Bleomycin Tattooing as a Promising Therapeutic Modality in Large Keloids and Hypertrophic Scars

BACKGROUND: Cryotherapy combined with intralesional triamcinolon injection is the most common traditional therapy for hypertrophic scars and keloids. The literature contains few articles on the use of bleomycin tattoo for treatment of these conditions. OBJECTIVE: This study compares the efficacy of bleomycin tattoo with that of cryotherapy combined with intralesional triamcinolon injection for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS: Forty-five patients with hypertrophic scars or keloids were randomly divided into two groups. Group A was treated with bleomycin tattoo, and group B, with cryotherapy combined with intralesional triamcinolon injection. There were four therapeutic sessions at 1-month intervals. All patients were followed for 3 months after the end of treatment. RESULTS: Therapeutic response in lesions less than 100 mm2 was higher than 88% in both groups, but in larger lesions, the therapeutic response to bleomycin was significantly better than cryotherapy combined with intralesional triamcinolon injection (p = .03). In group A, no relationship was observed between therapeutic response and lesion size (p = .58); however, in group B smaller lesions (< 100 mm2) displayed better therapeutic response (p = .007). CONCLUSIONS: Bleomycin tattoo may be more effective than cryotherapy combined with intralesional triamcinolon injection in treatment of larger keloids and hypertrophic scars (size > 100 mm2).     

Simultaneous superficial hyperthermia and external radiotherapy: report of thermal dosimetry and tolerance to treatment

Background : In vitro and animal studies indicate that a moderate temperature of 41°C maintained for ～ 1h will provide radiosensitization if radiation (RT) and hyperthermia (HT) are delivered simultaneously, but not with sequential treatment. A minimum tumour temperature of 41°C is a more feasible goal than the goal of >42°C needed for sequential treatment. Methods and materials: Forty-four patients with 47 recurrent superficial cancers received simultaneous external beam radiotherapy and superficial hyperthermia on successive IRB approved phase I/II studies. All lesions had failed previous therapy, 35 were previously irradiated (mean dose 52.7Gy). Hyperthermia was delivered with 915MHz microwave or 1-3.5MHz ultrasound using commercially available applicators. The average dimensions of 19 lesions treated with microwave were 4.7 3.6 1.7cm and the average dimensions of 28 lesions treated with ultrasound were 8.0 6.1 2.9cm. The most common sites were chest wall (15 cases) and head and neck (21 cases). Temperatures were monitored at an average of six intratumoral locations using multisensor probes. The median number of hyperthermia treatments was three and the median radiation dose 30Gy. Radiation dose per fraction was 4Gy with hyperthermia and 2Gy or 4Gy (depending on protocol) on non-hyperthermia days. Results: Six different measures of minimum monitored temperature and duration were found to be highly correlated with each other. There was nearly a one-to-one correspondence between minimum tumour time at or above 41°C (Min t41) and minimum tumour Sapareto Dewey equivalent time at 42°C (Min teq42). After four sessions 63% of cases had a per session average Sapareto Dewey equivalent time at 41°C which exceeded 60min in all monitored tumour locations. The complete and partial response rate in evaluable lesions were respectively 21/41 (51% ) and 7/41 (17% ) and were best correlated with site (chest wall showing best response). Toxicity consisted of 10/47 (21% ) slow healing soft tissue ulcers which healed in all cases but required a median of 7 months. The most important predictors for chronic ulceration were cumulative radiation dose >80Gy and complete response to treatment. Conclusions: Minimum tumour temperatures maintained for durations compatible in vitro with thermal radiosensitization (if RT and HT are delivered simultaneously) are clinically feasible and tolerable for broad but superficial lesions amenable to externally applied ultrasound or microwave hyperthermia. The current in-house protocol is evaluating the impact of more than four hyperthermia sessions on the overall thermal dose distribution and toxicity.     

Epidemiological Study of Gastrointestinal Helminthes of Canids in Chaharmahal and Bakhtiari Province of Iran

Background

The present study was carried out to describe the epidemiological aspects of gastrointestinal helminthic infections of canids in Chaharmahal and Bakhtiari Province, the central western part of Iran.

Methods

Forty nine canid species including, dogs, jackals, foxes and wolves were included in this study. The contents of their alimentary canal were inspected in order to isolate and identify the parasitic helminthes of this system. To identify the worms, the Soulsbey and Anderson identification key and light microscopy were used.

Results

Based on necropsy findings, 35 (71.4%) of examined animals were infected with at least one helminth. The prevalence of identified worms was as follows: Mesocestoides lineatus (55.1%), Joyeuxiella echinorinchoides (26.5%), Taenia hydatigena (12.2%), T. multiceps (8.2%), T. ovis (2%), Dipylidium caninum (2%) and Spirura spp. (2%). No significant difference was noticed between the sampling areas, age and helminth infection. Only a significant difference was observed for prevalence of T. multiceps in wolf (25%), dog (21.4%), jackal and fox (0%), respectively (P < 0.05).

Conclusion

The canids in Chaharmahal and Bakhtiari harbor several parasites that some kind of them have zoonotic importance and may pose a threat to community health specially in rural areas.     

Angiotensin-converting enzyme gene polymorphism and the progression rate of focal segmental glomerulosclerosis in Iranian children

Aim: Focal segmental glomerulosclerosis (FSGS) is one of the most common forms of glomerulonephritis leading to end-stage renal disease (ESRD). A few clinical and paraclinical factors are considered as contributing factors in progression rate. However, there are controversial reports on the relationship between ACE gene polymorphism and rapidity of progression of FSGS to ESRD in different populations. To elucidate this issue, we investigated the relationship between the insertion (I) and deletion (D) ACE gene polymorphism and rapidity of progression of FSGS to ESRD in Iranian children. Methods: Forty-one children aged 1–18 years admitted to St AlZahra Hospital, Isfahan, and St Ali Asghar Hospital, Tehran, Iran, with idiopathic FSGS were enrolled. Renal death was defined as a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m² or a decreased GFR to less than 50% compare to baseline. Reaching renal death in less or more than 2 years were labelled as rapid progressors (RP) or slow progressors (SP), respectively. Intron 16 of the ACE gene was amplified by the polymerase chain reaction technique. Results: Twenty-eight patients were male and 13 were female. In 15 RP patients, the genotype distribution was 26.6% DD, 6.7% II and 66.7% ID. In 26 SP patients, the genotype was similar (38.6% DD, 7.6% II and 53.8% ID, P > 0.05). There were no statistically significant differences for ACE I/D gene polymorphism between the two groups of patients (P > 0.05). Conclusion: Our study revealed no correlation between ACE I/D gene polymorphism and rapidity of progression of FSGS to ESRD in Iranian children.     

Towards the development of a multi-axial classification of people with learning difficulties

ABSTRACT. The complexity of need experienced by people with learning disabilities might best be described by a multi-axial classification. The data routinely collected for a register of people with learning disabilities were analysed to see whether factors that might discriminate between individuals could be identified. Three factors were identified. The factor scores were used in a cluster analysis. A ten-cluster model formed from these factors made empirical sense. The present investigation indicates that a multi-axial classification is feasible and may be useful. However, the results cannot be applied beyond the data set used for its development at the present time. Ultimately, it will be necessary to collect additional information in order to calibrate the factor scores.     

Pharmacological control of the human gastric histamine H2 receptor by famotidine: comparison with H1, H2 and H3 receptor agonists and antagonists

Histamine 0.1 microM-0.1 mM increased adenylate cyclase activity five- to ten-fold in human fundic membranes, with a potency Ka = 3 microM. The histamine dose-response curve was mimicked by the H3 receptor agonist (R) alpha-MeHA, but at 100 times lower potency, Ka = 0.3 mM. Histamine-induced adenylate cyclase activation was abolished by H2, H1 and H3 receptor antagonists, according to the following order of potency IC50: famotidine (0.3 microM) greater than triprolidine (0.1 mM) thioperamide (2 mM), respectively. Famotidine has no action on membrane components activating the adenylate cyclase system, including the Gs subunit of the enzyme stimulated by forskolin and cell surface receptors sensitive to isoproterenol (beta 2-type), PGE2 and VIP. The Schild plot was linear for famotidine (P less than 0.01) with a regression coefficient r = 0.678. The slope of the regression line was 0.64 and differs from unity. Accordingly, famotidine showed a slow onset of inhibition and dissociation from the H2 receptor in human cancerous HGT-1 cells. The results demonstrate that famotidine is a potent and selective H2 receptor antagonist with uncompetitive actions in human gastric mucosa. Consequently, famotidine might be a suitable drug with long-lasting actions in the treatment of Zollinger-Ellison syndrome. The results also confirm and extend the previous observations that (R) alpha-MeHA and thioperamide are two selective ligands at histamine H3 receptor sites. In the human gastric mucosa, these drugs are respectively 330 and 6700 times less potent than histamine and famotidine on the adenylate cyclase system. The possible involvement of histamine H3 receptors in the regulation of gastric secretion is proposed.