A preliminary study of imiquimod treatment in variants of basal cell carcinoma.

Imiquimod is a topical immune response modifier that has proved efficacious in the treatment of the superficial variant of basal cell carcinoma. The nodular variant of basal cell carcinoma has shown moderate response to imiquimod; other variants have not been tested. The mechanism of action is largely unknown; however, studies indicate the mechanism involves alteration of local cytokine production. The objective of this study is to evaluate the cytokine response of imiquimod in all variants of basal cell carcinoma. Ten patients were selected who had clinically and histologically proven basal cell carcinoma. All lesions were treated with imiquimod once a day, 5 days a week, for 3 weeks. After a 3-week rest period, the lesions were rebiopsied. All biopsy specimens were analyzed via polymerase chain reaction (PCR) for various cytokines. Nine of 10 lesions resolved clinically, which included nodular, superficial, infiltrative, adenoid, and micronodular variants. The cytokine with the greatest change pre- and post-treatment was IL-8, which decreased an average of 44 per cent (P = 0.06). We concluded that topical 5 per cent imiquimod is an effective treatment of various subtypes of basal cell carcinoma. IL-8, which plays an important role in the development and metastasis of melanoma, may be involved in the mechanism of action of imiquimod on cutaneous malignancies. Larger studies are needed to prove the efficacy of imiquimod on nonsuperficial variants of basal cell carcinoma and cutaneous melanoma metastasis.

A preliminary investigation of balloon angioplasty versus surgical treatment of thrombosed dialysis access grafts.

It has been estimated that 180,000 patients in the United States have end-stage renal disease requiring hemodialysis, and this number is currently increasing at a rate of 10 per cent per year. With the growing number of patients requiring hemodialysis the insertion and maintenance of dialysis access has become a common task for vascular surgeons. In fact dialysis access is now the most common vascular operation and may account for as much as 40 to 50 per cent of the practice of a busy vascular surgeon. The two major techniques for repairing thrombosed dialysis access grafts are open surgical revision and balloon angioplasty. Surgical revisions of access sites include patch angioplasty and interposition jump grafts. Balloon angioplasty involves declotting the graft mechanically or chemically followed by dilation of the stenotic segment by an angioplasty balloon under fluoroscopy. Few studies have compared the two methods of repair, and the studies that have been done reveal conflicting results. A retrospective chart review of patients treated at the New Hanover Regional Medical Center for repair of thrombosed dialysis access grafts was conducted. The final sample available for analysis consisted of 16 patients with balloon angioplasty and 44 patients with surgical revision. These two groups were compared in terms of demographics, past medical history, surgery time, complications, length of stay, length of graft patency, and typical costs. Overall balloon angioplasty as compared with surgical revision was associated with longer patency (5.5 vs 3.2 months), shorter surgical time (43.9 vs 64.5 minutes), shorter length of hospital stay (less than one day vs one day or more), and fewer complications (12% vs 30% of the patients). We concluded from this analysis that endovascular treatment of thrombosed dialysis grafts is an acceptable alternative to surgical revision and should be the first option after primary failure of the grafts caused by stenotic lesions.