Kazuhisa Yokoo

5-Aminolevulinic acid-based photodynamic therapy for the treatment of two patients with extramammary Paget's disease.

Photodynamic therapy (PDT), which employs a combination of a tumor‐localizing photosensitizer and visible light, has been used in the treatment of extramammary Pagets disease (EMPD). Two patients with EMPD were treated with PDT using 5‐aminolevulinic acid (ALA). Histologically, in both cases, Pagets cells were present within the epidermis. Case 1 was a 92‐year‐old male who underwent total extirpation for treatment of EMPD. Two topical ALA‐PDT treatments were applied to parts of the lesions at a total dose of 200 J/cm2. Case 2 was a 73‐year‐old female, whose lesions in the right labia majora were treated with 3 topical ALA‐PDT sessions at a total dose of 300 J/cm2. Clinical findings after the irradiation showed improvement in both patients, and elimination of tumor cells in the epidermis was confirmed histologically. Case 1 had no recurrence in the irradiation field at three months after PDT. Case 2 had a recurrence only in the periphery parts of the lesions at two months after PDT, but the periphery lesions remitted with two more PDT treatments. Topical ALA‐PDT is an effective treatment for EMPD with tumor cells within the epidermis. It is noninvasive and achieves a cosmetically excellent outcome, especially in elderly patients and those in poor general condition.

Composite Gastric Seromuscular and Omental Pedicle Flap for Urethral and Scrotal Reconstruction after Fournier's Gangrene

A new composite gastric seromuscular and omental pedicle flap is described that can provide immediate airtight or watertight closure in the repair of complex defects involving the urethra. This flap was used to repair defects of the urethra, scrotum, and abdominal wall in a patient with Fourniers gangrene. The seromuscular patch was sutured to the urethral defect, and the omentum was applied over the defects of the scrotum and abdominal wall. This new procedure made it possible to close the skin primarily without leakage or infection. The patient had an uncomplicated recovery. Postoperative urethrography demonstrated no leakage or stenosis.

Possibility of venous return through bone marrow in the free fibular osteocutaneous flap

The authors report a case of a free fibular graft that was successful as a result of venous return delivered through the bone marrow. A 26-year-old man underwent reconstruction of the left tibia and a soft-tissue defect of the lower leg. A free vascularized fibular bone and skin flap was elevated. The fibular vessels were anastomosed to the dorsalis pedis vessels. The elevated fibular bone was fixed to the tibia. The next day, reanastomosis was necessary because of venous thrombosis. However, the fibular vein rethrombosed, but blood flow was ascertained by Doppler flowmetry, with darker blood flow being recognized from the edge of the flap. Four days after surgery, the skin color gradually improved, and the flap had almost completely taken. On retrospective evaluation, the authors concluded that this flap succeeded because venous return was routed through the bone marrow in the free fibular graft.

Lymphoepithelioma-Like Carcinoma of the Skin with Potential for Sweat Glandular Differentiation

Lymphoepithelioma‐like carcinoma of the skin (LELCS) is a cutaneous malignancy with histopathological resemblance to lymphoepithelioma of the nasopharynx. Its histogenesis remains unknown, and few cases showing skin appendage differentiation have been reported to date. We present the case of a 77‐year‐old Japanese male with an asymptomatic red nodule on his left cheek. Because the histopathological study revealed focal growth of tumor cells lacking connections with the epidermis and marked lymphocytic infiltration surrounding the neoplastic cell nests, the case was diagnosed as LELCS. On immunohistological staining, the neoplastic cells were positive for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), multi‐cytokeratin (CK), CK6, CK18, and CK19. On the basis of these results, we suggested that skin appendage differentiation, particularly sweat glandular differentiation, was present in this case.

Systemic absorption of sulphadiazine, silver sulphadiazine and sodium sulphadiazine through human burn wounds

Systemic absorption of water-soluble and water-insoluble drugs through human burn wounds was compared. Serum levels of sulphadiazine were estimated after application of silver sulphadiazine (water-insoluble) cream, sulphadiazine (water-insoluble) cream and sodium sulphadiazine (water-soluble) cream. It was found that the absorption of sodium sulphadiazine was greater than that of sulphadiazine or silver sulphadiazine.

Surgical treatment of speckled skin caused by dyschromatosis symmetrica hereditaria--case report.

Thin split skin autografts taken from the abdomen were used to replace speckled skin caused by dyschromatosis symmetrica hereditaria in one patient. Normal skin colour appeared in the recipient areas and no recurrence was observed in the treated areas.

High-resolution 400K oligonucleotide array comparative genomic hybridization analysis of neurofibromatosis type 1-associated cutaneous neurofibromas.

Neurofibromatosis type 1 (NF1) is a genetic disorder where affected individuals develop benign or malignant nervous system tumors. To date, NF1 is caused by mutations in the NF1 tumor suppressor gene located at chromosome band 17q11.2. In this study, we aimed to characterize novel recurrent regional chromosomal imbalances and tumor-related candidate genes in NF1-associated cutaneous neurofibromas. Nine cutaneous neurofibromas from NF1 patients were screened for recurrent chromosomal imbalances using high-resolution 400K oligonucleotide array comparative genomic hybridization (aCGH). All the cases exhibited at least one sub-microscopic abnormality. Regions of recurrent chromosomal imbalances in a least one third of cases were loss of 1q13.2 (33%, FAM19A3), 1q21.1 (44%, RABGAP1L), 2q37.1 (56%, INPP5D), 3p25.1 (67%, CHCHD4), 4p15.32 (56%, FGFBP1), 5q11.2 (56%, ARL15), 6q22.31 (56%, NKAIN2), 6q22.33 (67%, ARHGAP18), 6q25.1 (67%, UST), 7q13 (56%, ADCY1), 12q13.13 (44%, KRT71), 19q13.32 (56%, GRLF1), and 20p11.21 (56%, NLP) and gain of 2p23.3 (76%, C2orf53), 8q22.3 (44%, ODF1) and 8q24.3 (67%, ARC). Several chromosomal imbalances, including loss of 7q11.23, 13q14.1, 14q32.13, 17p12, and 17q11.2 were detected at a lower frequency. We also confirmed that these chromosomal imbalances were not detected in the patient-matched lymphocyte DNAs. Amongst the 6 tumor-related candidate genes (RABGAP1L, ADCY1, SLIT2, GRLF1, UST, and ARC) identified in the regions of recurrent chromosomal imbalances, the gene expression changes of UST (down-regulation) and ARC (up-regulation) were found to be significantly associated with copy number alterations. The novel recurrent chromosomal imbalances and the altered expression levels of the tumor-related candidate genes may be associated with the development of NF1-associated benign cutaneous neurofibromas.

Lapachol suppresses cell proliferation and secretion of interleukin-6 and plasminogen activator inhibitor-1 of fibroblasts derived from hypertrophic scars

Objectives  The pathogenesis and therapy of hypertrophic scar have not yet been established. Our aim was to investigate the antiproliferative and antisecretory effects of lapachol, isolated from the stem bark of Avicennia rumphiana Hall. f., on hypertrophic scar fibroblasts.

Endoscopic correction of pectus excavatum.

Endoscopic surgery is minimally invasive and can be used to achieve superior cosmetic results. Conventional correction of pectus excavatum results in a long scar. Correction by use of endoscopic surgery involves a smaller skin incision. In this study, endoscopic correction of pectus excavatum was performed in 20 cases. A small transverse skin incision was made above the xyphoid process. A wide area beneath the pectoralis major muscle was dissected under endoscopic visualization. Subperichondrial resection was performed under direct visualization when possible. Subperichondrial resection of the third or fourth rib was performed under endoscopic visualization. Ravitchs chondrotomy of the second or third rib was performed under endoscopic visualization. Endoscopy was also useful for sternal elevation, with minimal risk of pleural perforation. Kirschner wire was inserted percutaneously under the sternum to prevent postoperative paradoxical respiration. In all cases, the postoperative course was uneventful. The advantages of endoscopic pectus excavatum correction are a short scar, control of bleeding, safe dissection of the pleura from the sternum without the risk of pleural perforation, and ease of sternal elevation without injury to the intramammary vessels. However, the endoscopic operation is long and is not useful in adults because subperichondrial resection in adults is difficult to perform. (Plast. Reconstr. Surg. 107: 333, 2001.)

Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach.

Abstract Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.