The most common primary tumors are lung in men and breast in women; oral metastases from colorectal primary are exceedingly rare. In fact, gingival metastasis is a very rare and late presentation Rapamycin clinical trial of colorectal carcinoma, and the consequent survival is just a few weeks or months. The gross appearance of gingival metastasis may be indistinguishable from other benign buccal lesions, such as pyogenic granuloma and giant cell granuloma. Histological examination with immunohistochemical

techniques is thus essential to confirm the diagnosis. Gingival metastasis can cause progressive discomfort, such as pain or bleeding, as illustrated in our case. Therefore, even in cases with advanced or disseminated disease, palliative treatment such as radiotherapy is necessary to improve the quality of life of patients. In selected cases with solitary oral metastasis, surgical resection can be considered. Contributed by “
“We read with interest the letter by Kershenobich et al. in Hepatology regarding the meta-analysis of randomized trials comparing Nutlin-3a supplier pegylated interferon (PEG-IFN) alpha-2a and alpha-2b in the treatment of chronic hepatitis C (CHC) by Awad et al.1, 2 We agree regarding the importance of a uniform study population

in treatment-naïve patients with CHC. This is especially true for the study by Laguno et al., which included patients coinfected with human immunodeficiency virus (HIV).3 We performed a meta-analysis of four available studies comparing PEG-IFN alpha-2a and peginterferon alpha-2b in the treatment of patients with

CHC who have concomitant HIV coinfection: one randomized,3 one prospective–retrospective,4 and two prospective studies5, 6 with one of them reported Bay 11-7085 as an abstract.6 A total of 1009 patients (581 treated with PEG-IFN alpha-2a; sample size, 63-557; mean age, 41 years; 69%-75% males) were treated in the four studies.3-6 Pooled analysis of the data showed that the odds of achieving rapid virologic response (RVR), early virologic response (EVR), and sustained virologic response (SVR) were similar with PEG-IFN alpha-2a and PEG-IFN alpha-2b (Table 1). Similarly, the odds of treatment discontinuation due to serious adverse effects were similar with PEG-IFN alpha-2a and PEG-IFN alpha-2b (Table 1). The data were homogeneous for all the analyses. There was no evidence to indicate any publication bias. After excluding the study reported as an abstract, the results with the two PEG-IFN compounds were still similar. The SVR rates were 36% and 35% with PEG-IFN alpha-2a and PEG-IFN alpha-2b, respectively. Subgroup analyses of the SVR based on the genotype status (genotype 1 or 4 and genotype 2 or 3) and viral load showed similar efficacy and safety data for the two types of PEG-IFN. The data were homogeneous without any suggestion of publication bias in all the analyses.