Long-term Follow-up After Interstitial Laser Thermotherapy of Breast Cancer.

AIM: To review the effect of immunological changes induced by interstitial laser thermotherapy (ILT) on long-term outcome of patients with breast cancer. PATIENTS AND METHODS: Twenty-four patients with invasive breast cancer were treated with ILT followed by standard surgical excision. Immunohistological reactions on immunocompetent cells were performed on specimens obtained before and after ILT. Follow-up time was 116 (range=91-136) months. RESULTS: Significant prognostic factors were histologically-positive axillary lymph nodes and Ki67 positivity. ILT increased cytotoxic T (CD8(+)) lymphocytes within the tumor and mature dendritic cells (CD83(+)) and reduced the number of T-regulatory cells (Treg) CD25(+)/Forkhead box p3(+) (FOXP3(+)) lymphocytes in regional lymph nodes. These changes did not correlate with prognosis. The number of CD8(+) cells within the tumor, both before and after treatment, was significantly higher in patients with recurrence than in those without recurrence (p<0.01 and p<0.05, respectively). Patients with recurrent disease had a lower number of CD57(+) cells in tumor-free lymph nodes than did patients without recurrence (p<0.05). CONCLUSION: ILT did not have any long-term adverse effects. The clinical impact of the supposedly favourable immune changes after ILT should be examined in a larger patient population.

Number of nexin links detectable at standard electron microscopy of normal human nasal cilia and at nexin link deficiency.

BACKGROUND: Eleven years ago we had described three patients with missing nexin links as a possible cause of primary ciliary dyskinesia (PCD). The assumption was substantiated last year by finding a mutation in these patients. MATERIALS AND METHODS: We counted the nexin links, inner (IDA) and outer (ODA) dynein arms and microtubuli in each of, if possible, 50 cilia in 41 patients with normal cilia, 4 patients with deficiency of nexin links only and 4 with deficiency of nexin links and IDA. RESULTS: In the control group the median number of nexin links was 4.5 per cilium, range 3.4-5.3. In the second group the mean numbers of nexin links per cilium were 1.1-1.4, in the third group 0.8-1.2, per patient. The median number of IDA was in the control group 4.2, range 3.3-5.2. In groups 2 and 3 the numbers were 3.0-3.5 and 0.2-1.0, respectively. Numbers of ODA were normal in all groups. CONCLUSIONS: It is possible to reliable count the number of nexin links in nasal human cilia and to distinguish cases with missing nexin links from normal controls.

The nexin-dynein regulatory complex subunit DRC1 is essential for motile cilia function in algae and humans.

Primary ciliary dyskinesia (PCD) is characterized by dysfunction of respiratory cilia and sperm flagella and random determination of visceral asymmetry. Here, we identify the DRC1 subunit of the nexin-dynein regulatory complex (N-DRC), an axonemal structure critical for the regulation of dynein motors, and show that mutations in the gene encoding DRC1, CCDC164, are involved in PCD pathogenesis. Loss-of-function mutations disrupting DRC1 result in severe defects in assembly of the N-DRC structure and defective ciliary movement in Chlamydomonas reinhardtii and humans. Our results highlight a role for N-DRC integrity in regulating ciliary beating and provide the first direct evidence that mutations in DRC genes cause human disease.

Accidente laboral en alumnos del internado rotatorio de la carrera de medicina de la UNNE / Occupational accident to students Rotating Internship Career UNNE Medicine

Resumen La exposición a material biológico es el más frecuente de los riesgos que corren los trabajadores de la salud, y enconsecuencia los estudiantes del internado rotatorio. El presente estudio propone el análisis de las características de los accidentes producidos por contacto con material biológico en alumnos del Internado Rotatorio de la carrera de Medicina de la Facultad de Medicina de la UNNE.Estudio descriptivo retrospectivo de corte transversal en base a las declaraciones de los alumnos que sufrieron exposición accidental a sangre y fluidos. De 400 cursantes, 25 denunciaron accidente laboral. Con mayor frecuencia se produjeron en Servicios de Emergencias, lesiones de tipo punzocortantes y contacto con sangre. Como medida de bioseguridad exclusiva se utilizaron guantes. La mayor parte de los encuestados desconocía las pautas postexposición. La mayoría de los estudiantes notificó el hecho, pero gran parte no tomó medidas al respecto. La toma de muestras para serología fue mínima, y el porcentaje de estudiantes que recibió tratamiento quimioprofiláctico post exposición fue aún menor. Por todo ello creemos fundamental insistir con diferentes estrategias en la concientización a los alumnos,jerarquizando la prevención y las pautas a seguir en caso de producirse el accidente.

Summary Exposure to biological material is the most frequent risk for the health workers, and the rotating internship studentstoo. This study proposes the review of characteristics of accidents caused by contact with biological material in studentscoursing what we call “Internado Rotatorio” at the UNNE School of Medicine.Retrospective descriptive study of cross-section based on statements by students who suffered accidental exposureto blood and other fluids.Among 400 students, 25 reported work- accidents. This event happened most frequently in Emergency Services, bysharp and contact with blood-like lesions. They used gloves as the exclusive biosecurity measure. Most of the studentsreported the fact, but not all of them took any action in this regard. Sampling for serology was minimal, and thepercentage of students receiving prophylaxis post exposure treatment was even lower. Because of this, we believe essentialto insist with different strategies awareness to students, structuring prevention and guidelines to be followedin case of this kind of accident.

La exposição a material biológico é o mais frequente dos riscos para dos trabalhadores da saúde estão expostos e, portanto,os alunos de estágio rotativo. O presente estudo propõe uma análise das características dos acidentes causadospor contato com material biológico em alunos do internato rotativo da Carreira Médica da faculdade de Medicinada UNNE.Estudo descritivo retrospectivo de secção baseado em declarações de estudantes que sofreram exposição acidentala sangue e fluidos. De 400 alunos, 25 relatou acidentes relacionados com o trabalho. Com mais freqüência ocorreuem serviços de emergência, afiada e contato com sangue, como lesões. Luvas foram usadas como medida de biossegurançaexclusiva. A maioria dos entrevistados sabem padrões pós-exposição. A maior parte dos estudantes relatouo fato, mas não tomaram nenhuma medida nenhuma ação quanto a isso. Amostragem de serologia era mínima, e apercentagem de alunos recebem tratamento de exposição do quimioprofiláctico post foi ainda menor.É por isso que consideramos essenciais para insistir com consciência de estratégias diferentes para estudantes, estruturaçãode prevenção e orientações a seguir em caso de acidente.

Accidente laboral en alumnos del internado rotatorio de la carrera de medicina de la UNNE / Occupational accident to students Rotating Internship Career UNNE Medicine

Resumen La exposición a material biológico es el más frecuente de los riesgos que corren los trabajadores de la salud, y enconsecuencia los estudiantes del internado rotatorio. El presente estudio propone el análisis de las características de los accidentes producidos por contacto con material biológico en alumnos del Internado Rotatorio de la carrera de Medicina de la Facultad de Medicina de la UNNE.Estudio descriptivo retrospectivo de corte transversal en base a las declaraciones de los alumnos que sufrieron exposición accidental a sangre y fluidos. De 400 cursantes, 25 denunciaron accidente laboral. Con mayor frecuencia se produjeron en Servicios de Emergencias, lesiones de tipo punzocortantes y contacto con sangre. Como medida de bioseguridad exclusiva se utilizaron guantes. La mayor parte de los encuestados desconocía las pautas postexposición. La mayoría de los estudiantes notificó el hecho, pero gran parte no tomó medidas al respecto. La toma de muestras para serología fue mínima, y el porcentaje de estudiantes que recibió tratamiento quimioprofiláctico post exposición fue aún menor. Por todo ello creemos fundamental insistir con diferentes estrategias en la concientización a los alumnos,jerarquizando la prevención y las pautas a seguir en caso de producirse el accidente. (AU)

Summary Exposure to biological material is the most frequent risk for the health workers, and the rotating internship studentstoo. This study proposes the review of characteristics of accidents caused by contact with biological material in studentscoursing what we call ôInternado Rotatorioö at the UNNE School of Medicine.Retrospective descriptive study of cross-section based on statements by students who suffered accidental exposureto blood and other fluids.Among 400 students, 25 reported work- accidents. This event happened most frequently in Emergency Services, bysharp and contact with blood-like lesions. They used gloves as the exclusive biosecurity measure. Most of the studentsreported the fact, but not all of them took any action in this regard. Sampling for serology was minimal, and thepercentage of students receiving prophylaxis post exposure treatment was even lower. Because of this, we believe essentialto insist with different strategies awareness to students, structuring prevention and guidelines to be followedin case of this kind of accident. (AU)

La exposiþÒo a material biológico é o mais frequente dos riscos para dos trabalhadores da saúde estÒo expostos e, portanto,os alunos de estágio rotativo. O presente estudo prop§e uma análise das características dos acidentes causadospor contato com material biológico em alunos do internato rotativo da Carreira Médica da faculdade de Medicinada UNNE.Estudo descritivo retrospectivo de secþÒo baseado em declaraþ§es de estudantes que sofreram exposiþÒo acidentala sangue e fluidos. De 400 alunos, 25 relatou acidentes relacionados com o trabalho. Com mais freq³Ûncia ocorreuem serviþos de emergÛncia, afiada e contato com sangue, como les§es. Luvas foram usadas como medida de biosseguranþaexclusiva. A maioria dos entrevistados sabem padr§es pós-exposiþÒo. A maior parte dos estudantes relatouo fato, mas nÒo tomaram nenhuma medida nenhuma aþÒo quanto a isso. Amostragem de serologia era mínima, e apercentagem de alunos recebem tratamento de exposiþÒo do quimioprofiláctico post foi ainda menor.E por isso que consideramos essenciais para insistir com consciÛncia de estratégias diferentes para estudantes, estruturaþÒode prevenþÒo e orientaþ§es a seguir em caso de acidente. (AU)

Helicobacter species and gut bacterial DNA in Meckel's diverticulum and the appendix.

AIM: To analyse the possible association of various Helicobacter species and certain common gut bacteria in patients with Meckel's diverticulum and appendicitis. METHODS: A nested-polymerase chain reaction (PCR), specific to 16S rRNA of the Helicobacter genus, was performed on paraffin embedded samples, 50 with acute appendicitis, 50 normal appendixes, and 33 Meckel's diverticulum with gastric heterotopia and/or ulcer. Helicobacter genus positive samples were sequenced for species identification. All samples were also analysed for certain gut bacteria by PCR. RESULTS: Helicobacter pullorum DNA was found in one out of 33 cases and Enterobacteria in two cases of Meckel's diverticulum. Helicobacter pylori (H. pylori) was found in three, Enterobacter in 18, and Bacteroides in 19 out of 100 appendix samples by PCR. Enterococcus was not found in any MD or appendix samples. All H. pylori positive cases were from normal appendixes. CONCLUSION: Helicobacter is not an etiological agent in the pathogenesis of symptomatic Meckel's diverticulum or in acute appendicitis.

Histology of adipose tissue inflammation in Dercum's disease, obesity and normal weight controls: a case control study.

BACKGROUND: Dercum's disease (DD) is characterised by obesity and chronic pain (> 3 months) in the adipose tissue. The pathogenesis of DD is unknown, but inflammatory components have been proposed. In previous reports and studies, an inconsistent picture of the histological appearance of the adipose tissue in DD has been described. The aim of this investigation was to examine the histological appearance of adipose tissue in patients with DD, with particular focus on inflammatory signs. METHODS: Fat biopsies were sampled from painful regions from 53 patients with DD. In 28 of the patients, a control adipose tissue biopsy was taken from a location where the patient did not experience any pain. In addition, fat biopsies were sampled from 41 healthy pain-free obese control patients and 11 healthy pain-free normal weight control patients. The extent of inflammation was evaluated on histological sections stained with haematoxylin-eosin. RESULTS: There was no statistically significant difference in the extent of inflammation between the biopsies from the painful knee and the biopsies from the non-painful area (p = 0.5), nor between the biopsies from the abdomen, and the biopsies from the non-painful area (p = 0.4), in patients with DD. A statistically significant difference in extent of inflammation was observed between DD and obese control patients regarding the abdomen (p = 0.022), but not the knee (p = 0.33). There were no differences in extent of inflammation between DD patients and normal weight controls (p = 0.81). CONCLUSION: The findings suggest that there is an inflammatory response in the adipose tissue in DD. However, this response is not more pronounced than that in healthy obese controls. This contradicts inflammation as the aetiology of DD.

Intimal hyperplasia in balloon dilated coronary arteries is reduced by local delivery of the NO donor, SIN-1 via a cGMP-dependent pathway.

BACKGROUND: To elucidate the mechanism by which local delivery of 3-morpholino-sydnonimine (SIN-1) affects intimal hyperplasia after percutaneous transluminal coronary angioplasty (PTCA). METHODS: Porcine coronary arteries were treated with PTCA and immediately afterwards locally treated for 5 minutes, with a selective cytosolic guanylate cyclase inhibitor, 1 H-(1,2,4)oxadiazole(4,3-alpha)quinoxaline-1-one (ODQ) + SIN-1 or only SIN-1 using a drug delivery-balloon. Arteries were angiographically depicted, morphologically evaluated and analyzed after one and eight weeks for actin, myosin and intermediate filaments (IF) and nitric oxide synthase (NOS) contents. RESULTS: Luminal diameter after PCI in arteries treated with SIN-1 alone and corrected for age-growth was significantly larger as compared to ODQ + SIN-1 or to controls (p < 0.01). IF/actin ratio after one week in SIN-1 treated segments was not different compared to untreated segments, but was significantly reduced compared to ODQ + SIN-1 treated vessels (p < 0.05). Expression of endothelial NADPH diaphorase activity was significantly lower in untreated segments and in SIN-1 treated segments compared to controls and SIN-1 + ODQ treated arteries (p < 0.01). Restenosis index (p < 0.01) and intimal hyperplasia (p < 0.01) were significantly reduced while the residual lumen was increased (p < 0.01) in SIN-1 segments compared to controls and ODQ + SIN-1 treated vessels. CONCLUSIONS: After PTCA local delivery of high concentrations of the NO donor SIN-1 for 5 minutes inhibited injury induced neointimal hyperplasia. This favorable effect was abolished by inhibition of guanylyl cyclase indicating mediation of a cyclic guanosine 3',5'-monophosphate (cGMP)-dependent pathway. The momentary events at the time of injury play crucial role in the ensuring development of intimal hyperplasia.

Changes in immunocompetent cells after interstitial laser thermotherapy of breast cancer.

BACKGROUND: Local tumour destruction has been shown to give rise to changes in immunocompetent cells. The aim of this study was to describe the effect of interstitial laser thermotherapy (ILT) of breast carcinoma in the tumour and in regional lymph nodes. METHODS: Seventeen women that underwent radical surgical excision after non-radical ILT were studied. ILT was performed at a steady-state temperature of 48°C for 30 min. Surgical excision was performed 12 (6-23) days after ILT. Six patients with breast cancer not treated with ILT before surgery served as controls. Immunohistological reactions were performed on core needle biopsies prior to treatment and on the excised specimens. RESULTS: ILT resulted in more CD8 lymphocytes and CD68 macrophages within the tumour (P < 0.05 and P < 0.01, respectively) and higher counts of CD20 (P < 0.05), CD68 (P < 0.001) and CD83 (P < 0.01) at the tumour border, when compared to pre-treatment values. In the control patients not receiving ILT, CD8 cells increased within the tumour after resection (P < 0.05). With the probable exception of CD25 Foxp3 cells, the presence of cancer in a lymph node influenced the findings in lymph nodes (examined for CD1a, CD25, Foxp3 CD25, CD83 cells). Thus, comparisons between ILT and control patients were restricted to patients without lymph node metastases. In these patients, ILT and resection were followed by a decrease in CD25 Foxp3 lymphocytes (P < 0.05), when compared to surgical resection alone. CONCLUSIONS: ILT induced changes in immunocompetent cells in patients with breast cancer. The stimulation of the immune system is an added feature of ILT in treatment of patients with breast cancer.

Interstitial laser thermotherapy of a rat liver tumour: effect of hepatic inflow occlusion.

BACKGROUND AND OBJECTIVE: Interstitial laser thermotherapy was used to treat rat liver tumours. The aim was to investigate the influence of temperature and temporary hepatic inflow occlusion on tumour growth and blood perfusion. STUDY DESIGN/MATERIALS AND METHODS: Liver tumours were treated at 44°C at the tumour border for 30 minutes, hepatic inflow occlusion only, or a combination of these methods. Interstitial laser Doppler flowmetry was used to measure hepatic perfusion at the tumour border during and after heat treatment, for a total time of 60 minutes. Tumour growth was evaluated 6 days after treatment. RESULTS: Tumours subjected to the combined treatment of hepatic inflow occlusion and interstitial laser thermotherapy displayed a blood perfusion reduction 30 minutes after treatment to 18 ± 5% of initial perfusion, which was significantly lower than achieved with thermotherapy alone (52 ± 10%, P = 0.02). The combined treatment and treatment with thermotherapy alone resulted in relative tumour growth of 0.3 ± 0.1 and 1.0 ± 0.2, respectively (P = 0.04). CONCLUSION: Inflow occlusion enhanced the effect of thermotherapy not by augmenting treatment temperatures but by increasing the thermal sensitivity of the tumour, reflected by an immediate effect on tumour blood perfusion.

Helicobacter species and common gut bacterial DNA in gallbladder with cholecystitis.

AIM: To analyze the association between Helicobacter spp. and some common gut bacteria in patients with cholecystitis. METHODS: A nested-polymerase chain reaction (PCR), specific to 16S rRNA of Helicobacter spp. was performed on paraffin-embedded gallbladder samples of 100 cholecystitis and 102 control cases. The samples were also analyzed for some common gut bacteria by PCR. Positive samples were sequenced for species identification. RESULTS: Helicobacter DNA was found in seven out of 100 cases of acute and chronic cholecystitis. Sequence analysis displayed Helicobacter pullorum (H. pullorum) in six cases and Helicobacter pylori in one; H. pullorum was only found in cases with metaplasia. Control samples were negative for Helicobacter spp. and some common gut bacteria. There was a significant difference (P = 0.007) between cholecystitis and control samples for Helicobacter DNA. CONCLUSION: A possible relationship was detected between Helicobacter DNA and cholecystitis. Further serological and immunohistochemical studies are needed to support these data.

First attempt to produce experimental Campylobacter concisus infection in mice.

AIM: To infect mice with atypical Campylobacter concisus (C. concisus) for the first time. METHODS: Three separate experiments were conducted in order to screen the ability of five clinical C. concisus isolates of intestinal origin and the ATCC 33237 type strain of oral origin to colonize and produce infection in immunocompetent BALB/cA mice. The majority of the BALB/cA mice were treated with cyclophosphamide prior to C. concisus inoculation to suppress immune functions. Inoculation of C. concisus was performed by the gastric route. RESULTS: C. concisus was isolated from the liver, ileum and jejunum of cyclophosphamide-treated mice in the first experiment. No C. concisus strains were isolated in the two subsequent experiments. Mice infected with C. concisus showed a significant loss of body weight from day two through to day five of infection but this decreased at the end of the first week. Histopathological examination did not consistently find signs of inflammation in the gut, but occasionally microabscesses were found in the liver of infected animals. CONCLUSION: Transient colonization with C. concisus was observed in mice with loss of body weight. Future studies should concentrate on the first few days after inoculation and in other strains of mice.

Perivascular epithelioid cell tumour of the liver.

Perivascular epithelioid cell tumour is not uncommon in the liver but seldom malignant.

Oralfacialdigital-like syndrome with respiratory tract symptoms from birth and ultrastructural centriole/basal body disarray.

UNLABELLED: A girl with polydactyly has had respiratory tract problems, including atelectasis, since birth. She has a high arched palate, a tongue hamartoma and dysmorphic face. Electron microscopy of nasal and bronchial brush biopsies repeatedly revealed centriole/basal body disarray and extreme sparseness of cilia. At the age of 2 years and 11 months, she displayed retardation of both motor and mental skills. CONCLUSION: The manifestations tally with a ciliopathy, partly with the Bardet--Biedl syndrome (BBS) but especially with the oralfacialdigital syndrome (OFDS); however, with the addition of persistent respiratory tract problems. As these two syndromes are considered to be due to mutations affecting the centriole/basal body apparatus, the ultrastructural demonstration of disarray of these structures, never before demonstrated in such a patient, is of fundamental interest.

Prevalence and genetics of immotile-cilia syndrome and left-handedness.

Immotile-cilia syndrome is characterized by severe respiratory distress from early infancy, and also often by situs inversus. The first description of the disease was based on just four persons, but reasons were given to suggest that the disorder may not be exceedingly rare. The purpose of the present study was to estimate just how rare or how common it is and to evaluate its association with situs inversus and with left-handedness. Data were mainly obtained from contacting a large number of Swedish clinicians who kindly informed us about their patients with suspected immotile-cilia syndrome. Diagnosis was in most cases performed by electron microscopical examination of nasal cilia or of spermatozoa. Based on these data, the prevalence of the syndrome in Sweden with or without situs inversus was estimated to be not far from 1 in 10,000. The syndrome consists of several subgroups that have a randomized determination of situs asymmetry (50% of these have situs inversus) and one subgroup in which situs inversus is not found. This results in a frequency of situs inversus in the syndrome of about 44 %. Left-handedness is no more common than it is in healthy persons and no more often associated with situs inversus than with situs solitus. In all cases it is about 14 %. It is concluded that the two major anatomical/physiological asymmetries of the human body are found with frequencies which indicate that they develop independently of each other. Both conditions appear with prevalences that may have changed at a centenary scale, left-handedness with a substantial increase and situs inversus with a less dramatic increase.

Helicobacter species ribosomal DNA in the pancreas, stomach and duodenum of pancreatic cancer patients.

AIM: To determine whether gastric and enteric Helicobacter species are associated with pancreatic cancer. METHODS: Patients with exocrine pancreatic cancer (n = 40), neuroendocrine cancer (n = 14), multiple endocrine neoplasia type 1 (n = 8), and chronic pancreatitis (n = 5) were studied. Other benign pancreatic diseases (n = 10) and specimens of normal pancreas (n = 7) were included as controls. Pancreatic tissue specimens were analyzed by Helicobacter-specific PCR-assay and products were characterized by denaturing gradient electrophoresis and DNA-sequencing. From a subset of the pancreatic cancer patients, gastric and/or duodenal tissue as well as gallbladder and ductus choledochus tissue were analyzed. Gallbladder and choledochus samples were included as controls. Stomach and duodenum samples were investigated to analyze whether a gastric helicobacter might disseminate to the pancreas in pancreatic cancer patients. Pancreatic specimens were analyzed by Bacteroides-specific PCR for detecting the translocation of indigenous gut microbes to the diseased pancreas. RESULTS: Helicobacter DNA was detected in pancreas (tumor and/or surrounding tissue) of 75% of patients with exocrine cancer, 57% of patients with neuroendocrine cancer, 38% of patients with multiple endocrine neoplasia, and 60% of patients with chronic pancreatitis. All samples from other benign pancreatic diseases and normal pancreas were negative. Thirty-three percent of the patients were helicobacter-positive in gastroduodenal specimens. Surprisingly, H. bilis was identified in 60% of the positive gastroduodenal samples. All gallbladder and ductus choledochus specimens were negative for helicobacter. Bacteroides PCR-assay was negative for all pancreatic samples. CONCLUSION: Helicobacter DNA commonly detected in pancreatic cancer suggests a possible role of the emerging pathogens in the development of chronic pancreatitis and pancreatic cancer.

Methods for detailed histopathological investigation and localization of biopsies from cervix uteri to improve the interpretation of autofluorescence data.

Fluorescence spectroscopy is one of many optical methods that are potentially clinically useful for noninvasive detection and characterization of disorders on the cervical part of uterus, including precancerous lesions. The cervix uteri exhibits a biologically complex tissue and the morphology of a biopsy is generally not homogenous. The standard histopathological protocol accounts only for the most severe condition found within the biopsy and no information is given on other constituents potentially influencing the recorded fluorescence spectra. Spectra are usually correlated, using multivariate techniques, to the histopathological diagnosis of the biopsies. Since the probe volume of fluorescence spectroscopy is considerably smaller than the extension of the biopsy, this can cause problems in the search for correlation between the fluorescence signals and the pathological structures. In addition, the orientation and location of the biopsies are normally not recorded. We now report on the first detailed histopathological protocol where numerous tissue parameters, such as thickness and type of the epithelium and the number of blood vessels, glands, and inflammatory cells, are tabulated and the orientation and location of the biopsy are recorded as precisely as possible. Hopefully, the use of this protocol together with sophisticated mathematical methods will increase the probability to classify cervical disorders of the uterus, including precancerous lesions, with high sensitivity and specificity.

Photodynamic therapy of nodular basal cell carcinoma with multifiber contact light delivery.

To overcome the limited treatment depth of superficial photodynamic therapy we investigate interstitial light delivery. In the present work the treatment light was delivered using a system in which three or six clear-cut fibers were placed in direct contact with the tumor area. This placement was thought to represent a step toward general purpose interstitial PDT. Twelve nodular basal cell carcinomas were treated employing delta-aminolevulinic acid and 635 nm laser irradiation. Fluorescence measurements were performed monitoring the buildup and subsequent bleaching of the produced sensitizer protoporphyrin IX. The treatment efficacy, judged at a 28-month follow-up, showed a 100% complete response. Two punch excisions at 7 months converted two partial responses to complete responses. One patient failed to appear at all follow-up sessions. The outcome of the treatments was comparable to superficial photodynamic therapy in terms of histological, clinical, and cosmetic results.