Retinoids, 585-nm laser, and carbon dioxide laser: a numeric comparison of neocollagen formation in photoaged hairless mouse skin.

BACKGROUND: A variety of new methods for treating photoaging have been recently introduced. There has been increasing interest in comparing the relative efficacy of multiple methods for photoaging. However, the efficacy of a single method is difficult to assess from the data reported in the literature. METHODS: Photoaged hairless mice were randomly divided into seven treatment groups: control, retinoids (tretinoin and adapalene), lasers (585 nm and CO(2)), and combination groups (585 nm + adapalene and CO(2 )+ adapalene). Biopsies were taken from the treated regions, and the results were analyzed based on the repair zone. The repair zones of the various methods for photoaging were compared. RESULTS: Retinoids produced a wider repair zone than the control condition. The 585-nm and CO(2) laser resurfacing produced a result equivalent to that of the control condition. A combination of these lasers with adapalene produced a wider repair zone than the lasers alone, but the combination produced a result equivalent to that of adapalene alone. CONCLUSION: Retinoids are potent stimuli for neocollagen formation. The 585-nm or CO(2) laser alone did not induce more neocollagen than the control condition. In addition, no synergistic effect was observed with the combination treatments. The repair zone of the combination treatment is mainly attributable to adapalene.

Cytokeratin staining for primary and metastatic colorectal cancer.

Determining the site of origin of metastatic adenocarcinoma lesions has obvious therapeutic and prognostic implications. Immunostaining for cytokeratin subtypes 7 and 20 is increasingly used to evaluate metastatic colorectal cancer lesions. We present the case of a patient with a history of colorectal cancer who subsequently developed an isolated metastatic lesion in the lung. As illustrated by our case, staining for cytokeratin subtypes can be helpful in determining the site of origin of metastatic lesions.

Radiogallium hot spleen in Trousseau's syndrome with splenic vein occlusion.

A 75-year-old man had multiple findings that indicated thromboembolic disease. A radiocolloid study showed splenic defects. The remainder of the spleen was hot on radiogallium imaging. The patient had Trousseau's syndrome (tumor-associated thromboembolism) due to carcinoma of the pancreas. The splenic vein was obstructed. Vascular compromise should be considered in the differential diagnosis of the radiogallium hot spleen.

Ventilatory support by pacing of the conditioned diaphragm in quadriplegia.

We provided full-time ventilatory support in five patients with respiratory paralysis accompanying quadriplegia by continuous electrical pacing of both hemidiaphragms simultaneously for 11 to 33 months through the application to the phrenic nerves of a low-frequency stimulus. The strength and endurance of the diaphragm muscle increased with pacing. Biopsy specimens taken from two patients who had uninterrupted stimulation for 6 and 16 weeks showed changes suggestive of the development of fatigue-resistant muscle fibers. When we compared these results with those of our earlier experience with intermittent unilateral stimulation of the diaphragm in 17 patients with respiratory paralysis, we found that continuous bilateral pacing using low-frequency stimulation appeared to be superior because of more efficient ventilation of both lungs, fewer total coulombs required to effect the same ventilation, and absence of myopathic changes in the diaphragm muscle. For patients with respiratory paralysis and intact phrenic nerves, continuous simultaneous pacing of both hemidiaphragms with low-frequency stimulation and a slow respiratory rate is a satisfactory method of providing full-time ventilatory support.

Metastatic basal cell carcinoma of the scrotum.

We report a rare case of basal cell carcinoma of the scrotum presenting with distant metastases. Rationale and treatment with bacillus Calmette-Guerin immunotherapy and subsequent combination chemotherapy are detailed.

Response of the diaphragm muscle to electrical stimulation of the phrenic nerve. A histochemical and ultrastructural study.

The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.

Choroid metastases from transitional cell carcinoma of the bladder: a case report and a review of the literature.

A case of choroidal metastases as the initial manifestation of disseminated bladder cancer is presented. Ocular metastases are an extremely rare manifestation of bladder cancer and when present, usually are a late manifestation. The pathophysiology of ocular metastases is discussed and literature is surveyed.