Adjuvant therapy with low-dose interferon-beta for stage II and III melanoma: results of a retrospective analysis.

Interferon (IFN)-alfa as an adjuvant therapy has been found to improve relapse-free survival in patients with malignant melanoma (MM). However, the efficacy of IFN-beta has not been studied in detail. This study evaluated the contribution of adjuvant IFN-beta therapy to improvements in the prognosis of patients with MM. We reviewed 63 patients with resected stage II/III primary MM at our institution. Of these, 36 had been treated with IFN-beta adjuvant therapy (subcutaneous injection, 3 × 106 IU/day, 10 days), while 27 patients had undergone observation alone. In comparisons of all patients (stage II/III), overall survival and relapse-free survival were significantly better in the IFN-beta group than in the observation group (P < 0.001 for both). The 75-month overall survival rate was 41.2% in the observation group and 68.7% in the IFN-beta group. Adjuvant therapy with IFN-beta may become a new treatment option for patients with stage II/III MM.

MMP13 can be a useful differentiating marker between squamous cell carcinoma and benign hyperkeratotic lesions in recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe hereditary mechanobullous disease resulting from mutations in the COL7A1 gene, coding for type VII collagen. Patients with RDEB tend to develop squamous cell carcinomas (SCCs) at sites of chronic ulceration or scarring on the whole body. Distinguishing SCC from benign hyperkeratotic lesions is often difficult, not only clinically but also histologically in patients with RDEB. We investigated several matrix metallopeptidase (MMP) subtypes by comparing the DNA amplification microarray findings between evident SCCs and benign hyperkeratotic lesions in the same patient with RDEB. We report that MMP13 was found to be strongly positive in SCCs but negative in benign hyperkeratotic lesions. We found that there is an evident difference in the transitional area between SCCs and benign hyperkeratotic lesions. We propose that MMP13 may be a useful differentiating marker between SCC and benign hyperkeratotic lesions in RDEB.

Lessons from 28 cases of reconstruction by lenticular island pedicle flap at a single institution.

BACKGROUND: Lenticular island pedicle flap (LIPF) has been reported to be one of the most useful techniques for reconstructing middle cheek skin defects. LIPF may have been used all over the world on a daily basis; however, no reports have examined a large number of LIPF cases at a single institution. MATERIALS AND METHODS: A total of 28 cases of reconstruction by LIPF at the Hokkaido University Hospital from 2005 to 2013 were analysed. We examined the tumour type, location, area of defect and presence/absence of antithrombotic treatment and complications, including transient circulatory impairment, damage to facial nerves and eyelid ectropion. RESULTS: We found that nine patients had transiently impaired circulation. This complication was statistically more frequent in the patients without antithrombotic treatment than in the patients with antithrombotic treatment (0/8 vs. 10/20, P = 0.0292; Fisher's exact test). CONCLUSION: We revelled that LIPF have been safely performed even under antithrombotic treatment, so, when patients are taking antithrombotic agents, we should choose LIPF rather than conventional flap including cheek flap, island pedicle flap and so on.

MUC5AC expression correlates with invasiveness and progression of extramammary Paget's disease.

BACKGROUND: Patients with in situ extramammary Paget's disease (EMPD) tend to have a good prognosis, although dermal invasion and metastasis are associated with significantly increased morbidity and mortality. Previous studies have addressed mechanisms underlying the EMPD pathogenesis; however, no molecular markers that reflect invasiveness or progression have been established. OBJECTIVE: This study aims to identify a reliable marker for predicting the risk of invasion and metastasis in EMPD. METHODS: We performed an initial microarray screening for in situ, invasive or metastatic lymph node lesions of EMPD. We analysed 44 specimens from 38 primary EMPD cases by immunohistochemical staining. RESULTS: We found that expressions of MUC5AC directly correlate with invasion and prognosis. Labelling rates of tumour cells were scored by staining intensity on a four-tiered scale (- to 3+) to investigate the correlation between the expression score of these molecular markers and the type of EMPD lesion. All the specimens scored positive (3+) for MUC1 and negative (-) for MUC6. MUC5AC expression was detected in 19 of 44 (43.2%) specimens. Invasive lesions and metastatic lymph nodes tended to express MUC5AC significantly higher than in situ lesions (P < 0.01). MUC2 was positive in 10 specimens (22.7%). There was no significant difference between the degree of MUC2 expression and invasiveness. CONCLUSION: The degree of MUC5AC expression may correlate with the invasiveness and progression of EMPD, and may be a useful marker for identifying high-risk EMPD cases.

Serum morphine levels in cats during dorsal horn neuron suppression by spinally administered morphine.

The degree of serum uptake of morphine following spinal morphine administration was measured in cats. Total serum morphine levels (free plus conjugated) were determined during suppression of noxiously evoked wide dynamic range neuron activity by spinally administered morphine and compared with total serum morphine levels following i.v. administration of similar doses. The serum levels at 30 minutes after spinal application of morphine (a time at which there was significant suppression of noxiously evoked neuronal activity) were low; after 0.1 and 0.25 mg the levels were 6.5 (n=6) and 12.5 (n=5) ng/ml respectively. In contrast, intravenous administration of the same doses (0.1 and 0.25 mg) produced levels at 30 minutes of 24 and 36 ng/ml respectively, while an intravenous dose commonly used in earlier neurophysiologic studies (2 mg/kg) produced serum levels in excess of 400 ng/ml. These results indicate that although there is systemic uptake following spinal administration of morphine, the serum levels achieved are much lower than those following intravenous administration of a comparable dose, and are insufficient to explain the resultant suppression of wide dynamic range neurons.

Alpha-chloralose suppression of neuronal activity.

Alpha-chloralose, an anesthetic agent widely used in neurophysiologic studies, caused a significant and long-lasting suppression of single neuron activity recorded from two areas of the central nervous system in decerebrate cats. A 50 mg/kg dose (an average anesthetic dose used in many neurophysiologic studies) caused suppression of spontaneous and evoked activity of neurons in the dorsal horn of the spinal cord and greater suppression of neurons in the nucleus reticularis gigantocellularis (NRGC) of the medial medullary reticular formation. Many researchers are of the opinion that alpha-chloralose causes less suppression of the central nervous system (CNS) than other commonly used anesthetic agents. The neuronal suppression recorded in this study appears similar in many ways to suppression caused by other anesthetic agents in the same two areas of the CNS. The results of the present study suggest that alpha-chloralose may be capable of producing significant suppression of neurons in the dorsal horn of the spinal cord and NRGC. Its ability to influence other areas of the CNS should not be inferred from these results, but the data do indicate the importance of evaluating the effects of anesthetics upon neurophysiologic systems under study.

Sympathetic ganglion blockade for the management of hyperhidrosis.

We present three patients with severe primary hyperhidrosis, refractory to conservative medical treatment, who were successfully managed with sympathetic ganglion blockade with ethanol. We also summarize 10 patients with hyperhidrosis who underwent sympathetic ganglion blockade in the past 2 years. This closed percutaneous method offers the patients considerably less discomfort and less stress with minimal morbidity and has a efficacy similar to that of surgical sympathectomy, which has previously been the only effective and permanent therapy for severe primary hyperhidrosis. It is concluded that chemical sympathectomy is an effective and useful method for treating severe hyperhidrosis which has advantages over surgical sympathectomy.

[A case of double cancer: renal pelvic transitional cell carcinoma and lung squamous cell carcinoma].

A 69-year-old woman was admitted with the chief complaint of gross hematuria and left flank pain ten years after curative right pneumonectomy. Retrograde pyelography showed a filling defect of inferior calyx. Computerized tomography revealed a solid tumor with a low density area arising from the left kidney. The tumor was demonstrated hypovascular by angiography. Left radical nephrectomy by a transabdominal approach was performed. Histological diagnosis was primary transitional cell carcinoma of the left renal pelvis largely replacing the renal parenchyma. Twenty six days after the operation she was discharged. Our case was of double cancer consistent with Warren and Gates criteria and was classified into the nonsimultaneous case according to Moertels criteria. Double cancer of the lung and renal pelvis is very rare and our case seems to be the 7th in the Japanese clinical literature.

Thiopental suppression of neurons of the nucleus reticularis gigantocellularis of the cat.

The effects of sodium thiopental on the single-unit activity of cells in the nucleus reticularis gigantocellularis (NRGG) were examined in decerebrated cats. Only cells in the NRGC that responded exclusively to electrical stimulation of A-delta fibers (noxious stimulation) in the superficial radial nerve were studied. Sodium thiopental caused a significant, dose-dependent suppression of spontaneous and evoked neuronal activity of cells in the NRGC. Spontaneous activity was suppressed by 66% and 98% after intravenous administration of sodium thiopental, 2.5 mg/kg and 5.0 mg/kg, respectively. Evoked activity was suppressed by 65% and 79%. These findings, when added to previous reports of the suppressive effects of nitrous oxide, morphine sulfate, ketamine hydrochloride, and halothane, suggest the involvement of the NRGC in nociception and provide evidence that sodium thiopental significantly modifies the neuronal message about a noxious stimulus as recorded at the level of the NRGC.