Merkel cell carcinoma: an aggressive malignancy.

Merkel cell carcinoma is a rare and aggressive malignant tumor of the skin. We retrospectively reviewed five patients treated from January 1987 to December 1995. The mean age was 75 years (range, 65-85). There were three primary lesions of the head and neck and two of the extremities. Three were stage II and two were stage III. All primary tumors underwent wide excision with clear margins. Four patients recurred, with a mean time to recurrence of 10 months (range, 2-17). All tumors were positive for immunohistochemical stains (cytokeratin and neuron-specific enolase). Only the two patients who did not have radiotherapy to the primary site had a local recurrence. There was regional recurrence in two of the three patients who had adjuvant radiotherapy to regional lymph nodes. One patient who had a wide excision of the primary lesion, prophylactic lymph node dissection (15 of 34 lymph nodes were positive), and adjuvant chemotherapy is alive and disease free at 23 months. Three patients have died with disease, and two are alive and disease free. Merkel cell carcinoma should be treated aggressively with wide excision of the primary lesion (3-cm margins), and prophylactic lymphadenectomy followed by irradiation to the primary site. If lymph node involvement is detected, then irradiation to the lymph node region must be performed. The role of chemotherapy in this disease is not well defined.

[Pathogenesis and psychosocial consequences of post-concussion syndrome]. / Patogeneza i psychospoleczne konsekwencje zespolu pourazowego.

About 35% of subjects with head injury (HI) suffer from postconcussion syndrome (PCS). These disturbances can be chronic or even permanent. Such patients are discharged from hospital without any apparent problems, but it is often the case that their families, and sometimes even they themselves, start to notice the emergence of new problems. They may exhibit affective changes, such as thinking that they are worthless, alone and without any future perspectives. When they are left without the help of specialists and/or family and friends, their problems gain even greater significance. PCS includes subjective physical complaints (i.e. headache, dizziness) and cognitive, emotional and behavioral changes. PCS influences all areas of the patient's life. Subjects who have sustained head injury often have problems with marital relationships, maintaining of independence, employment, leisure activities and other functions which are related to social adjustment. Various studies have attempted to predict the post-injury status of HI patients from information available, such as data on the severity of head injury, the duration of post-traumatic amnesia (PTA) and the results of neuropsychological assessment. This kind of prediction is important in planning of rehabilitation services and thus improving the kind of help available to survivors of HI. Early prediction of post-injury psychological status may also help the patient and his family in coping with the difficulties related to the trauma. We know a great deal about head injury and its consequences, but many questions still need to be answered. Among these are issues such as: the role of neurobehavioral data in the prediction of outcome for HI patients, the identification of variables determining the extent of PCS and the search for reliable factors which may influence future employment or school status. The assessment of patients for invalidity and other social security benefits also requires a more rational approach, based on the data available.

Analysis of deoxyribonucleic acid of Neisseria caviae and other Neisseria.

LaMacchia, Elizabeth H. (University of Maryland, College Park), and Michael J. Pelczar, Jr. Analyses of deoxyribonucleic acid of Neisseria caviae and other Neisseria. J. Bacteriol. 91:514-516. 1966.-The base composition of deoxyribonucleate preparations extracted from 11 strains of Neisseria caviae, expressed in terms of mole per cent guanine plus cytosine ranged from 47.7 to 50.4, with an average of 49.2. This compared closely with the values obtained for DNA from two strains of N. perflava, which were 49.2 and 50.5%, as well as with published values for most other Neisseria species. The values obtained for five strains of N. catarrhalis, however, ranged from 42.3 to 45.7%. These results suggest that N. caviae may be more closely related to Neisseria spp. other than N. catarrhalis.