Expression of MAGE-C1/CT7 and MAGE-C2/CT10 Predicts Lymph Node Metastasis in Melanoma Patients

MAGE-C1/CT7 and MAGE-C2/CT10 are members of the large MAGE family of cancer-testis (CT) antigens. CT antigens are promising targets for immunotherapy in cancer because their expression is restricted to cancer and germ line cells and a proportion of cancer patients presents with immune responses against CT antigens, which clearly demonstrates their immunogenicity. This study investigates the expression of MAGE-C1/CT7 and MAGE-C2/CT10 in primary and metastatic melanoma. Immunohistochemical staining of tissue microarrays that consisted of 59 primary malignant melanomas of the skin, 163 lymph node and distant melanoma metastases and 68 melanoma cell lines was performed. We found MAGE-C1/CT7 expression in 15 out of 50 (24%) primary melanomas and 15 out of 50 (24%) cell lines, whereas MAGE-C2/CT10 was detected in 17 out of 51 (33%) primary melanomas and 14 out of 68 (17%) cell lines. MAGE-C1/CT7 and MAGE-C2/CT10 were both detected in 40% of melanoma metastases. Patients with MAGE-C1/CT7 or MAGE-C2/CT10 positive primary melanoma had significantly more lymph node metastases (p = 0.005 and p<0.001, resp.). Prediction of lymph node metastasis by MAGE-C1/CT7 and MAGE-C2/CT10 was independent of tumor cell proliferation rate (Ki67 labeling index) in a multivariate analysis (p = 0.01). Our results suggest that the expression of MAGE-C1/CT7 and MAGE-C2/CT10 in primary melanoma is a potent predictor of sentinel lymph node metastasis

Efficacy of bath psoralen plus ultraviolet A (PUVA) vs. system PUVA in psoriasis: a prospective, open, randomized, multicentre study

BACKGROUND: Plaque psoriasis is an inflammatory disease affecting approximately 2% of the population. The clinical hallmarks of psoriasis are sharply demarcated, erythematous plaques with thick scales. Photochemotherapy (psoralen plus ultraviolet A, PUVA) is one of the most effective therapies of psoriasis. The photosensitizer 8-methoxypsoralen (8-MOP) can be applied either orally (system PUVA) or topically in a warm water bath (bath PUVA). OBJECTIVES: To compare bath PUVA and system PUVA in the treatment of plaque psoriasis. METHODS: This was a randomized, open, prospective, multicentre trial. We included 74 patients with moderate-to-severe plaque psoriasis during a 6-week treatment and a 4-week follow-up period. Of the patients enrolled in the study, 38 received bath PUVA and 36 system PUVA. RESULTS: Both treatment modalities significantly reduced the median Psoriasis Area and Severity Index (PASI) score in the intention-to-treat population. Within 6 weeks bath PUVA reduced the median PASI by 74% (16·4 to 4·2) while system PUVA did so by 62% (15·3 to 5·8). The difference between the two modalities was not significant with regard to treatment efficacy (P = 0·389). CONCLUSION: There is no difference between bath PUVA and system PUVA in the treatment of psoriasis

Audit of outpatient department management of patients with respiratory symptoms in Lilongwe

Setting: 6 outpatient departments (OPD) of 3 hospitals and 2 health centres in Lilongwe. Objective: To assess the existing health worker practice in providing care to patients with respiratory symptoms in the OPD. Methods:Between 1 and 31 July 2002 exit interviews were conducted with patients from OPD consultation rooms and possessing a prescription for respiratory diseases. Verbal confirmation of the patients\' complaints was done, patients\' OPD notes were reviewed and a questionnaire was completed. Data was collected for patients aged 5 and above. Results: 3001 patients with median age of 27 years were enrolled in the study. 1203 (40%) were male. 80% had made several visits to the OPD with the same symptom. In some cases verbal reports of main symptoms did not match with those recorded on OPD notes. 511 (17%) patients reported that a clinician listened to their chest. Antibiotics were prescribed to 2501 (83.3%) patients for various respiratory complaints. Similarly analgesics were prescribed to 2671 (89%) patients. Steroids were prescribed to 32 (1.2%) patients and a bronchodilator was prescribed to 185 (6.2%) patients. Only 56 (2%) patients were referred to another level of care. Conclusion: Management of patients with respiratory symptoms in Lilongwe is characterised by increased usage of antibiotics, analgesics and inability of health workers to examine the patients\' chests. Referral to other care facilities is also uncommon. More investigations are required to understand the causes of this practice so that corrective measures are designed and implemented. Malawi Medical Journal Vol. 17(2) 2005: 36-3