Characteristic differences in barrier and hygroscopic properties between normal and cosmetic dry skin. II. Depth profile of natural moisturizing factor and cohesivity.

OBJECTIVE: In a previous paper (Lu et al., International Journal of Cosmetic Science, in press), we reported that in comparison with normal skin, cosmetic dry skin characteristically has a thicker stratum corneum (SC) with weaker barrier quality. Our goal here was to obtain a more complete picture of the difference between normal and cosmetic dry skin, by further analysing the data collected from the same clinical study to address two additional aspects of skin: the amount and depth profile of natural moisturizing factor (NMF) and the cohesivity of the SC. METHOD: The SC samples were collected by sequential tape stripping in a clinical study consisting of 64 healthy Caucasian female subjects with either normal or cosmetic dry skin. Protein and free amino acids (FAA) on tape strips were extracted and analysed using high-throughput methods. The level of pyrrolidone carboxylic acid (PCA), the prominent component of NMF, was detected using HPLC analysis. RESULTS: It was found that dry skin had significantly lower ratios of FAA/protein and PCA/protein across the stripped SC depth, corresponding to a lower hydration level compared with the normal skin. Our results indicated that filaggrin to FAA hydrolysis occurred deeper in dry skin and at a lower level compared with normal skin. In addition, the mass of proteins stripped from dry skin subjects was significantly higher than that from the normal skin counterpart, especially for the first 10-12 tape strips. CONCLUSION: Our results showed that, compared with normal skin, cosmetic dry skin had a lower NMF level across the SC depth and a lower cohesivity. Such results suggested that NMF levels are critical for cosmetic skin conditions, and lower NMF production may be associated with dry skin. In addition, the NMF level and its depth profile and the SC cohesivity are useful clinical end points for assessing the efficacy of dry skin treatments such as skin moisturizers.

Characteristic differences in barrier and hygroscopic properties between normal and cosmetic dry skin. I. Enhanced barrier analysis with sequential tape-stripping.

OBJECTIVE: Cosmetic dry skin often has a lower hydration level but a similar apparent barrier function, as measured by transepidermal water loss (TEWL), than that of the normal skin. To investigate the intrinsic difference in barrier property and moisture-holding ability between the cosmetic dry and normal skin, we developed a new clinical and data analysis procedure based on sequential tape-stripping with TEWL measurement, coupled with chemical analysis for protein and natural moisturizing factors (NMF) in the stratum corneum. METHODS: A clinical study consisting of 64 healthy Caucasian female subjects with normal and cosmetic dry skin was conducted according to our clinical and data collection protocols. After the baseline visual dryness assessment, 20 tape-strips were placed and removed on each test site using D-Squame tapes. TEWL was measured at baseline and after the 5th, 10th, 15th and 20th tape-strips. All tapes were analysed for protein mass via chemical extraction and the Pierce BCA protein assay, as well as using an infrared densitometry device SquameScan 850A. The stratum corneum thickness and barrier quality (water transport resistance per thickness of the stratum corneum) were decoupled from the apparent barrier function using the TEWL and protein data. RESULTS: A linear relationship between 1/TEWL and cumulative protein removal was observed for both normal and cosmetic dry skin. However, the slope of the linear relation was significantly steeper for normal skin, and significantly more protein was removed from cosmetic dry skin. The results showed that on average, the barrier quality of the stratum corneum of the normal skin is about 40% higher than that of the dry skin, whereas the stratum corneum of the dry skin is about 30% thicker than that of the normal skin. In addition, the amount of SC removal in sequential tape-stripping is generally non-uniform. CONCLUSION: Our results demonstrated that there are characteristic differences in the barrier property between normal and cosmetic dry skin. In comparison to the normal skin, the stratum corneum of the cosmetic dry skin is considerably thicker, however, with a lower barrier quality. The results also showed that the amount of the SC removal in sequential tape-stripping is generally non-uniform. Therefore, the number of tape strips is not a good indicator for the tape-stripping depth.

Long-term results of balloon catheter dilation for benign gastric outlet stenosis.

BACKGROUND AND STUDY AIMS: In 1981, the authors introduced balloon catheter dilation for postoperative gastric outlet stenosis and later for peptic, corrosive and postvagotomy gastric outlet stenosis. This retrospective study evaluates the effectiveness, safety and outcome of balloon catheter dilation in these various indications. PATIENTS AND METHODS: Between September 1981 and September 2001, 177 balloon catheter dilation procedures were carried out in 72 patients with benign stenoses. Double-lumen or single-lumen balloon catheters with a mean diameter of 18 mm (range 12-25 mm) were used. Endoscopic check-up examinations were carried out 1-3 weeks later, and then after three, six and 12 months, or if symptoms returned. The mean follow-up period for patients who did not undergo surgery was 98 months (range 12-240 months). RESULTS: Symptomatic relief was obtained immediately in 80 % and after 3 months or more in 70% of the patients. The mean diameter of the stenoses was 6 mm (2.0-9.5 mm) before dilation and 16 mm (10-20 mm) afterwards. Gastric retention was observed in 49 patients (68%) before dilation and in 19 patients (26.4%) afterward. Sixteen patients had recurrent stenosis 1-18 months after the first dilation. All of the 18 postoperative strictures, 21 (70%) of the 30 peptic stenoses, six (35%) of the 17 patients with corrosive strictures, and five of the six patients with postvagotomy functional stenosis were successfully treated with dilation. Pyloric perforation occurred in two cases, and arterial hemorrhage was observed in one case after dilation. CONCLUSIONS: Balloon catheter dilation is an important and effective diagnostic and therapeutic method; depending on the causative factor, it can make surgery unnecessary in nearly 70% of patients with benign gastric outlet stenosis.

Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation.

BACKGROUND: Primary cricopharyngeal dysfunction (PCD) is a rare, idiopathic, functional disorder of the upper esophageal sphincter, characterized by dysphagia, frequent aspiration, and functional narrowing at the level of the upper esophageal sphincter. METHODS: Five of 29 patients with oropharyngeal dysphagia were found to have PCD. Patients presented with severe dysphagia and predisposition to aspiration. Radiography demonstrated narrowing at the level of the upper esophageal sphincter and aspiration. An endoscope could be introduced into the esophagus in only 2 patients before dilation. OBSERVATIONS: In contrast to organic stenoses, these functional upper esophageal sphincter stenoses were dilated without difficulty with a balloon catheter. After low-pressure (1.5-2 atm) progressive balloon dilation (to 20 mm), superficial mucosal injury was observed only in one patient. After dilatation, symptoms resolved and barium swallow demonstrated normal passage through the upper esophageal sphincter. During a mean follow-up of 21 months (7-33), redilation was necessary in only 1 case. CONCLUSIONS: Balloon catheter dilatation of PCD is minimally invasive and provides both important diagnostic information and effective therapy. It should be the first choice of therapy for PCD.

[Common bile duct tumor in a young woman with ulcerative colitis]. / Ductus choledochus-tumor kialakulása fiatal colitis ulcerosás nóbetegben.

Bile duct carcinoma is a rare complication of ulcerative colitis. In most of the cases it tends to occur together with primary sclerosing cholangitis predominantly in older males. The authors report a case of a 25 year old woman presenting with jaundice, 6 years after the diagnosis of colitis was made. The cause of the extreme extra- and intrahepatic bile duct dilation was revealed by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography showing polypoid tumor in the common bile duct. The histological result taken during the surgical exploration proved the diagnosis of adenocarcinoma. Radical pylorus preserving pancreato-duodenectomy was performed. Subsequently adjuvant chemotherapy was instituted according to the PAV protocol. This rare case proves, that a malignant bile duct tumor may develop in a young patient with ulcerative colitis without the presence of primary sclerosing cholangitis. The authors emphasise the connection between ulcerative colitis and bile duct carcinoma and the importance of the close follow-up of every patient with ulcerative colitis.

[Primary cricopharyngeal achalasia and its dilatation with balloon catheter]. / Primer cricopharyngealis achalasia és ballonkatéteres tágító kezelése.

The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.

[The role of endoscopic ligation in the management of esophageal varices and rupture]. / Endoszkópos gumigyürüzés szerepe a nyelöcsö-varicositas, -ruptura kezelésében.

In the last two decades sclerotherapy has became one of the most widespread procedures in the palliative therapy of esophageal varicosity and rupture. Beside many of its advantages, there are high numbers of local and general complications. The new ligation method is very effective, but less invasive and free from side effects. The single shot method in spite of using overtube is slower, unpleasant and not free from risks. The new six shooter system, which uses 6 rubber-bands eliminates these disadvantages. This technique was introduced the first time in Hungary by the authors. They performed ligations between June 1997 and June 1999 on 39 random patients, 55 times. 41 times due to rupture of varices, 8 times in no-bleeding periods for eradication of varices, 6 times for prophylaxis. The average age was 51 (27-75), 32 men and 7 women participating. The cause of esophageal varicosity was thrombosis of vena portae in 1 patient and cirrhosis in others. The background of the cirrhosis was alcohol in all cases except for one which was due to alcohol and hepatitis C in addition. Altogether 346 rubber-bands were applied. The average ligation was 6.3 (3-17) per patient and 4.5 (3-6) per session. The 41 ruptures of the 32 patients were treated with 80 units of blood, not including one patient given 29 units of blood who had mortal haemorrhage. It means 2.5 units of blood per patient and 2 units per varix rupture. After ligation patients had no complaints except for retrosternal discomfort in some patients. There were no complications observed. The mortality rate was 5 out of 32 one patient died due to bleeding. The follow up of the ligation was carried out by endoscopy and in the 4 dead patients by pathological procedures. The ligation method which was applied by the authors is effective, faster and has less complications in varix irradications than sclerotherapy. The prophylactic therapy of high risk patients and other therapeutic indications can contribute to its wider utilization.

[Malignant esophageal-respiratory fistula and esophageal stenosis treated with a Gianturco-Z-stent]. / Malignus oesophagorespiratoricus fistula és nyelöcsöstenosis kezelése Gianturco-Z-stenttel.

Oesophago-respiratory fistula in most instances in a complication of advanced malignant tumours of the oesophagus or the lung. In our patient group eleven oesophago-respiratory and one gastro-respiratory fistulas were encountered. Three patients were operated upon. In one of them with achalasia, early oesophageal carcinoma was discovered in the background of the fistula. Two patients had fistulas without of oesophageal narrowing, therefore, stent implantation into the trachea and bronchus was performed. One of them was previously managed endoscopically with lyodura plug and fibrin glue, but only temporary occlusion of the fistula was obtained. In five patients, seven conventional oesophageal prosthesis (6 Cook, 1 Rüsch) were used to close the fistulas. In one of these patients, three oesophago-respiratory fistulas developed one after the other at the level of the prosthesis funnel. They were closed with three prostheses connected with short silicone tubes. In the last two patients, Gianturco-Z stent was employed. Its advantages over the plastic prostheses include small basic and lager final luminal diameter, lesser predilatation, easier implantation, lower complication and mortality rate. The silicone coated and double funnel stent with expansile force is effective in fistulas closure. On implantation, stent shortening in minimal, allowing precise placement of the stent even in proximal malignant oesophageal stenosis with oesophago-bronchial fistula. The high price of the stent is compensated for by the lower complication rate, shorter hospitalization and subsequent reduction is hospital expenses. Therefore these metal stents should be financed by the National Health Service, at least in specialized centers for managing patients with dysphagia.