Chromosome Changes and Their Evolution in Subjects With Past Exposure to Benzene

Chromosome studies of peripheral blood lymphocytes in 25 subjects who had recovered from benzene hemopathy, in four subjects with bone marrow toxicity from benzene, and in three subjects who had recovered from acute benzene poisoning revealed significantly increased rates of “unstable” and “stable” chromosome aberrations which, In most cases, were still present several years after cessation of exposure to the toxic agent and recovery from the poisoning. The follow-up cytogenetic studies showed a tendency toward a decrease in unstable chromosome changes and, generally, a persistence or an increase in stable changes. Bn some cases there was evidence of abnormal clone formation in peripheral blood lymphocytes. Chromosomes of the G group seemed to be involved in stable changes with a frequency higher than expected.     

Suppression of the alveolitis in pulmonary sarcoidosis by oral corticosteroids

We evaluated the effects of daily prednisone therapy on alveolitis parameters and pulmonary function tests over a six month period in patients with active pulmonary sarcoidosis (>28% T lymphocytes in bronchoalveolar lavage and positive gallium-67 (⁶⁷Ga) lung scans). 10 patients with biopsyproven lung disease were studied. Analysis of bronchoalveolar lavage cells and of⁶⁷Ga scanning at the beginning and at the end of the study period demonstrated that prednisone treatment significantly lowered the percentages of T lymphocytes in bronchoalveolar lavage in all patients (baseline 48±3%, after treatment 19±5%, p<0.01) while⁶⁷Ga lung scans improved in 8 of the 10 patients. Pulmonary function tests showed improvement of the parameters studied (+7.5±2.1% mean change in vital capacity, +4.7±1.6% mean change in total lung capacity, +5.4±2% mean change in forced expiratory volume in one second and +6.2±1.5% mean change in diffusing capacity). In addition none of the treated patients deteriorated functionally and 9 of the 10 patients improved more than 10% in at least one parameter. These results indicate that daily oral prednisone therapy is effective in suppressing the alveolitis in pulmonary sarcoidosis and that it is able to preserve lung functions in patients who, without treatment, would be likely to deteriorate. Supported by C.N.R. grants n^o 82.00200.04 and 82.02057.56     

Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease

Background  

Omitting the extraction site incision potentially further decreases the abdominal wall trauma in laparoscopic surgery. The purpose of this study was to report the results of alternative specimen extraction techniques after laparoscopic emergency colectomy in patients with inflammatory bowel disease (IBD).     

Adopted children with cleft lip or palate, or both, require special needs cleft surgery

In recent years adoption of children with cleft lip, with or without cleft palate (CLP), and other birth defects has become more common. The aim of the present study was to describe the characteristics and initial care and treatment of adopted children with CLP. A total of 25 children were referred to our department between 2008 and 2010, 7 (28%) of whom had bilateral CLP and 16 (64%) had unilateral CLP. Two children had atypical clefts. Twenty of the patients (80%) had been operated on with a lip plasty in China before adoption. Most patients (n = 14) was seen by the cleft team within two months of arrival, and 13 were operated on within a month of the first visit at our department. In total, 22 primary palatoplasties, 6 lip plasties, and 1 lip adhesion were done. There were 5 fistulas (14%) three months after the palatoplasty. On arrival, 11 (44%) of the children were carriers of methicillin-resistant Staphylococcus aureus (MRSA). Adoption of children with CLP creates new challenges for the cleft teams, as we no longer have control over the overall treatment plan as regards preoperative and surgical treatment and timing of the operations. The patients are also often carriers of resistant bacteria, which create nursing challenges. In cases where the child is older than a year and has not been operated on, we advocate that the palatoplasty, or combined lip plasty and palatoplasty, is always given priority so that speech development is not compromised.     

Histopathologic excision margin affects local recurrence rate: analysis of 2681 patients with melanomas < or =2 mm thick

OBJECTIVE: Prospective trials have shown that 1-cm and 2-cm margins are safe for melanomas <1 mm thick and > or =1 mm thick, respectively. It is unknown whether narrower margins increase the risk of LR or mortality. SUMMARY BACKGROUND DATA: To determine the relationship between histopathologic excision margin, local recurrence (LR) and survival for patients with melanomas < or =2 mm thick. METHODS: Data were extracted from the Sydney Melanoma Unit database for all patients with cutaneous melanoma < or =2 mm thick, diagnosed up to 1996. Patients with positive excision margins or follow-up <12 months were excluded, leaving 2681 for analysis. Outcome measures were LR (recurrence <5 cm from the excision scar), in-transit recurrence, and disease-specific survival. Factors predicting LR and overall survival were tested with Cox proportional hazards analysis. RESULTS: Median follow-up was 83.8 months. LR was identified in 55 patients (median time to recurrence, 37 months). At 120 months, the actuarial LR rate was 2.9%. Five-year survival after LR was 52.8%. In multivariate analysis, only margin of excision and tumor thickness were predictive of LR (both P = 0.003). When all patients with a margin <0.8 cm in fixed tissue (corresponding to a margin of <1 cm in vivo) were excluded from analysis, margin was no longer significant in predicting LR. Thickness, ulceration, and site were predictive of survival, but margin was not (P = 0.49). CONCLUSIONS: Histopathologic margin affects the risk of LR. However, if the in vivo margin is > or =1 cm, it no longer predicts risk of LR. Patient survival is not affected by margin.     

Platelet Cyclic Guanosine Monophosphate as a Biomarker of Phosphodiesterase Type 5 Inhibitor Efficacy in the Treatment of Erectile Dysfunction: A Randomized Placebo-Controlled Study

Background

Phosphodiesterase 5 inhibitors (PDE5-Is) are a mainstay in the therapy of erectile dysfunction (ED). The primary end point of clinical efficacy, both in clinical studies and normal practice, is represented by the International Index of Erectile Function (IIEF).

Objective

To evaluate if platelet cyclic guanosine monophosphate (cGMP) could represent a valuable marker for PDE5-I activity in ED.

Design, setting, and participants

The study enrolled 46 patients with psychogenic, organic, and mixed ED (20–71 yr of age; IIEF score <26). Patients were randomized to 6 wk of vardenafil, 5 mg/d at bedtime, or placebo.

Intervention

All patients donated two blood samples, one before starting the protocol and the second after 6 wk of treatment.

Measurements

Platelet cGMP was measured in both placebo and vardenafil groups. All the patients completed the IIEF-Erectile Function (EF) domain and the sexual encounter profile (SEP) and underwent visual sexual stimulation (VSS) coupled with Rigiscan. All the measurements were performed prior to starting the protocol and after the 6 wk of treatment.

Results and limitations

Platelet cGMP production was significantly (p < 0.05) elevated in patients taking 5 mg vardenafil versus placebo. Vardenafil was not superior to placebo in improving IIEF-EF and SEP scores. Conversely, VSS-Rigiscan revealed a significant amelioration (p < 0.028) in the vardenafil group versus placebo. The changes in platelet cGMP level correlated well with VSS-Rigiscan (p = 0.0037) but not with IIEF-EF and SEP.

Conclusions

Platelet cGMP could represent a relatively simple, reliable, and objective biomarker of PDE5-I activity in ED clinical studies. Larger clinical studies are needed to further validate the use, utility, and limits of this assay.