Dapsone as monotherapy in cutaneous and mucocutaneous leishmaniasis

There is a need for an oral, safe, effective, easily administered and cheap treatment for cutaneous and mucocutaneous leisimianiasis. Pentavalent antimonials remain the mainstay of treatment for cutaneous and mucocutaneous leishmanjasis. We recruited 65 patients with leishmaniasis [52 patients with cutaneous leishmaniasis and 13 patients with mucocutaneous leishmaniasis]. All studied patients were given dapsone treatment for 2 months. During the study period, 3 male patients [4.6%] stopped the treatment due to adverse reactions and excluded from the study. Of the studied 62 patients treated with dapsone, 57 patients [9 1.9%] [42 males and 15 females] were cured and 5 patients [8.1%] [4 males and one female] showed no response. Out of the studied 49 cases with cutaneous leishmaniasis, 45 cases [92, 3%] [33 male and 12 female] were cured; 4 [7, 7%>] [3 males and one female] showed no response and out of the 13 cases with mucocutaneous leishmaniasis, 12 cases [91.3%] [9 male and 3 female] were cured and one male [8.7%] showed no response. The results did not find any significant difference between the cure rate in both cutaneous and mucocutaneous leishmanjasis. However the cure rate was showed significant differences with regard to age of the patients and the type of lesion among the cutaneous leishmaniasis cases. All cured patients were followed up for another two months with no relapse of cutaneous lesions

Immunohistochemical study of p16[ink4a] and retinoblastoma gene products in different clinicopathological stages of mycosis fungoides

Mycosis fungoides [MF] is usually an indolent disease that, after a variable period of time in a stable phase, evolves into a tumoral form with aggressive behavior. Knowledge about the molecular mechanisms involved in the pathogenesis of tumoral progression in MIF is still scarce. Alterations of p16[ink4a] and retinoblastonia [Rb] have been demonstrated in a wide range of human tumors, p16[ink4a] inhibits Rb protein and thus acts as a negative cell cycle regulator. This prompted us to investigate their hypothetical role in MF progression. Twenty-five patients with MF of different clinicopatholgical stages were studied. p16[ink4a] expression was absent in 28% of the studied cases, where it was more lost in tumoral lesions than in patches and plaques lesions and in higher clinical stages than in low stages and the difference was statistically highly significant [P<0.001]. Therefore, the loss of p16[ink4a] is associated with the aggressive forms of MF. The results of the present study also showed a significant reciprocal relationship between p16[ink4a] and Rb proteins in most MF cases. However, alterations of Rb protein were not correlated with any of the clinicopathological features of the studied cases. In conclusion, this study demonstrated that lack of p16[ink4a], expression is a sensitive and specific marker of advanced cases of MF in comparison to Rb and thus p16[ink4a] could he used as a marker for poor prognostic patients with MF

Detection of epidermal P53 and Mdm2 in vitiligo patients

Vitiligo is a common depigmented skin disorder that is caused by selective destruction of melanocytes resulting in disfiguring milky white patches. Since melanin is a unique light- absorbing and ultra -violet filtering system it is generally accepted that its main function resides in the protection of these cells against the deleterious effect of U-V light. Association of vitiligo and skin cancer has been a subject of controversy, occurrence of skin cancer in long lasting vitiligio is rare and PUVA therapy associated squamous cell carcinomas are not reported. There are reports on increased functional wild type P53 expression in the patients with vitiligo and there may be direct association between this tumor suppressor gene and absence of photo damage and skin cancer. The major regulator of P53 is MDM2 protein which can trigger its degradation. Thus the aim of this work is to detect the degree of expression of P53 protein, MDM2 protein, in both depigmented as well as 'normal' pigmented skin of vitiligo patients and compare it to normal control. Thirty four patients with vitiligo and ten age and sex matched healthy volunteers as a control were selected. Skin biopsies were taken from each case and control subjects. Histopathological examination of hematoxylin-eosin-stained sections of lesions included analysis and scoring of histopathological parameters. Expression of P53 and Mdm2 proteins were examined immunohistochemically. The results showed that both P53 and Mdm2 were highly expressed in uninvolved as well as involved skin of vitiligo patients in comparison to the control. This expression involves the epidermis, skin adnexa and blood vessels. In conclusion the over expression of the functioning wild type of P53 protein in both pigmented and depigmented epidermis of patients with vitiligo, could contribute to the decreased occurrence of actinic damage and skin cancer

Expression of DNA topoisomerase II alpha in melanocytic skin tumors

Topoisomerases are nuclear enzymes that modulate the topological structure of DNA in order to facilitate cellular events such as replication and transcripion. These enzymes are also the cellular targets of new classes of chemotherapy agents termed topoisomerase poisons. These drugs are showing activity against a wide variety of solid human neoplasms. However, malignant melanoma [MM] is considered to be a chemotherapy refractory tumor and the commonly used anticancer drugs do not seem to modify the prognosis of metastatic disease. Because of the challenges in treating MM, we performed an immunohistochemical study of this group of neoplasms to search for the presence of molecular marker that might indicate tumor response to topo II alpha active drugs. Forty- five patients with melanocytic skin tumors were the subjects of this study. They included 29 patients suffering from benign nevi, 4 dysplastic nevi and 12 MM. Topoisomerase II alpha expression showed significantly higher expression in MM cases than benign melanocytic nevi. Dysplastic nevi showed topo II alpha expression midway between the two extremities. The difference between the 3 groups was statistically highly significant p<0.0001. In MM cases, topo II alpha expression was significantly correlated with lymph node metastasis [p=0.001], tumor ulceration [p=0.001], tumor thickness [p=0.0001], Clark's level [p=0.008], and nodular type melanoma [p=0.003] In conclusion, expression of topo II alpha provides a useful marker for proliferation and can differentiate between benign and malignant melanocytic skin tumors. While in MM cases, it is considered as a poor prognostic marker. As the enzyme topo II alpha is the target of a group of cytotoxic drugs. its expression might serve to predict the success of adjuvant cytotoxic therapy especially in advanced MM cases

Systematic pelvic and aortic lymphadenectomy in cervical, endometrial and ovarian malignant tumours: patterns of spread and surgical implications

Pelvic and aortic nodes are common sites of metastasis from gynaecologic malignancies, and there is no question that evaluation of lymph node status provides an important prognostic infomation. The aim of the study was to assess the patterns of lymphatic spread of gynaecologic malignancies, the number of nodes which can be excised from each pelvic and aortic group, and the impact of this surgical procedure on the perioperative complications and survival. Between January 1998 and December 2002, 50 patients with previously untreated and biopsy-proven gynaecologic malignancies: cervix [n=15], ovary [n=17], and endometrium [n=18] Were operated upon in the Departments of General Surgery, and Gynaecology and Obstetrics, Minoufnya University Hospital. The surgical procedure consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy and/or omentectomy, in addition to systematic pelvic and Para-aortic Iymphadenectomy. The median number of nodes removed was 21 pelvic [range 11-38] and 8 aortic [range 5-18]. Positive nodes were found in 22 patients [44%], 12 having pelvic, 4 aortic, and 6 both pelvic and aortic metastasis. The median number of positive nodes was 5 pelvic [range 1-12] and one aortic [range 1-6] nodes. The most frequently involved node groups were the obturator group with both cervical and ovarian carcinomas, and the external iliac group with endometrial carcinoma. The higher prevalence of aortic metastasis was observed in ovarian carcinoma. Lymphocele was the most frequent postoperative complication in 20% of patients. No postoperative mortality occurred in this series. The 5-year survival rate of patients with lymph node metastasis was significantly worse than that of patients without node metastasis [31% versus 84% P=<0.001]. These data may be useful for tailoring lymphadenectomy in relation to the preferred sites of retroperitoneal lymph node metastasis and the median number of nodes resected from each group, and confirms that systematic pelvic and aortic lymphadenectomy is a feasible procedure and can be performed with acceptable morbidity and no mortality. However, to provide solid evidence that this procedure has a therapeutic benefit, randomized controlled studies are needed