[Metastases from a malignant melanoma as extensive, space-occupying lesion in the trachea]

We report the case of a 71-year-old man, who was transferred to our clinic with rapidly increasing dyspnea. On examination by flexible bronchoscopy the trachea was found to be almost completely obstructed by metastatic masses of a malignant melanoma. After endoscopic removal of the obstruction, we inserted a covered nitinol stent which led to instantaneous relief of symptoms. Chemotherapy and local radiotherapy were instituted. During the next 9 months there were no signs of recurrence of the tumour in regular pneumological control exams.

[Sentinel lymph node dissection in prostate cancer. Experience after more than 800 interventions]

There is no consensus on which prostate cancer patients should undergo lymph node removal and which lymph nodes should be included. Therefore, most clinicians rely on nomograms and dispense with lymph node dissection in patients with low-risk disease. Meanwhile, there are some studies which prove that there are also lymph node metastases in patients with low-risk prostate cancer and that lymph node metastases are predominantly localized outside the region of standard lymphadenectomy. In more than 800 men we could show that lymph node metastases were found more often than shown in the Partin tables. These lymph node metastases were detected by sentinel lymph node dissection outside the region of standard and extended lymphadenectomy. Because of insufficient preoperative diagnostics it is unclear which patients have positive lymph nodes. Therefore, it is useful to perform lymph node dissection in every patient. Men with positive nodes could have a better prognosis, when sentinel and extended lymph node dissection are performed.

Correlation between mouse potency and in vitro relative potency for human papillomavirus Type 16 virus-like particles and Gardasil vaccine samples

An in vitro relative potency (IVRP) assay has been developed as an alternative to the mouse potency assay used to release Merck's human papillomavirus (HPV) vaccine, Gardasil, for early phase clinical trials. The mouse potency assay is a classical, in vivo assay, which requires 4-6 weeks to complete and exhibits variability on the order of 40% relative standard deviation (RSD). The IVRP assay is a sandwich-type immunoassay that is used to measure relative antigenicity of the vaccine product. The IVRP assay can be completed in three days, has a variability of approximately 10% RSD and does not require the sacrifice of live animals. Because antigen detection is achieved using H16.V5, a neutralizing monoclonal antibody, which binds to a clinically-relevant epitope, the relative antigenicity measured by the IVRP assay is believed to be a good predictor of in vivo potency. In this study, the relationship between immunogenicity, as measured by the mouse potency assay and antigenicity as measured by the IVRP assay, is demonstrated. Freshly manufactured and aged samples produced using two different manufacturing processes were tested using both methods. The results demonstrate that there is an inverse correlation between the IVRP and mouse potency assays. Additionally, clinical results indicate IVRP is predictive of human immunogenicity. Thus, antigenicity, as defined by the H16.V5 epitope, can be used as a surrogate for immunogenicity and the IVRP assay is suitable for use as the sole potency test for Gardasil samples.

Ulcère de jambe et lymphangite nodulaire à Nocardia brasiliensis en France métropolitaine

INTRODUCTION

Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh.

CASE REPORT

A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective.

DISCUSSION

The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.

Nematic-amorphous polymer interfaces in the presence of a compatibilizer

We introduce and apply a variant of a dynamic self-consistent field simulation in two dimensions to predict the structure of interfaces between a nematic and an amorphous polymer compatibilized by a diblock copolymer. First, we investigate the effect of the nematic order on the polymer polymer interface without compatibilizer. Then we include the compatibilizer and consider two interfacial setups previously used in experiments, i.e., the bilayer setup and the trilayer setup. In the bilayer setup the diblock copolymer is mixed into the amorphous homopolymer and migrates to the interface in the course of the simulation forming a layered structure. We compare the amount of copolymer at the interface for initial concentrations of the copolymer below and above the critical micelle concentration. In the trilayer setup the initial thickness of the diblock copolymer is varied. The resulting interfacial morphology evolves in the competition between the lamellar structure induced by the interface and a micellar structure, which is intrinsic to the copolymer.

CT der Ureterolithiasis mit der Strahlendosis einer Ausscheidungsurographie: Ergebnisse bei 209 Patienten

PURPOSE

To evaluate a low-dose, nonenhanced helical CT protocol for the diagnosis of renal colic using an effective dose equivalent of radiation not higher than that of intravenous urography.

MATERIALS AND METHODS

A new low-dose helical-CT protocol (120 kV; 70 mA; rotation time 0.75 s; collimation 5 mm, pitch = 2) was used to examine 209 consecutive patients with symptoms of renal colic. The initial CT reports were compared with retrograde ureterography, ureteral endoscopy, stone retrieval, surgical or clinical findings. The effective radiation dose was calculated by the method published by Nagel. The prevalence of ureterolithiasis was 70 %.

RESULTS

Sensitivity and specificity of the low-dose-helical CT in detecting ureteral calculi were 97.7 % and 96.8 %, respectively. The positive predictive value was 99.3 % and negative predictive value 92.4 %. The mean effective radiation dose equivalent was 0.97 mSv in male and 1.35 mSv in female patients.

CONCLUSIONS

The diagnostic value of the reported CT protocol does no differ from previously published protocols. However, the effective radiation dose equivalent is at least 50 % lower than stated in the published protocols. We recommend the low-dose helical CT protocol as the method of choice.

[Imatinib-induced purpuric vasculitis]

INTRODUCTION

Imatinib (Glivec) is a new molecule that specifically inhibits tyrosine-kinase activity and is used in the treatment of chronic myeloid leukemia. Cutaneous side effects with imatinib are frequent. We report the first case of purpuric vasculitis probably due to this drug.

OBSERVATION

A 65 year-old man was treated for chronic myeloid leukemia with imatinib. After two months of treatment, he developed an erythematous and squamatous on the trunk, which regressed spontaneously one week after suspension of the product. Imatinib was reintroduced two months later. The patient immediately developed a painful, infiltrated, purpuric eruption on the legs. Histological examination revealed vasculitis compatible with the diagnosis of toxiderma. Since treatment could not be suspended, oral corticosteroids were introduced and the lesions cleared within three weeks.

DISCUSSION

Adverse cutaneous reactions to imatinib are frequent. Their physiopathological mechanism is unknown.

Changes in the cell wall network during the thermal dehydration of alfalfa stems

The effects of heat treatments used to dry alfalfa stems were investigated. Heating at 70 or 100 degrees C caused no major change in the cell wall composition, but xylanase had lower activity on the cell wall of heated material and the amount of xylose released varied with the temperature used. Chemical fractionation of cell wall carbohydrates showed that the main changes occurring during stem dehydration concerned pectic polymers and probably hemicelluloses. There was less material soluble in ammonium oxalate from alfalfa heated at 100 degrees C than from fresh alfalfa. The results suggest that heat processing causes some changes in the cell wall network. Environmental scanning electron microscopy was used to examine fully hydrated tissues at high resolution. There was cell distortion without disruption of cell walls as water was lost.

Radioisotope guided pelvic lymph node dissection for prostate cancer

PURPOSE

The localization of lymph node metastases in prostate cancer varies enormously. Due to high morbidity complete pelvic lymphadenectomy is often decreased to modified staging lymphadenectomy, resulting in loss of sensitivity for detecting micrometastases. Based on the promising results of intraoperative gamma probe application for identifying sentinel lymph nodes in malignant melanoma, breast and penis cancer, we identified sentinel lymph nodes in prostate cancer using a comparable technique.

MATERIALS AND METHODS

In 117 patients 99mtechnetium nanocolloid was transrectally injected directly into the prostate under ultrasound guidance 1 day before pelvic lymphadenectomy. Thereafter dynamic lymphoscintigraphy was done. Initially lymph nodes identified as sentinel lymph nodes by the gamma probe were removed and subsequently modified pelvic lymphadenectomy was performed.

RESULTS

Lymphatic metastasis was detected in 28 cases. An average of 4 sentinel lymph nodes were identified per patient in 25 of 27 patients with micrometastasis, of which those in 24 contained micrometastasis for 96% sensitivity. In contrast, sensitivity of modified pelvic lymphadenectomy was 81.5%. In 16 patients only sentinel lymph nodes were positive. An average of 21.8 lymph nodes (range 10 to 51) was dissected per patient at pelvic lymphadenectomy. Lymph node metastasis was noted in 6 of the 46 patients with a prostate specific antigen between 4 and 10 ng./ml. and in 8 of the 64 with a stage pT2 tumor.

CONCLUSIONS

Our study shows individual variability of lymphatic drainage of the prostate and limited sensitivity for detecting positive lymph nodes when the pelvic dissection area is limited. Furthermore, our experience implies that the identification of sentinel lymph nodes is feasible, not only in breast cancer and malignant melanoma, but also in prostate cancer using a comparable technique.

[Unenhanced spiral computerized tomography in acute diagnosis of flank pain. Examination in contraindications for contrast medium administration]

The diagnostic value of unenhanced helical computed tomography was investigated in a prospective study. In 53 patients (aged 35 to 82 years) with acute flank pain tomography was performed in addition to abdominal plain film and ultrasound examination. All 53 patients had a contraindication for intravenous administration of contrast medium. Ureteral calculi were either confirmed or excluded by retrograde ureteropyelography in 44 cases, in 9 patients by asservation of calculi and clinical follow-up. Helical computed tomography was able to precisely identify all of the 34 ureteral calculi, whereas abdominal plain films led to 6 false positive and 17 false negative findings. In 1 patient with retroperitoneal lymphoma (diagnosed by CT) false positive findings occurred. Unenhanced helical computed tomography reaches a distinctively increased diagnostic value (sensitivity 100%, specificity 95%, accuracy 97%) in the evaluation of acute flank pain as compared to conventional radiologic imaging and ultrasound. This non-invasive procedure is to be considered method of choice for patients with contraindications for the application of radiopaque material.