RESUMEN
OBJECTIVE: Modified microscopically controlled surgery (MCS) is a staged and margin-controlled excision; after MCS, the selection of an appropriate initial wound dressing plays an important role in wound healing. A wide range of dressings is available for temporary wound coverage; however, data comparing different types of wound dressings after MCS are lacking. The aim of this study was to compare two commonly used and commercially available types of wound dressings. METHOD: We assessed pain levels, wound adherence, bleeding upon dressing removal and signs of infection, with chlorhexidine-impregnated tulle gras and a lipidocolloid dressing used for primary wound dressing following MCS. RESULTS: A total of 42 patients were included. Adherence of the dressing to the wound (p<0.001) and bleeding after removal (p=0.001) were significantly higher in the chlorhexidine-impregnated tulle gras dressing group. Pain during removal of wound dressing had a higher visual analogue scale score (1.9 ± 2.2) in the chlorhexidine-impregnated tulle gras dressing group compared to 0.7 ± 1.0 in the lipidocolloid dressing group (p=0.022). CONCLUSION: The results indicate that the lipidocolloid dressing, when compared with the chlorhexidine-impregnated tulle gras dressing, offers a significant benefit during removal in terms of less pain, less wound adherence and less wound bleeding. DECLARATION OF INTEREST: The authors have no conflict of interest to declare.
Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Vendajes , Clorhexidina/administración & dosificación , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/cirugía , Cicatrización de Heridas/efectos de los fármacos , Heridas Penetrantes/terapia , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Coloides/administración & dosificación , Femenino , Humanos , Lípidos/administración & dosificación , Masculino , Microcirugia/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , Piel/lesiones , Resultado del Tratamiento , Heridas Penetrantes/etiologíaRESUMEN
BACKGROUND: Photodynamic therapy (PDT) and laser ablation (LA) are frequently used treatment options for multiple actinic keratoses (AK), yet they have not been compared head to head. OBJECTIVES: To compare PDT and carbon dioxide (CO(2) ) LA in the management of multiple AK using objective and subjective outcome measures. METHODS: A single-centre, randomized, two-treatment half-side comparative study of PDT vs. CO(2) LA was performed. Patients with at least four bilateral (e.g., scalp, forearms) AK were included. The primary outcome measure was the reduction of AK 3 months (v3) after therapy. Secondary outcome measures included the reduction of AK 4 weeks (v2) after therapy, decrease of epidermal p53 and Ki-67 protein expression, micromorphological changes as assessed by optical coherence tomography (OCT) in vivo, and investigators' and patients' satisfaction scoring. RESULTS: In total, 20 patients (18 men and 2 women) completed the study. Both treatments reduced AK quantity significantly. On v3, relative reduction of AK quantity was significantly higher following PDT (P = 0·0362). Ki-67 and p53 protein expression was reduced significantly from baseline (Ki-67, median 49·5%; p53, median 64·8%) to v2 by both procedures (PDT, median 18·5%, P < 0·0001; LA, median 16·2%, P < 0·0001). AK features as assessed by OCT imaging were also significantly reduced by both procedures. The investigators and patients rated the side-effects and inconveniences of PDT as more severe, but both overall preferred PDT due to the superior clinical outcome. CONCLUSIONS: CO(2) LA and PDT are both effective therapy options for multiple AK, yet PDT seems to be superior in terms of AK reduction and participants' and investigators' overall satisfaction.
Asunto(s)
Ácido Aminolevulínico/uso terapéutico , Queratosis Actínica/terapia , Terapia por Láser/métodos , Láseres de Gas/uso terapéutico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Anciano , Anciano de 80 o más Años , Epidermis/metabolismo , Femenino , Humanos , Queratosis Actínica/tratamiento farmacológico , Queratosis Actínica/patología , Queratosis Actínica/cirugía , Antígeno Ki-67/metabolismo , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
BACKGROUND: Antimicrobial peptides and proteins are not only effectors of the immune system but are also attributed important roles in tumour progression or tumour suppression in several malignancies such as oral squamous cell carcinoma (SCC). OBJECTIVES: These reports encouraged us to systematically investigate the expression of different classes of antimicrobial peptides and proteins in tissue samples of cutaneous SCC and its precursor lesions. METHODS: The protein expression of human beta-defensin (hBD)-1, -2, and -3, ribonuclease (RNase)-7 and the S100 protein psoriasin were analysed in 25 patients with actinic keratosis (AK), 30 with SCC in situ (SCCis), 23 with SCC, nine healthy skin controls and 10 healthy, chronically ultraviolet (UV)-exposed controls, by means of immunohistochemistry. RESULTS: Expression of hBD-1 was significantly reduced in SCC compared with UV-exposed healthy skin, AK and SCCis. RNase-7 expression was reduced gradually parallel to every step of malignant transformation, with the highest expression in healthy skin and the lowest expression in SCC. hBD-2 and psoriasin were significantly overexpressed in SCC and SCCis, compared with healthy controls. hBD-3 showed significantly more frequent expression in AK than in healthy controls, and in patients with SCCis and SCC. CONCLUSIONS: It is tempting to speculate that hBD-1 and RNase-7 might act as tumour suppressors while hBD-2 and psoriasin might act in the opposite way as promoters of tumour progression. Further investigations should clarify whether hBD-2 and hBD-3 could be potential targets for the development of pharmacological therapy.
Asunto(s)
Péptidos Catiónicos Antimicrobianos/metabolismo , Carcinoma de Células Escamosas/metabolismo , Queratosis Actínica/metabolismo , Lesiones Precancerosas/metabolismo , Neoplasias Cutáneas/metabolismo , Anciano , Anciano de 80 o más Años , Biomarcadores/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ribonucleasas/metabolismo , Proteína A7 de Unión a Calcio de la Familia S100 , Proteínas S100/metabolismo , beta-Defensinas/metabolismoRESUMEN
BACKGROUND: Perturbations in the expression profiles of microRNAs (miRNAs) have been reported for a variety of different cancers. Differentially expressed miRNAs have not been systematically evaluated in basal cell carcinoma (BCC) of the skin. OBJECTIVES: To initiate a microarray-based miRNA profiling study to identify specific miRNA candidates that are differentially expressed in BCC. METHODS: Patients with BCC (n = 7) were included in this study. Punch biopsies were harvested from the tumour centre (lesional, n = 7) and from adjacent nonlesional skin (intraindividual control, n = 7). Microarray-based miRNA expression profiles were obtained on an Agilent platform using miRBase 16 screening for 1205 Homo sapiens (hsa)-miRNA candidates. To validate the microarray data, the expression of seven dysregulated miRNAs was measured by TaqMan quantitative real-time reverse transcription polymerase chain reaction. RESULTS: We identified 16 significantly upregulated (hsa-miR-17, hsa-miR-18a, hsa-miR-18b, hsa-miR-19b, hsa-miR-19b-1*, hsa-miR-93, hsa-miR-106b, hsa-miR-125a-5p, hsa-miR-130a, hsa-miR-181c, hsa-miR-181c*, hsa-miR-181d, hsa-miR-182, hsa-miR-455-3p, hsa-miR-455-5p and hsa-miR-542-5p) and 10 significantly downregulated (hsa-miR-29c, hsa-miR-29c*, hsa-miR-139-5p, hsa-miR-140-3p, hsa-miR-145, hsa-miR-378, hsa-miR-572, hsa-miR-638, hsa-miR-2861 and hsa-miR-3196) miRNAs in BCC compared with nonlesional skin. Data mining revealed connections to many tumour-promoting pathways, such as the Hedgehog and the mitogen-activated protein kinase/extracellular signal-regulated kinase signalling cascades. CONCLUSIONS: This study identified several miRNA candidates that may play a role in the molecular pathogenesis of BCC.
Asunto(s)
Carcinoma Basocelular/genética , Regulación Neoplásica de la Expresión Génica/fisiología , MicroARNs/genética , ARN Neoplásico/genética , Neoplasias Cutáneas/genética , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/metabolismo , Estudios de Casos y Controles , Regulación hacia Abajo , Femenino , Perfilación de la Expresión Génica/métodos , Humanos , Masculino , Análisis por Micromatrices , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Neoplasias Cutáneas/metabolismoRESUMEN
BACKGROUND: Minimally invasive surgeries are frequently used in patients suffering from focal axillary hyperhidrosis (FAH). Sweat glands are removed surgically and the axillary skin is thinned out, with skin necrosis being a possible complication due to reduced microcirculation. Although of considerable interest, studies evaluating pre- and postoperative skin perfusion are unavailable. OBJECTIVE: To evaluate the blood flow of axillary skin in patients with severe focal axillary hyperhidrosis before and after liposuction curettage (LC). MATERIAL AND METHODS: The blood flow in the axillary skin of 11 patients was measured by laser Doppler perfusion imaging before surgery and on days 1, 7 and 28 after LC with a rasping cannula. Skin perfusion was measured in arbitrary units (AU) with measuring points in the axillary center (AC), the operated skin 2 cm from the center (2C) and the surrounding healthy skin (HS). RESULTS: No significant differences of preoperative skin perfusion were found (AC: 0.39 +/- 0.08 AU/2C: 0.38 +/- 0.07 AU/HS: 0.39 +/- 0.07 AU; p > 0.05). On the first and seventh postoperative days, AC (0.2 +/- 0.04 AU/0.27 +/- 0.81 AU) and 2C (0.2 +/- 0.03 AU/0.28 +/- 0.06 AU) area were significantly less perfused, whereas the HS showed higher perfusion values (0.59 +/- 0.1 AU/0.53 +/- 0.09 AU). Twenty-eight days after LC the 2C (0.36 +/- 0.07 AU) and HS (0.4 +/- 0.06 AU) skin revealed no significant differences compared to preoperative skin perfusion (p > 0.05). The AC perfusion was still slightly reduced (0.37 +/- 0.09 AU) without significant difference compared to preoperative findings. CONCLUSION: LC reduces the axillary skin blood flow with the axillary center being the least perfused area. However, in our collective, no correlation to possible side effects was observed.