Immunohistochemical Expression of Stem Cell Markers during the Wound Healing Process of Cutaneous Burn

PURPOSE: A cutaneous wound healing requires a well-orchestrated integration of the complex biological and molecular events of cell migration and proliferation, extracellular matrix deposition, angiogenesis and remodeling. Finally, skin regeneration is the main goal. Stem cells are self-renewing multipotent progenitors with the broadest developmental potential in a given tissue at a given time. The aim of this study was to examine the role of stem cells during the wound healing process of cutaneous burn in hairless mice by using immunohistochemical stainings (nestin, cytokeratin 15 and CD31). METHODS: Each mouse received 2 burns at the dorsal area by applying a metal stick heated in boiling water. Burn wound sites were dressed with duoderm. The mice were sacrificed at 0, 2, 7, 14 and 21 days after burn. Histological findings and immunohistochemical expression for stem cell markers were observed. RESULTS: Nestin was expressed in the stromal cells beneath the epidermis, hair follices, dermal cysts and endothelial cells. Cytokeratin 15 was expressed in the epidermis except in basal cells. On 7 and 14 days after burn, the regenerated epidermis didn't express cytokeratin 15. CD31 was expressed in the endothelial cells on 7 and 14 days after burn. The amount of nestin expression was the highest. CONCLUSION: Our results showed that nestin may have various effects on burn wound healing. Cytokeratin 15 was expressed before burn and after burn. It is likely that other cytokeratin may stimulate epithelial regeneration. CD31 may act in vascular regeneration during burn healing.

The Wound Healing Effect of a Silk Fibroin Film on Cutaneous Burn of Hairless Mice

PURPOSE: The aim of this study was to examine the effects of silk fibroin film on wound healing of cutaneous burn in hairless mice by using microscopic findings and stem cell markers (nestin, cytokeratin 15) and ki-67 proliferation marker. METHODS: Each mouse received two burns at the dorsal area by applying a metal rod heated with boiling water. Burn wound sites were dressed with Silk Fibroin Film and duoderm (SF group), Aquacel hydrofiber and duoderm (AC group) and duoderm only (Control group). All groups were covered externally with duodermas adhesive bands. Those mice were sacrificed at zero, two, seven, fourteen and twenty one days after burn. Histological findings and immunohistochemical staining for stem cell markers were observed. RESULTS: In SF group, inflammatory cell infiltration, formation of granulation tissue and inflammatory foci are greater than in AC and control group. Those factors appear to enhance mesenchymal stem cell markers such as nestin. Finally mesenchymal tissue regeneration was enhanced. In addition, the length of ki-67 expressed re-generating epithelium, which appeared to be associated with epithelial regeneration, was the longest in SF group. CONCLUSION: The results show that the wound healing effect of SF is the best among other treatment materials including AC in the experimental group and duoderm in the control group through mesenchymal regeneration and epithelial regeneration which are essential factors for wound healing.

Exit site infection in continuous ambulatory peritoneal dialysis single center experience / 대한내과학회지

BACKGROUND: Catheter-related infection is one of the most important causes of technical failure in peritoneal dialysis patients. We have examined the incidence and etiology of exit-site infection (ESI) at Keimyung University Dongsan medical center. METHODS: Between January 2001 and December 2003, 292 new patients received peritoneal dialysis using double cuffed straight Tenckhoff catheter and were reviewed retrospectively. RESULTS: In 292 patients, 81 (27.7%) patients experienced ESI and a total of 97 episodes of ESI has occurred during study period. The overall incidence of peritonitis during peritoneal dialysis was 0.27 episodes/patient-year. According to Twardowski's classification, equivocal infection in 14.4%, acute infection in 68.1% and chronic infection in 17.5% were noted. Staphylococcus aureus was the most frequently isolated organism, followed by Staphylococcus epidermidis, and Pseudomonas aeruginosa. The duration of treatment was significantly longer in chronic infection group than acute infection group (44.6 days vs. 18.5 days, p<0.05). The rates of Pseudomonas infection (p<0.05) and catheter replacement (p<0.05) were significantly higher in the chronic infection group than in the acute infection group. There was one catheter loss due to refractory peritonitis and three deaths unassociated with ESI during mean follow-up of 20.3 months. CONCLUSIONS: Exit-stie infection is still a major causes of peritonitis and catheter failure. Because of suboptimal quality of practice guideline, additional studies on the definition, prevention and treatment of ESI are required.

A Case of Primary Duodenal Carcinoid Tumor / 대한소화기내시경학회지

Carcinoid tumors are slow growing, rare neoplasms that arise from enterochromaffin cells, with malignant potential. Primary duodenal carcinoid tumors are rare, the reported incidence being 2.0 ~8.9% of all gastrointestinal carcinoid tumors. Unless the carcinoid syndrome has developed, the non-specificity of the symptoms and physical findings, makes the clinical diagnosis of these tumors difficult. However, with the introduction of large and deep endoscopic biopsies, it is possible to diagnose duodenal carcinoid tumors at an early stage. Usually, local resection is the therapy of choice because of the very slow growth of the lesion and the low incidence of metastasis. Radical surgery is mandatory only in lesions more than 2 cm in diameter, or in the presence of muscular invasion. A 69-year-old female visited our medical department, having had symptoms of upper ab-dominal pain and intermittent melena for 1 week. Endoscopic examination showed 2.5 2.5 cm sized elevated mass lesion with central ulceration in the anterior wall side of the duodenal bulb. Immunohistochemical stains of the biopsy specimen showed that the tumor cells are positive reactivity for NSE (neuron-specific-enolase), chromogranin A, and cyto-keratin.

A Case of Hemoperitoneum due to Splanchnic Artery (Left gastric artery) Aneurysmal Rupture / 대한내과학회지

Splanchnic artery aneurysms, previously thought to be rare, are being diagnosed with incresed frequency because of development of noninvasive imaging techniques. The pathogenesis of visceral aneurysms is varied and may be secondary to arteriosclerosis (30%), trauma (25%), inflammation (11%), gestational alteration, surgery, infection, medial necrosis, collagen vascular disease, arteritis, and congenital anomalies. Clinical manifestation of visceral artery aneurysms is vague and not specific. The diagnosis and treatment for them are difficult. Preoperative arteriography may be helpful in emergency situation to detect the aneurysm and visualize multiple aneurysms. Surgical ligation, resection and/or reconstructive surgery are first choice of treatment for them. Otherwise, transarterial embolization has also been reported for them recently. We report a case of hemoperitoneum due to left gastric artery aneurysmal rupture and a rare complication of splanchnic artery aneurysm "Double rupture". The patient was treated successfully with simple ligation of the ruptured vessel.