Melanoma de vulva. Una localización poco frecuente / Vulvar melanoma. An unusual location

El melanoma es el segundo cáncer invasor más frecuente en la vulva, con mal pronóstico, tendencia a la recurrencia local y una sobrevida entre un 16 a 50%.Material y métodos: Presentamos 7 pacientes con melanoma de vulva asistidos en el Sector de Dermato-Oncología del Hospital Ramos Mejía en el transcurso de 17 años, evaluamos sus características y los comparamos con la bibliografía internacional. Resultados: La incidencia de nuestra población fue de 1,3% con una edad promedio de 61 años, similar a la bibliografía consultada. De éstos 7 melanomas, el 72% se originó sobre piel sana y el 28% sobre nevo previo, 61% y 39% respectivamente para la bibliografía mundial. Estos melanomas se localizaron principalmente en labio mayor (72%), mientras que los de la bibliografía lo hicieron en la zona periclitoidea (30%). En nuestras pacientes la forma clínica más frecuente fue el Melanoma Extensivo Superficial (57%) y en la bibliografía el Melanoma Léntigo Maligno (43-57%). El pronóstico es malo, con una sobrevida a 5 años del 28% en nuestras pacientes y de 27-59% en la bibliografía consultada. En cuanto al tratamiento, la tendencia actual es realizar procedimientos menos radicales y más individualizados. Comentarios: Las características del melanoma de vulva indican que su comportamiento no difiere significativamente del melanoma cutáneo, aunque su diagnóstico más tardío conlleva a un peor pronóstico (AU)

Melanoma is the second most common invasive cancer of the vulva, with a poor prognosis, a tendency for local recurrence and survival between 16 to 50%.Methods:We present 7 patients with vulvar melanoma seen at the Dermatology Sector of Oncology, Hospital Ramos Mejía in the course of 17 years, we evaluate and compare their characteristics with the international literature. Results: The incidence in our population was 1.3% with an average age of 61 years, similar to the literature. Of these 7 melanomas, 72% originated on normal skin and preexisting nevi 28%, 61% and 39% respectively for the world literature. These melanomas were located mainly on labia majora (72%), while those in the literature were in the periclitoidea area (30%). In our patients the most common were Superficial Spreading Melanoma(57%) and in literature Mucosal Lentiginous Melanoma (43-57%). The prognosis is poor in both reviews, with a 5-year survival of 28% in our patients and 27-59% in the literature. For treatment, the current trend is to perform a less radical and more individualized. Conclusions: The features of vulvar melanoma indicate that their behavior does not differ significantly from cutaneous melanoma, although its latediagnosis leads to a worse prognosis (AU)

[Tuberculosis--a small-scale epidemic in a Turkish extended family]. / Tuberkulose--Kleinepidemie in einer türkischen Grossfamilie.

In a Turkish joint family including 15 family members seven persons suffered from pulmonary tuberculosis within a period of five months, namely, three adults and four children. Pulmonary tuberculosis also occurred in a boy from the neighbourhood. This infection chain originated from a girl of nineteen years of age.

[Adjuvant therapy of non-small cell bronchial cancer with mopidamol]. / Adjuvante Therapie des nicht-kleinzelligen Bronchialkarzinoms mit Mopidamol.

Between January 1982 and April 1986 a double-blind randomized placebo controlled study of mopidamol, employed as adjunct therapy to surgery in patients with non-small cell bronchial carcinoma, was performed at 7 hospitals. The main criteria were occurrence of metastases and survival. Mopidamol was given perioperatively at a dose of 2 x mg i.v. daily, and postoperatively orally at a dose of 3 x 500 mg daily. The treatment period was scheduled to at least 2 years and in some of the patients was prolonged to 3 years. The standard therapy of each individual center was given as basic therapy. A total of 270 patients were included in the study, 147 in the placebo and 123 in the mopidamol group. By the end of the study 52 deaths from metastases had occurred in the placebo group (35%) compared with only 32 (26%) in the mopidamol group. This difference is statistically significant at p less than 0.05 with the one-sided test. A comparison of life-tables according to Kaplan-Meier shows a statistically significant difference in favour of the group treated with mopidamol (savage p less than 0.05). Cox's multivariate analysis confirmed the statistically significant difference in favour of the group treated with mopidamol, the inclusion of the risk factors tumour stage and histology in the evaluation results in a p-value of 0.02. With respect to the incidence of metastases there were no appreciable differences between the treatment groups. The incidence of side effects or undesired events was equal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Preoperative (neoadjuvant) chemotherapy of small cell bronchial cancer]. / Präoperative (neoadjuvante) Chemotherapie des kleinzelligen Bronchialkarzinoms.

The high rate of locally delimited recurrences of parvicellular bronchial carcinoma, following chemotherapy and complete remission, primarily in cases of limited disease, prompted the authors to apply preoperative neoadjuvant chemotherapy to seven patients. Four of them were without tumours for six to 72 months from treatment. One patient died of myocardial infarction but with no tumour detectable 15 months after treatment. Locally delimited recurrence with additional lymphogenic spreading was recorded from one patient only. Two patients died of haematogenic metastasation. The concept should be tested for efficiency on larger groups of patients.

[The pharmacokinetics of josamycin]. / Zur Pharmakokinetik von Josamycin.

Determination of the distribution coefficients in vitro demonstrates that josamycin (Wilprafen) is at least 15 times more lipophilic than erythromycin. On the other hand the distribution coefficients of penicillin G and of amoxicillin be in the hydrophilic range. The serum protein binding of josamycin is 15%, which is markedly less than with the other macrolides. These in vitro experiments show that small structural differences can alter the physicochemical and biological behaviour of an antibiotic, even when the molecules are closely related. A cross-over experiment with 12 volunteers and multiple application of 1 g of josamycin base or 1.175 g of erythromycin ethyl succinate showed that both macrolides are rapidly absorbed and reach their maximum within the first hour. In 21 patients the concentration of josamycin in lung tissue was 2 to 3 times that in the blood. The highest concentration of josamycin reached was 3.68 micrograms/g lung tissue (mean of 12 patients) and this was found for the group of patients from whom the tissue samples had been taken 2-3 h after the last administration of the drug. Lower mean concentrations of erythromycin were found in the serum and lung tissue of a similar group of 31 patients. The results indicate that the new macrolide antibiotic josamycin accumulates well in lung tissue and that the concentrations necessary for the treatment of infections (minimal inhibitory concentrations [MIC]) are rapidly reached also in the tissue.