The volume-deficient orbit: clinical characteristics, surgical management, and results after extraperiorbital implantation of Silastic block.

The surgical techniques and results after extraperiorbital implantation of Silastic on the orbital floor of 70 patients are reviewed. In 11 patients the implant was through a subciliary approach and in 59 through an inferolateral cantholysis. The inferolateral cantholysis, a simplification of the McCord and Moses approach to the orbital floor, is particularly suited to this application. The implanted Silastic was retained in 66 patients, with an average follow up of 3.5 years (range less than 1 to 9.5 years), though six required surgery to debulk the anterior end of the implant. Further surgery was required in 27 patients, this generally being to correct the position of either the upper or the lower lid. Volume enhancement was effective in most cases, there being a significant reduction in the degree of recession of the prosthesis and the depth of the unsightly sunken sulci of the upper and lower lids. The mobility of the orbital contents, the prosthesis, and the upper lid was not improved.     

Surgical management of upper lid entropion.

One hundred and eighty-three surgical procedures were conducted on 107 patients over seven years. 91% of the cases of upper lid entropion were corrected satisfactorily with only one operation. It is postulated that this level of success is achieved by grading the degree of surgical intervention according to the clinical established on systematic examination of upper lid entropion.     

Effect of dipyridamole on fluorodeoxyuridine cytotoxicity in vitro and in cancer patients

Summary Dipyridamole (DP) has previously been studied both in vitro and in vivo in combination with various antimetabolites, including methotrexate and 5-fluorouracil (5FU). We evaluated in vitro and clinically the effects of adding DP to fluorodeoxyuridine (FUDR) in colorectal cancer. Using a human colony-forming assay, we observed that 0.05 M DP increased the cytotoxicity of FUDR by a median of 33.5-fold vs 1.5-fold for 5FU against human colon-cancer cell lines. The mechanism of the DP-enhanced antitumor activity of FUDR is not completely understood but appears to be related to a profound inhibition by DP of thymidine accumulation in and FUDR efflux from colon-cancer cell lines. On the basis of these in vitro results, 28 patients with metastatic colon cancer were entered in a clinical trial of monthly courses of 0.1 mg/kg FUDR daily for 14 days and 75 mg oral DP 5 times daily for 14 days starting on the 3rd day of continuous i.v. FUDR infusion. The pharmacokinetics of DP was studied in three patients; the results showed that 98% of total serum DP was protein-bound and that free DP levels were significantly lower than the concentrations necessary for the expected in vitro DP/FUDR modulation. Treatment was well tolerated, with only 12 patients developing mild to moderate toxicity. Of 27 evaluable patients, 4 achieved a partial response that lasted 2, 3, 5, and 6+ months. This relatively low response rate (15%), which is similar to that achieved with FUDR alone, may be explained by the low steady-state plasma concentrations of free DP achieved in our patients. Other means of DP administration, such as i.v., i.a., and i.p. injection, may be required to achieve free DP concentrations necessary for successful biochemical modulation of FUDR in patients.Supported in part by grants CA17094, CA23074, and CA39629 from the National Institutes of Health, Bethesda, Md 20205, and a grant from the Arizona Chronic Disease Commission. HSG is a recipient of an American Cancer Society Career Development Award     

TNF microsatellite alleles a2 and b3 are not primarily associated with celiac disease in the Finnish population

Abstract: Recently, an independent association between tumor necrosis factor (TNF) gene polymorphism and ceiiac disease was observed in the Irish population. We tested this association in Finnish patients with celiac disease. The TNF microsatellite alleles a2 and b3 were strongly associated (P_corr<0.0001 for both) with celiac disease when the patients were compared to the random population. However, when the comparison was made with the DQ2-matched controls, no association could be found. We therefore conclude that in Finland the TNFa2 and b3 alleles are associated with DQ2-positive haplotypes rather than celiac disease.     

Inflammatory malignant fibrous histiocytomas and dedifferentiated liposarcomas: histological review, genomic profile, and MDM2 and CDK4 status favour a single entity

Inflammatory malignant fibrous histiocytoma (inflammatory MFH) is a very rare tumour that occurs most often in the retroperitoneum. So far, it has been considered to be a special subtype of MFH. As it is now widely accepted that most retroperitoneal pleomorphic MFHs are dedifferentiated liposarcomas, the present study compared histological features, genomic profile (CGH analysis), and MDM2 and CDK4 status (immunohistochemistry, FISH, and quantitative PCR) in inflammatory MFHs from 12 patients and dedifferentiated liposarcomas that had an inflammatory MFH component from eight patients. Metaphase cytogenetic and FISH analyses were also performed on one inflammatory MFH. Histological review showed areas of well-differentiated liposarcoma in nine inflammatory MFHs. CGH analysis showed 12q13-15 amplification or gain in six of seven inflammatory MFHs and in seven of seven dedifferentiated liposarcomas. Immunohistochemistry showed positivity of tumour cells for MDM2 in every tumour in both groups and for CDK4 in ten and seven inflammatory MFHs and dedifferentiated liposarcomas, respectively. Metaphase cytogenetic and FISH analysis performed on one inflammatory MFH showed the presence of a supernumerary large marker chromosome and ring chromosome with high-level amplification of both MDM2 and CDK4 genes. FISH analysis on paraffin wax-embedded sections showed amplifications of MDM2 and CDK4 in seven of seven inflammatory MFHs and in seven of seven dedifferentiated liposarcomas. Quantitative PCR showed amplification of MDM2 in six and of CDK4 in seven of nine inflammatory MFHs. In conclusion, this study strongly suggests that most so-called inflammatory MFHs are dedifferentiated liposarcomas.     

Modification of Kiel and working formulation classifications for improved survival prediction in non-Hodgkin's lymphoma

The total survival of 203 patients with non-Hodgkin's lymphoma (NHL) was analyzed according to the working formulation (WF) and "expanded" Kiel classifications. The original Kiel classification consisting of low grade (LG) and high grade (HG) forms corresponded well to the LG and HG forms of the WF. When an expanded Kiel containing an intermediate grade (IG) composed of the original LG diffuse group was devised, this gave a much better separation of survival of the three grades as compared with the WF where the survival of IG and HG forms were nonsignificantly different. The main reason for this difference was the inclusion of the so-called centroblastic diffuse form in the HG Kiel, but in the IG according to the WF. In a "modified" WF analysis where this histologic entity was placed in the HG subgroup, the three survival curves then gave excellent separation like the expanded Kiel classification. Since the centroblastic diffuse form (and its analogous forms according to other classifications) has a poor prognosis, it is important that it be so recognized and treated accordingly with aggressive therapy. We propose either our expanded Kiel or modified WF classification of the three grade forms as an excellent predictor of survival.     

Longitudinal study of the risks related to the consumption of water not conforming to bacteriological norms

A prospective follow-up study lasting 18 months in 1983-1984 was conducted in 50 villages in order to assess the risk related to the consumption of drinking water which did not meet the bacteriology standards. 119 physicians, 52 pharmacists and 118 primary-school teachers enumerated the cases of acute gastro-intestinal diseases observed among a population of 29,272 inhabitants. A weekly water sample was analysed in each village as to the presence of four indicator germs of fecal contamination: total plate count, total coliforms, fecal coliforms (thermotolerant) and fecal streptococci. 1,950 cases of acute gastro-intestinal diseases were registered by the physicians and pharmacists during a population experience of 1,873,303 persons-weeks, i.e. an incidence density of 1.06 X 10(-3) cases per person-week. The risk notified by the school teachers among children aged 7 to 11 was higher: 16.3 X 10(-3) cases per child-week. The villages were classified in 3 groups, according to the proportion of substandard samples: "good", "intermediate", and "bad" categories. The relative risk contrasting the "bad" and "good" villages was 3.5 for the cases notified by the physicians and the pharmacists among the general population (95% confidence interval = 2.5-4.8); it was 1.7 for the cases reported by the teachers among the children (95% confidence interval = 1.5-1.9). This concordant difference was very significant but not constant across the 18 months of the survey. The authors conclude that the bacteriology standards are a relevant indicator of a health hazard.