Blue-Whitish Veil-like Structure as the Primary Dermoscopic Feature of Combined Nevus

The combined nevus is a clinical simulator of melanoma, and clinical examination alone can be inadequate to diagnose this melanocytic pigmented skin lesion. Dermoscopy is a useful tool to differentiate the features related to each type of nevus. We report two cases of combined nevi dermoscopically characterized by a diffuse blue-whitish pigmentation similar to the blue-whitish veil, suggesting the diagnosis of melanoma.     

Skin Storage in Liquid Nitrogen

The problem of cell survival as well as the biochemical and histological effects on skin of low temperature storage in liquid nitrogen has already received attention. However, little is known of the submicroscopic alterations induced by such treatment. Our study shows that rapid or slow freezing, direct or mediate contact with the liquid nitrogen, pretreatment before freezing, type and concentration of cryoprotectants, all have various effects on the fine morphology of epidermal cells. Glycerol is shown as having better cryoprotective activity than DMSO at concentrations of 15% or less. Our data are examined taking into account all available reports on the problem of cryopreservation and the use of cryoprotectants.     

Monitoring Intrathoracic Impedance with an Implantable Defibrillator Reduces Hospitalizations in Patients with Heart Failure

Purpose: Some implantable cardioverter‐defibrillators (ICDs) are now able to monitor intrathoracic impedance. The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs. Methods and Results: Five hundred thirty‐two heart failure (HF) patients implanted with these ICDs were followed up for 11 ± 7 months. A clinical event (CE) was deemed to have occurred if it resulted in hospitalization or milder manifestations of HF deterioration. Three hundred sixty‐two acute decreases in intrathoracic impedance (Z events) occurred in 230 patients. Of these episodes, 171 (47%) were associated with a CE within 2 weeks of the Z event. In another 71 (20%) Z events, drug therapy was adjusted despite the absence of overt signs of clinical deterioration. The rate of unexplained Z events was 0.25 per patient‐year and 25 hospitalizations were not associated with Z events. The audible alert was disabled in a group of 102 patients (OFF group). HF hospitalizations occurred in 29 (7%) patients in the ON group and 20 (20%, P < 0.001) patients in the OFF group. The rate of combined cardiac death and HF hospitalization was lower in patients with Alert ON (log‐rank test, P = 0.007). Conclusions: The ICD reliably detected CE and yielded low rates of unexplained and undetected events. The alert capability seemed to reduce the number of HF hospitalizations by allowing timely detection and therapeutic intervention.     

Temporal expression of the matrix metalloproteinase MMP-2 correlates with fibronectin immunoreactivity during the development of the vascular system in the chick embryo chorioallantoic membrane

In this study we have examined in the chick embryo chorioallantoic membrane (ChAM) the expression of the matrix metalloproteinase 2 (MMP-2) and have correlated this parameter with the expansion of the ChAM vasculature and with the expression of 3 extracellular matrix components (fibronectin, laminin and type IV collagen), which differentially modulate angiogenesis. In the early phases of ChAM development, between d 6 and d 8 of incubation, when the increase of the ChAM vasculature is maximal, higher values of MMP-2 and, respectively, of fibronectin immunoreactive area, are detectable. These results indicate that MMP-2 activity and fibronectin expression are 2 strictly related components of angiogenesis occurring in vivo.     

The compromised tooth: conservative treatment or extraction?

In everyday practice, the dentist is not seldom faced with the dilemma of assessing teeth troubled by a combination of endodontic, periodontal, and reconstructive problems. As attempts to saving such teeth may carry risks for failure in the mid and long term, a multidisciplinary team approach to a treatment decision is required. Recent advancement of implantology techniques has brought about a useful option to treacherous tooth‐saving efforts in that severly compromised teeth, following extraction, may be replaced by implants. Such an opportunity, however, involves the inherent risk for overuse to the detriment of the basic thrust of dental care to conserve the natural dentition when damaged or diseased. By referring to a variety of clinical treatment scenarios, this article discusses the factors that may assist the clinician to weigh maintenance against extraction of teeth with guarded prognosis.     

COST-EFFECTIVE PHARMACOLOGICAL PREVENTION OF ACUTE CORONARY SYNDROMES

The growing size of trials on primary and secondary prevention of acute coronary syndromes characterised by very broad inclusion criteria may seem logical to `trialists', who reason that the broader the inclusion criteria, the easier it is to recruit large numbers of patients in a short period of time and the more widely applicable are the results of the study. However, large trials with very broad inclusion criteria raise two grounds for concern for physicians. The first is that the broader the inclusion criteria for enrolment in a trial in order to prove a statistically significant benefit, the greater the heterogeneity of the study population which is likely to include both susceptible and non-susceptible patients to the tested treatment. The second is that this method of assessment rapidly increases the number of treatments that produce a statistically-significant improvement in prognosis within the same broad group of patients. On the contrary, the identification of potential responders to a specific treatment can provide a personalised form of medical care suited to the needs of each individual patient with an optimal cost–benefit ratio. This approach, however, represents a major challenge as it can only be based on the identification of homogeneous subgroups of patients with common risk factors for the development of acute coronary syndromes or of their recurrence. This challenge can only be overcome by a strong commitment in funding studies on the multiple causes of acute coronary syndromes.