Lymphatic invasion in cutaneous melanoma is associated with sentinel lymph node metastasis

Background:  Sentinel lymph node (SLN) metastasis is a major determinant for staging, prognostication and clinical management of patients with cutaneous melanoma. However, the role of lymphatic vs. vascular invasion (VI) for SLN spread remains unclear.
Methods:  We compared the frequency of lymphatic invasion (LI) vs. VI in melanoma sections from 94 patients with a mean three-year clinical follow up using immunostains for the lymphatic endothelial markers D2-40 (podoplanin) and LYVE-1 and the panvascular marker CD31.
Results:  LI occurred more frequently than VI (16 vs. 3%, respectively, p = 0.001) and correlated with higher American Joint Committee on Cancer stage at diagnosis (p = 0.0004). In a univariate analysis, LI was strongly associated with SLN metastasis (p = 0.008), independent of tumor thickness. In a multivariate analysis, LI was not a significant risk factor for SLN metastasis. The presence of intratumoral lymphatics (ITLs) was associated with distant metastasis, whereas VI was rare and did not correlate with SLN or distant metastasis. A combination of LI and ITL had higher positive and negative predictive values for the risk of developing SLN metastasis compared with routine histology and VI.
Conclusion:  Detection of LI in the primary tumor may aid in identifying melanoma patients with the propensity to develop SLN metastasis.     

Health-related quality of life among individuals with long-standing spinal cord injury: a comparative study of veterans and non-veterans

Background  

Spinal cord-injured (SCI) patients experience poor health-related quality of life (HRQOL) and they usually report lower HRQOL than the general population or population subgroups in Iran and elsewhere. The aim of this study was to compare HRQOL between veterans and non-veterans with SCI in Iran.     

Effects of short-term and subchronic lead poisoning on nitric oxide metabolites and vascular responsiveness in rat

Chronic exposure to low levels of lead results in sustained hypertension in humans and experimental animals. The mechanism of lead-induced hypertension remains unclear. We investigated the short-term (4 and 8 weeks) and subchronic (12 weeks) effects of lead treatment on responsiveness of vascular adrenergic system and level of nitric oxide metabolites, that is, total nitrates and nitrites (NOx). Male Sprague-Dawley rats were treated with lead acetate (100 ppm in drinking water) for 12 weeks. Short-term lead administration resulted in marked elevation of blood pressure accompanied by significant reduction in serum NOx levels. In contrast, after subchronic lead administration the trend of decrease in NOx levels somehow reversed despite further increase in blood pressure. Both short-term and subchronic lead administration resulted in significant differences in vascular reactivity with respect to either vasoconstrictor (phenylephrine and clonidine) or vasodilator (isoproterenol) agents. We conclude that vascular adrenergic system and nitric oxide pathway change in short-term and subchronic phases of lead poisoning.     

Scrotal ulceration as a consequence of all-trans-retinoic acid (ATRA) for the treatment of acute promyelocytic leukemia

Induction therapy with all-trans-retinoic acid (ATRA), an oral vitamin A derivative, has been shown to improve the short and long-term outcome of patients with acute promyelocytic leukemia (APML). Common side effects include headache, fever, dry skin, and bone pain, and approximately 25% of treated patients experience ATRA syndrome, which includes fever, dyspnea, weight gain, pulmonary infiltrates, and pleural or pericardial effusions. Scrotal ulcerations due to ATRA are rare with 16 previously documented cases, most of whom were Asian. We report a Caucasian male with APML who developed scrotal ulceration during ATRA induction therapy and review the previously reported cases. Physicians and patients should be aware of this disturbing, but self-limited, dermatologic complication of ATRA.     

Is there need for thoracic spine radiographs following a negative chest CT in trauma patients?

The purpose of this study was to assess the need for conventional radiographs of the thoracic spine for routine clearance of trauma patients in whom chest CT has revealed no spinal trauma. The study was in the form of a retrospective review of trauma patients over the previous five years who underwent conventional radiographs of the thoracic spine following a chest CT that revealed no spinal trauma. Two hundred thirty-five trauma patients were found to have undergone conventional thoracic spine series following a chest CT that showed no spinal trauma. In 234 of the cases, the thoracic spine series was also negative. In one case, the thoracic spine series revealed mild anterior compression of the T7 vertebral body. This injury was stable and required no specific intervention. CT of the chest is an adequate evaluation of the thoracic spine in trauma patients who require routine thoracic spine clearance, making subsequent conventional radiographs of the thoracic spine unnecessary. Electronic Publication