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Merkel cell carcinoma is an aggressive neuroendocrine tumor historically thought to arise from neural crest-derived cutaneous neuroendocrine cells. Recent evidence supports an epidermal origin. We present a case of Merkel cell carcinoma arising on the upper arm of a 94-year-old woman that had multiple morphologic patterns: small cells typical of Merkel cell carcinoma, malignant cells with squamous differentiation and malignant poorly differentiated spindle cells. Subsequent metastatic disease in regional lymph nodes showed only the small cells and the malignant spindle cells. To our knowledge, this is the first case of Merkel cell carcinoma showing these three patterns of differentiation at first presentation. This morphology raises the possibility that Merkel cell carcinomas may arise from epidermal stem cells that can differentiate along different lines.

There are well-documented differences in the prevalence of coronary artery disease and carotid disease between caucasians, Afro-Caribbeans and Indo-Asians. Very little data are available on ethnic differences in peripheral vascular disease (PVD). To investigate this further, we surveyed 200 consecutive patients attending the vascular surgery service at a city centre hospital serving a multiethnic patient catchment population. All patients had proven PVD, with an ankle brachial pressure index of less than 0.8. Within this cohort, Afro-Caribbeans presented more frequently with PVD compared with the proportion of this ethnic group in the local population (p = 0.013), with a greater proportion with diabetes mellitus than in the other two ethnic groups. There did not appear to be a significant difference between the ethnic groups in any of the other established risk factors or associations (i.e. treated hypertension, smoking, previous history of ischaemic heart disease, atrial fibrillation, previous history of cerebrovascular accident or transient ischaemic attack) with PVD. As with coronary artery disease and carotid disease, there are ethnic differences in the prevalence of PVD, and the underlying risk factors, between caucasians, Afro-Caribbeans and Indo-Asians. Furthermore, patients of Afro-Caribbean origin present more frequently with symptomatic PVD than do either caucasians or Indo-Asians.

This study examined the accuracy and precision of a hand-held, chemical analyser, i-STAT, in measuring selected blood constituents which may be of use in the diagnosis and management of metabolic disorders found in exercising horses. Venous blood samples were taken from 3 Thoroughbred geldings, fit and trained to exercise on a treadmill, both before and after exercise at a speed sufficient to elicit VO2max. The samples were analysed both with the i-STAT and with in-house analysers to compare the values of pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), lactate and base excess (BE). The i-STAT demonstrated acceptable accuracy and precision for determination of pH, PO2 and PCO2, and lactate. We concluded that these parameters could be reliably evaluated by the i-STAT. The i-STAT was further evaluated at veterinary checkpoints during a 60 and 100 mile endurance ride. Because a built-in thermostat prevents function when the temperature of the analyser is outside the optimum range (16-30 degrees C), it was necessary to insulate the i-STAT from extreme ambient temperatures. As this portion of the study was conducted in warm temperatures, the appropriate insulation was to maintain the i-STAT in an ice-cooled container except during actual blood analyses. Further investigation into the feasibility of using hand-held chemical analysers at the veterinary checkpoints during endurance rides is recommended.

Background: Benzydamine was evaluated in patients with head and neck carcinoma for treatment of radiation-induced oral mucositis, a frequent complication of radiation therapy (RT) for which there is no predictable therapy or preventive treatment currently available., Methods: The safety and efficacy of 0.15% benzydamine oral rinse in preventing or decreasing erythema, ulceration, and pain associated with oral mucositis during RT were evaluated in a randomized, placebo-controlled trial conducted in patients with head and neck carcinoma. Subjects were to rinse with 15 mL for 2 minutes, 4-8 times daily before and during RT, and for 2 weeks after completion of RT; study evaluations were conducted before RT and routinely thereafter up to 3 weeks after RT., Results: During conventional RT, regimens up to cumulative doses of 5000 centigrays (cGy) benzydamine (n = 69) significantly (P = 0.006) reduced erythema and ulceration by approximately 30% compared with the placebo (n = 76); greater than 33% of benzydamine subjects remained ulcer free compared with 18% of placebo subjects (P = 0.037), and benzydamine significantly delayed the use of systemic analgesics compared with placebo (P < 0.05). Benzydamine was not effective in subjects (n = 20) receiving accelerated RT doses (> or = 220 cGy/day). The incidence of adverse events between treatment groups was comparable without significant differences. Early discontinuation because of adverse events occurred in 6% of benzydamine subjects and 5% of placebo subjects, and there was 1 death (related to the primary diagnosis) in a placebo subject., Conclusions: Benzydamine oral rinse was effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis., (Copyright 2001 American Cancer Society.)

Five sequences were isolated by selection for multiple copy plasmids that conferred resistance to laminarinase, an enzyme that specifically degrades cell wall beta(1-3) glucan linkages. Strains carrying three of these plasmids showed alterations in cell wall glucan labelling. One of these plasmids carried PBS2, a previously identified, non-essential gene which produces a variety of phenotypes and encodes a mitogen-activated protein kinase kinase analogue (Boguslawski and Polazzi, 1987). Cells carrying PBS2 at multiple copy show a small decrease in cell wall beta(1-6) glucans. Measurements of beta(1-3) glucan synthase activity in multi-copy PBS2 cells showed an approximate 30-45% increase in enzyme specific activity while a pbs2 delta disruption strain showed a decrease in glucan synthase activity of approximately 45% relative to control. A pbs2 delta disruption strain was laminarinase super-sensitive and supersensitive to K1 killer toxin while a strain carrying PBS2 at multiple copy was resistant to killer toxin. A second plasmid carried a portion of the MHP1 gene which has been reported to encode a microtubule-interacting protein (Irminger-Finger et al., 1996). The MHP1 gene product is a predicted 1398 amino acid protein and only approximately 80% of the amino portion of this protein is required for laminarinase resistance. Cells carrying the amino portion of MHP1 at multiple copy show a decrease in high molecular weight cell wall beta(1-6) glucans and were killer toxin resistant while a disruption strain was viable and killer toxin super-sensitive. Cells carrying this plasmid showed decreased levels of high molecular weight beta(1-6) glucans and increased glucan synthase activity. The laminarinase resistance conferred by the third plasmid mapped to the previously uncharacterized YCL051W open reading frame and this gene was therefore named LRE1 (laminarinase resistance). The LRE1 gene encodes a non-essential 604 amino acid hydrophilic protein. Unexpectedly, cells carrying LRE1 at multiple copy show no alteration in cell wall glucans or glucan synthase activity. Subcloning experiments demonstrated that the production of these cell wall effects requires the presence of both LRE1 and YCL052C (PBN1), a second open reading frame present on the original plasmid. Cells carrying multiple copies of PBN1 alone show no significant alterations in cell wall glucans or glucan synthase activity, indicating that these effects require the presence of multiple copies of both genes.

Background: Torsion of an intraabdominal testicular tumor is a rare event. We report a new case and review the literature., Methods: A review of the literature was carried out in order to identify reported cases of an intraabdominal testicular tumor undergoing torsion of its vascular pedicle. Data on histologic type, common presenting signs and symptoms, radiographic studies, and adjuvant therapy were tabulated., Results: There are 36 reports of an intraabdominal testicular tumor presenting with torsion. The most common histologic types, in descending order, were seminoma, sarcoma, teratoma, embryonal carcinoma, and choriocarcinoma. Common presenting signs and symptoms included pain and/or tenderness, fever, nausea and/or vomiting, and a palpable mass. Most seminoma patients received adjuvant radiation therapy whereas one patient with choriocarcinoma received adjuvant chemotherapy., Conclusions: Although a rare event, the diagnosis of torsion of an intraabdominal testicular tumor should be considered in any patient presenting with an acute abdomen and a history of cryptorchidism. The presence of a mass may raise the index of suspicion. Preoperative investigation with computed tomography scanning may aid surgical planning.

Choanal atresia was diagnosed radiographically using a water soluble contrast media in 2 of 7 Papio cynocephalus exposed to triamcinolone acetonide in utero. In one P. cynocephalus, the atresia was complete and was associated with other orofacial abnormalities. The other animal, previously considered to be normal, had a partial nasal obstruction. The radiographic appearance of the drug-induced defects observed in the baboon closely resemble the descriptions of spontaneously occurring defects in human infants.

HEp-2 cells were infected with herpes simplex virus type 1 (HSV-1) and harvested at selected times thereafter. IgG, IgA, and IgM antibody to virus antigens present in these cells at each time was measured in sera from oral cancer patients, and in matched controls. The IgA response of oral cancer patients was significantly greater than that of controls both at 8 and at 48 hours after infection, but showed no difference in response to HSV-1 virus particles. IgM antibody detected two peaks of antigen synthesis, at 4 and 48 hours after infection. Oral cancer patients had a stronger IgM response than did controls to both early and late peaks; the latter was significant at the 5% level. Oral cancer patients also had a significantly higher IgM response to the virus particle. These results imply the existence of at least two different HSV-1 antigens associated with oral cancer. Both are late antigens; one is recognized by IgA, and the other is recognized by IgM antibody.

An enzyme-linked immunosorbent assay was used to measure antibody of the IgG, IgA, and IgM classes against Herpes simplex virus type 1 (HSV-1) in human sera. Patients with untreated oral cancer had higher levels of IgM antibody to HSV-1 than did either patients with acute or recurrent herpetic infections or age-matched control subjects. Levels of IgM antibody to cytomegalovirus and total serum IgM concentrations were similar in all groups. Patients who had been treated successfully for oral cancer more than one year earlier did not have higher levels of IgM antibody to HSV-1. The results are consistent with the hypothesis that cancer of the mouth is associated with expression of HSV-1 antigens that stimulate IgM rather than IgG antibody responses.