A Randomized Controlled Trial on the Effect of Local Insulin Glargine on Venous Ulcer Healing.

INTRODUCTION: To determine whether the local administration of insulin glargine compared with placebo in nondiabetic patients with venous ulcers (VUs) leads to increased wound healing. METHODS: A randomized controlled trial using a split-plot design was performed in 36 adults with leg VUs >25 cm2 and more than 3 mo of evolution. Each hemi-wound received either 10 UI insulin glargine or saline solution once a day for 7 d. Size of the wounds, thermal asymmetry, the number of blood vessels, and the percentage area of collagen content in wound biopsies were assessed at baseline and after 7 d of treatment. Blood capillary glucose was monitored once a day after the insulin injection. RESULTS: After 7 d of treatment, the hemi-wounds treated with insulin glargine were significantly smaller, had less thermal asymmetry, more blood vessels, and more collagen content than the saline-treated side. Correlation between thermal asymmetry and the number of blood vessels was also found (r2 = 66.2, P < 0.001). No patient presented capillary glucose levels ≤3.3 mmol/L nor any adverse effects. CONCLUSIONS: In nondiabetic patients with chronic VUs, the topical administration of insulin glargine seems to be safe and promotes wound healing and tissue repair after 7 d of treatment.

Effects of Local Use of Insulin on Wound Healing in Non-diabetic Patients.

BACKGROUND: Clinical trials have shown the positive effects of local insulin therapy in the formation of new vessels and fibrosis in acute and chronic diabetic wounds without major adverse effects. OBJECTIVE: The aim of this study was to investigate the effects of local insulin use on wound healing in non-diabetic patients. METHODS: A randomized, split-plot, double-blind, placebo-controlled trial was conducted. Ten non-diabetic patients with full-thickness acute wounds were recruited (5 due to trauma, 3 to burns, and 2 to pressure). All wounds received standard bedside treatment. Each wound was divided into 2 zones. One side received a standard care plus insulin, while the other received standard care plus injection of saline solution. A biopsy specimen was taken from both sites on days 0 and 14. The amount of blood vessel growth and the percentage of fibrosis were evaluated. RESULTS: A significant difference in the number of new vessels was observed on the insulin-treated site (70.6 [29.21]) compared to saline only (26.5 [34.3]; P < .04). The percentage of fibrosis (insulin 34.7 [28.02] vs saline 27.8 [29.9]) showed no significant difference. No adverse events related to the study occurred. The clinical implications of this study are considerable in terms of the formation of blood vessels but not fibrosis. CONCLUSION: We suggest that local insulin administration is a safe therapeutic option for angiogenesis in wounds of non-diabetic patients.

HISTORIQUE: Les essais cliniques démontrent les effets positifs de l'insulinothérapie localisée pour former de nouveaux vaisseaux ou une fibrose en cas de plaies aiguës ou chroniques causées par le diabète, sans entraîner de réactions indésirables majeures. OBJECTIF: La présente étude visait à évaluer les effets de l'utilisation localisée d'insuline chez des patients non diabétiques. MÉTHODOLOGIE: Les chercheurs ont réalisé un essai aléatoire et contrôlé contre placebo, en parcelles divisées et à double insu. Ils ont recruté dix patients non diabétiques ayant des plaies aiguës de pleine épaisseur (cinq à cause d'un traumatisme, trois à cause de brûlures et deux à cause de pression). Toutes les plaies ont fait l'objet de soins standards au chevet du patient et chacune a été divisée en deux zones. Une zone faisait l'objet de soins standards avec l'ajout d'insuline et l'autre zone, de soins standards avec l'injection de soluté physiologique. Les chercheurs ont prélevé une biopsie dans chaque zone les jours 0 et 14. Ils ont évalué la croissance des vaisseaux sanguins et le pourcentage de fibrose. RÉSULTATS: Les chercheurs ont observé une différence significative dans le nombre de nouveaux vaisseaux de la zone traitée à l'insuline (70,6 ± 29,21) par rapport à celle traitée à l'aide de soluté physiologique (26,5 ± 34,3; P <0,04). Ils n'ont pas constaté de différence significative dans le pourcentage de fibrose (insuline 34,7 ± 28,02 et soluté physiologique 27,8 ± 29,9) ni de réactions indésirables liées à l'étude. Les conséquences cliniques de la présente étude sont considérables à l'égard de la formation de vaisseaux sanguins, mais pas de la fibrose. CONCLUSION: Selon les chercheurs, l'administration localisée d'insuline serait sécuritaire pour l'angiogenèse des plaies des patients non diabétiques.

Cutaneous metastatic pigmented breast carcinoma.

A 66-year-old woman presented with a 3 cm black, ulcerated nodule located on the skin of the upper abdomen, just below the breast. The lesion was painful to the touch, but the patient reported no other associated symptoms and was otherwise healthy. A 4-mm punch biopsy of the affected skin was obtained and the histological diagnosis was cutaneous metastatic pigmented breast carcinoma.

Rapidly growing pigmented tumor on a scalp nevus sebaceous of a pediatric patient: Observation or excision.

A 14-year-old girl presented with a new, rapidly growing, pigmented tumor on a previously existing yellowish, verrucous plaque on the scalp. The patient received complete surgical excision. Routine histology ruled out basal cell carcinoma (BCC) and the histological diagnosis was pigmented trichoblastoma arising in nevus sebaceous (NS). It is important to define management for new lesions developing in pediatric patients with existing nevus sebaceus.

Local use of insulin in wounds of diabetic patients: higher temperature, fibrosis, and angiogenesis.

BACKGROUND: Clinical trials have shown the effectiveness of systemic and local insulin therapy in improving wound healing. Diabetic wounds remain a challenge for healthcare providers. Impaired angiogenesis and reduced granulation tissue formation contribute to inadequate wound healing. The aim of this study was to investigate the effect of local insulin administration in acute and chronic diabetic wounds. METHODS: Eight diabetic patients presenting with full-thickness wounds, of different causes, were included in this study. Five wounds were due to necrobiosis, one to trauma, and two to postneoplasm resection. All wounds were treated with regular bedside treatment. In addition, half of the wound surface was treated with insulin and the other half did not receive insulin. Thermographic and biopsy specimens of the two sides were obtained on days 0 and 14. The presence of fibrosis, change in temperature, and amount of blood were evaluated. RESULTS: Significant differences in the number of vessels were observed on the insulin-treated side (96 ± 47) when compared with the no-insulin side (32.88 ± 45) (p < 0.026). The percentage of fibrosis (insulin: 44.42 ± 30.42 percent versus no insulin: 12.38 ± 36.17 percent; p < 0.047) and the mean temperature (insulin: 1.27 ± 1.12°C versus no-insulin: 0.13 ± 1.22°C; p < 0.001) were also significantly different between sides. No adverse events related to the study occurred. CONCLUSION: The use of local insulin improves the formation of new blood vessels, increases fibrosis, and correlates with increased temperature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Primary monophasic synovial sarcoma of the tonsil: immunohistochemical and molecular study of a case and review of the literature.

Synovial sarcoma (SS) arises primarily in the lower extremities with a predilection for sites in proximity to large joints, such as the knee. It rarely occurs in the head and neck region, and the tonsil is an unusual site for the tumor, with only eight previously published cases in this anatomical site. We present a case of a primary monophasic SS arising in the right tonsil in a 63-year-old male. His medical history was noncontributory. Immunohistochemistry showed that cytokeratin OSCAR, EMA, Bcl-2, vimentin, PGP 9.5, and TLE1 were diffusely positive. A molecular analysis using RT-PCR indicated that the patient was positive for the SYT/SSX1 fusion transcript. A diagnosis of monophasic synovial sarcoma of the tonsil was made.

Noninvasive estimation of chronological and photoinduced skin damage using Raman spectroscopy and principal component analysis.

BACKGROUND: Skin aging can be attributed to endogenous and exogenous factors which modify the hydration and protein structure of the skin which can be measured using Raman spectroscopy. METHOD: This study included 21 healthy adult volunteers, aged 32-81 years, Raman spectra were obtained from sun-protected and sun-exposed skin, also three millimeter punch biopsies of sun-exposed skin were collected and analyzed. The Raman spectra were analyzed using principal component analysis and the results were correlated with clinical and histological findings. RESULTS: The principal component analysis of the Raman spectra shows that the first principal component (PC1) obtained from the sun-protected skin is related to the age of the subject, which can be taken as a measure of chronological aging, the second (PC2) and fourth (PC4) principal components obtained from Raman spectra of sun-exposed skin are related to the amount of solar elastosis and collagen, respectively. CONCLUSION: In this work a relationship was found between histological properties of photoaged skin and noninvasive measurements based on Raman and principal components analysis (PCA). These relationships can be used to assess noninvasively the photoinduced damage and chronological characteristics of skin.