[Cost-effective change in treatment after split skin grafting to lower leg defects]. / Omkostningseffektiv ændring af behandling ved delhudstransplantat på crus.

We present a clinical comparison of short stretch bandage versus a two-layer compression bandage and early mobilization after split skin grafting to lower leg defects. A total of 38 patients were included. The first group were immobilized for four days and given a short stretch support bandage. Group 2 were mobilized one day after the operation with a two-layer compression bandage (Pro-Guide). There was no difference in healing or frequency of complications. The patients treated with Pro-Guide had significantly fewer admission days and out-patient consultations. Larger randomized trials are warranted.

Persistent pain after surgery for cutaneous melanoma.

OBJECTIVES: Chronic pain is a well-known complication after surgery, but the prevalence of persistent pain after melanoma surgery is unknown. This study examined the prevalence and predictors of persistent pain after melanoma surgery. METHODS: Between September 2005 and June 2009, 448 patients underwent surgery for cutaneous melanoma at the Department of Plastic Surgery, Aalborg Hospital. A questionnaire was sent to all 402 survivors, and 350 (87.1%) responded. In addition, all patients with pain and a control group of sex-matched and age-matched patients without pain were invited to a clinical examination. RESULTS: Thirty-four patients (9.7%) reported pain in the scar area within the last month, and 8.6% reported chronic pain. The pain was mostly mild with little impact on daily life, but 1.7% reported moderate to severe pain, and 3.4% reported at least moderate impact of pain on daily life. Sensory changes were reported by 108 patients (31.5%); 25% of these had pain compared with 3% of patients with normal sensation [P<0.001, 10.8 (4.5 to 25.8)]. Young age was a predictor for persistent pain. A small group of patients (10 with and 22 without pain in the questionnaire) were clinically examined, suggesting that the areas of sensory disturbances were larger in patients reporting persistent pain or dysesthesia. DISCUSSION: The results support previous findings that persistent postoperative pain is a complication of almost any surgical intervention. Persistent pain was related to abnormal sensation, and neuropathic pain should be considered in these patients.

[Unusual long-term survival following non-radical treatment of oral mucosal melanoma]. / Usædvanlig langtidsoverlevelse efter ikkeradikal behandling af oral slimhindemelanom.

Malignant mucosal melanomas are rare and aggressive. The five-year survival rate for malignant oral melanomas is 15%. A case of a 65-year old male with progressive melanosis in the oral mucus and development of four malignant melanomas during a 15-year follow-up period is presented. The patient was treated non-radically. Radical surgical excision of the melanotic area would have included partial mandibulectomy and maxillectomy followed by massive reconstruction and was thus not an option. The patient has been followed closely during the follow-up period and invasive components have been excised followed by local reconstruction. The patient remains without signs of metastatic disease.

[Adult onset xanthogranuloma in a 73-year-old woman]. / Adult onset-xantogranulom hos en 73-årig kvinde.

Adult onset xanthogranuloma (AOX) is a rare benign xanthogranulomatous disease with unknown aetiology and incidence. AOX presents as yellow-brownish skin tumours of different sizes, mostly as solitary lesions, but also as multiple lesions with predilection areas on the face and collum. We here present the case of a 73-year-old woman, who was treated for third and fourth facial AOX recurrences by surgical excisions at the Department of Plastic Surgery, Aalborg Hospital. Due to the rare occurrence of AOX, a prospective evaluation of its treatment is hardly feasible. Oncological, dermatological and surgical treatment of AOX has been described in the literature.

Intraneuronal signaling pathways of metallothionein.

Metallothionein (MT) belongs to a family of metal-binding cysteine-rich proteins comprising several structurally related proteins implicated in tissue protection and regeneration after injuries and functioning as antiapoptotic antioxidants in neurological disorders. This has been demonstrated in animals receiving MT treatment and in mice with endogenous MT overexpression or null mutation during various experimental models of neuropathology, and also in patients with Alzheimer's disease and amyotrophic lateral sclerosis. Exogenously applied MT increases neurite outgrowth and neuronal survival in rat cerebellar, hippocampal, dopaminergic, and cortical neurons in vitro. In this study, the intraneuronal signaling involved in MT-mediated neuritogenesis was examined. The MT-induced neurite outgrowth in cultures of cerebellar granule neurons was dependent on activation of a heterotrimeric G-protein-coupled pathway but not on protein tyrosine kinases or on receptor tyrosine kinases. Activation of phospholipase C was necessary for MT-induced neurite outgrowth, and furthermore it was shown that inhibition of several intracellular protein kinases, such as protein kinase A, protein kinase C, phosphatidylinositol 3-kinase, Ca(2+)/calmodulin kinase-II, and mitogen-activated protein kinase kinase, abrogated the MT-mediated neuritogenic response. In addition, exogenously applied MT resulted in a decrease in phosphorylation of intraneuronal kinases implicated in proinflammatory reactions and apoptotic cell death, such as glycogen synthase-serine kinase 3alpha, Jun, and signal transducer and activator of transcription 3. This paper elucidates the intraneuronal molecular signaling involved in neuroprotective effects of MT.