CDKN2A germline mutation frequency estimates are commonly based on families with several melanoma cases. When we started counseling in a research setting on gene susceptibility analysis in northern and central Italy, however, we mostly found small families with few cases. Here we briefly characterize those kindred, estimate CDKN2A/CDK4 mutation test yields, and provide indications on the possibility of implementing formal DNA testing for melanoma-prone families in Italy. In September 1995 we started genetic counseling in a research setting at our Medical Genetics Center. Screening for CDKN2A/CDK4 mutations was performed on families with two melanoma patients, one of whom was younger than 50 years at onset, the other complying with one of the following: 1) being a first-degree relative, 2) having an additional relative with pancreatic cancer, or 3) having multiple primary melanomas. Sixty-two of 67 (80%) melanoma cases met our criteria. Four previously described CDKN2A mutations (G101W, R24P, V126D, and N71S) were found in 21 of the 62 families (34%) with a high prevalence of G101W (18/21). The percentage of families with two melanoma cases/family harboring a mutation was low (7%, 2/27), but rose to 45% (9/20) if one of the melanoma patients carried multiple melanomas or if pancreatic cancer was present in that family. In the 15 families with three melanoma cases the presence of a mutation was higher (67%, 10/15) and reached 100% in the 4 families with four or more melanoma cases. Our results suggest that CDKN2A/CDK4 counseling-based mutational analysis may be reasonably efficient also for families with two melanoma cases, if one patient carries multiple melanomas or if pancreatic cancer is present in the family.
CDKN2A germline mutation frequency estimates are commonly based on families with several melanoma cases. When we started counseling in a research setting on gene susceptibility analysis in northern and central Italy, however, we mostly found small families with few cases. Here we briefly characterize those kindred, estimate CDKN2A/CDK4 mutation test yields, and provide indications on the possibility of implementing formal DNA testing for melanoma-prone families in Italy. In September 1995 we started genetic counseling in a research setting at our Medical Genetics Center. Screening for CDKN2A/CDK4 mutations was performed on families with two melanoma patients, one of whom was younger than 50 years at onset, the other complying with one of the following: 1) being a first-degree relative, 2) having an additional relative with pancreatic cancer, or 3) having multiple primary melanomas. Sixty-two of 67 (80%) melanoma cases met our criteria. Four previously described CDKN2A mutations (G101W, R24P, V126D, and N71S) were found in 21 of the 62 families (34%) with a high prevalence of G101W (18/21). The percentage of families with two melanoma cases/family harboring a mutation was low (7%, 2/27), but rose to 45% (9/20) if one of the melanoma patients carried multiple melanomas or if pancreatic cancer was present in that family. In the 15 families with three melanoma cases the presence of a mutation was higher (67%, 10/15) and reached 100% in the 4 families with four or more melanoma cases. Our results suggest that CDKN2A/CDK4 counseling-based mutational analysis may be reasonably efficient also for families with two melanoma cases, if one patient carries multiple melanomas or if pancreatic cancer is present in the family.
The authors report the results of a randomized clinical trial of antibiotic prophylaxis for post-operative infection following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. The aim was to evaluate the efficacy and tolerability of short-term parenteral prophylaxis with teicoplanin; the endpoint of the study was the reduction of wound contamination assessed by microbiologic culture of drain fluid. From October 1990 to March 1992, 38 patients were recruited: 20 patients were included in the antibiotic prophylaxis arm (teicoplanin i.v. 400 mg one hour before operation and in the following 12 h plus 200 mg i.v. at 24 h after operation) and 18 patients in the control group. Analysis of drain fluid showed a higher contamination (15/18=83%) in the control group
(Staphylococcus epidermides, Streptococcus alfa-emoliticus, Enterobacter aerogenes, Peptostreptococcus magnus)as compared to the prophylaxis arm with teicoplanin (2/20=10%) (Staphylococcus coagulase-negative) (p< 0.0001). Moreover, 11 patients in the control group suffered from fever > 37.5 ° C as compared to one patient in the antibiotic prophylaxis group (p<0.0001); the post-operation stay was 13.3+4.3 and 9.0_+1.6 in the control and antibiotic arm, respectively (p = 0.0002). There were no antibiotic related side effect in this study. These results seem to confirm the value of parenteral short-term antibiotic prophylaxis of post-operative infection in this type of "clean" operative procedure.
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