Congenital Absence of Superior Vena Cava: Unusual Anomaly of Superior Systemic Veins Complicating Pacemaker Placement

Congenital anomalies of the superior systemic veins can complicate placement of transvenous pacemaker electrode leads. Persistent left superior vena cava is the most common congenital anomaly; in this paper, we describe the case of a patient who had con-genital absence of both superior venae cavae, which has not been reported pre-viously. The superior syslemic veins drained into persistent double ozygos veins subdiaphragmatically. The anomaly was verified by venography. Temporory car-dioc pacing was established by passing the electrode lead through the femoral vein, and a permanent epicordial pacemaker lead was placed thereafter. This appears to be the first recorded case of such an anomaly.     

MYCOBACTERIUM MARINUM CUTANEOUS INFECTIONS ACQUIRED FROM OCCUPATIONS AND HOBBIES

Background. Nontuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included. Methods. The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x-ray, and treatments were recorded. Results. M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure. Conclusions. Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term “M. marinum cutaneous infection” or “M. marinum granuloma” instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.     

A Th2-score in the tumor microenvironment as a predictive biomarker of response to Bacillus Calmette Guérin in patients with non-muscle invasive bladder carcinoma: A retrospective study

Intravesical Bacillus Calmette Guerin (BCG) is the gold standard therapy for intermediate/high-risk nonmuscle invasive bladder cancer (NMIBC). However, the response rate is ~60%, and 50% of non-responders will progress to muscle-invasive disease. BCG induces massive local infiltration of inflammatory cells (Th1) and ultimately cytotoxic tumor elimination. We searched for predictive biomarker of BCG response by analyzing tumor-infiltrating lymphocyte (TIL) polarization in the tumor microenvironment (TME) in pre-treatment biopsies. Pre-treatment biopsies from patients with NMIBC who received adequate intravesical instillation of BCG (n = 32) were evaluated retrospectively by immunohistochemistry. TME polarization was assessed by quantifying the T-Bet+ (Th1) and GATA-3+ (Th2) lymphocyte ratio (G/T), and the density and degranulation of EPX+ eosinophils. In addition, PD-1/ PD-L1 staining was quantified. The results correlated with BCG response. In most non-responders, Th1/Th2 markers were compared in pre-and post-BCG biopsies. ORR was 65.6% in the study population. BCG responders had a higher G/T ratio and a greater number of degranulated EPX+ cells. Variables combined into a Th2-score showed a significant association with higher scores in responders (p = 0.027). A Th2-score cut-off value >48.1 allowed discrimination of responders with 91% sensitivity but lower specificity. Relapse-free survival was significantly associated with the Th2-score (p = 0.007). In post-BCG biopsies from recurring patients, TILs increased Th2-polarization, probably reflecting BCG failure to induce a pro-inflammatory status and, thus, a lack of response. PD-L1/PD-1 expression was not associated with the response to BCG. Our results support the hypothesis that a preexisting Th2-polarized TME predicts a better response to BCG, assuming a reversion to Th1 polarization and antitumor activity.