PARATESTICULAR LIPOSARCOMA: COEXISTENCE WITH URINARY BLADDER CANCER

A 58-year-old man with liposarcoma originating from the right paratesticular area was reported. Histologically, liposarcoma showed a well-differentiated sclerosing type. Coexistence of transitional cell carcinoma of the urinary bladder and liposarcoma was also revealed. The cases of paratesticular liposarcoma in the literature are briefly reviewed.     

Could mitochondrial haplogroups play a role in sporadic amyotrophic lateral sclerosis?

Mitochondrial impairment has been implicated in the pathogenesis of the amyotrophic lateral sclerosis (ALS). Furthermore, mitochondrial-specific polymorphisms were previously related to other neurodegenerative diseases, such as Parkinson, Friedreich and Alzheimer disease. To investigate if specific genetic polymorphisms within the mitochondrial genome (mtDNA) could act as susceptibility factors and contribute to the clinical expression of sporadic ALS (sALS), we have genotyped predefined European mtDNA haplogroups in 222 Italian patients with sALS and 151 matched controls. Individuals classified as haplogroup I demonstrated a significant decrease in risk of ALS versus individuals carrying the most common haplogroup, H (odds ratio 0.08, 95% confidence interval 0.04-0.4, p < 0.01). Further stratification of the dataset by sex, age and site of onset of disease and survival failed to reach significance for association. Our study provides evidence of the contribution of mitochondrial variation to the risk of ALS development in Caucasians. Further it may help elucidate the mechanism of the mitochondrial dysfunction detectable in ALS, and may be of relevance in development of strategies for the treatment of this disease.     

Cotrimoxazole therapy ofToxoplasma gondii encephalitis in AIDS patients

Twenty-four consecutive HIV-positive patients affected byToxoplasma gondii encephalitis received trimethoprim-sulfamethoxazole (cotrimoxazole) as acute-phase treatment. Two dosage regimens of cotrimoxazole were used: 40 mg/kg/day (12 patients) or 120 mg/kg/day (12 patients) of total compound (trimethoprim plus sulfamethoxazole). Clinical and radiological responses to treatment were evaluated, and the product-limit method for survival data analysis was used. Eighteen of 24 patients showed both a clinical and radiological response (75 % response rate). There were no differences in response rates between patients receiving the two dosage regimens of cotrimoxazole. Adverse reaction consisted of leukopenia (two cases) and skin rash (three cases) which led to the discontinuation of the drug in one case. These results suggest that a randomized, controlled clinical trial should be carried out comparing cotrimoxazole versus sulfadiazine-pyrimethamine in AIDS patients withToxoplasma gondii encephalitis.Deceased.     

Creativity and quality

Edward de Bono's work helped shatter the theory that creativity is a talent possessed only by a gifted few who can see beyond current paradigms. His seminal work in The Mechanism of the Mind and later in Lateral Thinking established the theory that creativity is a skill that can be developed and enhanced through structured training and teaching. The editors of QMHC invited Dr. de Bono to share his thoughts on the relationship between creativity and quality. In this essay, he presents his views on possible limitations of traditional quality improvement thinking and demonstrates the importance that creativity plays in enhancing quality improvement efforts.     

Glutathione metabolism during Yoshida ascites sarcoma growth

Glutathione (GSH) metabolism and protein synthesis were observed over a period of about two weeks in Yoshida ascites sarcoma and intracellular concentration relative to days 7, 10 and 13 assumed as 'markers' of different stages of tumor development. During this period the decrease in rate of cell proliferation was followed by decrease in protein synthesis, GSH, oxidized glutathione (GSSG), adenosine triphosphate (ATP), glutathione-S-transferase (GSH-S-transferase) and gamma-glutamyl-cysteine synthatase (gamma-GCS); by increase in glutathione-peroxidase (GSH-peroxidase); while glutathione-reductase (GSH-reductase) and glucose-6-phosphate-dehydrogenase (G-6-PD) remained unchanged. In relation to growth curve of the tumor, GSH concentration was very high up to day 7 (logaritmic phase), decreased till quantity similar to that of corresponding normal cells up to day 10 (plateau phase) and on day 13 was significantly smaller. Correlation between high concentration of GSH in tumor cells and their survival and proliferation after intraperitoneal implantation is discussed.     

Postoperative synergistic gangrene after spinal fusion

STUDY DESIGN: A case of synergistic necrotizing gangrenous fasciitis after spinal surgery is reported. OBJECTIVES: To describe this unusual complication, explain the rationale of treatment, and increase awareness of this serious postoperative complication. SUMMARY OF BACKGROUND DATA: Although several cases of postoperative synergistic necrotizing fasciitis have been reported, there are no previously reported cases of this condition after spinal surgery. METHODS: A rapidly progressive necrotizing spinal wound infection after fusion for degenerative disc disease was treated in a 39-year-old man. RESULTS: The infection was successfully treated with serial debridements, appropriate antibiotics, and hyperbaric wound oxygenation. CONCLUSIONS: The authors suggest adherence to the fundamental principles of treatment including radical surgical debridement and appropriate antibiosis for necrotizing gangrene after spinal surgery. In evaluation of aggressive spinal wound infections, diagnosis of synergistic necrotizing fasciitis should be kept in mind. Although hyperbaric wound oxygenation was implemented as an adjunct and appeared to aid in controlling the infection, its effect on outcome is not clear.