2-deoxy D-glucose treatment does not elicit a hair growth response in alopecia areata.

2-deoxy D-glucose (2DG) was tested for efficacy in treating alopecia areata using the C3H/HeJ skin graft model. 2DG has proven to be efficacious in treatment of various mouse models of autoimmunity with minimal serious side effects noted. This agent has been shown to normalize abnormally activated T-cell populations while also preventing cell surface expression of NKG2D; key factors defining alopecia areata disease progression. Daily oral ingestion of 2DG via drinking water to mice with patchy or diffuse alopecia areata for 16 weeks failed to prevent expansion of alopecia or cause regrowth of hair in treated mice. Histologically, there were no differences between treated and control groups. These results indicate that, while 2DG is effective for some autoimmune diseases, it was not efficacious for the cell-mediated autoimmune mouse disease, alopecia areata.

Common overuse tendon problems: A review and recommendations for treatment.

There is a common misconception that symptomatic tendon injuries are inflammatory; because of this, these injuries often are mislabeled as "tendonitis."' Acute inflammatory tendinopathies exist, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy." Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems. The natural history is gradually increasing load-related localized pain coinciding with increased activity. The most common overuse tendinopathies involve the rotator cuff, medial and lateral elbow epicondyles, patellar tendon, and Achilles tendon. Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain. Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear. Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.

Patterns of recurrence in patients treated with photodynamic therapy for intraperitoneal carcinomatosis and sarcomatosis.

The purpose of this study was to evaluate the patterns of recurrence in patients treated with Photofrin-mediated intraperitoneal photodynamic therapy (IP PDT). Sixty-six patients with gastrointestinal cancers, ovarian cancers, and sarcomas have been enrolled to date and 51 patients underwent IP PDT. Photofrin, 2.5 mg/kg, was administered intravenously 48 h prior to surgical debulking and intraoperative light treatment. Forty-five, and 49 patients were evaluable for response rates, and patterns of recurrence, respectively. Response to treatment was evaluated by CT or MRI scans of the abdomen and pelvis every 3 months. Patterns of recurrence were determined by evaluating the abdomen as a combination of different treatment regions. Of the 51 patients enrolled and treated with IP PDT two are alive without evidence of recurrence. Eleven of 45 patients showed no evidence of recurrence 3 months after treatment. No evidence of recurrence was noted in 7/17 sarcoma patients, 2 of 13 ovarian cancer patients, and 2 of 15 gastrointestinal cancer patients. The most common site of recurrence as determined by radiographs was the pelvis, which was noted in 19 of 49 (39%) patients. The presence of gross residual disease before light treatment (as determined by the attending surgeon) did not affect the site of recurrence. When studying those patients who had only locoregional recurrence, 9 of 33 evaluated radiographically and 10 of 24 evaluated operatively recurred only in peritoneal areas not previously involved with gross disease. The pelvis was the site with the highest rate of recurrence after IP PDT. A significant minority of patients recurred only in sites not previously involved with gross disease. Patients with gross residual disease before light therapy had similar recurrence rates to those without gross residual disease. Since sites involved with gross residual tumor often received boost doses of light, this could suggest a dose-response relationship for IP PDT.