Anorectal malignant melanoma. Report of three cases

The authors report three cases of primary anorectal malignant melanoma in order to discuss the various diagnostic problems, therapeutic modalities and to remind of the prognostic factors of this rare and unknown affliction. The diagnosis is unfortunately realized in the advanced stage. Mrs B.O, 55 years old, presented rectal hemorrhages and false meeds since a year, the clinical examination showed rectal tumor that bleeds with touch. The mass has been biopsed during the rectoscopy and the diagnosis of the malignant melamoma has been confirmed. Abdominoperitoneal amputation had been realized. Mr F.K, 35 years old, hospitalized because of constipation and rectal hemorrhages that evolve since 7 months with loss of weight and alteration of the general state. The rectal touch emphasizes a budy rectal polypoid tumor about 6 cm that the biopsies confirmed the diagnosis of invasive malignant. A Hartman's operation has been realized. A resection of the tumoral bud has been realized 3 months later, the patient died 4 months after that. Mrs F.K, 50 years old, presented since 50 days relapsing rectorrhages. The rectal touch showed a rectal tumor far about 6 cm from the amal margin, the biopsy during the rectoscopy confirmed the diagnosis of the pigmented and little invasive malignant melanoma. The abdominal exhography showed hepatic metastases and a resection by endo-mal way in order to reduce the tumor has been realized. The inclusion of the primary anorectal malignant melanoma in the diagnosis of the afflictins of the anorectal region would permit an improvement of this affliction prognosis, this is still unfortunate when the diagnosis is late. Its treatment is still surgical, the role of the other therapies still needs to be defined.     

Molecular markers that predict response to colon cancer therapy

Progress in the treatment of colon cancer depends on the development of target-based molecules built on an improved understanding of the molecular biology of the disease. Defining end points for chemotherapy resistance is needed as drug resistance develops quickly and patients demonstrate variation in response to chemotherapy. Many techniques that measure a marker's preponderance have been developed including biochemical, immunohistochemical, genomics, proteomics or a combination thereof. However, standardization of these techniques that measure either genes or their protein products is urgently needed. This article reviews several markers (TS,TP, DPD, FT, EGFR, VEGF, CD44v6, TRAIL, microsatellite instability, allelic deletions, oncogenes and suppressor genes [c-myc, Ki-Ras, p53, p21, Topo I, Topo IIalpha, Fos, hMLH1, Bcl-2/Bax and MDR1], MDR-related proteins [Pgp, MRP and LRP], genomic polymorphisms [XPD, ERCC1, GSTP1 and TS 3 -UTR] and COX-;2) that influence DNA metabolism, DNA damage, programmed cell death, the immune or vascular system, or lead to mutations. When combined together and tested by newly developed genomic and proteomic approaches, many of these markers provide a more sensitive indicative predictor of response than when evaluated separately or by older biochemical, immunohistologic or morphologic methods. A global approach involving the simultaneous testing of several predictive multimarkers will provide critical information for improving chemotherapy to alleviate suffering from this disease.     

Pick bodies in a family with presenilin-1 Alzheimer's disease

Presenilin-1 (PS-1) mutations can cause Pick's disease without evidence of Alzheimer's disease (AD). We describe a family with a PS-1 M146L mutation and both Pick bodies and AD. Sarkosyl-insoluble hyperphosphorylated tau showed three bands consistent with AD, although dephosphorylation showed primarily three-repeat isoforms. M146L mutant PS-1 may predispose to both Pick's disease and AD by affecting multiple intracellular pathways involving tau phosphorylation and amyloid metabolism.     

Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptance

BACKGROUND AND PURPOSE: To assess the long-term acceptance of non-invasive nasal continuous positive air pressure (CPAP) in multiple system atrophy (MSA) patients with polysomnographic (PSG)-confirmed sleep apneas and/or nocturnal stridor. PATIENTS AND METHODS: Sleep-related breathing disorders were investigated by PSG in 22 MSA patients in whom stridor and sleep-related respiratory disturbances were clinically suspected. Patients in whom the first PSG disclosed either a sleep apnea/hypopnea index (AHI)> or =10 or stridor with or without apneas underwent a second PSG for CPAP titration. RESULTS: Three patients presented with an obstructive sleep apnea syndrome without stridor, whereas 15 patients presented stridor occurring alone or accompanied by apneas. Twelve patients pursued CPAP. Two severely disabled patients died a few days after CPAP initiation, and five discontinued CPAP because of discomfort. One patient died after 17 months of follow-up. Since the onset of CPAP, the four remaining patients reported more efficacious sleep and improved daytime alertness. These patients had significantly less severe disease at the time of CPAP initiation. Age, disease duration, the presence of sleep complaints, excessive daytime somnolence (EDS) and AHI did not account for CPAP compliance. CONCLUSION: The severity of motor impairment at the initiation of treatment appears to be the most significant limiting factor for CPAP long-term acceptance.     

CARDIAC AUTONOMIC NEUROPATHY IN DIABETES MELLITUS

Forty-eight out of 95 patients with diabetes mellitus, who were asymptomatic for autonomic nervous system affections, were evaluated with 3 bedside tests to detect subclinical cardiac neuropathy. There were 25 males and 23 females in the age range of 10-60 years. The three tests carried out were, heart rate response to Valsalva manoeuvre, heart rate variation during deep breathing, and systolic blood pressure fall in response to standing. Of these 48 patients, 15 (31.3%) had evidence of neuropathy. Abnormality of the parasympathetic division was found in 13 patients and the remaining 2 patients had borderline affection. Three patients had evidence of a combined parasympathetic and sympathetic involvement. Sympathetic affection alone was not detected in any patient. Increased incidence was seen in older age group. Autonomic neuropathy was more common in patients who had the disease for over 5 years. There was no correlation with the sex of the patient or with metabolic control of diabetes.KEY WORDS: Autonomic nervous system diseases, Diabetes Mellitus, Neuropathy     

Pycnogenol((R)) in the Management of Asthma

Asthma is characterized as a chronic inflammatory process. Pycnogenol((R)), a bioflavonoid mixture extracted from Pinus maritima, is known to scavenge free radicals while possessing antioxidant and antiinflammatory properties. The objective of this study was to evaluate the efficiency of this agent in a randomized, double-blinded, placebo-controlled, crossover study in patients with varying asthma severity. Twenty-six patients who fulfilled the American Thoracic Society criteria for asthma were enrolled in the study. Medical history, physical examination, blood sample analyses, and spirometric values were obtained at baseline, 4 weeks, and 8 weeks. The patients were randomly assigned to receive either 1 mg/lb/day (maximum 200 mg/day) Pycnogenol or placebo for the first period of 4 weeks and then crossed over to the alternate regimen for the next 4 weeks. No adverse effects were observed related to the study drug. Within the contingent of 22 patients who completed the study, almost all responded favorably to Pycnogenol in contrast to placebo. Pycnogenol treatment also significantly reduced serum leukotrienes compared with placebo. The results of this pilot study indicate that Pycnogenol may be a valuable nutraceutical in the management of chronic asthma. We recommend that further clinical trials be conducted in larger groups of asthmatics to establish its efficacy.     

COMPARATIVE EVALUATION OF NO-SCALPEL VASECTOMY AND STANDARD INCISIONAL VASECTOMY

No-scalpel vasectomy employs a refined method of dissection and delivery of the vas deferens. We compared no-scalpel vasectomy with standard incisional vasectomy in 176 patients over a 33 month period. The haemorrhage rate was 1.08 per cent for no-scalpel vasectomy compared with 11.9 per cent for standard vasectomy (p < 0.005). The infection rate was 3.26 per cent for no-scalpel vasectomy as against 14.28 per cent for standard vasectomy (p < 0.01). There was a 37.5 per cent reduction in operating time and a substantial reduction in pain during and after the procedure when no-scalpel vasectomy was performed and also there was no failure of vasectomy. No-scalpel vasectomy is a satisfactory alternative to standard vasectomy with fewer complications and increased patient acceptability.KEYWORDS: Male sterilization, Vasectomy     

Evaluation of diluted amniotic fluid effects on histological changes of intestine of rabbit fetus with gastroschisis

Amniotic fluid exchange is a method for prevention of intestinal damage in gastroschisis, but its techniques are different in studies. We investigated the effects of amnioinfusion exchange on histological changes of intestine and feasibility and safety of amniotic fluid exchange through central vein catheter (CVC) placed in pregnant rabbit uterus. A total of 15 pregnant New Zealand white rabbits were selected. Fetuses were randomly divided into three groups (case, control, sham). On gestational day 25, under general anesthesia with midline laparotomy, the graved bicornuate uterus was exposed. In controls, fetus abdomen was opened by a transverse incision in right lower quadrant region and intestines were eviscerated. In cases, after intestine evisceration, a central venous catheter was passed from mother skin and uterus and fixed to uterus wall. In shams, fetus was delivered on gestational day 32 and its abdomen was opened. In case group, after operation, 1–2 cc of warm saline solution was replaced through catheter every 6 h. On gestational day 32, fetuses of case and control groups were delivered. Mucosal and serosal thickness, muscle thickness, fibrin deposition, serosal collagen and ganglia were compared. Ten fetuses as shams, 7 fetuses as controls and 7 fetuses as case group were studied. Serosal thickness was 4.5 ± 3.6 μm in shams, 64.2 ± 28.7 μm in controls and 6 ± 4.1 μm in cases. Serosal thickness in control group was higher than sham (P < 0.001) and case (P < 0.002) groups. In case group, infiltration of inflammatory cells with mild edema without fibroblast infiltration was seen. Application of the CVC technique was found to be a simple procedure that effectively decreased serosal inflammatory response of intestine in gastroschisis.     

Sodium hypochlorite as dentin pretreatment for etch-and-rinse single-bottle and two-step self-etching adhesives: atomic force microscope and tensile bond strength evaluation

PURPOSE: The aim of this study was to evaluate the effect of using 5.25% commercial sodium hypochlorite treatment prior to the application of etch-and-rinse and self-etching adhesives on dentin surface microtopography and tensile bond strength. MATERIALS AND METHODS: Thirty-two noncarious, nonrestored human third molars were collected. The occlusal enamel of all teeth was removed using diamond disks to expose flat dentin surfaces. The exposed dentin surfaces were abraded using 600-grit SiC disks, to create a uniform dentin smear layer. For AFM characterization, 12 teeth were equally divided into 4 groups according to the proposed dentin surface treatment. Three dentin disks, 2 mm thick, were evaluated per group using tapping mode assessment. Twenty teeth were used for TBS and SEM evaluation and were equally divided into 4 groups, according to the proposed dentin surface treatment. For TBS, 8 dentin/composite slabs, 2 mm thick, were used in each group, while for SEM evaluation 2 slabs were used. Each slab was tested in tension at a crosshead speed of 0.5 mm/min until failure occurred. The samples were examined using SEM operated at 30 kv to evaluate the hybrid layer photographically at 1500X. Statistical analysis was carried out using StatsDirect 2.5.7. One-way ANOVA followed by Tukey-Kramer multiple-comparison post-hoc tests were performed to test the difference between roughness parameters and TBS between groups. RESULTS: Sodium hypochlorite followed by the application of 37% phosphoric acid significantly increased the arithmetic average of the absolute values of surface height deviations (Sa), the surface area ratio which expresses the ratio between the surface area (taking the z height into account) and the area of the flat x,y plane (Sdr), and the surface bearing index (Sbi) parameters, while the application of sodium hypochlorite prior to the application of the self-etching primer significantly increased the valley fluid retention index (Svi) parameter. Self-etching primer without sodium hypochlorite pretreatment significantly increased the core fluid retention index (Sci) parameter. Sodium hypochlorite/AdheSE (7.42 +/- 2.16 MPa) significantly increased TBS value compared to other groups. However, no statistically significant difference was found between sodium hypochlorite/Excite (4.68 +/- 1.26 MPa), AdheSE (4.42 +/- 1.36), and Excite (4.06 +/- 1.35). Remnants of smear layer were detected with areas devoid of resin tags in SEM images of samples bonded with AdheSE self-etching adhesive, in contrast to samples bonded with sodium hypochlorite followed by AdheSE self-etching adhesive. CONCLUSION: The application of 5.25% commercial sodium hypochlorite with rubbing action for 60 s (total application time 120 s) seems to positively influence the TBS of the self-etching adhesive; however, it has no significant effect on TBS of etch-and-rinse single-bottle adhesive to dentin. The addition of functional roughness parameters to study the dentin surface was shown to be of importance in evaluating the relationship between bond strength and surface topography of conditioned dentin.     

Facial dysmorphism associated with distinctive spine abnormalities in a girl and her mother: novel syndromic association

Facial dysmorphism associated with distinctive spine abnormalities has been encountered in a girl and her mother. A three-dimensional reformatted spinal computed tomography scan showed a combination of distinctive abnormalities such as failure of anterior formation of the vertebral bodies, malsegmentation, and Forestier disease. Mutations were not found in the GDF6 gene. We describe a hitherto undescribed autosomal dominant entity.