Immunohistochemical detection of V600E BRAF mutation is a useful primary screening tool for malignant melanoma.

BACKGROUND: We compared the use of an immunohistochemical (IHC) method using a monoclonal antibody to BRAF V600E (which detects the main BRAF mutation) with existing DNA probe screening in tissue samples from 71 patients with malignant melanoma. MATERIALS AND METHODS: Paraffin blocks were cut to provide consecutive slides for haematoxylin and eosin staining, and for known positive micro-array DNA control material. IHC was performed by the Optiview detection system. All slides were scored independently by the clinical lead and the laboratory lead using a positive/negative system. RESULTS: The DNA method found 26 samples to be positive, the IHC found 21 to be positive, giving a sensitivity value for IHC of 80.8%. However, all of the 45 samples found to be negative by DNA were also negative by IHC, giving a specificity of 100%. There were 66 instances of full agreement, giving a concordance of 93%. Together, these data give a kappa statistic of 0.843, indicating very good agreement. CONCLUSION: The data reveal a very close link between the two methods, supporting the use of the V600E as a primary screen for BRAF mutations in malignant melanoma. Samples found to be negative by this method may be retested by the DNA probe method. IHC detection conserves patient DNA from tumour blocks as only one section is required to perform the assay. The V600E antibody method is considerably cheaper and faster than the DNA probe assay, with a turn-around time of 24-48 hours, enabling more rapid clinical management.

Perioperative management of and recommendations for antithrombotic medications in dermatological surgery.

With the ever-increasing number of patients on anticoagulant or antiplatelet medications presenting for a dermatological surgical procedure, dermatological surgeons are facing the challenge of managing these drugs in order to balance the bleeding complications against the risk of thromboembolic events. The difficulty arises from the scarce available recommendations, the data in the literature that is in part contradictory and the rate of emergence of newer agents that have not been thoroughly studied and widely used. Although the common approach in the past was to stop any antithrombotic medications, including warfarin and aspirin, several days prior to cutaneous surgery, recent data suggest that this practice should be changed as the relatively low risk of bleeding does not justify the life-threatening nature of a likely thrombosis. For patients on warfarin, surgery should be avoided if the international normalized ratio is > 3·5; aspirin should not be stopped prior to dermatological surgery and in most other circumstances patients taking long-term antithrombotic medication should not stop this prior to dermatological surgery. In more complicated cases liaison with the prescriber is indispensable even when the therapy should be discontinued for a short period of time. This review studies the available data and presents the dermatological surgeon with up-to-date information about all studies concerning the old and new antithrombotic agents in the setting of dermatological surgery procedures. Our aim is to propose our recommendations based on the most recent evidence and our experience and provide a comprehensive approach to the dermatological surgeon without excluding the need for individual assessment of each case.

Topical timolol maleate for treatment of infantile haemangiomas: preliminary results of a prospective study.

An infantile haemangioma (IH) is a benign tumour of infancy. The standard approach to uncomplicated lesions is 'wait and see', but active intervention is sometimes preferred to avoid the unpredictable risk of cosmetic disfigurement. Topical beta-blockers were recently introduced as an effective alternative in such cases, but data are still lacking. We report the initial phase of a prospective study evaluating the efficacy and safety of topical timolol gel for IH, and present the interim analysis of the first 25 patients who completed a 6-month course of treatment. These 25 patients, with 39 localized, superficial haemangiomas, were treated with timolol 0.1% gel for 6 months and evaluated at 4-week intervals using the Physician's Global Assessment Score; the mean change was an 85% improvement from baseline, and complete clearance was achieved in four children. The treatment was more effective for plaque than for nodular lesions, and for proliferating than for involuting lesions. No side-effects were seen or reported. These early data confirm that timolol is a very effective and relatively safe treatment for small, localized, superficial IHs.

[Preclinical studies of Pharmachem's teravit]. / Niakoi predklinichni izsledvaniia na teravit "Farmakhim".

Studied was the preparation Teravit Pharmachim in terms of its physical and chemical properties, antimicrobial activity, resorption, retention, and distribution, within the body of chickens and albino rats. It was found that Teravit Pharmachim was strongly sensitive to light, slightly hygroscopic, and relatively heat resistant. It showed good antimicrobial activity with regard to both Gram-positive and Gram-negative organisms. At 60-day feed application to albino rats at the rates of 30 and 300 mg/kg it stimulate the growth of test animals, and at the rate of 1500 mg/kg it delayed their development but did not produce negative effects on the red and white blood picture. Teravit Pharmachim was shown to bind the proteins of the body liquids and tissues, which depended on the biologic substrate and the antibiotic concentration. At the single oral application (chickens) or the administration with feed in the course of 60 days (albino rats) Teravit Pharmachim was resorbed depending on the dose, was retained in the blood, and was further followed up in the internal organs. It was eliminated from the body for about 3 to 5 days, did not cumulate in the ovarian follicles, and was not excreted with the eggs.