Analysis of histologic and clinical changes associated with Polaris WR treatment of facial wrinkles.

BACKGROUND: The Polaris WR is a device that combines laser energy with radiofrequency (RF) treatment to provide more focused RF energy on the skin to reduce wrinkles and/or tighten skin. Clinical results have varied from highly visible to no obvious reduction in wrinkles. OBJECTIVE: This prospective study investigated whether there was any corollary between clinical results, standardized VISIA (Canfield Imaging Systems, Fairfield, NJ) and digital photographs, and skin biopsy analysis after the treatment of facial wrinkles with the Polaris WR device. METHODS: Fifteen patients received four full-face treatments. Biopsy of the treated skin was performed before and 1 and 3 months after their last treatment. A VISIA computer analysis of facial wrinkle density and depth was performed before any treatment and then 3 months after the last treatment. Digital photographs were reviewed by four surgeons to evaluate wrinkle reduction at 3 and 6 months after the four treatments. RESULTS: Physicians' ratings of these digital images revealed that 58% of the patients were improved at 3 months after treatment, and 42% were still improved at 6 months. The patient questionnaire responses revealed that 75% of patients felt that they looked better at 3 months, and 67% felt that they remained improved 6 months after their last treatment. VISIA photographic analysis demonstrated that 67% of the patients had fewer and/or shallower wrinkles at their 3-month visit. The average degree of improvement with VISIA analysis was 30%. Biopsy specimens in the group of patients that were defined as improved by VISIA assessment showed a greater dermal thickness and interfibrillar spacing P < .024). Two patients received superficial second-degree burns that did not require corrective treatment. CONCLUSIONS: Improvement in skin wrinkling after Polaris WR therapy was confirmed in patients at 3 months after treatment by physician assessment, VISIA analysis, and patient assessment, with a lower rate of improvement at 6 months after treatment. VISIA analysis tended to confirm patient assessments. Physician assessments of improvement tended to be lower.

Outcomes of acute rejection after interferon therapy in liver transplant recipients.

Interferon alfa has been increasingly used against recurrent hepatitis C (HCV) disease in post-liver transplant (LT) recipients. A serious potential adverse effect is acute rejection. We reviewed our experience using interferon-based therapy (interferon or pegylated interferon with or without ribavirin) for treating recurrent HCV in LT recipients. Forty-four LT recipients were treated with interferon for recurrent HCV. Five of the 44 patients developed acute rejection during interferon-based therapy. These 5 patients started treatment of 42.4 +/- 33.89 months (mean +/- SD) after LT. Mean (+/- SD) histological activity index and fibrosis scores before initiating antiviral therapy were 8.8 (+/- 1.92) and 2.6 (+/- 0.55), respectively. Patients were treated for 3.3 +/- 2.28 months (mean +/- SD) prior to rejection. At the time of rejection, HCV load was not detectable in 4 of the 5 recipients. All 5 patients had tolerated interferon therapy, and none had stopped therapy because of adverse effects. The rejection was successfully treated in 3 patients. In 2 of those 3 patients, cirrhosis eventually developed. In the 2 patients who did not respond to rejection treatment, immediate graft failure occurred, leading to re-LT in 1 patient and death from sepsis in the other. In conclusion, the results indicate that further studies are needed to assess the safety of interferon in LT recipients. Interferon-based therapy may lead to acute rejection and subsequent graft loss and should therefore be used with caution. Treated recipients may also develop progressive cirrhosis despite achieving a sustained virological response.

Is MAGE-1 expression in metastatic malignant melanomas really helpful?

Melanoma antigen-encoding gene (MAGE-1) has been introduced as a sensitive immunohistochemical marker to aid in the diagnosis of malignant melanomas, in particular, those that are HMB-45 negative. Our goal was to determine the consistency of positive staining in melanomas on the basis of the usefulness of MAGE-1 in comparison with tyrosinase and MART-1. We studied 56 malignant melanomas using immunohistochemical markers to MAGE-1, tyrosinase, MART-1, HMB-45, and S-100. Six of 17 HMB-45-negative cases were strongly positive for MAGE-1 (35%), while 9 of 39 HMB-45-positive cases were positive for MAGE-1 (23%), overall, 27% positivity (n = 56). Tyrosinase and MART-1 were both strongly positive in 42 of 56 cases (75%). Fifty-two of 56 cases were strongly positive for S-100 (93%). We found MAGE-1 to be less sensitive than described in other studies, and overall, not very helpful, especially as a predictor of aggressive behavior. Although MAGE-1 expression has been considered as a target for immunomodulation therapy, our findings do not indicate consistent expression of this epitope in a majority of melanomas. S-100 protein, tyrosinase, and MART-1 immunomarkers were more frequently positive in our melanoma cases and appear to constitute a useful panel of markers to aid in the diagnosis of metastatic malignant melanomas, especially in patients with an unknown primary.

Fine-needle aspiration biopsy as an adjunct to the diagnosis of a rare adnexal tumor of hair follicle origin: trichoblastoma.

Fine-needle aspiration biopsy (FNAB) is a technique used increasingly for the investigation of primary and metastatic cutaneous tumors. Trichoblastoma is a rare benign skin appendage tumor of hair germ origin. We report the diagnosis by FNAB of a rare giant subcutaneous tumor, trichoblastoma, from an 81-yr-old woman with a subcutaneous mass in the interscapular area of her back. The cytologic characteristics of the tumor are discussed in detail in this report. The findings have been compared with the histologic features of the tumor after surgical excision. We have characterized several distinctive cytologic features that may aid in the diagnosis of this rare neoplasm. While most reported cases have been diagnosed from surgical excisional biopsy specimens, FNAB may also be a valuable tool for the accurate diagnosis of trichoblastoma in the proper clinical context.

FK506 vs. cyclosporin. Pathologic findings in 1067 endomyocardial biopsies.

INTRODUCTION: Whether FK506 or cyclosporin is better for chronic immunosuppression in heart transplant patients has been debated. We examined endomyocardial biopsies from patients treated with these two drugs to determine if there was a difference in frequency of histologic cellular rejection episodes and Quilty lesions. The Quilty lesion (AKA cyclosporin effect) may be an atypical form of rejection, and is thought to be related to the use of cyclosporin immunosuppression. METHODS: We reviewed 1067 endomyocardial biopsies from 65 patients who were assigned FK506 or cyclosporin after heart transplantation. RESULTS: The number of episodes of rejection (162 FK506 vs. 145 cyclosporin) was the same. However, when compared to cyclosporin treatment, FK506 was associated with significantly more Quilty A lesions and fewer Quilty B lesions. CONCLUSION: FK506 appears to prevent some Quilty A lesions from progressing to Quilty B lesions. Since Quilty B lesion is associated with myocyte injury and Quilty A is not, this effect of FK506 could be associated with improved long-term graft function.