Recurrence of stage I thymoma in sternum, 13 years after "complete" excision

Recurrence after complete excision of non-invasive thymoma is infrequent. We report a case of recurrent thymoma in the sternum in a 76-year-old man 13 years after complete surgical resection of stage I thymoma.

Fabric-staining properties and washability of a novel liposomal dithranol formulation

AIM

To test the staining potential of a novel liposomal dithranol gel on different types of fabrics and compare it with the only commercially available dithranol preparation in India, Derobin.

METHODS

Pure cotton, pure polyester and four blends of the two fabrics were tested for staining and washability.

RESULTS

Both products showed the least staining and spreading on pure cotton with progressively worse stains as the proportion of polyester in the fabric increased. When compared with each other the liposomal dithranol gel showed markedly lighter staining than Derobin on all fabrics. It also washed off completely with water whereas the Derobin stains could not be washed off, even with detergent.

CONCLUSION

The liposomal gel due to its superior staining properties may potentially increase the acceptability of dithranol amongst psoriasis patients.

Pesticide (acephate) removal by GAC: a case study

Pesticides are persistent pollutants which need utmost attention in agricultural pollution. They usually accumulate in the food chain, and hence are hazardous in nature. The present study reports the performance of granular activated carbon (GAC) in the removal of acephate contained in the effluent of a nearby pesticide manufacturing industry. In the batch study, the optimum dose of GAC was found to be 85 gm/litre for almost 100% removal of acephate from its initial concentration of 2.9 mg/litre which was found in the industrial effluent under treatment. The adsorption kinetics were represented closely by Langmuir isotherm. The equilibrium time was found as 80 minutes. The adsorptive capacity of GAC for acephate (pesticide) was of the order of 0.04614 mg/gm. A column system was devised and designed based on bed depth-service time (BDST) approach with the experimental value of 'a' and 'b' as 6.125 and 47.75 respectively.

Pros and cons of antioxidant use during radiation therapy

Radiation therapy is one of the major treatment modalities in the management of human cancer. While impressive progress like more accurate dosimetry and more precise methods of radiation targeting to tumor tissue has been made, the value of radiation therapy in tumor control may have reached a plateau. At present, two opposing hypotheses regarding the use of antioxidants during radiation therapy have been proposed. One hypothesis states that supplementation with high doses of multiple micronutrients including high dose dietary antioxidants (vitamins C and E, and carotenoids) may improve the efficacy of radiation therapy by increasing tumor response and decreasing some of its toxicity on normal cells. The other hypothesis suggests that antioxidants (dietary or endogenously made) should not be used during radiation therapy, because they would protect cancer cells against radiation damage. Each of these hypotheses is based on different conceptual frameworks that are derived from results obtained from specific experimental designs, and thus, each may be correct within its parameters. The question arises whether any of these concepts and experimental designs can be used during radiation therapy to improve the management of human cancer by this modality. This review has analyzed published data that are used in support of each hypothesis, and has revealed that the current controversies can be resolved, if the results obtained from one experimental design are not extrapolated to the other. This review has also discussed the scientific rationale for a micronutrient protocol that includes high doses of dietary antioxidants (vitamin C, vitamin E succinate and natural beta-carotene) which can be used adjunctively with radiation therapy.

Lack of effect of dimethylsulphoxide in cutaneous amyloidosis

OBJECTIVE

To evaluate dimethylsulphoxide (DMSO) as a topical therapeutic agent for the treatment of two major variants of primary, localized, cutaneous amyloidosis -- macular amyloidosis (MA) and papular/lichen amyloidosis (LA) -- using a monocentric, open, prospective trial.

METHODS

A total of 25 patients with histopathologically proven cutaneous amyloidosis - MA, LA and BA (biphasic amyloidosis) (13 MA, seven LA, five BA) were requested to undertake a once daily application of either 50% or 100% DMSO for 12 weeks. Progress was regularly assessed with a scoring system for pruritus, pigmentation and papules.

RESULTS

In 17 (68%) cases, the scores for pruritus decreased but never completely disappeared in any of the patients. Lightening of the pigmentation was noted in only six (24%) cases and the scores for the papules were decreased in only two out of 12 (16.6%) patients. Post-treatment skin biopsies did not reveal a reduction/disappearance of the amyloid deposits. In the follow-up period, the relapse rate was 100%.

CONCLUSION

DMSO does not have an anti-pruritic effect or amyloid-dissolving properties. As the results are partial and transient, it is concluded that DMSO is not a satisfactory treatment for cutaneous amyloidosis.

Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients

Hydroxyurea is an anti-tumour agent most commonly used to treat chronic myeloproliferative disorders in doses up to 4 g per day. Dermatological adverse effects reported so far have been observed predominantly in these patients. As we are treating selected psoriasis patients with low dose hydroxyurea we attempted to define the spectrum and chronology of dermatological adverse effects in this group of patients prospectively. Of the 29 evaluable patients, 19 (65.5%) developed a mucocutaneous adverse reaction after a mean duration of 6.4 weeks of treatment. Pigmentation of nails, skin or mucosa was the most common observation and was seen in 17 (58.6%) patients. Other less common findings were xerosis, diffuse alopecia, oedema of the legs, oral ulcers and actinic psoriasis. Adverse effects subsided in 11 (57.9%) patients during a mean follow up of 18 weeks. Three hitherto unreported side-effects - scleral pigmentation, acquired ichthyosis and pigmentation of lunula of the nails - were noted. This first study of dermatological adverse effects of hydroxyurea therapy on Asian psoriatic patients reveals several new findings. Pigmentation of skin, nails and mucosa appears to be very common and occurs early. Serious dermatological side-effects probably do not occur with low dose (up to 1.5 g per day) hydroxyurea in patients with psoriasis.

Rediscovering hydroxyurea: its role in recalcitrant psoriasis

BACKGROUND

There is an acute paucity of second-line systemic agents for the treatment of extensive chronic plaque psoriasis (CPP). Recent studies using hydroxyurea in patients with HIV infection and sickle cell anemia have rekindled interest in this old drug and have provided more data regarding safety and dosage.

OBJECTIVE

We wanted to test the efficacy and tolerability of hydroxyurea in patients with extensive CPP who had to discontinue first-line oral agents for any reason.

METHODS

The study was a prospective nonrandomized series. Thirty-one patients, including 26 with prior history of systemic antipsoriatic therapy were given hydroxyurea 1-1.5 g per day for a median duration of 36 weeks. They were followed up for a mean period of 36.1 +/- 13.8 weeks.

RESULTS

Almost 75% of the patients showed an adequate response (35% reduction in Psoriasis Area and Severity Index at or before 8 weeks) with over half showing more than 70% reduction in PASI score. All adverse effects were mild and reversible and none of the patients required cessation of therapy.

CONCLUSION

Hydroxyurea is an effective, very safe but relatively slower acting alternative for patients with extensive CPP over the short-to-medium term.

Alpha tocopheryl succinate, retinoic acid and polar carotenoids enhanced the growth-inhibitory effect of a cholesterol-lowering drug on immortalized and transformed nerve cells in culture

OBJECTIVE

Statins (cholesterol lowering drugs) with a closed-ring structure (lovastatin, simvastatin and mevastatin) and an open-ring structure (pravastatin and fluvastatin) are currently used in the management of cardiac disease. Lovastatin and simvastatin inhibit the growth of tumor cells; however, the studies on the effect of a statin in combination with micronutrients such as alpha-tocopheryl succinate (alpha-TS), 13-cis retinoic acid (RA) and polar carotenoids (PC) have never been performed. The primary objective of this study was to investigate the effect of mevastatin alone and in combination with the above micronutrients on the growth of mouse neuroblastoma (NB) cells and rat immortalized dopamine (DA) neurons in culture. In addition, a comparative efficacy of mevastatin and pravastatin on the growth of NB cells was studied.

METHODS

Cells were treated with mevastatin in combination with individual antioxidants, alpha-TS, RA and polar carotenoids, 24 hours after plating. Fresh growth medium and agents were changed at two days after treatment, and the viability in control and experimental groups was determined at three days after treatment by MTT assay. Each experiment was repeated three times with triplicate samples per treatment. Growth in experimental groups was expressed as % of untreated cells.

RESULTS

Mevastatin inhibited the growth of neuroblastoma (NB) cells and immortalized, non-tumorigenic dopamine (DA) neurons in culture in a dose-dependent manner. Immortalized DA neurons were more sensitive to mevastatin than NB cells. Pravastatin at similar concentrations was ineffective in inhibiting the growth of NB cells. Mevastatin in combination with alpha-TS, RA or PC was more effective in reducing the growth of NB and DA neurons than the individual agents.

CONCLUSIONS

Statins with a closed-ring structure can inhibit the growth of established cancer cells as well as immortalized cells (equivalent to pre-malignant lesion), whereas statins with an open-ring structure may be ineffective. A combination of a statin having a closed-ring structure with alpha-TS, RA and PC may be one of the potentially useful anti-cancer agents for prevention and treatment strategies.

Zosteriform pilar leiomyoma

Pilar leiomyomas are usually multiple and are commonly found on the extensor aspects of the arm, trunk, and face. They are rarely distributed in a linear fashion or seem to follow a dermatome. We report a case of painful, unilateral, zosteriform cutaneous leiomyoma in a 25-year-old housewife. Histopathology revealed interlacing smooth muscle bundles arising from arrector pili muscles. Nifedipine (10 mg) twice daily was remarkably effective in diminishing the pain in our patient.

Differentiation genes: are they primary targets for human carcinogenesis?

In spite of extensive research in molecular carcinogenesis, genes that can be considered primary targets in human carcinogenesis remain to be identified. Mutated oncogenes or cellular growth regulatory genes, when incorporated into normal human epithelial cells, failed to immortalize or transform these cells. Therefore, they may be secondary events in human carcinogenesis. Based on some experimental studies we have proposed that downregulation of a differentiation gene may be the primary event in human carcinogenesis. Such a gene could be referred to as a tumor-initiating gene. Downregulation of a differentiation gene can be accomplished by a mutation in the differentiation gene, by activation of differentiation suppressor genes, and by inactivation of tumor suppressor genes. Downregulation of a differentiation gene can lead to immortalization of normal cells. Mutations in cellular proto-oncogenes, growth regulatory genes, and tumor suppressor genes in immortalized cells can lead to transformation. Such genes could be called tumor-promoting genes. This hypothesis can be documented by experiments published on differentiation of neuroblastoma (NB) cells in culture. The fact that terminal differentiation can be induced in NB cells by adenosine 3',5'-cyclic monophosphate (cAMP) suggests that the differentiation gene in these cells is not mutated, and thus can be activated by an appropriate agent. The fact that cAMP-resistant cells exist in NB cell populations suggests that a differentiation gene is mutated in these cancer cells, or that differentiation regulatory genes have become unresponsive to cAMP. In addition to cAMP, several other differentiating agents have been identified. Our proposed hypothesis of carcinogenesis can also be applied to other human tumors such as melanoma, pheochromocytoma, medulloblastoma, glioma, sarcoma, and colon cancer.

Contact leukoderma of the scalp or an unusual variant of vitiligo?

Contact leukoderma due to hair dyes is strongly suspected in patients presenting with depigmented patches sharply localized to the scalp. We describe three patients with a striking pattern of depigmentation, which stopped abruptly at the hair margins. However, no definite correlation with the use of hair dyes could be made in any of them. Our cases represent an unusual pattern of vitiligo of the scalp, which seems to have been previously attributed mainly to hair colorants. Careful examination of the lesions on the scalp may reveal more cases with this pattern.

Scientific rationale for using high-dose multiple micronutrients as an adjunct to standard and experimental cancer therapies

We have hypothesized that high-dose multiple micronutrients, including antioxidants, as an adjunct to standard (radiation therapy and chemotherapy) or experimental therapy (hyperthermia and immunotherapy), may improve the efficacy of cancer therapy by increasing tumor response and decreasing toxicity. Several in vitro studies and some in vivo investigations support this hypothesis. A second hypothesis is that antioxidants may interfere with the efficacy of radiation therapy and chemotherapy. This hypothesis is based on the concept that antioxidants will destroy free radicals that are generated during therapy, thereby protecting cancer cells against death. None of the published data on the effect of antioxidants in combination with radiation or chemotherapeutic agents on tumor cells supports the second hypothesis. Scientific rationale in support of a micronutrient protocol to be used as an adjunct to standard or experimental cancer therapy is presented.

Treating ingrown toenails by nail splinting with a flexible tube: an Indian experience

Ingrown toenail is a common problem, and currently available treatments are either quite invasive or associated with unacceptably high recurrence rate. Recently a new non-invasive therapy. "Nail splinting", has been introduced. In this procedure, the nail is splinted with a longitudinally incised plastic tube. We conducted the present study to evaluate the efficacy and safety of this procedure in fifty patients (68 nail edges in 61 nails) with ingrown toenails at all stages. The pain disappeared almost immediately, and inflammation subsided in about one week in all nail edges. Thirty-nine patients came for regular follow-up for six months after removal of the tube. Eight (20.5%) of these patients showed recurrence of the problem. No serious side effects were noted.

Atopy and alopecia areata in North Indians

This study was undertaken with the aim of evaluating the effect of associated atopy on severity and age at onset of alopecia areata in north Indians. Presence of atopy was elicited by detailed history, examination and intracutaneous tests. Chisquare test was carried out to evaluate statistical significance. One hundred patients (76 males and 24 females) with alopecia areata were evaluated. Historical evidence of atopy was present in 50 including patients alone (23), Patients and first degree relatives (11) and first degree relatives alone (16). Intracutaneous tests were positive in 23 out of 50 patients tested randomly. There was a trend towards increasing frequency of severe alopecia as evidence of atopy became stronger e.g. both patient and first degree relative with atopy or positive intracutaneous test but results did not attain statistical significance. Similarly the onset and duration of alopecia areata was not significantly related to the presence of atopy. It is concluded that in north Indians with alopecia areata, the presence of atopy is not significantly associated with severe alopecia or onset at younger age.

Impact of combined Mycobacterium w vaccine and 1 year of MDT on multibacillary leprosy patients

A total of 20 bacteriologically positive multibacillary (MB) leprosy patients older than 18 years of age with a bacterial index (BI) of 2+ or greater were given standard World Health Organization multiple drug therapy (MDT-MB) for 12 consecutive months plus four intradermal doses of Mycobacterium w vaccine at 3 monthly intervals (Study group). Twenty age-matched MB patients were given WHO/MDT alone (Control group). The patients of both groups were followed up for 1 year. Improvements in the patients were periodically monitored by clinical (Ramu's score), bacteriological (SSS), histopathological (skin biopsy) and immunological (lepromin conversion) parameters. Study group patients showed more significant improvements in all parameters except for lepromin conversion compared to patients in the Control group. The incidence of type 1 reaction was more in the Study group (30% vs 10%), while the incidence of type 2 reaction was more in the Control group (25% vs 15%). Neuritis associated with reactions was seen more often in the Control group compared to the Study group (20% vs 10%). The addition of Mycobacterium w vaccine as an adjunct to the 1-year WHO/MDT regimen appears to be significantly more beneficial in MB leprosy patients with a high initial BI compared to WHO/MDT given alone. Studies on larger numbers of patients with extended follow up will be in order.

Comparison of calcipotriol and coal tar in conjunction with sun exposure in chronic plaque psoriasis: a pilot study

This study was a left-right comparison of the efficacy of 0.005% calcipotriol ointment and 5% coal tar ointment in conjunction with sun exposure in 10 patients with stable plaque psoriasis. After four weeks of therapy, the calcipotriol treated site showed a significantly faster fall in PASI compared to the coal tar treated site. At eight weeks, this difference was not significant with both sides showing comparable improvement in lesions, as shown by PASI values. There were no significant side effects from either therapy. We conclude that both calcipotriol and coal tar ointments have comparable efficacy in treating stable plaque psoriasis when used simultaneously with sun exposure, although the initial response to calcipotriol is faster.

Rediscovering hydroxyurea: its role in recalcitrant psoriasis

BACKGROUND

There is an acute paucity of second-line systemic agents for the treatment of extensive chronic plaque psoriasis (CPP). Recent studies using hydroxyurea in patients with HIV infection and sickle cell anemia have rekindled interest in this old drug and have provided more data regarding safety and dosage.

OBJECTIVE

We wanted to test the efficacy and tolerability of hydroxyurea in patients with extensive CPP who had to discontinue first-line oral agents for any reason.

METHODS

The study was a prospective nonrandomized series. Thirty-one patients, including 26 with prior history of systemic antipsoriatic therapy were given hydroxyurea 1-1.5 g per day for a median duration of 36 weeks. They were followed up for a mean period of 36.1 +/- 13.8 weeks.

RESULTS

Almost 75% of the patients showed an adequate response (35% reduction in Psoriasis Area and Severity Index at or before 8 weeks) with over half showing more than 70% reduction in PASI score. All adverse effects were mild and reversible and none of the patients required cessation of therapy.

CONCLUSION

Hydroxyurea is an effective, very safe but relatively slower acting alternative for patients with extensive CPP over the short-to-medium term.