[Multiple melanoma metastasis. Case report]

OBJECTIVE

Malignant melanoma has a high incidence. Malignant melanoma metastasis can develop in all viscera, including brain. They are encephalophiles. Rarely, the primary tumor remains unknown. Treatment of this metastasis is complex.

CLINICAL PRESENTATION

A 50-year-old man in an excellent clinical condition was diagnosed with multiple metastasis. Lesions were diagnosed using modem imaging methods: MRI, PET-scan. They were treated by chemotherapy, radiotherapy and immunotherapy. In the evolution of the disease, appeared brain metastases.

RESULTS

The chemotherapy, radiotherapy and immunotherapy have not stopped the evolution of visceral lesions which increased in number and size. They had not toxic effects. The general condition of the patient was very good, with KPS=100. The brain metastases had no response to RCS. His surgical excision improved the neurological condition but, thereafter, general condition get worse and the patient died 3 months after surgical intervention. Biopsies from subcutaneous nodes and brain lesion sustained the malignant melanoma diagnosis.

CONCLUSIONS

In rare instances there are malignant melanoma metastases without a primary tumor. The patient was in a very good condition, although the treatment methods have not produced a regression of stabilization of the disease. The results of melanoma metastasis treatment are not satisfactory.

Immunophenotypic analysis of cerebrospinal fluid cell populations with the Cell-Dyn Sapphire haematology analyser: method feasibility and preliminary observations

Cerebrospinal fluid (CSF) samples (n=50) from patients with neurological disease (bacterial infection, viral infection, neuroborreliosis and multiple sclerosis) were analysed to characterize cell populations by fluorescent immunocytometry with the CD-Sapphire haematology analyser. Reagent combinations applied to all CSF samples comprised CD3/CD19/HLA-DR and CD4/CD8, with some being further analysed using CD3/CD4, CD3/CD16 and CD3/CD25 protocols. Of the 50 samples, 11 were excluded because of high proportions of nonviable cells (n=2) or insufficient cell numbers (n=9). Apart from bacterial infection with granulocytosis, all diagnostic groups showed high proportions (51.4-77.0%) of CD3+ T cells. There was a modest association between T-cell and B-cell counts, but absolute B-cell numbers exceeded 5 cells/microl in only 7/39 cases (neuroborreliosis, n=6; bacterial meningitis, n=1). CD3/Ia antigen (activation) co-expression was low and only exceeded 5% in 7/39 samples with no diagnostic correlation. Primary CD4+ and CD8+ T-cell subsets showed similar quantitative trends and CD4/CD8 co-analysis revealed the presence in all diagnostic groups (neuroborreliosis and multiple sclerosis in particular) of a CD4+CD8int fraction that was predominantly CD3+ and CD16- and had a morphological profile consistent with small lymphoid cells. Supplementary CD-Sapphire cellular immunological analysis of most CSF samples is feasible using the procedure detailed in this communication.

Occurrence of endemic plasmids causing β-lactam resistance inEnterobacteriaceae in children’s university hospital in Munich

Susceptibility of 62 clinical isolates of Enterobacteriaceae to 15 aminoglycosides, beta-lactams and fluoroquinolones was determined. The isolates originating from 3 intensive care units (neonatal, pediatric, and surgical) and the Department of Infant Internal Medicine of the Children's University Hospital City Center in Munich (Germany) were collected in August 1999, and March and October 2000. Transferability of antibiotic resistance from donors to their E. coli transconjugants was also demonstrated. The majority of isolates were resistant to ampicillin, cefoxitin, ceftriaxone, cefotaxime, ceftazidime and azthreonam but they were susceptible to cefepime, meropenem, aminoglycosides and fluoroquinolones. The occurrence of beta-lactamases and extended-spectrum beta-lactamases (ESBL) was also shown. In August 1999 75% of isolates produced beta-lactamases and 15% ESBL, in March 2000 95% of isolates produced beta-lactamases and 9% ESBL; in October 2000 all isolates produced beta-lactamases and only 5% produced ESBL. Plasmid DNA analysis in randomly chosen isolates and their transconjugants revealed the presence of plasmids ranging from 19 to 136 kb; in the majority of isolates a 120-kb plasmid was observed. Further analysis using restriction endonuclease suggested a dissemination and persistence of an endemic plasmid at all 4 wards of the large pediatric hospital in the City Center of Munich which may be responsible for resistance to beta-lactams among Enterobacteriaceae isolates.

Indices of iron deficiency and anaemia in Bedouin and Jewish toddlers in southern Israel

AIMS

To estimate the prevalence of iron deficiency and iron deficiency anaemia using haematological indices.

METHODS

Prospective interventional study. Healthy toddlers from Bedouin and Jewish towns in southern Israel. Capillary blood was sampled to assess iron status and nutritional history recorded. Parents were given specific nutritional instructions. Anaemia was defined as haemoglobin level < or = 11 gr/dL. Iron deficiency without anaemia was defined as mean corpuscular volume (MCV) < 70 fL and/or red blood cell width (RDW) > or = 16, with haemoglobin level > 11 gr/dL. Toddlers with iron deficiency were treated with 5 mg/kg/day of elemental iron. Follow-up iron and nutritional status was performed 1 and 2 months after enrolment.

RESULTS

At the time of enrolment 42% of the 107 Jewish and 93% of the 43 Bedouin toddlers were iron deficient (p < 0.001). Significantly higher proportions of Bedouin toddlers were breastfed, drank tea, did not eat meat, did not take supplementary iron in their first year of life and were previously diagnosed with anaemia. Rate of follow-up was 55% among Bedouins and 33% among Jews. The mean haemoglobin rise over two months was 0.91 gr/dL (95% CI: 0.63-1.18 gr/dL; p < 0.001) in Bedouins and 0.58 gr/dL (95% CI: 0.14-1.02 gr/dL; p = 0.014) in Jews.

CONCLUSIONS

Higher rates of anaemia and iron deficiency, as well as most of the risk factors, found among the Bedouin toddlers, call for the design and implementation of innovative, culturally appropriate interventions in the Bedouin population.

Optimization of bulk and surface biosensing in plane stratified configurations

Various biochemical and tissue sensors utilize layered configurations to accurately measure the physical parameters (e.g. refractive index) of the suspension or tissue under investigation. The most sensitive techniques, like these based on well-known Surface Plasmon Resonance (SPR) phenomenon, are usually limited to surface sensing at the infrared and light wavelength bands. We present a new type of broadband absorption biosensing method, which utilizes Lossy Resonance Modes (LRM) in thin lossy film configurations and can be facilitated in a highly scalable and sensitive manner for both bulk and surface sensing in various frequency bands, from radio to light frequencies.

Antibiotikatherapie: Fortschritte und Resistenzentwicklung

This contribution illustrates reasons, spread, and mechanisms of development of resistance especially in gram-positive microorganisms such as methicillin resistant staphylococcus aureus (MRSA) or vancomycin resistant enterokoccus (VRE). Possibilities of overcoming these are described as well as strategies for antibacterial therapy with recently developed antibiotics against multiple resistant microorganisms. These are linezolid as an oxazolidinone, daptomycin as a lipopeptid and tigecyclin as a new glycylcycline, which are already on the market or will be launched soon in Germany. Differences in magnitude and frequency of still existing resistances between hospital and practice are discussed with respect to their importance for the internal physician.

Prophylactic management of children at risk for recurrent upper respiratory infections: the Preventia I Study

BACKGROUND

Given the morbidity and mortality of asthma and the recent dramatic increase in its prevalence, pharmacologic prophylaxis of this disease in children at risk would represent a major medical advance.

OBJECTIVES

The Preventia I Study was designed to evaluate the efficacy and long-term safety of loratadine in reducing the number of respiratory infections in children at 24 months. A secondary objective was to investigate the benefit of loratadine treatment in preventing the onset of respiratory exacerbations.

METHODS

Preventia I was a randomized placebo-controlled study involving 22 countries worldwide. The children were 12-30 months of age at enrollment and had experienced at least five episodes of ENT infections, and no more than two episodes of wheezing during the previous 12 months. Phase I was a 12-month double-blind period during which the children were treated with loratadine 5 mg/day (2.5 mg/day for children</=24 months of age) or placebo. Phase II was a double-blind follow-up period without study medication.

RESULTS

Of the 412 children enrolled, 342 and 310 completed Phase I and Phase II, respectively. The results showed a significant decrease in the number of infections in the whole population of children. However, no difference was observed between the loratadine and placebo group. When considering secondary end-points, loratadine was shown to reduce the number of respiratory exacerbations during the treatment phase. None of the 204 children who received loratadine discontinued the study because of drug-related events. Loratadine treatment was not more sedative than placebo and was not associated with cardiovascular events.

CONCLUSION

The strong decrease in the rate of infections in the children at risk of recurrent infections, while not being influenced by loratadine treatment, should encourage future reflection in terms of prophylactic management. This study also confirms the long-term safety of loratadine and its metabolites in young children.

Beta-lactam/beta-lactamase inhibitor combinations in empiric management of pediatric infections

Beta-lactam antibiotics have long played a central role in the management of pediatric infections. However, widespread beta-lactam resistance among community- and hospital-acquired pathogens, mainly due to beta-lactamase production, has reduced the usefulness of these trusted and well-tolerated agents. Many regions have reported an increase in beta-lactamase-mediated resistance to cephalosporins and carbapenems as well as penicillins among clinically important Gram-positive and Gram-negative aerobes and anaerobes. For some pathogens such as Moraxella catarrhalis, Klebsiella species and Pseudomonas aeruginosa, virtually all strains worldwide are beta-lactamase producers. The development of beta-lactamase inhibitors for co-administration with a number of established beta-lactam agents has restored their usefulness in pediatric patients. The combination of ampicillin plus sulbactam has broad anti-aerobic and anti-anaerobic activity in vitro and achieves high concentrations in many body tissues and fluids. The availability of a mutual oral prodrug, sultamicillin, has enabled the development of an oral formulation. Excellent clinical response and bacterial eradication rates with ampicillin/sulbactam and sultamicillin have been demonstrated for upper and lower respiratory tract infections, urinary tract infections, osteomyelitis, and meningitis in pediatric patients and neonates. Furthermore, many studies have demonstrated an excellent tolerability profile. Thus, ampicillin/sulbactam has an important role in the management of pediatric infections.