Hyperhomocysteinemia and MTHFR C677T and A1298C polymorphisms are associated with chronic allograft nephropathy in renal transplant recipients

Hyperhomocysteine has been reported to be an important risk factor for the development of atherosclerosis. Identification of risk factors, such as hyperhomocysteinemia, is crucial for a better understanding of the events that lead to degenerative processes in the vascular system and for a correct understanding of the potential role of methylene-tetrahydrofolate reductase enzymes (MTHFR) to help in the treatment of vascular disease observed in chronic allograft nephropathy (CAN). In this study we analyzed the plasma homocysteine concentrations and MTHFR C677T and A1298C polymorphism frequencies among 110 renal transplant recipients (53 with CAN and 57 with normal renal function). All recipients had undergone renal transplantation at least 12 months prior to this investigation to establish a possible correlation with the posttransplant outcome. Plasma homocysteine concentrations were measured by liquid chromatography-tandem mass spectrometry and MTHFR polymorphisms were investigated by the PCR-RFLP technique. The results demonstrated that in renal transplant recipients, hyperhomocysteinemia in addition to the presence of the allelic variants for both MTHFR polymorphisms (677T/1298C) might play a role as an additional risk factor for CAN. We understand that analysis of these polymorphisms might have a role in the CAN process. Therefore, studies to evaluate their presence in renal transplant patients may be extremely useful to individualize immunosuppressive protocols to inhibit or retard the progression of CAN.

[Congenital quintus varus supraductus: surgical procedure]

Quintus varus supraductus is a congenital malformation that associates a hyperextension, a varus and an external rotation of the fifth toe coming over the fourth. The goal of this study is to explain an easy, reproducible and efficient surgical procedure to correct that malformation. Our procedure is only about soft tissues. It comprises a fifth toe extensor tenolysis, a circular capsulotomy and lateral ligament section of the fifth metacarpophalangeal articulation. The glenoid plaque is desinserted only if the peroperative reduction did not seem sufficient. The stabilization is achieved through a cutaneous plasty of modified BUTLER, with a cutaneous lengthening VY plasty. Exceptionally, an axial broaching of the articulation has been done. On about 20 children, aged 4-17 years, operated with this procedure, we have noticed a complete and definitive correction in 19 patients. Only one patient showed an incomplete resurgence, but without any functional disturbance. We did not notice any failure. This procedure seems efficient, and all the more interesting that it is technically easy to perform.

Respiratory mechanics and pleural remodelling in pleurodesis induced by barium sulphate

The aim of this study was to determine whether an intrapleural injection of barium sulphate would produce pleurodesis in rats. Additionally, respiratory mechanics and pleural remodelling were analysed. Single intrapleural injection of barium sulphate (100%) or saline was given to Wistar rats. Respiratory system, lung, and chest wall elastic, resistive and viscoelastic/inhomogeneous pressures were measured by the end-inflation occlusion method at 2 and 30 days after injection. The pleura were examined for gross and histopathological evidence of pleural inflammation and fibrosis, and the underlying lungs were also studied by morphometry. All pulmonary mechanical parameters increased at day 2, but were not different from control at 30 days after injection. Chest wall mechanical parameters did not change. Macroscopic evaluation demonstrated pleural adherence without haemothorax. Histopathologic analysis showed pleural inflammation and fibrosis. There was no alveolar inflammation or fibrosis in both groups. In conclusion, barium sulphate induced pleurodesis with either no changes in respiratory mechanics or lung lesion at day 30.

Quality control system for blood irradiation using a teletherapy unit

BACKGROUND AND OBJECTIVES

Irradiation of whole blood and blood components before transfusion is currently the only accepted methodology to prevent transfusion-associated graft-vs.-host disease. In the present work, we developed an automated system for blood bag storage during irradiation, using a teletherapy unit.

MATERIALS AND METHODS

A device with two thermal compartments was constructed in acrylic and foam, for the storage of blood bags during irradiation. An automatic acquisition system, coupled with an amplifier and a thermal-sensitive probe, were developed to check blood temperature during irradiation. A polystyrene phantom was constructed to simulate the volume of blood routinely irradiated. The dose distribution was measured in the phantom using thermoluminescent dosimeters and represented in terms of isodose curves.

RESULTS

The thermal device kept the blood temperature below 6 degrees C for more than 2 h. Our system allowed the simultaneous irradiation of two different blood components while maintaining a constant temperature. The temperature monitoring system remained invariant (0.2 degrees C) over the whole irradiation interval. Phantom dosimetric results showed a homogeneous dose distribution when the phantom was irradiated, using rotational fields with a 2 r.p.m. frequency.

CONCLUSIONS

The methodology developed in the present work provides appropriate storage conditions during irradiation of both red blood cells and platelet blood components using a teletherapy unit.

[Do we need a chart of quality for websites related to cosmetic surgery?]

Convergence of medicine and Internet may be one of the most remarkable transformations in the health care business. Following the path led by the United States, the number of French websites related to cosmetic surgery is growing rapidly. In this study, we intend to assess the quality of French websites dedicated to cosmetic surgery regarding good quality criteria currently available and recommendations suggested by the French Medical Association.

MATERIALS AND METHODS

We browsed the main French search engines on the Web that initially answering the following question: how many webpages are available regarding cosmetic surgery and what are the best referenced websites. For each website, we surveyed the following data: author's name and qualification, date of creation and last update, sources of information, level of interactivity, and adherence to a chart of quality such as HON.

RESULTS

Eighty-five websites were surveyed and assessed. Forty-five French websites were active websites dedicated to cosmetic surgery. Websites are mainly hosted by private clinics (18 sites = 40%), with informative content. We found that no website adheres to any chart of quality, and the French Society for Plastic Surgery (SOF.C.P.R.E.) is never mentioned. Intrinsic quality criteria for websites (author's identification, last update, sources of information, confidentiality) are only partially present.

DISCUSSION

We recall the key statistics regarding e-health business in the world, the various charts of quality available for medical websites, and recommendations provided by the French Medical Association. We suggest that websites should be available as a service (for information to the patient, for managing the office, for setting up medical records) rather than a poor personal webpage or a showcase.

CONCLUSION

The quality of websites for cosmetic surgery is poor; however, as in the USA, the number of web surfers on medical sites is growing. Online presence of our speciality should evolve. To improve medical websites, collective awareness is required. We recommend using a specific chart of quality, with recommendations rather than constraints.

[The fetal ECG--ST analysis in the diagnosis of fetal hypoxia]

OBJECTIVE

Clinical tests of a new apparatus STAN S21 evaluating the foetal ECG--ST section in the diagnosis of foetal hypoxia.

DESIGN

Retrospective analysis.

SETTING

Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital, Prague.

METHOD

Within the framework of clinical tests 27 analyses were made on a apparatus STAN S21 manufactured by Swedish firm Neoventa. Contrary to hitherto implemented and published studies, in all monitored deliveries the CTG curve was evaluated as well as FpO2 and STAN. After each delivery in the neonate the Apgar score and acid-base equilibrium from the umbilical artery was evaluated. ST analysis was included mainly in case of abnormal CTG records, risk and pathological deliveries. Evaluation was divided into two groups: in one delivery was terminated by the vaginal route, in the second one by Caesarean section. For evaluation of the CTG curve the FIGO terminology was selected (intermediary-suspect) and (abnormal-pathological). For evaluation of the FpO2 pathology 30% saturation for 10 minutes was used. In STAN analysis important phenomena were evaluated by computer (increase of T wave, increase of T/QRS complex and biphasic character of ST).

RESULTS

In reduced values of the Apgar score (during the 5th minute < 8 points) and the acid-base balance from umbilical artery (pH < 7.2, BE > -8) pathological CTG records and FpO2 were present in 25%. STAN had in these instances pathological records in 50%).

CONCLUSION

ST analysis is another very effective link in the diagnosis of interpartial foetal hypoxia. Initial experience indicates, that STAN will have probably a higher diagnostic specificity than CTG and FpO2.

Immunoguided lymph node dissection in colorectal cancer: a new challenge?

Knowledge of lymphatic involvement in patients with colorectal cancer is important in surgery and in the postoperative decision-making process. Fifty-eight patients with recurrent colorectal cancer underwent operation with the RIGS/(Radioimmunoguided Surgery) technology. Preoperatively, patients were injected with 1 mg monoclonal antibody (MoAb) CC49 (anti-TAG-72-tumor-associated glycoprotein) labeled with 2 mCi of iodine 125. Traditional surgical exploration was followed by survey with a gamma-detecting probe. Localization of MoAb on tumor was noted in 54/58 patients (93%). Traditional exploration identified 117 suspected tumor sites. With RIGS, 177 suspected tumor sites were detected. In 17 of the 58 patients (27.5%), at least one occult tumor site identified by RIGS was confirmed by pathology with hematoxylin & eosin (H & E) staining. This finding resulted in 16 major changes in surgical plan. RIGS performance varied between lymphatic and non-lymphatic tissue, with a positive predictive value (PPV) of 95.6% and negative predictive value (NPV) of 90% in non-lymphoid tissue compared to PPV of 40% and NPV of 100% in lymphoid tissue. In patients with tumors that localize, no RIGS activity in lymph nodes signifies no tumor, while decisions based on RIGS activity in lymph nodes requires H & E confirmation. Using this guideline, additional information acquired by RIGS can help the surgeon in making an informed decision during surgery and in planning postoperative therapy.

Hepatocyte growth factor expression in human cancer and therapy with specific inhibitors

Hepatocyte growth factor/Scatter Factor (HGF/SF) mediated stimulation of the Met receptor tyrosine kinase results in pleiotropic cellular effects including proliferation, morphogenesis, motility and invasion. In vivo, HGF/SF-Met activation has been shown to participate in tumorigenesis, angiogenesis and metastasis. Coupled with accumulating evidence that aberrant HGF/SF-Met expression is frequently observed in a variety of human tumors, often in association with progressive disease, these data present HGF/SF-Met as an attractive target for therapeutic intervention in human cancer. In this review, we will present the most compelling evidence suggesting a key role for HGF/SF-Met signaling in tumorigenesis, and discuss several possible therapeutic strategies.

Screening for high utilizing somatizing patients using a prediction rule derived from the management information system of an HMO: a preliminary study

BACKGROUND

Somatization is a common, costly problem with great morbidity, but there has been no effective screening method to identify these patients and target them for treatment.

OBJECTIVES

We tested a hypothesis that we could identify high utilizing somatizing patients from a management information system (MIS) by total number of visits and what we termed "somatization potential," the percentage of visits for which ICD-9 primary diagnosis codes represented disorders in the musculoskeletal, nervous, or gastrointestinal systems or ill-defined complaints.

METHODS

We identified 883 high users from the MIS of a large staff model HMO as those having six or more visits during the year studied (65th percentile). A physician rater, without knowledge of hypotheses and predictors, then reviewed the medical records of these patients and identified somatizing patients (n = 122) and nonsomatizing patients (n = 761). In two-thirds of the population (the derivation set), we used logistic regression to refine our hypothesis and identify predictors of somatization available from the MIS: demographic data, all medical encounters, and primary diagnoses made by usual care physicians (ICD-9 codes). We then tested our prediction model in the remaining one-third of the population (the validation set) to validate its usefulness.

RESULTS

The derivation set contained the following significant correlates of somatization: gender, total number of visits, and percent of visits with somatization potential. The c-statistic, equivalent to the area under the ROC curve, was 0.90. In the validation set, the explanatory power was less with a still impressive c-statistic of 0.78. A predicted probability of 0.04 identified almost all somatizers, whereas a predicted probability of 0.40 identified about half of all somatizers but produced few false positives.

CONCLUSIONS

We have developed and validated a prediction model from the MIS that helps to distinguish chronic somatizing patients from other high utilizing patients. Our method requires corroboration but carries the promise of providing clinicians and health plan directors with an inexpensive, simple approach for identifying the common somatizing patient and, in turn, targeting them for treatment. The screener does not require clinicians' time.

Regression and clonally distinct recurrence of human immunodeficiency virus related Burkitt-like lymphoma during antiretroviral therapy

An increased incidence of intermediate to high-grade Non Hodgkin's Lymphoma is found in individuals with AIDS. Although immune function in AIDS patients can be improved through the use of antiretroviral therapy, the contribution of these drugs to lymphoma regression is not known. Here we describe the complete regression and subsequent recurrence of high grade, Burkitt-like lymphoma during antiretroviral therapy in a patient with AIDS. Antiretroviral therapy resulted in diminished viral load and modest improvement in CD4+ T cell counts. Lymphoma regressed initially, but relapsed 3 months later. Tissue taken from the initial and recurrent tumor demonstrated different clonal rearrangements. The recurrent lymphoma did not respond to continued antiretroviral therapy. In Conclusion, antiretroviral therapy may contribute to lymphoma regression in AIDS lymphoma. Clinically recurrent disease may be clonally distinct.

Amino acid quantitation in aqueous matrices via trap and release membrane introduction mass spectrometry: homocysteine in human plasma

Trap and release membrane introduction mass spectrometry (T&R-MIMS) using a removable direct insertion membrane probe (DIMP) is employed to determine the total homocysteine concentration (tHcy) directly from human plasma after derivatization with ethyl chloroformate. The method uses no chromatographic separation, is linear, reproducible, and displays limit of quantitation (2 pM) sufficiently below the threshold concentration of tHcy in plasma. It also combines chemical, membrane, and mass spectrometric discrimination, and can be used to determine selected amino acids in human plasma simultaneously. After derivatization with ethyl chloroformate, many amino acids in aqueous solution are observed to be efficiently detected; hence T&R-MIMS is promising as a simple and sensitive technique for simultaneous quantitation of selected amino acids in plasma and urine, and in other aqueous matrices.

Some inflammation-related parameters in patients following normo- and hypothermic cardio-pulmonary bypass

AIMS

One of the complications of Cardio-Pulmonary Bypass is the Systemic Inflammatory Response Syndrome. Cardio-Pulmonary Bypass can be performed under either normothermic or hypothermic conditions. The aim of this study was to compare some inflammation-related parameters of patients following normothermic and hypothermic bypass. Moreover, attempts were undertaken to detect endotoxin, an inflammatory agent that has been implicated in the Systemic Inflammatory Response Syndrome, in the serum of patients. Levels of serum anti-endotoxin antibodies were estimated since they have been reported to negate the effect of endotoxin in the inflammatory syndrome.

METHODS AND RESULTS

Seventeen normothermic and 20 hypothermic cases were studied. Blood specimens were collected pre-, off- and post-bypass. Pertinent clinical and surgical data were collected. Hematological parameters (leukocyte, neutrophil and platelet counts) and liver function tests were determined by standard procedures. Endotoxin was determined by the Limulus Lysate Assay and anti-endotoxin antibodies by an enzyme immunoassay. Complement (C3 and C4) levels were determined by radial immunodiffusion. There were increases in leukocyte and neutrophil, and a decline in platelet numbers in both groups of patients. There was a decline in C3 and C4 levels in both groups of patients. Endotoxin was not detected in sera, and anti-endotoxin antibody levels were similar, in both groups of patients.

CONCLUSION

There were no significant differences in most of the altered inflammation-related parameters between the two groups of patients. Some of the findings might be partly due to hemo-dilution. The hydrophobic nature of endotoxin among other factors, might have hindered its detection in serum.

Self-assembly of mesoscopically ordered chromatic polydiacetylene/silica nanocomposites

Nature abounds with intricate composite architectures composed of hard and soft materials synergistically intertwined to provide both useful functionality and mechanical integrity. Recent synthetic efforts to mimic such natural designs have focused on nanocomposites, prepared mainly by slow procedures like monomer or polymer infiltration of inorganic nanostructures or sequential deposition. Here we report the self-assembly of conjugated polymer/silica nanocomposite films with hexagonal, cubic or lamellar mesoscopic order using polymerizable amphiphilic diacetylene molecules as both structure-directing agents and monomers. The self-assembly procedure is rapid and incorporates the organic monomers uniformly within a highly ordered, inorganic environment. Polymerization results in polydiacetylene/silica nanocomposites that are optically transparent and mechanically robust. Compared to ordered diacetylene-containing films prepared as Langmuir monolayers or by Langmuir-Blodgett deposition, the nanostructured inorganic host alters the diacetylene polymerization behaviour, and the resulting nanocomposite exhibits unusual chromatic changes in response to thermal, mechanical and chemical stimuli. The inorganic framework serves to protect, stabilize, and orient the polymer, and to mediate its function. The nanocomposite architecture also provides sufficient mechanical integrity to enable integration into devices and microsystems.

Benefits of radioimmunoguided surgery for pelvic recurrence

AIM

Surgery for recurrent rectal cancer is usually traumatic and of questionable curative value. The use of radioimmunoguided surgery (RIGS) in enhancing the surgeon's assessment of the extent of disease in these patients was investigated.

METHODS

Twenty-one patients diagnosed with recurrent pelvic cancer were operated using the RIGS(O)system. Preoperative assessment included CTs of chest, abdomen and pelvis as well as colonoscopy. Patients were injected with CC49, a monoclonal antibody (MoAb) labelled with 125I. Surgical exploration was followed by survey with the gamma-detecting probe.

RESULTS

Surgical exploration identified eight intra-colorectal recurrences, nine extra-colonic pelvic recurrences and five extra-pelvic lymph node metastases. RIGS exploration confirmed all intra-colonic recurrences except for one (patient with no MoAb localization), identified 13 pelvic recurrences and 10 lymph node metastases. There were seven patients with occult findings (33%), resulting in a modified surgical procedure. Surgery included five abdomino-perineal resections, six low anterior resections, seven excisions of presacral tumour, eight total abdominal hysterectomy and bilateral salpingo-oophorectomy, one pelvic exenteration and one post-exenteration. There were no operative deaths. Eight patients had minor complications, and one patient had a major complication with reoperation due to urinary leak. The mean follow-up was 18 months. Ten patients died of disease.

CONCLUSION

Although not curative, RIGS can help the surgeon in the decision-making process through better disease staging.

[New approach to hand dressings in young children: the puppet dressing]

Applying a postoperative dressing on a child's hand is a very important matter, for it must be done rigorously and according to well established principles in order to be effective and inoffensive. The strictness of execution, that holds the surgeon's attention, makes us sometimes forget that the dressing is for a child who is usually anxious. First, we recall the general principles of a postoperative dressing adapted to young children. Then, we explain a method of applying a dressing in the shape of a puppet, which at first can appear to be funny, but seriously which is completely adapted to a young child. This pediatrician adaptation, that parents appreciate very much, makes the situation less stressful because the child finds himself in a game situation. The puppet dressing seems to be an advantageous modification of the traditional dressing of a child's hand.

Confirmation of the autosomal recessive syndrome of ectopia lentis and distinctive craniofacial appearance

We report four members of a Lebanese Druze family with the syndrome of lens dislocation, spontaneous filtering blebs, anterior segment abnormalities, and a distinctive facial appearance. The constellation of clinical abnormalities in these patients is not suggestive of the Marfan syndrome or other connective tissue disorders associated with ectopia lentis. We previously described this syndrome in another presumably unrelated and highly inbred Druze family from the mountains of Lebanon. We postulated autosomal recessive inheritance in a pseudo-dominant pedigree. A few isolated reports of similar cases are scattered in the world literature. We now confirm that this is a distinct autosomal recessive syndrome whose gene mutation is enriched in the Lebanese Druze community.

Identification of lymph node metastases in recurrent colorectal cancer

Lymph node metastases are an important prognostic prediction factor in patients with recurrent colorectal cancer, particularly those with liver metastasis. Fifty-six patients with recurrent colorectal cancer were operated by us using the RIGS (radioimmunoguided surgery) technology. Patients were injected with 1 mg monoclonal antibody (MoAb) CC49 labeled with 2 mCi 125I. In surgery, traditional exploration was followed by survey with a gamma-detecting probe. Sixty of 151 patients enrolled in the Neo2-14 Phase III study for recurrent colorectal cancer were diagnosed with liver metastases based on preoperative CT. In 17/56 patients (30%), RIGS identified at least one tumor site confirmed by pathology (H&E). This resulted in 16 major changes in surgical plan. RIGS performance varied between lymphatic and non-lymphatic tissue, with positive predictive value (PPV) of 100% and negative predictive value (NPV) of 94% for non-lymphoid tissue, compared to PPV of 46.5% and NPV of 100% for the lymphoid tissue. Thirty-five out of 60 patients were considered resectable after traditional evaluation. RIGS identified occult tumor in 10 of these patients (28.5%). 7/10 occult patients expired (70%), while only 7/25 of the non-occult patients expired (28%) (P = 0.046). In localizing patients, no RIGS activity in lymph nodes signifies no tumor, while H&E confirmation is needed for decisions based on RIGS activity in the lymph nodes. RIGS provides important staging information, identifying patients for whom surgery may be done with curative intent.

Predictors of response and survival after concurrent chemotherapy and radiation for locally advanced squamous cell carcinomas of the head and neck

BACKGROUND

The objective of this study was to determine prognostic factors for response and survival on three consecutive institutional trials utilizing concurrent chemotherapy and radiation for locally advanced squamous cell carcinomas of the head and neck (SCCHN).

METHODS

Since 1985, patients with locally advanced SCCHN at the University of Maryland have been managed with concurrent chemotherapy and radiation therapy (RT). Three consecutive pilot studies have been performed evaluating the utility of weekly chemotherapy with standard fractionated RT. Chemotherapy consisted of carboplatin either alone (28 patients) or in combination with bleomycin (23 patients) or paclitaxel (60 patients). In all three studies, RT was given to 70.2 gray (Gy) at 1.8 Gy/fraction/day to the primary site. All patients had locally advanced SCCHN and were believed to be poor surgical candidates. Sixty-seven percent of patients had T4 disease, and 21% had T3 disease. Seventy-five percent of patients had N2-N3 disease. One hundred eleven patients were examinable for toxicity, response, and survival analysis. Factors including age, race, gender, primary site location, histologic grade, T classification, N classification, and treatment regimen were evaluated to identify predictors of these endpoints.

RESULTS

The median follow-up for patients treated on study 1 (carboplatin and RT) and study 2 (carboplatin and bleomycin [C + B]/RT) was 98 months, and it was 30 months for study 3 (carboplatin and paclitaxel [C + P]/RT). The complete response rates were 54%, 52%, and 70% respectively (P = 0.01). Multivariate analysis identified length of treatment break (< 1 week vs. > 1 week) as the only predictor of complete response to therapy. The local control for the entire group was 50%. The local control for C + P/RT was 63%, versus 32% and 36% for C/RT and C + B/RT respectively (P = 0.004). The 2-, 3-, and 5-year disease free and overall survivals for the entire population were 41%, 41%, and 35% and 42%, 36%, and 33%, respectively. The 3-year overall survival rates by treatment regimen were 18% (C/RT), 35% (C + B/RT), and 47% (C + P/RT; P = 0.01). On univariate analysis, age younger than 50 years (P = 0.01), treatment with C + P/RT (P = 0.005), and treatment break of 5 days or fewer (P < 0.05) were also predictive of improved overall survival. On multivariate analysis, only complete response (P < 0.0001) and treatment with C + P/RT (P = 0.02) remained statistically significant.

CONCLUSIONS

Chemoradiation provides patients with locally advanced SCCHN the opportunity for long term survival. Among the three chemoradiation regimens studied, C + P/RT was associated with the best complete response and survival rates. Complete response to therapy was the single most important predictor of overall survival. These three consecutive concurrent chemotherapy and radiation trials achieved a 5-year survival of greater than 30% for the entire population. These results support the use of this nonoperative approach for this group of patients with a historically poor prognosis.

Effects of intravenous gamma immunoglobulins treatment on severe peritonitis in rats

BACKGROUND

Generalized purulent peritonitis is characterized by an early exposure of the immune system to a large number of bacterial antigens. The hypothesis that intravenous IgG treatment may improve the outcome of severe experimental peritonitis was studied.

METHODS

Peritonitis was induced in rats by cecal ligation and perforation. Continuous intravenous fluid infusion, broad-spectrum antibiotics, and twenty-four hours treated forty rats after the induction of the disease they were re-operated and the perforated cecum was excised. Twenty of these animals received in addition specific rat IgG in two intravenous infusions (0.4 gr./kg), two and twenty four hours after the induction of peritonitis.

RESULTS

Elevated WBC counts and mild metabolic acidosis was found one day after the induction of peritonitis. IgG treatment was associated with lower WBC counts in the following days and with higher pH than in the control group (p < 0.05 for both parameters). All peritoneal cultures and 90% of blood cultures were positive 24 hours after the initial operation. These rates decreased in the following days and in the IgG treatment rats the peritoneal cavity and blood were sterile earlier than in the control animals (p < 0.05). Serum IgG was depleted in the control animals within 48 hours after the induction of peritonitis, while in the IgG treated animals its levels were remarkably elevated. IgG administration significantly improved the survival, which was 70% in the IgG treatment rats as compared to 40% in the control rats.

CONCLUSION

These results indicate that intravenous IgG has beneficial effects on severe experimental peritonitis.

[Photodynamic therapy of nasal basal cell carcinoma]

Photodynamic therapy (PDT) is a noninvasive modality used topically for several skin cancers. We evaluated the effects of PDT on basal cell carcinoma (BCC) of the nose, using aminolevulinic acid (ALA) as a photosensitizer and a non-laser light source (Versa-Light). The advantages of this light source are synergistic, hyperthermia and fewer side effects. A paste of 20% ALA was applied topically to biopsy-proven BCC of the nose. Lesions were covered with occlusive light-shielding dressing and after 18 hours they were submitted to 10 minutes of exposure to the light. Initial evaluation was made after 21 days and every 3 months thereafter. Patients who did not respond after 2 treatments were referred for surgery. Mean follow-up in 31 patients was 19 months (range 6-36). There were no significant side-effects. There was complete response in 24/27 (88.9%), in whom there was recurrence in 2/27 (7.4%).

The hand in recessive dystrophic epidermolysis bullosa

Recessive dystrophic epidermolysis bullosa is still a difficult challenge for surgeons and doctors. Hand retractions are different from burns. The medical team must have a good knowledge of the disease. Surgery must be performed with the collaboration of every member of the team, as well as the family. In young children, complete correction of the retractions is possible. On the other hand, when retractions are present for a long time in children and adolescents, surgery is purely functional. Static and dynamic splints delay recurrences, but their prolonged use presents psychological obstacles in adolescents and adults.

Radioimmunoguided surgery for recurrent colorectal cancer manifested by isolated CEA elevation

BACKGROUND

Carcinoembryonic antigen (CEA) is a sensitive marker for detecting recurrent colorectal carcinoma. An asymptomatic rise of CEA can precede by several months the detection of recurrent cancer by standard imaging modalities. Yet, surgeons are hesitant to operate solely on the basis of an observed increase in CEA. We investigated the ability of radioimmunoguided surgery to enhance the surgeon's capability of detecting intraabdominal disease in these patients.

METHODS

Nineteen patients who underwent radioimmunoguided surgery for suspected tumor recurrence based solely on elevated CEA were included in the study. They underwent colonoscopy and CT of the abdomen and chest, all of which were negative. They then underwent scintigraphy scan with an anti-CEA monoclonal antibody (MoAb) labeled with (99m)Tc or Indium I-111. All patients were injected with the CC49 MoAb (an anti-TAG-72 tumor-associated glycoprotein) labeled with (125)I three weeks before surgery. During surgery, traditional exploration was followed by survey with a gamma-detecting probe.

RESULTS

Traditional surgical exploration identified 26 recurrent tumors: 7 hepatic, 8 pelvic, 6 retroperitoneal, 3 colonic, 1 splenic, and 1 anastomotic. Radioimmunoguided surgical exploration confirmed all recurrent tumors and identified additional tumor sites in seven patients that resulted in changing the surgical plan. CEA scans correlated with intraabdominal findings in seven patients. Abdominal pathology did not correlate completely with the scans in three patients, and CEA scan results were undetermined in two patients.

CONCLUSION

Patients with elevated CEA and no other findings should be operated upon without delay, and radioimmunoguided surgery should be used to enhance the surgeon's knowledge of the extent of disease.