[A chancre instead of cancer]. / Geen kanker, maar een sjanker.

BACKGROUND: Syphilis (lues) is a sexually transmitted infection caused by the spirochete Treponema pallidum. In adolescents, the diagnosis of primary syphilis can be made promptly by taking a sexual medical history and inspecting the glans penis. CASE DESCRIPTION: A 17-year-old male was referred to the paediatric oncology centre for additional diagnostics due to inguinal lymphadenopathy, with a strong suspicion of a malignant lymphoma. None of the physicians took a sexual medical history or investigated the glans penis, as a result of which essential information was lacking. The combination of inguinal lymphadenopathy and the ultrasound findings for the inguinal region made the physicians only consider a malignancy. However, it actually concerned a reactive lymphadenopathy associated with primary syphilis. CONCLUSION: This case demonstrates that a full medical history and thorough physical examination can prevent the need for costly and invasive diagnostics.

Partial matrix excision or orthonyxia for ingrowing toenails.

BACKGROUND: We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. STUDY DESIGN: We conducted a prospective randomized clinical trial with 12-month observer-blinded followup, in the surgical outpatient department of a teaching hospital. We randomized 105 consecutive patients with a total of 109 ingrown toenails to either partial matrix excision (n=58) or an orthonyxia procedure (n=51). The main outcomes measurements were rate of recurrence after 12 months, postoperative morbidity, and time to complete recovery. RESULTS: The 12-month followup was completed in 55 of 58 patients undergoing partial matrix excision and 47 of 51 patients having orthonyxia. There were four ingrown toenails, four recurrences in the partial matrix excision group, and eight in the orthonyxia group (NS, p=0.14). Postoperative morbidity parameters (redness, pus, postoperative bleeding); time to complete recovery, wearing shoes (p < 0.01), and performing activities of daily living and hobbies; postoperative symptoms; and patient satisfaction all favored orthonyxia. CONCLUSIONS: Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.

Telomerase in relation to expression of p53, c-Myc and estrogen receptor in ovarian tumours.

Telomerase activity and its subunits (hTERC, hTERT mRNA) were evaluated in ovarian tumours in relation to the expression of p53, c-Myc and estrogen receptor (ER). Furthermore, relations between telomerase activity, hTERC and hTERT with known clinicopathologic prognostic factors and survival in patients with malignant tumours was investigated. Telomerase activity was determined with TRAP, hTERC and hTERT with RT-PCR, while p53, c-Myc and ER expression with immunohistochemistry. Telomerase activity and hTERT mRNA were more frequently observed in malignant ovarian tumours compared to borderline and benign tumours, whereas hTERC was present in all tumour types. p53 and c-Myc were more frequently detected in malignant compared to borderline and benign tumours. Telomerase activity was positively related to hTERT mRNA, p53 and c-Myc expression, but not to hTERC and ER expression. In malignant tumours, hTERC levels were related to tumour stage, while telomerase activity and hTERT mRNA expression were not related to any clinicopathologic feature. Tumour stage, differentiation grade, residual tumour after first laparotomy and presence of ascites were related to (progression free) survival, whereas telomerase activity or its subunits were not. In conclusion, these data suggest that p53 expression (e.g. p53 mutation) as well as c-Myc expression may have a role in regulation of telomerase activity in ovarian tumours.