Metachronous merkel cell carcinoma: a case report.

Merkel cell carcinoma (MCC) typically presents as an isolated cutaneous lesion with a measurable risk of regional lymph node involvement. Uncommonly, synchronous or metachronous lesions have been described to be attributed to a field effect. This case report describes a patient presenting with metachronous lesions, separated by several years, which cannot be attributed to a field effect given the tumor distribution.

The diagnosis and treatment of childhood melanoma.

The incidence of melanoma in prepubertal children is 0.3% to 0.4%, with 2 percent of all melanomas occurring in patients under the age of 20 years. Superficial spreading and nodular melanomas are the most common subtypes in childhood melanoma. This article describes conditions associated with an increased incidence of juvenile melanoma and how to best manage this disease.

Concentrations of trace minerals in the spinal cord of horses with equine motor neuron disease.

OBJECTIVE: To compare concentrations of trace minerals in the spinal cord of horses with equine motor neuron disease (EMND) with those of horses without neurologic disease (control horses). ANIMALS: 24 horses with EMND and 22 control horses. PROCEDURE: Spinal cord trace mineral concentrations in horses with EMND and control horses were analyzed by use of inductively coupled plasma atomic emission spectroscopy (calcium, phosphorus, sodium, potassium, magnesium, copper, iron, manganese, nickel, zinc, aluminum, cobalt, and chromium), atomic absorption spectrophotometry (lead and cadmium), flameless atomic absorption (mercury), and fluorometry (selenium). RESULTS: Copper concentration was significantly higher in the spinal cord of horses with EMND, compared with control horses; spinal cord concentrations of all other trace minerals were similar between groups. CONCLUSION AND CLINICAL RELEVANCE: Among spinal cord trace minerals investigated in the study, only copper concentrations were significantly different between horses with EMND and horses without neurologic disease, which suggests that copper may be involved in the pathogenesis of EMND. An hypothesis of oxidative injury in this disease is supported by the finding of increased copper concentrations in the spinal cord and by low vitamin E concentrations reported by other researchers.

Melanoma: latest diagnosis methods, surgical treatments and follow-up procedures.

Melanoma is a disease that is estimated will affect approximately 1 in 80 Americans. It is a potentially lethal cutaneous malignancy that requires initial diagnosis by full thickness incisional or excisional biopsy followed by appropriate surgical care. Prospective randomized studies for adjuvant therapy with intermediate (0.76-4 mm. Breslow depth), and deeper (4 mm. or greater Breslow depth) lesions will be discussed. This paper outlines an algorithm for lifelong postoperative clinical follow-up.

Intestinal haemorrhage associated with colonic vascular ectasia (angiodysplasia) in a dog.

An eight-year-old, sexually intact, male, 37 kg crossbred dog was referred for investigation of two acute episodes of intestinal bleeding and severe anaemia within a five-month period. There was no evidence of coagulopathy or underlying systemic disease. Technetium-labelled red blood cell scintigraphy suggested the colon as the site of bleeding. Colonoscopy identified a focal area of dilated and tortuous mucosal blood vessels. Histopathology of the resected colon revealed vascular ectasia (angiodysplasia). At nine months post-resection, the dog remained healthy and free of any overt intestinal haemorrhage.

Quantitative assessment of motor neuron loss in equine motor neuron disease (EMND).

The mean number of motor neurons was assessed in the C7 spinal cord segment of 5 EMND and 5 control horses. Mean number per section in EMND horses was reduced significantly (P<0.001). The mean neuronal loss was estimated at 31%. Each of the 5 affected horses had a mean neuronal count below the 95% confidence interval for control horses. The statistically significant difference between the 2 groups was consistent in the cranial, middle and caudal thirds of the C7 segment (P<0.001). The results of regression analysis indicated an association between neuronal reduction in EMND horses and the duration of the disease when adjusted for age (P<0.001). This is the first quantitation of the neurodegenerative loss in EMND and it provides a clearer explanation for residual deficits in horses that survive EMND.

TRH receptor on immune cells: in vitro and in vivo stimulation of human lymphocyte and rat splenocyte DNA synthesis by TRH.

This work examined whether (1) immune cells express thyrotrophin releasing hormone (TRH) receptor mRNA and (2) TRH modulates lymphocyte activation. By Northern blot of RNA extracted from human peripheral blood mononuclear cells (PBMC) and rat splenocytes, a single TRH receptor mRNA band of about 3.8 kb (identical to that obtained from pituitary cells) was obtained, under both basal and stimulated conditions. A significant increase in DNA synthesis was observed in phytohemagglutinin-stimulated PBMC and concanavalin A (Con A) stimulated splenocytes when TRH (10(-6) M-10(-12) M) was added. After 5, 30, 60, 180 min and 24 h of TRH administration in vivo, a significant increase in the rat splenocyte proliferative response to Con A was observed. In vivo administration of anti-rat TSH antibody (1/1000) blocked the increase observed after 30 min of TRH administration on the Con A stimulated splenocyte response. TRH possess immunostimulatory functions directly via its receptor and indirectly via release of other immunostimulatory factors such as thyrotrophin.

Cultured peripheral blood mononuclear leukocytes from anorexia nervosa patients are refractory to visible light.

Cultured human peripheral blood mononuclear leukocytes [PBML] from patients with anorexia nervosa [AN] did not respond to light stimulation as PBML of normal controls [NC] did. During winter, visible light increased [3H]thymidine incorporation into DNA of NC-PBML stimulated with phytohemagglutinin [PHA]. This effect was enhanced by 10(-7) M melatonin. PHA-stimulated DNA synthesis of PBML from AN patients failed to respond to photic stimulation during winter, and their proliferative response to melatonin was significantly blunted. In vitro photic stimulation of NC-PBML reduced melatonin while increasing both serotonin and 5-hydroxyindole 3-acetic acid [HIAA] production in both basal and PHA-stimulated conditions. In contrast AN-PBML, that in darkness enhanced the oxidative deamination of serotonin into HIAA more than NC-PBML, did not switch their indole metabolism in response to light. Light did not inhibit the binding of both melatonin and serotonin to AN-PBML as occurred in NC-PBML. The present data suggest that AN-PBML do not respond to light in vitro, because of a failure in the regulation of serotonin and melatonin metabolism.

The glucocorticoid sensitivity of lymphocytes changes according to the activity of the hypothalamic-pituitary-adrenocortical system.

Cortisol inhibition of phytohemagglutinin (PHA)-induced lymphocyte activation was studied in vitro in peripheral blood mononuclear cells (PBMC) of patients with pathologies of the hypothalamic-pituitary-adrenocortical (HPA) system (n = 18) as well as in students under and out of academic stress. In patients with HPA pathologies, cortisol-induced inhibition of lymphocyte interleukin-2 (IL-2) secretion in vitro positively correlated (p < .005) with IL-2 synthesis, such that lymphocytes secreting less IL-2 were less cortisol sensitive. Similarly, in stressed students there was a positive correlation (p < .02) between lymphocyte DNA synthesis and cortisol inhibition in vitro. Academic stress also resulted in a decrease (p < .01) of lymphocyte cortisol sensitivity. The same tendency was observed in patients with Cushing's syndrome when compared with hypocortisolemic patients. Normal controls whose lymphocytes were glucocorticoid resistant showed higher lymphocyte activation than glucocorticoid sensitive subjects. This pattern of glucocorticoid sensitivity was reversed in individuals with abnormal glucocorticoid secretion due to HPA pathology or stress.

Sensitivity of human peripheral blood mononuclear leukocytes to visible light.

Overnight light exposure of cultured human peripheral blood mononuclear leukocytes [PBML], significantly increased basal [3H]thymidine incorporation and upon stimulation with phytohemagglutinin [PHA]. Melatonin (10(-9) to 10(-5) M) enhanced the light-induced increase of [3H]thymidine incorporation, while serotonin (10(-9) to 10(-7) M) stimulated [3H]thymidine incorporation in the dark. The wavelengths responsible of this effect were restricted to the blue-green zone of the spectrum. The stimulatory effect of visible light on PHA-induced DNA replication had a circannual rhythm, being maximal during winter. In winter, white light also reduced melatonin and serotonin binding to PBML membranes and switched the PBML indole metabolism towards serotonin and 5-hydroxy-indole-acetic acid [HIAA] synthesis, with a concomitant decrease of melatonin production.

Low lymphocyte interferon-gamma production and variable proliferative response in anorexia nervosa patients.

Interferon-gamma (IFN-gamma) production by peripheral blood mononuclear cells (PBMC) in 14 patients with anorexia nervosa (AN) was significantly lower than in 14 age-matched healthy controls. Follow-up samples in four patients displayed low levels, except in two when they recovered the IFN-gamma production as the hormonal cycles were restored. A large interindividual variation for the lymphocyte proliferative response was observed in 30 AN patients. DNA synthesis of PBMC was normal in 8 patients (27%), significantly increased in 6 (20%) (P < 0.001), and significantly decreased in 16 (53%) (P < 0.001). IFN-gamma inhibition was reversed by culturing a control lymphocyte population with monocytes from patients with AN. This was not observed in cultures of control monocytes and AN lymphocytes. IL-2 receptor (TAC subunit) was assessed and no difference was found in the number of TAC-positive cells between patients and controls. These results point out impaired production of the immunomodulator cytokine IFN-gamma as a major functional defect of AN peripheral lymphocytes.

[The central nervous system and neuroendocrine system in the regulation of the immune response]. / El sistema nervioso central y el sistema neuroendócrino en la regulación de la respuesta inmune.

There is at present a clear trend in the study of psychoneuroimmunoregulatory events. Different experimental models have demonstrated: a) the participation of stress, psychosocial factors and the central nervous system in the regulation of the immune response; b) an extensive innervation by the autonomic nervous system of the lymphatic organs; c) the presence of receptors for the neuroendocrine mediators in the mononuclear peripheral cells; d) the activity of neuropeptides, hormones and neurotransmitters in lymphocyte activation and function; e) the production of neuroendocrine substances by lymphocytes; f) the existence of feedback pathways in the immune system. In our laboratory we have contributed to these studies with the description of: a) the regulatory activity of different neuroendocrine substances on interferon-gamma production; b) the characterization of the immune regulation exercised by the muscarinic cholinergic system; c) the in vitro activity of the indoleamines, serotonin and melatonin on the immune response, and the production of these indoleamines by lymphocytes and monocytes, thus establishing a model of paracrine regulation.

The psychological impact of traumatic amputations. A team approach: physician, therapist, and psychologist.

This article discusses the psychological problems that may arise following upper extremity traumatic amputation. Members of a health team consisting of surgeon, hand therapist, and counseling psychologist describe their individual and group functions in assisting the patient's recovery.

Lymphomatoid papulosis: a proposed treatment plan.

An example is presented of the chronic, nonhealing ulceration that may be present with lymphomatoid papulosis. A treatment plan is outlined, and the importance of long-term follow-up for signs of disseminated malignancy is emphasized.

Pretracheal cervical granular cell myoblastoma.

This case report deals with a solitary granular cell myoblastoma extrinsic to the proximal trachea. This lesion can be encountered frequently by the plastic surgeon; its histology, incidence and treatment are reviewed here. It is important to reemphasize that local extirpation is appropriate treatment of what is almost always a benign neoplasm, and intraoperative pathological diagnosis guides the surgeon in providing curative therapy.