Clinical, Histopathological and Therapeutical Analysis of Inferior Eyelid Basal Cell Carcinomas.

RATIONALE: Eyelids are very susceptible area for non-melanoma skin cancers; among that, basal cell carcinoma has the highest incidence (almost 90% of malignant eyelid tumors) and 50-60% of eyelid basal cell carcinomas appear on inferior eyelid. OBJECTIVE: To analyze clinical features of inferior eyelid basal cell carcinoma and to determine the efficacy of surgical treatment with frozen sectioncontrolled margins and methods of primary reconstruction of defects. METHODS: A review of medical records of cases with primary inferior eyelid basal cell carcinoma treated by surgical excision with urgent histopathology controlled margins by FS technique, doubled by paraffin examination from October 2011 to October 2014. After histopathology confirmation of tumor free margins, proper inferior eyelid reconstruction was performed. RESULTS: The review resulted in 36 patients with 36 lesions analyzed by clinical, histopatological and therapeuticalaspectswith a mean follow-up of 20 months. All lesions were primary BCC affecting inferior eyelid. There were no recurrence in the follow-up period. Inferior eyelid reconstruction techniques were direct closure for small defects and complex techniques for defects more than one third of eyelid length. DISCUSSION: Appropriate eyelid examination is mandatory in any routine ophthalmic check-up. Clinical signs suggestive of BCC should be familiar to ophthalmologist in order to have an early diagnosis and treatment for these tumors. Surgical treatment with FS controlled excision followed by eyelid reconstruction is an efficient treatment for inferior eyelid BCC. ABBREVIATIONS: basal cell carcinoma (BCC); frozen section (FS);Mohs micrographic surgery (MMS).

Study of serum ceruloplasmin and of the copper/zinc ratio in cardiovascular diseases.

The serum copper and zinc concentration, the Cu/Zn ratio and ceruloplasmin activity have been studied in 400 subjects divided into 4 groups of study: 50 normal subjects (controls), 100 patients with ischemic heart disease, 100 subjects with myocardial infarction in the past history and 150 patients with acute myocardial infarction. It was observed that in normal subjects the Cu/Zn ratio is about 1, in acute myocardial infarction it reaches 2.5 but it returns to normal during convalescence. In the patients with ischemic heart disease the ratio decreases to 0.8 and in the subjects with infarction in the past history it is about 1.6 (almost normal). The variation of these ratio is due to the serum zinc concentration which in ischemic heart disease presents values over the upper normal limit and in acute myocardial infarction below the lower normal limit. In the subjects with acute infarction ceruloplasmin (copper depending enzyme) the activity was observed to be inversely proportional to the Cu/Zn ratio in the first 4 days after the onset of the disease. The quick normalization of one or of both parameters is a sign of positive evolution of the disease.

Possible correlation between the zinc and copper concentrations involved in the pathogenesis of various forms of anemia.

The concentrations of three trace elements (iron, copper and zinc) involved in hematopoiesis were studied in 200 patients with iron-deficit anemia, hemolytic anemia and Biermer's anemia, in comparison with a group of normal subjects. The method used was atomic absorption spectrophotometry. The results obtained showed that in iron-deficit anemia resistant to iron therapy the copper and ceruloplasmin serum concentrations are at the lowest limit of normal. This copper deficit has a negative effect on the disease by preventing hemoglobin synthesis. In iron-deficit anemias responding to iron therapy the relatively low (about 90 gamma %) zinc values have a negative effect by blocking the iron in the iron reserve. In hemolytic anemia the very high zinc serum concentrations (over 200 gamma %) may lead to a shortening of the erythrocytes life span due to its "entatic state". In Biermer's anemia zinc by its high concentration has a positive role owing to carbonic anhydrase which eliminates more rapidly carbon dioxide from the organism.

Variations of zinc, calcium and magnesium in normal subjects and in patients with neoplasias.

The serum zinc, calcium and magnesium concentration as well as the possible relationship between these elements was determined by means of atomic absorption spectrophotometry in 150 patients with prostatic, lung, liver and breast neoplasms as well as with chronic leukemia, and in 80 normal subjects. These determinations showed that zinc concentration is increased in almost all the forms of cancer except prostatic and lung cancer in which the zinc values were below the lowest normal limits. From this study it also resulted that high zinc values favour the development of cancer. The antagonic relationship between zinc and calcium or magnesium in neoplasias proves the protective role played by the latter elements in the forms of cancer in such cases.

Study of the relationship between the granulocyte LDH, alkaline phosphatase and Zn at the level of the leukocyte in patients with chronic myeloid leukemia.

Mixed leukocyte suspensions were prepared from heparinized blood collected from healthy subjects and from patients with chronic myeloid leukemia (CML). In all the suspensions determinations were made for: zinc, by atomic absorption; granulocyte alkaline phosphatase (GAP), using the method with p-nitrophenylphosphatase; granulocyte LDH, by means of the enzymatic autoanalyser LKD 8,600. In the patients with CML, the values of zinc and of granulocyte alkaline phosphatase activity were very low while the granulocyte LDH values were higher than normal. The chromatogram of the granulocyte LDH isoenzymes on DEAE-Sephadex A50 minicolumn (0.5 X 12 cm) showed an "alpha type abnormality" revealed by the increased activity of the isoenzymes with high electrophoretic mobility LDH2 and LDH1 specific for tissues with intense oxidative phosphorylation. In the normal subjects the chromatogram of the leukocyte LDH isoenzymes showed a type M (skeletal muscle) prevalence denoting intense anaerobic glycolysis. Therefore the low zinc concentrations (0.55 micrograms mg N2 as compared with the normal 1.24 micrograms mg N2) in these patients cause the decrease of GAP activity by the lack of zinc in the active center of the enzyme and the decrease of cellular permeability thus allowing the extracellular release of granulocyte LDH.