A case of metastatic melanoma in the liver mimicking colorectal cancer with synchronous liver metastasis.

INTRODUCTION AND IMPORTANCE: Colorectal cancer (CRC) presenting with synchronous liver metastasis is relatively common, occurring in approximately 20 % of patients1. Herein we report an atypical case of a patient who presented with a new, obstructing colon mass with synchronous liver metastasis, biopsy proven to be malignant melanoma. CASE PRESENTATION: An 81-year-old male presented to the hospital emergency department with abdominal pain, diarrhea, and 30-pound unintentional weight loss over the past 4 months. Investigations revealed an obstructing cecal mass with multiple large, hypodense hepatic masses suspicious for metastatic disease. A multidisciplinary evaluation ensued, and the decision was made to treat with palliative intent. The patient was surgically treated with a diverting stoma and an intraoperative biopsy of the hepatic masses demonstrated metastatic melanoma. The patient did report a remote history of malignant melanoma and underwent curative-intent resection a decade earlier. There was no evidence of a new primary cutaneous melanoma. A tentative plan for checkpoint inhibitor therapy was discussed, but his medical issues worsened, and the patient died before any anti-cancer therapy could be started. CLINICAL DISCUSSION: The clinical picture of obstructing colon mass with synchronous liver masses most commonly represents a colon primary with synchronous liver metastasis. The capacity for melanoma to mimic other pathologies is unusual but has been described, with case reports describing metastasis to the eye, biliary hilum, liver, pancreas, colon, small bowel, and brain. This case serves as a good reminder that melanoma may mimic a variety of oncologic presentations, even after a very long disease-free interval. CONCLUSION: Our patient suspected to have metastatic colon cancer was found instead to have metastatic melanoma, with significantly different therapeutic options and prognosis.

Contrast transesophageal echocardiography using the Acunav ultrasound catheter through the mouth way as a guide to percutaneous closure of patent foramen ovale.

AIM: Contrast-enhanced transesophageal echo-cardiography (c-TEE) represents the gold standard in the diagnosis of patent foramen ovale (PFO) but it is not always well tolerated by the patient, and it is influenced by his cooperation. Purpose of the present study was to assess feasibility and safety of c-TEE through the oral way using a miniaturized 10-Fr, monoplane probe (Acunav-TEE) and establish its utility in the diagnosis or PFO when compared with c-TEE using the traditional multiplane probe (standard-TEE). METHODS: From January 2008 to September 2008, 54 consecutive patients with presumed paradoxical cerebrovascular events and a suspected PFO were prospectively enrolled in this study. After signing a consensus form, these patients underwent both standard-TEE and Acunav-TEE in the same day by two independent operators. RESULTS: Feasibility of standard-TEE in our study was 96.3% (52/54) while feasibility of Acunav-TEE was 100% (54/54). When compared to standard-TEE, Acunav-TEE required shorter average time to insert the probe (1.0+/-0.2 vs. 4.1+/-1.1 minutes, P<0.001) but longer average time to look for the best projection and start the examination (13.8+/-2.4 vs. 9.1+/-2.7 minutes, P<0.001). Using standard-TEE as gold standard we defined a sensitivity of 100% (20/20) and a specificity of 97% (31/32) for Acunav-TEE. The positive predictive value, the negative predictive value and the global diagnostic accuracy were 95% (20/21), 100% (31/31) and 98% (51/52), respectively. CONCLUSION: Consistent with our experience, Acunav-TEE seems to be a feasible and safe technique when used for the diagnosis of PFO, with excellent sensitivity and specificity as compared with standard-TEE.

The science of communicating the art of esthetic dentistry. Part III: precise shade communication.

Shade matching is inherently complex and involves understanding the science of color, determining the shade and surface characteristics of teeth, and communicating this information to the laboratory technician. The laboratory technician then has the difficult task of mimicking the selected shade and ultimately reproducing it in the final restoration.

The science of communicating the art of esthetic dentistry. Part I: Patient-dentist-patient communication.

Many contemporary restorative procedures are primarily esthetically driven, and patients have high expectations. It is imperative for the restorative dentist to understand patients' desires and expectations prior to initiating irreversible therapy. It is equally important for patients to understand the anatomic and technical limitations inherent with restorative therapy.

The science of communicating the art of esthetic dentistry. Part II: Diagnostic provisional restorations.

Provisional restorations fulfill many functions in restorative dentistry. Quality provisional restorations can provide the clinician, the patient, and the laboratory technician much valuable information prior to fabrication of the definitive restoration. Such diagnostic provisional restorations fabricated with acrylic resin are easily adjusted and modified until both esthetic and functional results are approved by the patient. Once this approval has been obtained, the definitive restorations can be fabricated with confidence, using the esthetic form of the provisional restorations as a blueprint.

A technique to replicate soft tissues around fixed restoration pontics on working casts.

When missing maxillary incisors are replaced, the patient's primary concern is usually esthetics. Depending on the patient's smile line and the display of the incisors, the esthetic zone may extend to the entire clinical crown and include the surrounding soft tissue. For these patients, the appearance and form of the soft tissue at the base of the pontics is as critical as the esthetics of the incisal edges of the restoration. A technique is presented to precisely transfer the soft tissue morphology of the pontic area to the working cast. This modified master cast allows the laboratory technician to fabricate restorations that will harmonize precisely with the soft tissues of the patient.

[The construction of plates for intraoral registration with photopolymerizing resins. An original method]. / Costruzione di placche per la registrazione intraorale con resine fotopolimerizzabili. Metodica originale.

The recording of maxillo-mandibular relationships using Gothic arch assembly in dentulous subjects is useful not only in prosthetic rehabilitation, but also in the analysis of mandibular range of motion on patients with temporomandibular disorders. The traditional methodology to assemble Gothic arch plate is too long and elaborate, so it is remitted to the laboratory. This study describes a quick and simplified technique utilizing photopolymerizing resins which can be used by the dentist in his own office, in order to permit a greater use in the clinical practice.

[Effect of ultrasonic scalers, burs and silicone points on the resins for denture bases]. / Effetto degli ultrasuoni, di frese e di gomme abrasive sulle resine per basi protesiche.

BACKGROUND: Complete dentures in elderly patients often present a large build-up of dental calcolus. In order to avoid this leading to the onset of mycosis or other infections of the oral cavity, all the dental calcolus must be removed during check-ups. METHODS: In order to analyse the consequences of removing the dental calcolus by mechanical means on the resin of the dentures, a polymethylmetacrylate (PMMA) plate was treated with a ultrasonic scaler, with rotating silicone points and with tungsten carbide burrs mounted on a straight hand-grip. The specimens were observed under a light stereomicroscope and their surface was analysed using a surface roughness tester. Observation under the stereomicroscope showed that in all cases the smooth surface of the resin is damaged and modified. RESULTS: The analysis using the surface roughness tester revealed that only very limited quantities of resin are removed whatever the method. Using the lateral edge of the ultrasonic scaler tip and the rotating silicone points mounted on a hand-grip were the techniques that gave the best results, causing the least abrasions. CONCLUSIONS: The results obtained show that after removing the dental calcolus with the instruments tested, the dentures need to be polished in order to prevent the roughness and irregularities caused by the instruments from favouring plaque retention and the consequent reformation of dental calcolus.

The science of communicating the art of dentistry.

Laboratory work authorization forms are mainly developed in the form of written instructions, two-dimensional drawings or photographs. These can be supplemented with other forms of communications, which will give three-dimensional information and take into account the lips, which are considered the frame of the teeth. This article will describe a systematic approach to communication with a patient and laboratory technician using three-dimensional aids such as a smile replica, lip reproductions, provisional restoration casts and soft tissue casts.

Genomics and transcription analysis of human TFIID.

TFIID, a multisubunit protein comprised of TBP (TATA box-binding protein) and TAF(II)s (TBP-associated factors), has a central role in transcription initiation at class II promoters. TAF(II)s role as mediators of regulatory transcription factors, such as pRb and p53, and their involvement in signal transduction pathways suggest that some may participate in the control of cell proliferation and differentiation: therefore, they could be considered potential protooncogenes or antioncogenes. With the aim of starting to analyse these potential roles, we have determined the genomic position of nine human TAF(II) genes (TAF[II]250, TAF[II]135, TAF[II]100, TAF[II]80, TAF[II]55, TAF[II]43, TAF[II]31, TAF[II]28, TAF[II]20/15) and of two previously unknown sequences related to TAF(II)250 and TAF(II)31, respectively. Except for those encoding TAF(II)250 and TAF(II)31, these genes are present in a single copy and, with the exclusion of those for TAF(II)43 and TAF(II)28 (both at 6p21), are localized in different segments of the genome. Indeed, six of them map to a chromosomal region commonly altered in specific neoplasias, which defines them as candidates for involvement in oncogenesis. Our experiments also demonstrate that TAF(II) transcripts are synthesized ubiquitously, mostly at low levels similar to those of TBP. Interestingly, the amount of the major mRNA species detected by TAF(II)20/15 cDNA is higher, which suggests that the polypeptide it encodes may also perform functions independently of TFIID. TAF(II) isoforms, indicated by additional bands on Northern blots, may play a role in modulation of TFIID function. These data will be useful for analysing variations of TAF(II) mRNA phenotype during cell proliferation, differentiation and development, both normal and pathological.

Burning mouth syndrome: the role of contact hypersensitivity.

The burning mouth syndrome is characterized by an unpleasant sensation of burning in the oral cavity, without clinical signs. Causal factors may be psychogenic, systemic or local. The aim of the study was to determine the significance of contact allergy in the pathogenesis of burning mouth syndrome. Fifteen patients with burning mouth syndrome were studied through anamnesis and laboratory analysis. Epicutaneous patch tests were performed with the Italian standard series (GIRDCA - Gruppo Italiano di Ricerca Dermatiti da Contatto ed Ambientali), preservative and dental series. The same tests were carried out in 12 healthy age- and sex-matched subjects. The number of patients affected by burning mouth syndrome with a positive reaction to patchtesting was 6 out of 15, while the number of allergic patients in the control group was 3 out of 12. No association could be found between positive reaction at patchtesting and exposure to allergens. Contact allergy in burning mouth syndrome seems not to play a primary role; nevertheless, it is advisable to perform patch tests in selected patients to identify a possible aetiological agent.

Substance abuse treatment options: a federal initiative.

Pervasive drug enforcement efforts and new federal sentencing guidelines have led to an increase in substance abusers entering the federal prisons. Although the Federal Bureau of Prisons (BOP) has been committed to providing substance abuse treatment since the 1960s, a comprehensive expansion of its programs was necessary so that quality services could be provided for the growing drug-offender population. This article describes the BOP's six-part drug treatment strategy, which includes screening, education, residential treatment, nonresidential treatment, transitional treatment, and evaluation. The programs entail a biopsychosocial model and a multiphasic approach to comply with the BOP's goal of preparing inmates for a successful reentry into the community, free from criminal and substance-abusing behaviors.

Polyamine involvement in functional activation of human macrophages.

Polyamines naturally occur in all living beings and play an important role in the regulation of cell proliferation, differentiation, and functional stimulation of terminally differentiated cells. Our studies, using specific inhibitors of polyamine biosynthesis such as alpha-difluoromethylornithine and methylglyoxal-bis[guanylhydrazone] to prevent polyamine accumulation, have indicated that polyamines are associated with functional activation of human macrophages. Both inhibitors diminished the respiratory burst activity of macrophages induced by lipopolysaccharide and interferon gamma. The methylglyoxal-bis]guanylhydrazone] inhibitory effect was concentration-dependent and could be reversed by spermine, which is the final product of polyamine biosynthesis.

AO 1535 inhibits O2- production by human macrophages.

AO 1535 is a semisynthetic monoglycosylceramide derived from O-glycosilated sphingosine, with a chemical structure similar to the glycolipids present in many mammalian tissues. In the epidermis monoglycosylceramides contribute to consolidate the structure of cutaneous layers. It has been recently shown that sphingosine and its derivatives are potent inhibitors of Protein kinase C, and block the 'respiratory burst' of phagocitic cells. In macrophages, like in neutrophils, the reactive oxygen intermediates are produced by a membrane associated enzymatic complex, NADPH-oxidase, which is activated by Protein kinase C. This study demonstrates that AO 1535 is able to inhibit the production of reactive oxygen intermediates in human monocytes and macrophages stimulated by phorbol ester and chemotactic tetrapeptide, suggesting a potential clinical application of AO 1535 in the treatment of inflammatory dermatoses.

Inhibitors of polyamine biosynthesis block tumor necrosis factor-induced activation of macrophages.

The activation of polyamine biosynthesis, dependent on increased gene expression of ornithine decarboxylase, has been found to play an important role in the control of cell proliferation and differentiation. In this report it has been found that accumulation of ornithine decarboxylase mRNA also follows stimulation of human monocytes/macrophages by tumor necrosis factor. Human recombinant tumor necrosis factor (100 units/ml) also evoked an enhanced respiratory burst of macrophages. The respiratory burst response was inhibited in a dose-dependent manner with difluoromethylornithine, an inhibitor of ornithine decarboxylase, and methylglyoxal-bis(guanylhydrazone), an inhibitor of the formation of spermidine and spermine. The data presented in this paper suggest that polyamines may play a functional role in tumor necrosis factor-driven macrophage activation, and they are discussed in the context of their possible use as inhibitors of polyamine metabolism in tumor chemotherapy.

Transcription factor activation and functional stimulation of human monocytes.

Activation of expression of genes encoding transcription factors: c-fos and c-jun and formation of AP1 transcriptional complex in human monocytes was investigated. It was found that lipopolysaccharide induced strongly both c-fos and c-jun expression as well as AP1 formation. Interferon gamma activated strongly c-fos and weakly c-jun and AP1. Tumor necrosis factor induced slightly c-fos and had almost no effect on c-jun and AP1. The data suggest that differences in functional responses elicited in monocytes by all three factors may be dependent on different routes on nuclear signalling employed by the factors.

Accumulation of ornithine decarboxylase mRNA accompanies activation of human and mouse monocytes/macrophages.

Accumulation of ornithine decarboxylase (ODC) mRNA was investigated in human monocytes and mouse peritoneal macrophages. Treatment of both populations of mononuclear phagocytes with bacterial lipopolysaccharide induced a marked and rapid increase in the accumulation of the ODC gene transcript. A similar phenomenon, albeit less pronounced, was also observed following treatment of human monocytes with human recombinant interferon-gamma. These results suggest a role for ODC, and therefore polyamines, in the regulation of mononuclear phagocyte functions.

Induction of protooncogene fos by extracellular signals in primary glial cell cultures.

In the present study various extracellular factors, acting through different second messenger systems, were examined for their capacity to increase the level of c-fos mRNA in primary glial cell cultures. In particular EGF, 12-O-tetradecanoylphorbol 13-acetate, the beta-adrenergic agonist isoproterenol, and the glutamate agonists, ibotenic and quisqualic acid, were studied. All the extracellular stimuli tested induced a rapid and transient increase in c-fos mRNA level in glial cell cultures regardless of the signal transduction pathway and the final effect on cell proliferation.