Expression of the caveolins in dermal vascular tumors.

INTRODUCTION: Histopathologic criteria are usually sufficient for the accurate distinction of benign from malignant dermal vascular tumors. A minority of cases, however, pose a vexing diagnostic dilemma. Recent studies suggest that caveolin, a scaffolding cell membrane protein, may prove helpful in predicting the biologic behavior of endothelial-derived neoplasms. METHODS: We analyzed a series of 30 dermal vascular tumors including 12 lobular capillary hemangiomas (LCH), 4 cases of targetoid hemosiderotic hemangiomas (TH), 4 cases of tufted angioma (TA), 12 cases of Kaposi's sarcoma (KS), 4 epithelioid (EH) and 1 spindle cell hemangioendothelioma (SH), and 4 cases of angiosarcoma (AS). The distribution of immunoreactivity was analyzed by quantifying cell membrane staining in each case. RESULTS: There was a statistically significant difference in the expression of caveolin between LCH (mean labeling index=91.6), TH (mean labeling index=89.7), and TA (mean labeling index=87.2) and the cases of KS (mean labeling index=21.6, EH mean labeling index= 23.1), and the AS (mean labeling index=6.3). CONCLUSIONS: These results indicate that antibodies to caveolin may be useful in separating benign and malignant dermal vascular tumors and possibly implicates this peptide in their pathogenesis.

Experience the culture.

The purpose of this article was to describe the Nicaraguan Venture as an experiential learning opportunity for graduate and undergraduate nursing students at the University of Mobile. The recently dedicated Latin American Campus in San Marcos, Nicaragua, was the site chosen for this 10-day experience that provided learning opportunities in both hospital and community nursing for 13 students and 2 faculty. Experience was a powerful teacher for participants who learned to provide culturally competent care in this unique environment. Language was the most important limitation addressed. Flexibility in student opportunities, local community support, and student interpreters from the Latin American campus added to the success of the venture, which will be continued annually.

Detection of tyrosinase mRNA from the blood of melanoma patients.

Surgical therapy for localized melanoma is highly successful. However, if melanoma spreads beyond its primary site, the results of treatment are poor. Therefore, early detection of circulating melanoma cells in the blood may be important. Currently, circulating melanoma cells are undetectable. Tyrosinase is an enzyme in the melanin synthetic pathway the expression of which is only found in melanin-producing cells. Because melanocytes are not normally found in the peripheral blood, we hypothesize that melanoma cells circulating in the peripheral blood could be detected by amplifying the tyrosinase mRNA using the reverse transcription-PCR (RT-PCR). The purpose of this study was to determine the sensitivity of a RT-PCR-based assay for tyrosinase mRNA from peripheral blood and evaluate correlations with tumor status in melanoma patients. RNA was isolated from the peripheral blood or tissue culture cells, and cDNA was prepared. DNA was amplified using RT-PCR with nested primers for tyrosinase and beta(2)-microglobulin. Serial dilution experiments using cells from the SK-MEL-28 cell line were performed in culture media and in whole blood. Twelve patients with melanoma, 10 healthy controls, and 15 patients with nonmelanoma malignancies were tested for tyrosinase expression in peripheral blood. The sensitivity of this assay was determined to be as low as 1 melanoma cell in 5 ml of whole blood. No tyrosinase was found in healthy subjects or other cancer control patients. Tyrosinase mRNA was detected in the blood of five melanoma patients (one stage II, two stage III, and two stage IV). Three of these tyrosinase-positive patients had biopsy-proven evidence of melanoma, whereas the other two had no clinical evidence of malignant disease after surgical resection. The remaining seven melanoma patients had no evidence of disease and tested negative for tyrosinase mRNA. This study suggests that a RT-PCR-based assay for the detection of tyrosinase mRNA in peripheral blood is feasible. Moreover, the presence of tyrosinase mRNA in the blood seems to correlate with the stage of melanoma. Further study and follow-up are needed to clarify the role of tyrosinase mRNA as a tumor marker for malignant melanoma.

Palpable purpura: an algorithmic approach.

Cutaneous vasculitis, secondary to drug reaction, infection or collagen vascular disease, is the most common identifiable cause of palpable purpura. Common causes of palpable purpura often can be identified during the patient's history and physical examination. When this condition occurs in a patient who has not had a known precipitating event, or when the cause is unclear from the history and physical examination, diagnosis may be based on findings of the laboratory investigations and skin biopsy. Many cases of palpable purpura are idiopathic and self-limited. When treatment is necessary, dapsone, colchicine or systemic corticosteroids are useful drugs.

Immunohistochemical assessment of tumor vascularity in recurrent Clark II melanomas using antibody to type IV collagen.

Thin melanomas, measuring 0.76 mm or less, are generally associated with an excellent prognosis. However, a certain subset of these seemingly innocuous lesions have been reported to develop recurrences. Therefore, the predictive values of currently accepted prognostic indicators have been questioned in thin melanomas. Several studies concerning tumor vascularity in melanoma and certain non-melanocytic malignancies suggest that the degree of vascularization correlates with growth rate and biologic aggressiveness. In the present study, we determined the vascularity of a small group of Clark level II melanomas that resulted in recurrence, and compared these results to an equal number of nonrecurrent lesions with similar prognostic indicators. Blood vessels were labeled by immunoperoxidase staining techniques for Type IV collagen, and quantified by image analysis. No statistical difference was found between the two groups when mean blood vessel counts and percent vascular area were measured. The recurrent tumors had a mean PVA of 4.68 compared to 4.34 for the nonrecurrent group (p = 0.677). The mean blood vessel count beneath the recurrent group was 29.6 per 400 x field, and the corresponding value for the nonrecurrent group was 31.8 (p = 0.681). Our data is preliminary within this limited group of tumors, yet it suggests that tumor vascularity is not a distinctive prognostic indicator by which eventual outcome can be predicted in thin Clark level II malignant melanomas.

Family caregivers of institutionalized and noninstitutionalized elderly individuals.

This article provides an overview of the literature that has examined the issues of institutionalization and community care of elderly persons. Specifically, those studies are discussed that report on the family's decision to institutionalize the elderly person and those that report on the effect of institutionalization of the family. Studies about community caregiving that report on caregiver characteristics, the stress of caregiving, and interventions to manage care issues and caregiver stress also are detailed. Implications for nursing research and practice can be derived from the article.

Family caregiver stress: clinical assessment and management.

This intervention study compares the effectiveness of two approaches on caregiving stress reduction. Caregivers' psychobiological symptom experience and coping were profiled over time by identifying the types of stress-related symptoms most frequently experienced. Following pretesting (and selected matching procedures) using family functioning, coping, stress and mental status instruments, random assignment of caregivers was made to one of four groups: educative/didactic, psychotherapeutic/support, placebo, or control. Patients were tested at the end of eight weekly 2-hour sessions and again at 1-, 3-, 6-, and 12-month intervals after treatment. Although both the educative and psychotherapeutic groups were effective interventions for the reduction of strain, the psychotherapeutic/support group was the most effective over time, both at posttest and at the 3-month intervals. Neither group intervention was more effective than the control groups in reducing other types of stress, including anxiety, somatization, or depression. The psychobiological symptoms experienced by caregivers peaked at crisis periods in the caregiving trajectory, or when multiple demands were made of the caregiver during any one point in time.

Element content in tissues of four rodent species sampled in the Geysers geothermal steamfield.

Liver and kidney tissue samples from four rodent species collected in the Geysers geothermal steamfield of northern California were analyzed for content of 28 elements. Element concentrations in samples from the developed region of the Geysers were compared with samples from undeveloped reference regions to determine the influence of geothermal power development on element content in small mammal tissues. Eight elements (B, Ca, Cu, Mg, Mn, P, Sr, Ti) were enriched in samples from the Geysers, 12 (Ag, Al, Co, Cr, Fe, K, Mo, Na, Ni, Pb, Si, Zn) were decreased within the Geysers, Ba and Li were inconclusive, and six (As, Be, Cd, Hg, Sn, V) were below the minimum analytical limits. The longest-lived species (Neotoma fuscipes) had the greatest occurrence of statistically significant differences in element content. Sites in grassland habitat produced more significant differences in element content than either chaparral or streamside habitats for samples from Peromyscus maniculatus. Peromyscus boylii and P. truei provided additional data, but no distinct advantages for element monitoring. The data indicate regional influences from geothermal power development on element levels in rodent tissues.

Manometric evaluation of esophageal disease.

Esophageal manometry has been helpful in delineating several aspects of the pathophysiology of esophageal disease. Its immediate contribution to patient care, however, is not clear. We reviewed our experience with 59 consecutive patients who had been referred to our laboratory specifically for this study. Manometry provided new information resulting in better patient management in only eight patients (14%). Manometric abnormalities are uncommon when radiographs and endoscopy are normal; thus, manometry should rarely be used alone to evaluate subjective complaints. It is useful preoperatively in patients with reflux esophagitis if a motility disorder is suspected and in patients with cricopharyngeal abnormality. After hiatal hernia repair performed with an adequate preoperative radiologic and endoscopic evaluation for reflux esophagitis, esophageal manometry contributes little additional information to the evaluation of postoperative dysphagia.

High-pressure liquid chromatographic analysis of diazepam, oxazepam and N-desmethyldiazepam in human blood.

We describe a rapid method for precisely measuring concentrations of diazepam, oxazepam and N-desmethyldiazepam in blood by high-pressure liquid chromatography. The drugs, together with an internal standard, prazepam, are extracted from 2 ml of blood and analyzed isocratically on a reversed-phase column with a mobile phase consisting of acetonitrile-0.01 M sodium acetate buffer (35:65 v/v). The eluted drugs are detected by their absorption at 240 nm. The sensitivity of this method is 30 microgram/l for oxazepam and N-desmethyldiazepam, 40 microgram/l for diazapam, for 2-ml blood samples. Relative recovery of added drugs to blood varies from 91 to 110%. The day-to-day precision (coefficient of variation) established by 10 replicate analyses was 2.8 to 9.6%.