Merkel cell carcinoma: an unusual indication for isolated limb perfusion

Isolated limb perfusion (ILP) is a surgical technique that enables the administration of high-dose chemotherapy while minimizing serious systemic side effects. The clinical value and indications are well established for skin and soft tissue tumors on limbs. For skin tumors, this technique is mainly indicated for melanoma with in-transit metastasis. For soft tissue tumors--sarcoma and osteosarcoma--it is useful as a palliative technique to reduce the tumoral mass. Limb perfusion can also be an option in other tumors, such as advanced stage squamous cell carcinoma or Merkel cell carcinoma. We present a case report of a 68-year-old man with Merkel cell carcinoma on the right tibiotarsical region, with in-transit metastasis throughout the whole lower limb. Regional chemotherapy involving ILP with melphalan and tumor necrosis factor-alpha (TNFalpha) was performed in order to avoid amputation; the primary tumor was not excised. A steady regression of the disease was observed, with complete resolution of all visible in-transit metastases at the 45th day post-perfusion. However, systemic metastasis leading to fatal outcome occurred 4 months later. Although there was no change in the patient's prognosis, ILP was able to avoid limb amputation as it controlled local-regional disease and produced complete regional remission. The addition of TNFalpha to melphalan in ILP appears to produce greater efficacy in the treatment of patients with bulky tumors or a large number of in-transit metastases.     

Hypermethylated <Emphasis Type="Italic">14-3-3-σ</Emphasis> and <Emphasis Type="Italic">ESR1</Emphasis> gene promoters in serum as candidate biomarkers for the diagnosis and treatment efficacy of breast cancer metastasis

Background  

Numerous hypermethylated genes have been reported in breast cancer, and the silencing of these genes plays an important role in carcinogenesis, tumor progression and diagnosis. These hypermethylated promoters are very rarely found in normal breast. It has been suggested that aberrant hypermethylation may be useful as a biomarker, with implications for breast cancer etiology, diagnosis, and management. The relationship between primary neoplasm and metastasis remains largely unknown. There has been no comprehensive comparative study on the clinical usefulness of tumor-associated methylated DNA biomarkers in primary breast carcinoma and metastatic breast carcinoma. The objective of the present study was to investigate the association between clinical extension of breast cancer and methylation status of Estrogen Receptor1 (ESR1) and Stratifin (14-3-3-σ) gene promoters in disease-free and metastatic breast cancer patients.     

Factor de crecimiento de hepatocitos plasmático en preeclampsia y eclampsia

Objective

To compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women.

Materials and method

We included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis.

Results

Plasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05).

Conclusion

The findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women.     

Concentraciones de neuroquinina B como marcador de riesgo en pacientes con preeclampsia

Objective

To establish the usefulness of neurokinin B concentrations as a risk marker in patients with preeclampsia.

Method

A total of 100 patients were selected. Fifty patients with preeclampsia were selected as cases (group A) and 50 healthy normotensive pregnant women with a similar age and body mass index to the study group were selected as controls (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine neurokinin B concentrations.

Results

Statistically significant differences in neurokinin B concentrations were found between group A (16.3 ± 9.6 ng/L) and group B (3.5 ± 2.0 ng/L; P<.05). There was a positive and significant correlation with values of systolic and diastolic blood pressure (P<.05). A cut-off value of 5 pg/ml had a value under the curve of 0.93, sensitivity of 75.0%, specificity of 87.5%, a positive predictive value of 90.0%, a negative predictive value of 70.0%, and a diagnostic accuracy of 81.2%.

Conclusions

Concentrations of neurokinin B were significantly higher in patients with preeclampsia than in healthy normotensive pregnant women. This peptide is useful as a risk marker in patients with preeclampsia.     

Concentraciones de interleucina-16 en pacientes con preeclampsia y gestantes normotensas sanas

Objective

To compare interleukin-16 concentrations in patients with preeclampsia and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. Fifty patients with preeclampsia were selected as the study group (group A) and 50 healthy normotensive pregnant women with the same age and body mass index as the study group were selected as controls (group B). Blood samples were extracted from all patients before labor and immediately after diagnosis in group B to determine interleukin-16 concentrations.

Results

There was statistically significant difference in interleukin-16 concentrations between group A (211.9 ± 78.7 pg/ml) and group B (83.6 ± 9.9 pg/ml; p < 0.05). There was a strong, positive and significant correlation with systolic blood pressure values (r = 0.282; p < 0.05) and with diastolic blood pressure values (r = 0.320; p < 0.05). A cutoff value of 180 pg/ml had an area under the curve of 0.95, sensitivity of 94.0%, specificity of 70.0%, a positive predictive value of 75.8% and a negative predictive value of 92.1%, with a diagnostic accuracy of 75.0%.

Conclusions

Interleukin-16 concentrations were significantly higher in patients with preeclampsia than in healthy normotensive pregnant women.     

Porcine model to compare real-time intraocular pressure during LASIK with a mechanical microkeratome and femtosecond laser

PURPOSE: To compare real-time intraocular pressure (IOP) during laser in situ keratomileusis (LASIK) in porcine eyes using two types of microkeratomes. METHODS: An interventional, prospective study of two microkeratomes: a Moria 2 (Moria group) and an IntraLase femtosecond laser (IntraLase Corp., Irvine, CA; IntraLase group). These devices were used to create lamellar corneal flaps in freshly enucleated porcine eyes. The IOP changes induced by the procedures were recorded with a reusable blood pressure transducer connected to the anterior chamber by direct cannulation. RESULTS: Seven porcine eyes were studied in each group. The IOP increased during the suctioning phase, reaching a mean of 122.52 +/- 30.40 and 160.52 +/- 22.73 mm Hg during the cutting phase in the Moria group (the total time in this group was 36.42 +/- 7.48 seconds; suctioning required 21.42 +/- 7.48 seconds and the cutting phase, 15 +/- 2.88 seconds). In the IntraLase group, the IOP reached 89.24 +/- 24.26 mm Hg during the suctioning phase and 119.33 +/- 15.88 mm Hg during the intrastromal laser application (the total time was 92.85 +/- 13.49 seconds; suctioning required 40.00 +/- 9.57 seconds and the cutting phase 52.85 +/- 5.66 seconds). Both IOPs during both phases differed significantly between the two groups (P = 0.01 for all comparisons). CONCLUSIONS: Real-time IOP can be measured during LASIK using a transducer connected to the anterior chamber. The results showed a significant increase in IOP during the procedure in both groups, although with the IntraLase the IOP seemed to increase to a lesser extent than with the conventional mechanical microkeratome.     

Laser treatment of port wine stain

Laser treatment of vascular skin lesions is rapidly improving. Port wine stain (PWS) is one of the first lesions successfully treated with laser. The pulsed dye laser (PDL) has been developed on the concept of selective photothermolysis and has revolutionized PWS treatment. Even though the response is variable, substantial blanching can be obtained after several sessions. Greater selectivity and better response have been achieved by modifying PDL parameters such as longer pulse width, longer wavelength, or higher energy fluencies with cooling skin devices. It is known that thick, deep or raised lesions present poor response to conventional treatments. The aim of this study is to review the different lasers and other light sources which are developing for the treatment of PWS and other vascular lesions.     

Brown-McLean syndrome after insertion of an anterior chamber intraocular lens: description of one case

CASE REPORT: We report one case of Brown-McLean syndrome. DISCUSSION: In this case, a 71-year-old male developed a Brown-McLean syndrome after implantation of an anterior chamber lens in one aphakic eye. A phacoemulsification procedure was performed in the other eye without development of corneal clearance alterations in the next 7 years. The cause of Brown-McLean syndrome is still unexplained. It is possible that it could develop in eyes with a genetic predisposition when these eyes are exposed to certain conditions, such as insertion of an anterior chamber lens.