[A primary adenomucinous carcinoma on the upper eyelid]. / Primært adenomukøst karcinom på øjenlåget.

In this case we present a 70-year-old male with a primary adenomucinous carcinoma (PKMK) on the upper eyelid. Radical surgery or radiotherapy could not be implemented, due to aggressive behaviour caused by dementia. PKMK is a rare tumour with 228 described cases. Clinically the tumour can be misdiagnosed as benign, but has the potential to lymph node-, regional- and remote metastasis. Histologically it may be difficult to distinguish from adenocarcinomas (breast-, colorectal-, ovarian-, prostate- and lung cancer). The treatment is surgical with radical excision by Mohs' procedure (abroad) or guided by intraoperative biopsies (Denmark).

A novel knee prosthesis model of implant-related osteomyelitis in rats.

BACKGROUND AND PURPOSE: There have been numerous reports of animal models of osteomyelitis. Very few of these have been prosthesis models that imitate human conditions. We have developed a new rat model of implant-related osteomyelitis that mimics human osteomyelitis, to investigate the pathology of infection after orthopedic implant surgery. METHODS: 2 wild-type strains of Staphylococcus aureus, MN8 and UAMS-1, and their corresponding mutants that are unable to produce poly-N-acetyl glucosamine (PNAG) (ica::tet) were injected into the medullary canals of the femur and tibia at 3 different doses: 10(2), 10(3), and > 10(4) CFU/rat. We measured clinical signs, inflammatory markers, radiographic signs, histopathology, and bacteriology in the infected animals. RESULTS: An inoculum of at least 10(4) cfu of either wild-type bacterial strain resulted in histological, bacteriological, and radiographic signs of osteomyelitis with loosening of the prosthesis. An inoculum of 10(3) CFU gave signs of osteomyelitis but the prosthesis remained in situ. Bacterial inocula of 10(2) cfu gave no signs of osteolysis. INTERPRETATION: We have established a new knee prosthesis model that is suitable for reliable induction of experimental implant-associated osteomyelitis with the prosthesis in situ, using a small inoculum of S. aureus. At a dose of 10(3) CFU/rat, bacteria unable to produce PNAG (ica::tet) had only minor defects in their virulence.

Tumour necrosis factor-alpha and matrix metalloproteinase-2 are expressed strongly in hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic skin condition, characterized clinically by painful, recurrent, deep- seated nodules and suppuration, and histologically by hyper-trophic scarring of apocrine gland bearing skin and sinus tracts. The overall consequence of the disease is considerable tissue remodelling and the underlying alterations in innate immunity are poorly understood. The aim of this study was to evaluate the expression of human beta-defensin 2, tumour necrosis factor (TNF)-α and matrix metalloproteinase-2 in skin lesions of patients with hidradenitis suppurativa. A total of 14 skin samples from patients and 2 skin samples from healthy volunteers were evaluated by immunohistochemistry. Human beta-defensin 2 was negative in 12/14 specimens. Elevated expression of metalloproteinase-2 was observed in keratinocytes, fibroblasts and inflammatory cells in dermis, sweat glands, hair follicles and sinus tracts, suggesting a key role for hidradenitis suppurativa pathogenesis. Decreased human beta-defensin 2 in the presence of inflammatory (TNF-α-containing) cells suggests a decreased innate immunity in hidradenitis suppurativa-affected skin.

Improved quality of optical coherence tomography imaging of basal cell carcinomas using speckle reduction.

BACKGROUND: Optical coherence tomography (OCT) is a possible imaging method for delineation of non-melanoma skin cancer. Speckle noise is the dominant noise contribution in OCT images; it limits the ability to identify cellular structures especially skin cancer. QUESTIONS ADDRESSED: This report suggests a method for improving OCT image quality for skin cancer imaging. EXPERIMENTAL DESIGN: OCT is an optical imaging method analogous to ultrasound. Two basal cell carcinomas (BCC) were imaged using an OCT speckle reduction technique (SR-OCT) based on repeated scanning by altering the distance between the probe and the surface of the skin. RESULTS: SR-OCT resulted in improved visualisation and more accurate thickness measurements in BCC lesions. CONCLUSION: This OCT speckle reduction method led to improved visualisation and better defined delineations in two BCC lesions. Thus, OCT was improved to a clinically relevant level when imaging BCC lesions.

Sentinel node biopsy in cutaneous melanoma.

Status of the regional lymph nodes is a strong prognostic factor in patients with cutaneous malignant melanoma (CMM) and can be assessed by sentinel lymph node biopsy (SLNB). We present our technique of preoperative lymphatic mapping and intraoperative vital dye and handheld gamma probe. Our results and three years follow-up of its routine use in 198 patients with verified primary CMM are presented. Median follow-up time was 24 months (range 1-47). Metastatic regional lymph node disease was found by SLNB in 61 patients (31%) and additional metastatic nodes were found by formal node dissection in 30% of these cases. Complications were relatively mild but included one case of lymphoedema in a node negative patient. By follow-up, 13% had developed a recurrence including 26% of node positive patients and 8% of node negative patients. Mortality was also substantially higher in node positive cases with 18% dying in the follow-up period and 3% in the node negative group. The SLNB procedure was associated with a false negative rate of 8%. Using the presented technique, we found that SLNB was a useful procedure for staging patients with CMM and for selecting patients for more extensive metastatic screening and inclusion in trials of adjuvant treatments.