Incidence and in-vivo relevance of anti-interferon antibodies during treatment of low-grade cutaneous T-cell lymphomas with interferon alpha-2a combined with acitretin or PUVA

Interferon-α combined with retinoid or PUVA is used for the treatment of cutaneous T-cell lymphoma. Anti-IFN-α antibodies (IFN ab) occur regularly during IFN-α treatment. We investigated the incidence of neutralizing and binding IFN ab and analysed their relationship with clinical and immunological parameters. A group of 17 CTCL patients were treated with IFN alpha-2a three times weekly subeutaneously at a dose of 3 Mill. I.U. combined either with retinoid (acitretin, Neotigason; 0.5 mg/kg body weight) daily or with 5-methoxypsoralen (1.2 mg/kg body-weight) plus UVA radiation three times weekly. Prior to and during treatment we monitored stage, skin involvement by a tumour burden index, serum levels of β2-microglobulin, neopterin, binding and neutralizing IFN ab, Interleukin-6 (IL-6), soluble IL-2 receptors (sIL-2r) and the CD4/CD8 ratio of peripheral blood mononuclear cells. We observed two complete, two partial and six minor responses, four patients with stable disease and three patients with progressive disease. Of the 17 patients, 7 developed binding IFN ab, but only 2 had neutralizing IFN ab which were associated with high titres of binding IFN ab. IFN ab formation was more frequent in patients with normal CD4/CD8 ratios and a high tumour burden index and showed a trend to be more frequent in PUVA-cotreated patients than in retinoid-cotreated patients. Responses were more frequently seen in IFN ab-negative patients. IFN ab developed in patients treated with PUVA or retinoid combined with IFN. Binding as well as neutralizing IFN ab may have an impact on the treatment success in CTCL patients.     

Nutritional status among rural Meitei children of Manipur,India

The nutritional status of 301 rural Meitei children (5–11 years old, 163 boys and 138 girls) from low socioeconomic backgrounds was evaluated with the help of dietary survey, clinical signs of mineral and vitamin deficiencies, and selected anthropometric dimensions. The diet was cereal and starchy food—based with rice forming the staple food. Potatoes and green grams, were the commonly consumed tubers and pulses, respectively. Consumption of fruits, eggs, milk, and milk products was extremely low. Vitamin A and C deficiencies were the most common. Spongy bleeding gums (19%), and Bitot's spot (11%) and conjunctival xerosis (12%) were the most prevalent clinical signs of vitamin C and A deficiency, respectively. Compared to girls, boys had a significantly higher incidence of deficiency signs. Mean statures and weights are below the 20th percentile of U.S. (NCHS) reference data. The incidence of stunting was substantially more than that of wasting. Nearly 29% of the children had z-scores 2 S.D. or more below the NCHS median in stature-for-age. Only 1.7% of the children had z-scores 2 S.D. or more below the reference median of weight-for-stature. More girls than boys were classified as having normal weight/age, stature/age, and weight/stature. The results are contrary to the common belief that Indian girls are at a nutritional disadvantage compared to boys. Rather, the findings support the concept of better buffering of female than males under conditions of environmental stress. © 1994 Wiley-Liss, Inc.     

Enhanced oxidative phosphorylation in rat liver mitochondria following prolonged in vivo treatment with imipramine.

1. Effects of prolonged in vivo administration of the tricyclic antidepressant drug imipramine on oxidative energy metabolism in rat liver mitochondria were examined. 2. Imipramine treatment resulted in an increase in state 3 respiration rates with all the substrates tested as early as one week after treatment; this was sustained through the second week of treatment. 3. The changes in respiration rates were accompanied by a selective increase in the intramitochondrial cytochrome aa3 and c + c1 contents after both one and two weeks of treatment. 4. Administration of imipramine did not alter the total liver protein content per g tissue, the mitochondrial protein content per g tissue or the mitochondrial yield. 5. Kinetic analyses of succinoxidase activity in terms of Arrhenius plots indicated possible alterations in mitochondrial membrane lipid milieu and membrane fluidity after the drug treatment, especially in the second week.     

The pectoralis major myocutaneous flap in head and neck reconstruction

The pectoralis major myocutaneous flap (PMMC flap) represents a landmark in the development of head and neck reconstructive surgery. After Stephan Ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery. Here, we present our initial experience with fourteen PMMC flaps in head and neck reconstruction. In most of the instances it was used for oral or oropharyngeal reconstruction. It was used for five other reconstructive tasks as well. Wound infection was the most common complication. There was no case of total flap loss. It has proven to be a reliable method of reconstuction in the head and neck.     

Cholecystectomy and drainage: Ultrasonographic and radioisotopic evaluation

Eighty patients undergoing cholecystectomy were either assigned deliberately (n=30) or randomized (n=50) to drainage (n=38) or nondrainage (n=42). Subhepatic collections were seen on ultrasonography (US) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage (p<0.05). Only two patients with subhepatic collections were symptomatic, and none required treatment. Postoperative infective complications were seen in 13 of 38 patients with drainage and 4 of 42 without drainage (p<0.01). Five of 12 patients with drainage and with a collection, and none of the 18 patients without drainage and without a collection had postoperative infective complications (p<0.05). Cholecystectomy was then performed in 100 patients without using a drain. BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied. Subhepatic collections were seen on US after 48 to 72 hours in 42 patients. The collection resolved in 22 patients and was smaller in 6 on repeat US. None of the patients with collection was symptomatic, and none required treatment. Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection (not significant). We conclude that (1) cholecystectomy with drainage is associated with more infective complications than when a drain is not used; (2) cholecystectomy without drainage is safe; and (3) asymptomatic nonbilious subhepatic collections are common after cholecystectomy without drainage but do not require treatment, resolving spontaneously.

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Resumen Ochenta pacientes sometidos a colecistectomía fueron randomizados a drenaje (38) o no drenaje (42). Se observaron colecciones subhepáticas en ultrasonografía practicada a las 48–72 horas en 12/35 pacientes con drenaje y en 24/42 pacientes sin drenaje (p<0.05). Sólo 2 de tales colecciones fueron sintomáticas y ninguna requirió tratamiento. Complicaciones sépticas postoperatorias fueron registradas en 13/38 pacientes con drenaje y en 4/42 sin drenaje (p<0.01). Cinco de 12 con drenaje y con colección subhepática, y ninguno de 18 sin drenaje y sin colección presentaron complicaciones sépticas postoperatorias (p<0.05). Después de esta serie se practicaron 100 colecistectomías sin drenaje. La escanografía con radioisótopos, BULIDA, reveló escape biliar en sólo 4 de 34 pacientes estudiados; se visualizaron colecciones subhepáticas por US a las 48–72 horas en 42 pacientes. La colección se resolvió en 22 y apareció menor en 6 casos en que se repitió la US. Ninguna de estas colecciones fue sintomática y ninguna requirió tratamiento alguno. Se registraron complicaciones sépticas en 7/42 pacientes con colección y en 5/58 sin colección (ns). Nuestra conclusión es que la colecistectomía con drenaje se asocia con un numéro mayor de complicaciones sépticas. La colecistectomía libre de drenaje es un procedimiento seguro; las colecciones no biliares subhepáticas asintomáticas son frecuentes después de la colecistectomía sin drenaje pero no requieren tratamiento y se resuelven espontáneamente.

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Résumé Quatre-vingt patients (50 par randomisation) ont eu un drainage (n=38) ou non (n=42) après cholécystectomie traditionnelle. Une collection soushépatique a été mise en évidence par échographie dans les 48–72 heures postopératoires chez 12/35 patients avec drainage et chez 24/42 patients sans drainage (p< 0.05). Seulement deux de ces collections étaient symptomatiques et aucune n'a nécessité de geste thérapeutique. Des complications postopératoires infectieuses ont été observées chez 13/38 patients ayant eu un drainage comparées à 4/42 des patients sans drainage (p<0.01). Cinq des 12 patients ayant eu un drainage et une collection ont eu une infection postopératoire comparés à aucun des 18 patients sans drainage ni collection (p<0.05). On a ensuite réalisé 100 cholécystectomies sans drainage. Une scintigraphie au technétium a mis en évidence une fuite biliaire chez 4 des 34 patients étudiés. Une collection soushépatique a été mise en évidence par échographie chez 42 patients. Lors de la surveillance échographique, la collection s'est résorbée spontanément chez 22 patients et a diminué d'importance chez 6. Aucune de ces collections n'étaient symptomatiques et aucune n'a nécessité de geste thérapeutique. Des complications postopératoires ont été observés chez 7/42 patients avec une collection comparés à 5/58 patients sans collection (différence non significative). Nous concluons que: (1) il y a plus d'infection lorsque l'on draine l'abdomen après une cholécystectomie que lorsque l'intervention se termine sans drainage; (2) la cholécystectomie sans drainage est sans danger; et (3) des collections bilieuses asymptomatiques sont fréquentes après cholécystectomie sans drainage, mais elles se résorbent habituellement sans nécessiter d'intervention.

     

Chemoprophylaxis and gonococcal infections in prostitutes

The influence of chemoprophylaxis on gonorrhoea has not been reported recently. 777 prostitutes were interviewed and checked for evidence of chemoprophylaxis. The study showed that chemoprophylaxis does reduce the risk of gonococcal infections and that those who took penicillin chemoprophylaxis had a higher risk of Penicillinase producing Neisseria gonorrhoeae (PPNG) infections compared to those who took non-penicillin chemoprophylaxis and those who did not take any prophylaxis.     

Sinonasal epithelial-Myoepithelial carcinoma-A rare entity

Epithelial-myoepithelial carcinoma is a rare salivary gland tumor. It comprises less than 1% of all salivary gland tumors. It generally arises from the parotid gland. Unusual sites of occurrence include sinonasal tract, lung, trachea, lacrimal gland and breast. Histopathologically epithelial-myoepithelial carcinoma comprises a dual population of ductal and myoepithelial cells. We report an extremely rare case of epithelial-myoepithelial carcinoma occurring in the sinonasal tract of young man.