suicide Intent Scale, were administered to a group of 37 subjects admitted to the general hospital of Padua for suicide attempts. The purpose of our study was to verify if these tools could be considered useful in assessing the severity of the attempts. 10 subjects were DST-positive, but the test evidenced very low sensitivity and predictive value. The 2 rating scales demonstrated a good degree of concordance in identifying the adjustment disorder group as being at a lower risk for a serious attempt.     

Gene therapy of inherited skin adhesion disorders: a critical overview

Gene therapy has the potential to treat devastating inherited diseases for which there is little hope of finding a conventional cure. These include lethal diseases, like immunodeficiencies or several metabolic disorders, or conditions associated with a relatively long life expectancy but poor quality of life and expensive and life-long symptomatic treatments, such as muscular dystrophy, cystic fibrosis and thalassaemia. Skin adhesion defects belong to both groups. For the nonlethal forms, gene therapy, or transplantation of cultured skin derived from genetically corrected epidermal stem cells, represents a very attractive therapeutic option, and potentially a definitive treatment. Recent advances in gene transfer and stem cell culture technology are making this option closer than ever. This paper critically reviews the progress and prospects of gene therapy for epidermolysis bullosa, and the technical and nontechnical factors currently limiting its development.     

Stretch-activated cation channels with large unitary conductance in leech central neurons.

Stretch-activated cation channels were identified in the soma membrane of leech central neurons. These channels were almost silent under normal experimental conditions and were distinctly activated by application of negative pressure to the patch pipette. The channels exhibited a preferential selectivity for K+ and a slope conductance of about 200 pS, in symmetrical K+ solution. In cell-attached patches these cation channels were activated by cell swelling.     

Combined surgical approach to coexistent carotid and coronary artery disease.

Combined coronary artery bypass and carotid endarterectomy were performed in 52 patients (mean age 61 years) between 1981 and 1990. Of these, 36 (69%) had functional class III-IV angina pectoris, 33 (63%) had triple-vessel disease, 36 (69%) had one, or more, previous myocardial infarctions, and 33 (63%) had an abnormal left ventricular function. In 4 cases, additional cardiac procedures were performed. Asymptomatic carotid stenosis was documented in 29 patients (56%) and the remaining 23 (44%) had experienced cerebrovascular symptoms. All patients had hemodynamically significant stenosis of at least one carotid artery, 17 (33%) had severe bilateral carotid artery stenosis, and 6 (11%) had an additional occlusion of the contralateral internal carotid artery. There were no early deaths. Perioperative morbidity included: myocardial infarction in 4 patients (7.7%) and neurological deficit in 3 (5.7%) but functional impairment was not permanent. Late results have been obtained for all 52 patients at a mean postoperative interval of 35 months. Four patients (7.7%) have died, and the 5 year life-table survival rate was 83%. At five years, actuarial curves showed 67% of patients to be free of all serious events or death. Late mortality and morbidity were related above all to the progression of the coronary artery disease. We concluded that simultaneous endarterectomy of significant carotid artery stenosis in candidates for coronary bypass can be done safely and considered as more practical for the patient.     

Subclinical subretinal fluid detectable only by optical coherence tomography in choroidal naevi—the SON study

BackgroundSubretinal fluid is a risk factor for growth and malignant transformation of choroidal naevi, however it is unclear if this applies to subclinical fluid that is only detectable by optical coherence tomography (OCT). The objective of this study was to determine the prevalence and associations of subclinical but OCT-detectable subretinal fluid over choroidal naevi.MethodsCross-sectional study of 309 consecutive cases of choroidal naevi imaged by OCT between July 2017 to January 2019. Multicentre international study involving ten retinal specialist centres. All patients presenting to retinal specialists had routine clinical examination and OCT imaging. The prevalence of subclinical OCT-detectable subretinal fluid over choroidal naevi and its associations with other features known to predict growth and malignant transformation were noted and analysed.ResultsOf 309 identified consecutive cases, the mean patient age was 65 years, 89.3% of patients were Caucasian and 3.9% were Asian. The prevalence of subclinical but OCT-detectable subretinal fluid associated with choroidal naevi was 11.7% (36/309). Naevi with fluid were associated with larger basal diameters, greater thickness, presence of a halo, orange pigmentation, hyperautofluorescence, and hypodensity on B-scan ultrasonography.Conclusion and relevanceOf choroidal naevi where subretinal fluid is not visible on clinical examination, 11.7% demonstrate subretinal fluid on OCT scans. These naevi more commonly exhibit features known to be associated with growth and transformation to melanoma. The presence of subclinical OCT-detectable fluid over choroidal naevi may assist in their risk stratification.Subject terms: Risk factors, Uveal diseases, Eye manifestations     

Malignant melanoma with osteoid formation

We report a case of malignant melanoma with osteoid formation arising in a patient who had had a diagnosis of neurofibromatosis. The presence of osteoid was confirmed histochemically by the picrosirius-polarization method and by transmission electron microscopy. Osteoid formation in malignant melanoma is rare, with only three cases reported prior to ours. Neoplasms arising from derivatives of the neural crest are known to show areas of metaplastic differentiation and heterologous elements. Among neural tumors, malignant nerve sheath neoplasms in particular are noted to display such heterologous elements as rhabdomyoblasts, cartilage, osteoid, and bone. Such heterologous elements are much less common in malignant melanoma. Our case report is an unusual example of a neural crest-derived neoplasm with heterologous elements.     

Vagotomy During Hiatal Hernia Repair: A Benign Esophageal Lengthening Procedure

Introduction  This study describes the use of vagotomy in patients during complex laparoscopic esophageal surgery (e.g., reoperative antireflux surgery (rLARS) or paraesophageal hernia (PEH) repair) when, after extensive esophageal mobilization, the gastroesophageal junction cannot be made to reach the abdomen without tension. In doing so, we hope to understand the risk incurred by vagus nerve division in this setting in order to evaluate its role in managing the short esophagus. Methods  One hundred and sixty-six patients underwent rLARS or PEH repair between 1/1998 and 6/2003 at our institution. Clinical data was obtained from a prospectively maintained database and systematic patient questionnaires administered for this study. Follow-up was available for 102 (61%) of these patients, at a median of 19 months (range 6–69 months). Results  Fifty-two patients underwent rLARS while 50 patients underwent PEH repair. Thirty patients had a vagotomy during the course of their operation (Vag Group; 20 anterior, six posterior, four bilateral), 13 in the rLARS group (25%), and 17 in the PEH group (34%). The primary presenting symptoms for rLARS and PEH repair patients were improved in 89% in the Vag Group and 91% in the No Vag Group. Similarly, there was no difference in the severity of abdominal pain, bloating, diarrhea, or early satiety between the Vag and No Vag groups at follow-up. No patient required a subsequent operation for gastric outlet obstruction. Conclusions  Vagotomy during rLARS and PEH repair does not lead to a higher rate delayed gastric emptying, dumping syndrome, or other side effects. Thus, we propose vagotomy to be a legitimate alternative to Collis gastroplasty when extensive mobilization of the esophagus fails to provide adequate esophageal length. Presented at the annual meeting of The Society for Surgery of the Ailmentary Tract New Orleans, 2004 This work was supported in part by the Mary and Dennis Wise Fund.     

Metastatic renal cell cancer treated with recombinant alpha 2a interferon and vinblastine.

42 patients with advanced renal cell carcinoma were treated with a combination therapy with interferon alpha 2a (mean dosage 16 x 10(6) U i.m. 3 times/week) and vinblastine (0.1 mg/Kg every 21 days). 12 patients (28.5%) had a positive response. Of them 1 presented a complete response (2.38%), 5 a partial response (11.9%) and 6 a stable disease (14.2%). No significant side effects were observed apart from the flu-like syndrome (all patients) and a moderate leukopenia (45.2%). The median duration of responses was 10+ months (range 3-37 months). At 4-year follow-up the median survival time was 16.0 months (range 4-37 months).     

Selection of monoclonal antibodies which induce internalization and phosphorylation of p185HER2 and growth inhibition of cells with HER2/NEU gene amplification.

In order to obtain further information on the biological role of the HER2/neu oncoprotein monoclonal antibodies (MAbs) were produced against the p185 extracellular domain. To immunize the mice and screen the hybridoma supernatants we selected a lung adenocarcinoma cell line (Calu-3), which demonstrated an over-expression of p185HER2 measured as the reactivity with polyclonal rabbit serum to the 14-amino-acid carboxy-terminal-HER2/neu. Two MAbs, designated MGR2 (IgG1) and MGR3 (IgG2), selected for reactivity on Calu-3 and negativity on A43I live cells, the reference target cell for EGF receptor expression, were found to immunoprecipitate a 185-kDa molecule. Immunodepletion experiments with the polyclonal antiserum and cross-competition experiments indicated that the 2 reagents recognized 2 different epitopes located on the p185HER2 molecule. One of the 2 MAbs, MGR3, was found to internalize, induce p185HER2 phosphorylation and inhibit tumor cell growth in vitro. These results indicate that MGR3 is directed against a determinant located in the p185HER2 ligand binding site and may compete with the p185HER2 ligand, but is incapable of inducing a complete mitotic signal.