Treatment of nevoid hyperkeratosis of the nipple and areola by shave excision

The case is presented of a 29-year-old female who, at the age of 13 years, developed bilateral verrucous thickening of her areolae. Despite the condition causing her significant psychosocial morbidity, a specialist referral was initially denied on the grounds that no treatment was apparently available. The condition progressively deteriorated over the subsequent 14 years. She was eventually referred for a dermatology opinion, and the diagnosis of nevoid hyperkeratosis was made. Topical therapy with keratolytics was unsuccessful, and she was referred for a plastic surgery review. Bilateral shave excision of the lesion was performed under general anesthesia, with a satisfactory outcome and no evidence of recurrence at 10 months.     

Lower limbs revascularization originated in the descending thoracic aorta

The revascularization of the lower limbs through a bypass graft from the descending thoracic aorta is one of the most uncommon surgical procedures within the scope of the so-called "extra-anatomic revascularization". It is an highly selective procedure in terms of indications and is regarded as an effective hemodynamic alternative, with acceptable long-lasting results. Two patients who underwent successfully the operation are reported, followed by a discussion on the technical aspects, indications, complications and early and late results of the procedure.     

Isolated obstructive lesions of the cervical common carotid: clinical and surgical aspects

Isolated lesions of the extra-thoracic common carotid arteries are unusual in clinical practice. Contrarily to the well known lesions of carotid bifurcation, its natural history is poorly understood and indications for surgical management are not well defined. In this paper, seven patients with isolated lesions of the common carotid arteries are reported, being two symptomatic (TIA's). Patients underwent successful surgical management. The main features of clinical presentation, diagnosis and surgical management are presented and discussed     

Elevated Serum Parathormone after Roux-en-Y Gastric Bypass

Background: Abnormalities in calcium and vitamin D metabolism are observed early after gastric bypass, whereas clinical or biochemical evidence of metabolic bone disease might not be detected until many years after the procedure. The aim of the present study was to evaluate the impact of bariatric surgery on bone metabolism determined on the basis of postoperative laboratory changes in calcium, phosphorus, magnesium, alkaline phosphatase and parathormone (PTH) levels. Methods: 110 patients submitted to Roux-en-Y gastric bypass (RYGBP) were followed after surgery, and the following parameters were determined: intact PTH molecule (PTHi; chemiluminescence), alkaline phosphatase (colorimetric method), ionic calcium (selective electrode), phosphorus and magnesium (colorimetric method). Results: Elevated serum PTHi levels were observed in 29% of the patients and hypocalcemia in 0.9% from the 3rd postoperative month and afterwards (3 to 80 months after surgery). Conclusion: There is a need for careful evaluation of bone metabolism and for routine calcium replacement after RYGBP.     

Expression of protein kinase C (PKC) alpha, delta, epsilon, zeta in primary chick chondrocyte cultures: immunocytochemical study

PKC is a family of 12 serine/threonine isoenzymes that plays a pivotal role in signal transduction in a large number of biological processes. In the present work we have investigated the expression of PKC (alpha, delta, epsilon, zeta) in chick chondrocyte primary cultures at different differentiation times, i.e. at 48, 55, 62 and 69 days after cell collection from tibiae of 6-day old chick embryos. We would also detect cell differentiation stages towards the osteoblast-like cell phenotype by observing the immunocytochemical expression of the specific osteoblast marker, type I collagen. At the considered culture times, cells exhibited immunocytochemical positivity for type I collagen, thus showing their differentiation towards the osteoblast-like phenotype. PKC-zeta was the isoenzyme that exhibited the most relevant immunocytochemical expression in all considered culture times, whereas PKC-epsilon always less expressed in comparison to the other PKC-isoforms. No relevant differences were observed for the immunocytochemical expressions of PKC-alpha and PKC-delta. On the basis of the immunocytochemical data obtained from the present investigation, we could affirm that PKC-alpha, -delta, -epsilon, and -zeta may play peculiar roles in the differentiation process of chick chondrocytes towards the osteoblast-like cell phenotype.     

Evaluation of toxicity after one-months treatment with <Emphasis Type="Italic">Bauhinia forficata</Emphasis> decoction in streptozotocin-induced diabetic rats

Background  

Previous experiments have shown that a decoction of Bauhinia forficata leaves reduces the changes in carbohydrate and protein metabolism that occur in rats with streptozotocin-induced diabetes. In the present investigation, the serum activities of enzymes known to be reliable toxicity markers were monitored in normal and streptozotocin-diabetic rats to discover whether the use of B. forficata decoction has toxic effects on liver, muscle or pancreas tissue or on renal microcirculation.     

Production of interferon gamma in respiratory syncytial virus infection of humans is not associated with interleukins 12 and 18

In order to understand early events in the immune response to respiratory syncytial virus (RSV) infection, we studied the presence of various chemokines and cytokines in respiratory secretions of human infants with RSV infection. Interferon gamma (IFNgamma) was present in 30/39 (76.9%) subjects tested, but the IFNgamma-inducing cytokines interleukin (IL)12 and IL18 were detectable in 6/40 (15%) and 11/38 (28.9%) subjects, respectively. Quantities of IL12 and IL18 did not correlate with those of IFNgamma. IL18, but neither IFNgamma nor IL12 was found in significantly greater concentrations in subjects with mild, nonhypoxic forms of bronchiolitis than in those with upper respiratory illness alone or hypoxic bronchiolitis. The findings suggest that IFNgamma may be induced independently of the activities of IL12 and IL18 during RSV infection. Immune responses characterized by relatively greater release of IL18 may be associated with milder forms of bronchiolitis.     

Can oncology nurses treat depression? A pilot project

BACKGROUND: Depression is a common problem in all medically ill populations. Reported prevalence rates of major depression in patients with cancer are up to 50%. Cancer patients attending primary care and medical outpatient clinics with comorbid major depressive disorder frequently do not receive effective treatment. More effective ways of identifying and treating patients with both cancer and depression are therefore urgently required. AIM: The paper reports a study addressing the question of whether oncology nurses can be trained to take on a greater role in the management of major depression in their patients. METHOD: We developed and piloted an intervention that can be delivered by a specially trained oncology nurse. The intervention is multifaceted and based on a problem-solving model. It requires a widening of the role and expertise of specialist nurses. DISCUSSION: The challenges this role presents to the nurses are discussed. We suggest that they must have a varied work programme that is not exclusively about managing depression, that they require adequate peer support and are likely to be most effective when working as part of a multidisciplinary psycho-oncology team. CONCLUSION: We conclude that it is possible to train selected specialist oncology nurses to manage major depression in patients with cancer in the context of an appropriately constituted multidisciplinary team.