Expression of AKR1C3 Protein in Human Keloid Skin Tissue

BACKGROUND: Keloids are abnormal wound responses that are caused by hyperproliferative growth of connective tissue during the healing process. Recent research findings introduced the roles of reactive oxygen species (ROS) in the process of keloid formation. ROS induces oxidative stress and promotes the activities of oxidative damage-inducible genes. Aldo-keto reductase 1C3 (AKR1C3) prevents destructive ROS toxicity by detoxification of reactive carbonyl species. Thus, this study aimed to compare the expression of AKR1C3 in both normal and keloid skin in vivo. METHODS: Six specimens of normal skin and six specimens of keloid tissues from human subjects were used to evaluate the expression of AKR1C3 by immunofluorescent staining of tissues and western blotting. RESULTS: By western blotting, it was confirmed that the amount of AKR1C3 protein is significantly reduced in keloid tissues compared to normal tissues. Weak expression of AKR1C3 was also found in keloid tissues by immunofluorescent staining. CONCLUSIONS: This study confirmed that the expression of AKR1C3 protein participates in ROS metabolism and plays a part in the downregulation of human keloid formation. To the best of our knowledge, this is the first work that reveals that AKR1C3 can affect the formation of keloids.

Cutaneous Fusariosis in Unprotected Snake Bite Wound of Farmer's Hand

No abstract available.

Oxidative Damage and Nuclear Factor Erythroid 2-Related Factor 2 Protein Expression in Normal Skin and Keloid Tissue

BACKGROUND: Reactive oxygen species (ROS) play an important role in the induction of apoptosis under pathological conditions. Recently, a significant increase in ROS production and disrupted apoptosis mechanisms in keloids have been reported. Nuclear factor erythroid 2-related factor 2 (Nrf2) represents one of the most important cellular defense mechanisms against oxidative stress and is implicated in the regulation of apoptosis. Recently, it has been reported that Nrf2 upregulates Bcl-2, an anti-apoptotic protein. OBJECTIVE: To compare Nrf2 protein expression in normal skin tissues to keloid tissues. METHODS: ROS generation in keloid tissues was evaluated with OxyBlot analysis. Western blotting and/or immunohistochemical staining approaches were used to study expression of Nrf2 or Bcl-2 in keloid and normal skin tissues. Cellular fractionation was performed to examine subcellular distribution of Nrf2. Transfection of fibroblasts with Nrf2-specific small interfering RNA (siRNA) was conducted to understand the relationship between Nrf2 expression and apoptosis induction. RESULTS: Protein oxidation, a marker of oxidative stress, is increased in keloid tissues. Western blot analysis clearly showed that Nrf2 and Bcl-2 are downregulated in keloid tissues. Immunohistochemical staining of Nrf2 confirmed the results of the western blot analysis. Transfection of fibroblasts with the Nrf2-specific siRNA results in increased apoptosis and decreased cell viability. CONCLUSION: Collectively, our data indicate that Nrf2 expression is downregulated in keloid tissues, and that Nrf2 is involved in the development of apoptosis in Nrf2 siRNA-transfected fibroblasts. We propose that a defective antioxidant system and apoptotic dysregulation may participate in keloid pathogenesis.

Oxidative Damage and Nuclear Factor Erythroid 2-Related Factor 2 Protein Expression in Normal Skin and Keloid Tissue

BACKGROUND: Reactive oxygen species (ROS) play an important role in the induction of apoptosis under pathological conditions. Recently, a significant increase in ROS production and disrupted apoptosis mechanisms in keloids have been reported. Nuclear factor erythroid 2-related factor 2 (Nrf2) represents one of the most important cellular defense mechanisms against oxidative stress and is implicated in the regulation of apoptosis. Recently, it has been reported that Nrf2 upregulates Bcl-2, an anti-apoptotic protein. OBJECTIVE: To compare Nrf2 protein expression in normal skin tissues to keloid tissues. METHODS: ROS generation in keloid tissues was evaluated with OxyBlot analysis. Western blotting and/or immunohistochemical staining approaches were used to study expression of Nrf2 or Bcl-2 in keloid and normal skin tissues. Cellular fractionation was performed to examine subcellular distribution of Nrf2. Transfection of fibroblasts with Nrf2-specific small interfering RNA (siRNA) was conducted to understand the relationship between Nrf2 expression and apoptosis induction. RESULTS: Protein oxidation, a marker of oxidative stress, is increased in keloid tissues. Western blot analysis clearly showed that Nrf2 and Bcl-2 are downregulated in keloid tissues. Immunohistochemical staining of Nrf2 confirmed the results of the western blot analysis. Transfection of fibroblasts with the Nrf2-specific siRNA results in increased apoptosis and decreased cell viability. CONCLUSION: Collectively, our data indicate that Nrf2 expression is downregulated in keloid tissues, and that Nrf2 is involved in the development of apoptosis in Nrf2 siRNA-transfected fibroblasts. We propose that a defective antioxidant system and apoptotic dysregulation may participate in keloid pathogenesis.

Expression of Nuclear Factor Erythroid 2 Protein in Malignant Cutaneous Tumors

BACKGROUND: Reactive oxygen species (ROS) damages cell molecules, and modifies cell signaling. The nuclear factor E2-related factor (Nrf2) is a critical transcription regulator, which protects cells against oxidative damage. Nrf2 expression is increased in a large number of cancers. However, little information has been reported regarding the expression of Nrf2 in skin cancers. Hence, we explored the expression of Nrf2 protein in skin cancers. METHODS: The Nrf2 protein expression in 24 specimens, including 6 malignant melanomas (MM), 6 squamous cell carcinomas (SCC), 6 basal cell carcinomas (BCC), and 6 normal skin tissues, was evaluated by western blotting. Immunohistochemical staining was performed. The expression of Kelch-like ECH-associated protein 1 (Keap1), the key regulator of Nrf2, was also analyzed by western blotting. RESULTS: Small interfering RNA transfection to the melanoma cell line G361 confirmed that an approximately 66 kDa band was the true Nrf2 band. The western blot revealed that the Nrf2 protein was definitely expressed in normal skin tissues, but the Nrf2 expression was decreased in MM, SCC, and BCC. Immunohistochemical examination showed that expression of Nrf2 was decreased in all skin cancer tissues compared to the normal skin tissues. Keap1 was not expressed in all malignant skin tumors and normal skin tissues by western blot. CONCLUSIONS: ROS was increased in various types of cancers which proteins were highly expressed or underexpressed. This study demonstrated that the expression of Nrf2 protein was down-regulated in human malignant skin tumors. We suggest that decreased expression of Nrf2 is related to skin cancers.

Characteristics of Dermoid Cyst of the Auricle

BACKGROUND: Dermoid cysts of the auricular area are extremely rare. We report on six cases of auricular dermoid and epidermoid cyst, and differentiate dermoid cyst from epidermal cyst along with a review of the literature. METHODS: Three cases involved a gradually enlarging mass of the superior and anterior aspect of the helix of their ear. Another two cases were located in the posterior aspect of the ear. RESULTS: During the operation, a tumor was found just under the skin, not fixed mastoid or adjacent cartilage. Histologically, all specimens contained desquamated squamous epithelium and keratin in the lumen. However, two cases of posterior masses showed the presence of adnexal structures and three cases did not. CONCLUSION: A key in diagnosis of the dermoid cyst is the presence of adnexal structures. If the wall does not bear adnexal structures, the term epidermoid or keratin cyst is applied. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Finally, the congenital epidermoid cyst grew at the upper part of the auricle; however, the dermoid cyst grew at the lower and posterior part of the auricle.

A Solitary Neurofibroma of the Small Finger Associated with Trauma

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately 15x20 mm which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.

Analysis of Anatomical Relationship between Stensen's Duct and Buccal Branch of Facial Nerve

BACKGROUND: When using the anterior approach for performing superficial parotidectomy, the first thing to do is to find the buccal branch of the facial nerve and the parotid duct. The buccal branch usually runs transversely with the parotid duct from the anterior border of the parotid gland. We wanted to check the relationship between the two structures during the operation and to get clinically helpful information. METHODS: Twelve patients with parotid mass were treated with superficial parotidectomy between May 2012 and August 2012. The outline of superficial and deep lobes of the parotid gland, parotid duct, and the buccal branch of the facial nerve were drawn on the transparent film by tracing the structures intraoperatively. RESULTS: In 7 (58.3%) of 12 cases, the buccal branch of the facial nerve was located more caudally than the parotid duct at the anterior border of the superficial lobe of the parotid gland. In 3 cases (25%), the buccal branch was located more cephalically than the parotid duct. The mean distance between two structures were 2.54+/-1.48 mm. In 11 cases, the parotid duct was located deeper than the buccal branch. CONCLUSION: The buccal branch of the facial nerve tends to be located more caudally than parotid duct and runs more superficially than parotid duct in all cases. We identified the relationship between the parotid duct and the buccal branch of the facial nerve during the operations on living subjects, not from the cadavers, so it would be a clinically helpful study which supplied more accurate anatomical information.

Anatomic Study of the Vessels of the Digital Nerves in the Fingers

PURPOSE: The vessels of peripheral nerves have been extensively studied since Breidenbach used vascularizd nerve grafts. Tayor and Pinel studied the course and distribution of the vessels of peripheral nerves. However, the vessels of digital nerves are still not well known. The objective of this study was to prove vessels of digital nerves and to investigate the pathway of that. MATERIALS AND METHODS: 36 patients and 2 fresh human cadavers were studied under the microscope and histologic sections under the light microscope. RESULTS: We found that digital nerves had own arterioles and venules as well as peripheral nerves. This small vessels of digital nerves paralleled the digital nerves or run in a spiral. Digital nerves were abundantly vascularized throught their length by a succession of vessels and by their repeated divisions and anastomoses. CONCLUSIONS: The clinical implications of this results can be discussed in relation to the dissection of nerves, the possibility of vasculized nerve grafts.

Botulinum Toxin A Treatment for Cervical Dystonia Resulting in Endoscopic Thyroidectomy: A Case Report

PURPOSE: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia(CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A(BTA, Botox(R), Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. METHODS: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1mL solution was administered in a 1mL tuberculin syringe. RESULTS: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. CONCLUSION: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.

A Case of Generalized Pyoderma Gangrenosum Involving Scalp and Face

PURPOSE: Pyoderma gangrenosum is a rare inflammatory, reactive dermatosis marked by painful cutaneous ulcer. The causes of pyoderma gangrenosum remain unclear. Gastrointestinal, hematological, rheumatological, and immmune disorders may be associated with pyoderma gangrenosum. The appearance of this disease may range from mild skin ulcers to life-threatening conditions. Generalized multiple ulcerative pyoderma gangrenosum is very rare. Here we report our experience with a case of multiple ulcerative pyoderma gangrenosum accompanied by ulcerative colitis. METHODS: A 67-year-old man had cutaneous ulcers at multiple sites including the scalp, face, chest, abdomen, hands, and buttocks. He also developed gastrointestinal symptoms such as intermittent dyspepsia and bloody excrement. Debridement and irritation aggravated the disease progress. We gave a diagnosis of pyoderma gangrenosum with ulcerative colitis based on the clinical appearance and biopsy. The patient was treated with systemic intravenous steroid therapies and careful wound cares. Ulcers of the scalp and buttocks were treated with split thickness skin grafts. RESULTS: Most of the multiple cutaneous ulcers were treated by systemic intravenous steroid therapies and wound cares. The rest of the ulcers were treated with skin grafts. Systemic intravenous steroid therapy was used to treat the ulcerative colitis. CONCLUSION: Generalized multiple ulcerative pyoderma gangrenosum is very rare. Without making an accurate diagnosis, hasty surgical treatments could aggravate the progression of the disease. Additionally, care should be taken to systemically treat underlying disease as well as administrating local treatments for the skin lesions. Intravenous systemic steroid therapy and skin grafts are useful treatments for generalized pyoderma gangrenosum.

Reconstruction of Hard Palatal Defect using Staged Operation of the Prelaminated Radial Forearm Free Flap

PURPOSE: The radial forearm fasciocutaneous free flap is currently considered as the ideal free flap for reconstruction of mucosal and soft tissue defects of the palate. But the availability of stably attached oral and nasal mucosal lining is needed. In addition to this, for better operation field, operating convenience and esthetics, we planned a prelaminated radial forearm free flap. METHODS: A 64-year-old male patient was admitted due to a 4x4.5cm full through defect in the middle of the hard palate caused by peripheral T cell lymphoma with actinomycosis. In the first stage, the radial forearm flap was elevated, tailored to fit the hard palate defect, and then it positioned up-side down with split thickness skin graft. Two weeks later, the prelaminated radial forearm free flap was re-elevated and transferred to the palatal defect. One side covered with grafted skin was used to line the nasal cavity, and the other side(the cutaneous portion of the radial forearm flap) was used to line the oral cavity. RESULTS: The prelamination procedure was relatively easy and useful. The skin graft was well taken to the flap. After 2nd stage operation, the flap survived uneventfully. There was no prolapse of the inset flap into the oral cavity and the cutaneous portion of the flap was mucosalized. The procedure was very successful and the patient can enjoy normal rigid diet and speech. CONCLUSION: The use of prelaminated radial forearm free flap for hard palate reconstruction is an excellent method to restore oral function. Based upon the result of this case, microvascular free flap transfer with prelaminated procedure is a valid alternative to the prosthetic obturator for palatal defect that provides an improved quality of life. It should be considered as an integral component of head and neck cancer therapy and rehabilitation.

A Clinical and Histopathologic Study on Actinic Keratosis in the Province of Chungcheongnam-do / 대한피부과학회지

BACKGROUND: Actinic keratoses (AK) have been recognized as precancerous lesions, they have been recently considered to be an early in situ squamous cell carcinoma (SCC). However, there have been few studies to determine the clinical and histopathological characteristics of AK, and especially in the Province of Chungcheongnam-do. Objective: The purpose of this study was to evaluate the clinicopathological characteristics of 80 cases of AK in the province of Chungcheongnam-do. METHODS: The authors evaluated the clinical and histopathological features of 80 patients with AK at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. RESULTS: The ratio of male to female patients was 1:4.7. The age distribution ranged from 42 to 93 years old. Single lesions are more common than multiple lesions. The duration of lesions was variable with a mean duration of 25.1 months. The most commonly involved sites were the face and especially the cheek. The color was erythematous in 63.3% of the cases, brownish in 24.5%, dark-brownish in 9.5% and gray in 2.7%. Crust and scale were noted in 37.4% and 22.4% of the cases, respectively. SCC was associated with AK in 6.3% of the cases, basal cell carcinoma was associated with AK in 1.3%, and keratoacanthoma in 1.3%. The most common histopathological types of AK were atrophic types in 20.6%, and this was followed by the hypertrophic types in 18.6% of the cases and the hypertrophic and atrophic types in 14.7% of the cases. CONCLUSION: Our results are similar to those of the previous reports. In addition, we observed a consistently higher incidence in females than males in the Korean reports and a more frequent incidence of single lesions than multiple lesions in the Asian reports. We found that AK is not easily distinguishable from SCC both clinically and cytologically. Thus, we suggest that biopsies and active treatments should be performed on AK lesions.

A Clinical and Histopathologic Study on Actinic Keratosis in the Province of Chungcheongnam-do / 대한피부과학회지

BACKGROUND: Actinic keratoses (AK) have been recognized as precancerous lesions, they have been recently considered to be an early in situ squamous cell carcinoma (SCC). However, there have been few studies to determine the clinical and histopathological characteristics of AK, and especially in the Province of Chungcheongnam-do. Objective: The purpose of this study was to evaluate the clinicopathological characteristics of 80 cases of AK in the province of Chungcheongnam-do. METHODS: The authors evaluated the clinical and histopathological features of 80 patients with AK at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. RESULTS: The ratio of male to female patients was 1:4.7. The age distribution ranged from 42 to 93 years old. Single lesions are more common than multiple lesions. The duration of lesions was variable with a mean duration of 25.1 months. The most commonly involved sites were the face and especially the cheek. The color was erythematous in 63.3% of the cases, brownish in 24.5%, dark-brownish in 9.5% and gray in 2.7%. Crust and scale were noted in 37.4% and 22.4% of the cases, respectively. SCC was associated with AK in 6.3% of the cases, basal cell carcinoma was associated with AK in 1.3%, and keratoacanthoma in 1.3%. The most common histopathological types of AK were atrophic types in 20.6%, and this was followed by the hypertrophic types in 18.6% of the cases and the hypertrophic and atrophic types in 14.7% of the cases. CONCLUSION: Our results are similar to those of the previous reports. In addition, we observed a consistently higher incidence in females than males in the Korean reports and a more frequent incidence of single lesions than multiple lesions in the Asian reports. We found that AK is not easily distinguishable from SCC both clinically and cytologically. Thus, we suggest that biopsies and active treatments should be performed on AK lesions.

The Treatment for Mandibular Condyle Fracture of Children by a Threaded Kirshcner Wire and External Rubber Traction

PURPOSE: The treatment of children mandibular condyle fracture that is severely displaced is controversial. The conservative treatment of it may lead to complications- mandibular deficiency, asymmetry, malocclusion and temporomandibular joint dysfunction. Moreover, open reduction carries risks for growth retardation, facial nerve injury, scarring and joint stiffness. The aim of this article is to present an alternative technique of the treatment by using a threaded Kirschner wire and external rubber traction. METHODS: From November 2005 to May 2008, three patients underwent the management by using a threaded Kirschner wire and external rubber traction. A threaded Kirschner wire was inserted in the condylar segment by using a C-arm. We applied the external rubber traction, and we reducted the segment progressively until complete reduction. The mandibular-maxillary fixations were removed after 3 weeks, and patients were sent to training for mouth opening. RESULTS: The technique didn't result in complications- joint dysfunction, facial nerve injury, sore, infection and nonunion during follow-up period. Radiologic follow-up examinations revealed correct reduction in all patients. In all cases, we found restoration of preinjury occlusion and temporomandibular joint function. CONCLUSION: Closed reduction of children mandibular condyle fracture by using a threaded Kirschner wire and external rubber traction did achieve anatomic reduction and restore mandibular height. This alternative technique is simple, effective, inexpensive, easy to apply and minimally invasive.

Surgical Treatment of Sacrococcygeal Pilonidal Sinus with the Partial Deepithelized Gluteal Transposition Flap

PURPOSE: Pilonidal sinus is a frequent disease that occurs mostly in hairy young men, defined as chronic inflammation and infection of the postsacral sinuses. Wide excision of the affected area is the treatment of choice. Many techniques have been described to cover the defect. However none appears to be the ideal procedure to prevent infection, recurrence, and delayed wound healing. We present the results of an alternative technique that we performed by using partial deepithelized gluteal transposition flap for reconstruction of the defect following wide excision. METHODS: From October 2004 to September 2007, we performed the partial deepithelized gluteal transposition flap method on 6 patients. We modified the transposition flap techniques by deepithelialising the medial parts of the flap and burying them under the opposing edge of the flap. The results were compared with previous studies and evaluated regarding duration of surgery, size of defect, hospitalization periods, and complications. RESULTS: All the flaps were healed well with no partial or complete loss of the flap. Hospitalization and immobilization periods were acceptably shortened. Recurrence was not seen. The aesthetic outcome was also satisfactory and all patients were satisfied with the results. CONCLUSION: The main advantage of our techniques is using healthy tissues to obliterate the dead space, to provide an extra-cushion, and to prevent deep dehiscence. We believe that the partial deepithelized gluteal transposition flap is a good alternative method for treatment of pilonidal sinus.

Clinical Experiences of PTGC(Progressively Transforming Germinal Center) in Neck Lymph Nodes

First described in 1975 by Lennert and Muller-Hermelink, progressively transforming germinal centers(PTGC) are follicular structures that are at least two to three times the diameter of a reactive follicle and are composed of small B lymphocytes with scattered centroblasts and follicular dendritic cells. PTGC may resemble the nodules of lymphocyte predominance Hodgkin's disease(NLPHD) and are often seen in lymph nodes involved by NLPHD. The distinction between NLPHD and PTGC are difficult because of their histologic similarities. Many authors performed an immunohistochemical study to determine whether there might be immunophenotypic differences between these two processes to aid in the differential diagnosis. We experienced PTGC in sibling and two cases is presented with the review of literatures.