[Marjolin's ulcer on burn scar, a curable but neglected disease]. / Ulcerul Marjolin dezvoltat pe cicatrici postcombustionale--afectiune vindecabila, dar neglijata.

We discuss 9 consecutive carcinomas developed on postburn scars. Our interest was focused on surgery, recurrence, metastasis and long-term survival. The delay between burn trauma and the first clinical manifestation was 25-63 years. The most common localisation was in the limbs (10). Two cases presented with visceral metastasis. We performed either wide excision and grafting (5) or amputation (5). From the anatomo-pathological stand point we encountered 8 SCC and 1 BCC. In 6 cases we had no local recidive or metastasis. One presented a local recidive. There were two deaths--lung metastasis and "spontaneous" rupture of invaded axillary artery. The Marjolin's ulcer has a low incidence because of the patient's poor education. The prophylactic attitude is optimal. We favour early excision--grafting of the deep burns, long-term follow-up, excision and grafting of unstable areas (joint area, depigmented regions, chronic ulcers). The optimal surgical technique is excision followed by skin grafting since it allows early detection of the recurrence.

[A microsurgical patient, a procedural dilemma]. / Un pacient microchirurgical, o dilema tactica.

We are presenting a case which had five operations with the central point being the microsurgery. The patient is admitted in our unit 48 ours after sustaining a complex trauma of the left forearm with cvasicomplete destruction of the volar muscles, defects on cubital and radial vasculo-nervous axes and the median nerve. Upon arrival we performed the staged surgical debridement, ligature of the radial and ulnar vessels, anchoring of the ends of the nerves, forearm volar and dorsal fasciotomies, followed by skin grafting. After five months, the grafted skin is replaced by an ipsilateral parascapular free flap. After other three months we repaired the nerves by the mean of sural nerve grafts. The particularity of the case consists in fact that the ulnar nerve, with a longer defect, was reconstructed in a two stage approach. Long-time follow up (one year) shows a very good functional clinical result, confirmed by electromyography. Apart from the clinical challenge, this case confronted us with tactical dilemma. In a case of the facial nerve for the best results the cross-face is performed in two stages. Why shouldn't we do the same thing for all the nerve grafts when we are faced to semnificative defects?

Cell line specific radiosensitizing effect of zalcitabine (2',3'-dideoxycytidine).

The potential of zalcitabine (ddC) to act as an ionizing radiation response modifier was tested on exponentially growing human cancer cells in vitro. Two human cell lines, WiDr (colon) and MCF-7 (breast) were exposed to ddC at 10 microM concentration for various lengths of time (18, 24, 48 and 72 h). On the WiDr cell line the dual effect of concentration and duration of exposure prior to irradiation was investigated. Experimental endpoints were clonogenicity and viability, as measured by colony formation assay (CFA) and MTT assay respectively. The impact on cell-cycle distribution prior to irradiation was assessed by flow cytometry using a double labeling technique (propidium iodide and bromodeoxyuridine pulse label). A significant reduction in surviving fraction and viability was observed for WiDr-cells irradiated after pre-exposure to 10 microM for 18, 48 and 72 h as compared to corresponding irradiated controls. At lower concentrations (1 and 5 microM), the radiosensitizing effect was only significant after a 72-h exposure (assessed by CFA). For MCF-7, ddC induced a significant modification of the dose response only with 24 and 48 h preincubation. However, the overall effect was less pronounced as compared to WiDr. Cell-cycle analysis showed accumulation in S-phase, 48 and 72 h after treatment with 10 microM ddC in the WiDr cells, with a progressive shift to late S-phase as shown by the biparametric analysis. The degree of radiosensitization is cell-line dependent with the most important sensitization observed on the most "radioresistant cell line", i.e., the cell line with the lowest alpha value and highest SF 2 (WiDr). For WiDr, radiosensitization by ddC depends on the duration of exposure and the concentration of the drug.

[The treatment of superficial burns of the hands under controlled microclimate conditions]. / Tratamentul arsurilor superficiale ale mâinii în conditii de microclimat controlat.

In the treatment of the superficial burns of the hands, since October 1996, we have used exclusively the method of the controlled microclimate, verified in different variants starting early sixties. At the end of the usual primary wound treatment, the hand covered with the chosen topic is an ordinary new polyethylene bag. The bags are not pre-sterilized but the test showed no pathogen germs. The patient uses the hands for the daily activities--eating, reading. He/she is encouraged to perform active exercises (light gymnastics). We change the bags daily or whenever necessary, after a careful of the wound. We evaluated the healing time, the epithelial quality, secretions, mobility, patient's and medical personnel's acceptability, and the economic aspect. Though we couldn't notice a shorter period of healing, the epithelium showed a better quality in the early period of regeneration. The range of mobility was faster restored but long term results were the same as with usual dressings. We consider the method is appropriate for standardization in superficial hand burns in inpatients or outpatients for at least 4 reasons: comfort for the patient, his active and conscious participation in the process of healing, high acceptability among medical personnel, the semnificative economic advantage.

Azidothymidine (AZT) as a potential modifier of radiation response in vitro.

The potential effect of AZT as a thymidine analogue on radiation response in vitro was investigated. Two human cell lines (WiDr and HeLa) were used. The effect of 10 microM AZT on exponentially growing cells was studied after different exposure times (24, 48 and 72 h). The surviving fraction (clonogenic assay) or metabolic activity (MTT assay) after irradiation of AZT-exposed cells, was compared to unexposed irradiated controls. Flow cytometry was used to assess the cell-cycle effect of pre-exposure of exponentially growing cells to AZT. AZT had a radioprotective effect for all experimental time points as far as WiDr was concerned. For HeLa the effect was significant at 24 h. Cell-cycle analysis showed a significant accumulation in S-phase at 72 h for WiDr. For HeLa there was a significant accumulation in S-phase at 48 h. We conclude that under the reported experimental conditions, AZT as a thymidine analogue seems to reduce the cytotoxic effect of irradiation.