Uterine composite tumor composed of leiomyosarcoma and embryonal rhabdomyosarcoma with immature cartilage.

SUMMARY: We report a rare composite uterine mesenchymal neoplasm in a 66-year-old woman composed of approximately equal amounts of leiomyosarcoma and embryonal rhabdomyosarcoma, the latter containing foci of immature cartilage. Immunohistochemically, both components were positive with desmin. The leiomyosarcomatous element was positive with alpha smooth muscle actin and h-caldesmon and the rhabdomyosarcomatous component with myogenin and myo-D1. In a review of the literature, we have identified only a single example of a similar case. This is likely to represent rhabdomyosarcomatous differentiation in a leiomyomatous neoplasm or alternatively bidirectional differentiation from an uncommitted mesenchymal stem cell.

Paclitaxel/carboplatin/etoposide versus paclitaxel/topotecan for extensive-stage small cell lung cancer: a Minnie Pearl Cancer Research Network randomized, prospective phase II trial.

PURPOSE: To compare the combination of paclitaxel (Taxol; Bristol-Myers Squibb, Princeton, NJ, http://www.bms.com) and topotecan (Hycamtin; Glaxo SmithKline, Philadelphia, http://www.gsk.com) with paclitaxel, carboplatin (Paraplatin; Bristol-Myers Squibb), and etoposide (Etopophos, VePesid; Bristol-Myers Squibb) in patients with previously untreated extensive-stage small cell lung cancer. PATIENTS AND METHODS: In this phase II trial, 120 patients were randomly allocated to receive either topotecan (1.5 mg/m(2) i.v. days 1, 2, and 3) and paclitaxel (175 mg/m(2) i.v. day 1) every 21 days orpaclitaxe l (200 mg/m(2) i.v. day 1), carboplatin (area under the concentration-time curve 6 i.v. day 1), and etoposide (50 mg/100 mg alternating daily by mouth days 1-10) every 21 days, each regimen for a maximum of eight cycles. The primary end points were objective response rate and time to progression. RESULTS: The paclitaxel-carboplatin-etoposide combination produced a significantly higher overall response rate (78% versus 48%), longer median time to progression (7.6 months versus 5.5 months), and greater number of patients free from progression at 1 year (14% versus 8%) compared with paclitaxel plus topotecan. There was no difference in overall survival. Toxicities were similar in the two treatment arms. CONCLUSIONS: The paclitaxel-carboplatin-etoposide combination produced a superior overall response rate and time to progression in patients with extensive-stage small cell lung cancer compared with paclitaxel plus topotecan. The platinum compounds continue to be a necessary component of the initial therapy for these patients.

Validity of the WHO operational classification and value of other clinical signs in the classification of leprosy.

The objective of this study is to examine the validity of the WHO operational classification using skin smear results as the gold standard and explore the value of additional clinical signs independently and in combination with the WHO classification. Between 1985 and 2000, 5439 new untreated leprosy patients were registered at the Schieffelin Leprosy Research and Training Center, Karigiri. They were classified according to the Ridley Jopling classification as well as WHO operational classification based on the number of skin lesions. The sensitivity and specificity of the WHO operational classification tested, using skin smear results as the gold standard, was found to be 88.6% and 86.7% respectively. The Receiver Operator Characteristic (ROC) curve confirms that the best option for sensitivity and specificity is a cut off of 6 and more lesions for MB. The validity of the number of enlarged nerves and size of the largest skin lesion as independent criteria to classify patients was found to be poor. Addition of three enlarged trunk nerves to the WHO classification improved its sensitivity to 91.4%, while the specificity remained almost unchanged at 85.3%. Addition of the size of the largest skin lesion to the WHO classification reduced its validity considerably. The study concludes that the WHO recommendation of using six and more lesions for classifying a patient as MB is the best option available at the moment, and calls for further research to identify other clinical criteria that have a better validity and could be easily applied in the field.

Relapses in multibacillary patients treated with multi-drug therapy until smear negativity: findings after twenty years.

The Schieffelin Leprosy Research and Training Center at Karigiri, India participated in several of the World Health Organization (WHO) trials. The first trial on combined therapy in multi-bacillary leprosy was initiated in 1981. The main objectives of this field trial were to evaluate the efficacy of WHO recommended regimens in preventing relapses, especially drug resistance relapses. This paper reports on the relapses twenty years after patients were inducted into the WHO field trial. Between 1981 and 1982, 1067 borderline lepromatous and lepromatous patients were inducted into the WHO field trial for combined therapy in multi-bacillary leprosy trial. Among them, 357 patients were skin smear positive. During the follow-up in 2002, only 173 of them could be traced and assessed. The mean duration of follow-up was 16.4 +/- 1.83 years. Two patients relapsed 14 and 15 years after being released from treatment, the relapse rate being 0.07 per 100 person years follow-up. Drug susceptibility tests done on one of the relapsed patients revealed drug sensitive organisms to all multi-drug therapy drugs.

Secondary rifampin resistance following multi-drug therapy--a case report.

This is the first report of secondary resistance to rifampin following MDT in a patient with prolonged, but irregular treatment. Repeated mouse foot-pad studies demonstrated resistance to dapsone after several years of monotherapy, and following subsequent MDT the studies demonstrated the development of resistance to rifampin.

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in south India.

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6%) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in South India

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5 per cent) patients had lagophthalmos, 1 (1.6 per cent) patients each had ectropion and trichiasis, 32 (53 per cent) patients had impaired corneal sensation in both eyes, 2 (3.3 per cent) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6 per cent) patients had cataract associated with decreased vision, 1 (1.6 per cent) patient had blocked naso-lacrimal duct and 13 (21.7 per cent) patients had pterygium. Seven (12 per cent) patients had a visual acuity of 6/18 or less, 4 (6.7 per cent) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups...

Epidemiological significance of first skin lesion in leprosy

The epidemiological significance of monolesions in leprosy and the possible inferences on the mode of entry by Mycobacterium leprae into the body are presented based on data from the clinical records of the Leprosy Control Programme of Gudiyatham Taluk in India; 660 children with monolesions (335 males, 305 females) younger than 15 years of age and detected during the period 1990-1995 were included in the study. Detailed investigations on the location of monolesions were carried out and compared with a random sample of 669 normal rural children matched for age and sex. A large majority of the leprosy monolesions were in the uncovered parts of the body, with special predilection for the posterior aspects of the upper extremities and the anterior aspects of the lower extremities. Based on observation of normal children, these happen to be precisely the sites vulnerable for trauma since they are exposed to the environment where M. Leprae could enter through abraded skin and manifest as a patch. The need for further studies is emphasized.