Surgical management of orbital malignant melanoma: our experience and a report of three cases

PURPOSE: The aim of this study is to illustrate our personal experience concerning the diagnostic and therapeutic management of primary and secondary orbital melanomas. PATIENTS AND METHODS: Nine patients (five men and four women) with a histological diagnosis of orbital malignant melanoma were surgically treated in our department during the last 10 years (1995 - 2005). RESULTS: All the patients had a unilateral orbital malignant melanoma. A primary tumour was diagnosed in one case. There was metastatic orbital localisation of a cutaneous malignant melanoma in two cases. In six cases, a secondary melanoma originated from the uveal tract (three cases), conjunctiva (two cases), or paranasal sinuses (one case). All the patients underwent surgical treatment of the tumour (exenteration in 5 cases; subtotal exenteration in one case; subtotal excision in two cases; and craniofacial resection in one case) combined with immunotherapy in one case. The median age at surgery was 66 years, with a mean postoperative follow-up of 17 +/- 14 months. Four patients died of widespread dissemination of the melanoma after a mean time of 13 +/- 7 months. Two more patients died of causes other than melanoma. Three patients were still living at 9, 33 and 45 months after surgery. None of the patients presented with a local relapse of the melanoma during follow-up. CONCLUSION: Although different approaches have been proposed, the prognosis of orbital melanoma remains poor. In our experience too, the patients with longest survival were those whose tumours were exenterated.     

Cyclosporin A in the ocular fluids of uveitis patients following long-term systemic administration

BACKGROUND/AIMS: To determine the levels of cyclosporin A (CsA) in tears and the anterior segment of the eye following long-term oral intake for autoimmune diseases. METHODS: Subjects taking oral CsA to treat relapsing autoimmune ocular inflammation were included in this study. All of the patients had been quiescent for at least 6 months. In patients scheduled for cataract extraction (group A), the CsA levels in the blood, aqueous humour and anterior capsule of the lens were determined. In subjects not requiring surgical intervention (group B), CsA was measured in tears and blood. The samples were analysed using turbulent flow chromatography coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: There were 19 subjects in group A and 43 subjects in group B. CsA was detectable in all of the tear samples with a mean value of 22.4 +/- 20.2 ng/ml and there was a significant positive correlation between the CsA levels in tears and blood (P = 0.012). CsA was not detected in any of the surgical samples. CONCLUSION: LC-MS/MS proved very sensitive for detecting CsA in low-volume biological samples. CsA was present in human tears in proportion to the blood level after an average of 12 hours from the last oral intake.     

Determination of malondialdehyde-induced DNA damage in human tissues using an immunoslot blot assay

Malondialdehyde (MDA) is a product of lipid peroxidation and prostaglandin biosynthesis. It is mutagenic and carcinogenic and the major adduct formed by reaction with DNA, a highly fluorescent pyrimidopurinone (M1-dG), has been detected in healthy human liver and leukocyte DNA. Analytical methods used so far for the detection of M1- dG have not been applied to a large number of individuals or variety of samples. Often, only a few microg of DNA from human tissues are available for analysis and a very sensitive assay is needed in order to detect background levels of M1-dG in very small amounts of DNA. In this paper, the development of an immunoslot blot (ISB) assay for the measurement of MI-dG in 1 microg of DNA is described. The limit of detection of the assay is 2.5 adducts per 10(8) bases. A series of human samples were analysed and levels of 5.6-9.5 (n = 8) and 3.1-64.3 (n = 42) of M1-dG per 10(8) normal bases were detected in white blood cell and gastric biopsy DNA, respectively. Results on four human samples were compared with those obtained using an HPLC/32P-post- labelling (HPLC/PPL) method previously developed and indicated a high correlation between M1-dG levels measured by the two assays. The advantages of ISB over other assays including HPLC/PPL, such as the possibility of analysing 1 microg DNA/sample and the fact that it is less time-consuming and laborious, means that it can be more easily used for routine analysis of a large number of samples in biomonitoring studies.      

Pharmacological evidence of catecholaminergic involvement in the behavioral effects of luteinizing hormone releasing hormone in rats

The influence of L-DOPA on the behavioral effects of LHRH was studied in male rats. Subcutaneous administration of LHRH (100 micrograms/kg) caused a significant disruption in the acquisition of a conditioned avoidance response (CAR) and a significant increase in head shaking behavior (HSB). Pretreatment with this hormone antagonized the stimulatory action of amphetamine (1 mg/kg, IP) in acquisition of CARs, spontaneous motor activity (SMA) and rearing behavior (RB). L-DOPA (100 mg/kg, IP), administered after LHRH, stimulated SMA, RB and HSB. In addition L-DOPA antagonized the effect of LHRH on acquisition of CARs and counteracted the antagonism between LHRH and amphetamine in acquisition of CARs and SMA. These findings indicate that LHRH could exert its behavioral effects through an inhibitory action upon brain catecholamine synthesis. The suppression of CARs may be the response to DA antagonism and the interaction with amphetamine could be mediated by an inhibition of both DA and NE activities. The possibility of an interaction between LHRH and central serotonin mechanisms is also discussed.     

Reimagining care for young adults living with type 1 diabetes

Young adults living with type 1 diabetes often struggle to achieve what clinicians consider to be optimal levels of metabolic control. Despite the impact that this can have on a young person''s future risk of complications, there are relatively few studies reporting new ways of organizing or delivering care to this cohort. In this article, we explore some of the reasons why young adult diabetes care is challenging, and describe approaches to “re‐imagining” how care might be improved. The work is informed by the ‘Making Care Fit’ collaborative and by a program of research, entitled D1 Now, involving co‐design of a complex person‐centered intervention with young adults.     

Electrical stimulation versus extracorporeal magnetic innervation for urinary incontinence after radical prostatectomy

Nurses use several conservative methods for treating urinary incontinence after radical prostatectomy. Functional electrical stimulation (FES) has a recognized role, while extracorporeal magnetic innervation (ExMI) is still under evaluation in the international guidelines. Few data are available in literature, regarding comparisons between these two treatments. The aim of the study is to compare electrical stimulation and magnetic innervation for treating urinary incontinence after radical prostatectomy. Twenty‐two patients treated with ExMI and 18 treated with FES were enrolled in a retrospective study. ExMI was available for 6 weeks; the number of times ExMI was required by the patients to reduce their leakages to 10 g/d or less was compared. The groups had comparable age and body mass index. Initial leakages showed clinically relevant differences (median = 80 g/d in the ExMI patients and 150 g/d in the FES group). After 6 weeks, 71·9% of ExMI patients and 29·2% of FES patients had completed rehabilitation. The difference was statistically significant even after adjusting the analyses for initial leakages (p = 0·008). Six patients treated with ExMI had already undergone FES, with no clinically relevant results after five sessions (leakages reduction <50 g/d). The difference remained even after removing the data of these patients from the analysis (p = 0·004). Both FES and ExMI produce muscle strengthening, which is just one step of rehabilitation. Our findings suggest the possibility of using ExMI instead of FES to reduce the times required to improve muscular performance. Pelvic muscle exercises remain essential to develop the ability to automatically perform the contractions needed to avoid leakages.     

Translumbar catheter redirection using a tip-deflector technique

A new technique is described for reversing the direction of the catheter tip during translumbar aortography, without the need for partial withdrawal of the catheter from the aortic lumen. The method ensures optimal delivery of contrast medium at the desired level, while avoiding the risk of retroperitoneal bleeding or dislodgement during catheter manipulation.