Diagnostic reliability of the Tzanck smear in dermatologic diseases

Background The Tzanck smear is a simple, easily applicable, rapid, and inexpensive test for the diagnosis of erosive vesiculobullous, tumoral, and granulomatous diseases. The diagnostic accuracy of the Tzanck smear is known, but its diagnostic reliability has been evaluated only in herpetic infections and basal cell carcinoma. Objectives The aim of this study was to evaluate the diagnostic reliability of the Tzanck smear in erosive vesiculobullous, tumoral, and granulomatous diseases. Methods Patients evaluated by Tzanck smear at Ba?kent University Faculty of Medicine, Department of Dermatology, between February 2009 and July 2010, were included. Three dermatologists were involved in the study. Dermatologist A performed a clinical dermatologic examination, took the smear material, made a clinical diagnosis, and compared the clinical and cytological diagnoses. Dermatologists B and C evaluated the smears. Agreement between the latter two dermatologists on the cytological diagnoses was determined. Results In 500 patients, a total of 272 (54%) erosive vesiculobullous, 190 (38%) tumoral, and 38 (8%) granulomatous lesions were diagnosed. The diagnostic reliability of the Tzanck smear was reasonably substantial (κ = 0.59) for all types of lesions, substantial for erosive vesiculobullous (κ = 0.79) and granulomatous (κ = 0.68) lesions, and moderate (κ = 0.50) for tumoral lesions. Conclusions The Tzanck smear may be used for the evaluation of erosive vesiculobullous and granulomatous lesions with brief training. However, the evaluation of tumoral lesions by Tzanck smear requires more experience.     

Diagnostic Imaging of Pulmonary Embolism Using Endobronchial Ultrasound

Endobronchial ultrasound (EBUS) is a new technique that can be used for the diagnostic imaging of central pulmonary thromboembolism (PE). In eight cases at our clinic, EBUS was used because of mediastinal lymphadenopathies or paramediastinal nodular lesions and at the same time images of a PE were obtained by means of EBUS. The PE was diagnosed before the EBUS with computed tomography (CT) of the lungs in all cases (5 women and 3 men). The repletion defects of all the cases compatible with a PE were clarified with CT-angiography. EBUS may be an alternative method for the diagnosis of PE, since it can indicate the presence of a thrombus in the central pulmonary arteries in hemodynamically stable cases.     

Molecular advances in pretargeting radioimunotherapy with bispecific antibodies

The use of antibodies against tumor-associated cell surface antigens for the targeted delivery of radionuclides was introduced >20 years ago. Although encouraging results have been achieved with radiolabeled antibodies in the management of hematopoietic malignancies, there remains a need for successfully treating solid tumors with this modality. One promising approach involving pretargeted delivery of radionuclides has been shown to be capable of significantly increasing the radioactive uptake in tumor relative to normal organs, thereby potentially improving the efficacy of both detection and therapy of cancer. Uncoupling of the radionuclide from the tumor-targeting antibody allows the relatively slow process of antibody localization and clearance to occur before a very rapid and highly specific delivery of the radioactive payload carried on a small molecule, such as a peptide. This minireview discusses the various strategies and advancements made since the concept of pretargeting was proposed in the mid-1980s, with emphasis on those comprising bispecific antibodies for cancer therapy. Critical aspects of these pretargeting systems for achieving higher tumor:nontumor ratios are considered. In addition, both preclinical and clinical results obtained from a pretargeting method known as the Affinity Enhancement System are presented. Future directions of pretargeting technology are also suggested.     

Infectious complications in patients receiving mobilization chemotherapy for autologous peripheral blood stem cell collection

The purpose of this retrospective study was to evaluate infectious complications in patients receiving mobilization chemotherapy for stem cell collection prior to autologous peripheral blood stem cell transplantation. An additional goal was to evaluate risk factors associated with the development of infectious complications. At the Medical College of Georgia BMT center, 54 patients were administered mobilization chemotherapy for the purpose of collecting stem cells between June, 1997, and May, 2002. All patients received Filgrastim in addition to chemotherapy, and 50 of 54 patients received prophylactic acyclovir, fluconazole, and ciprofloxacin until neutrophil recovery. The median duration to neutrophil recovery was 11 days. Fourteen of 54 (26%) patients developed fever/infections during the mobilization phase. One patient developed both a catheter-related infection and Clostridium difficile colitis, increasing the total number of infectious episodes to 15. Twelve patients had a documented site of infection whereas 2 patients had neutropenic fever with no identifiable source. Eight of the 15 (55%) infections were Gram-positive catheter infections. All the patients were treated successfully with antibiotics. No systemic fungal infections were identified and none of the patients died from complications related to mobilization chemotherapy. Logistic regression was applied for univariate and multivariate analysis and showed that age, sex, diagnosis, neutrophil recovery, disease status, use of salvage chemotherapy, and mobilization regimen used did not affect the infection rate. In our series of 54 patients, 14 patients developed fever/infections during mobilization. Although there is a substantial risk of infectious complications among patients who receive mobilization chemotherapy, it is not clear that prophylactic antibiotics decrease infectious complications. Because the vast majority of infections are Gram-positive catheter infections, it appears reasonable to employ Gram-positive prophylaxis. Controlled studies should be conducted to define the optimum mobilization regimens as well as the optimum combination of prophylactic antibiotics.     

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.     

Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

Purpose  

To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.