Teruichi Harada

Dynamic relationship of focal contacts and hemidesmosome protein complexes in live cells.

Epidermal cells adhere to the basement membrane zone through cell-matrix junctions termed hemidesmosomes. During wound healing, hemidesmosomes are disassembled to allow keratinocytes to move over wound sites. Such movement is mediated by both hemidesmosome protein complexes (HPCs) and focal contacts (FCs). In this study, we analyzed the interaction between HPCs and FCs in live HaCat cells expressing yellow fluorescent protein (YFP)-tagged beta4 integrin and cyan fluorescent protein (CFP)-tagged alpha-actinin as markers of HPCs and FCs, respectively. In HaCat cells migrating to repopulate wounds, FC proteins cluster rapidly in the direction of the wound. HPC assembly then follows and the newly formed HPCs occupy sites vacated by the disassembled FCs. HPC dynamics are dramatically reduced, and HaCat cells cease migration upon treatment with reagents that affect FC integrity/function. Upon treatment with reagents that destabilize HPCs, the dynamics of FCs in HaCat cells at the edges of wounds are enhanced, although FC assembly is irregular and the migration of the cells is aberrant. We also show that the complex interaction between hemidesmosomes and FCs in keratinocytes is myosin dependent and requires energy. In summary, we suggest that HPCs and FCs dynamics are tightly co-regulated in keratinocytes undergoing migration during wound healing.

Dermatofibrosarcoma protuberans with atrophic appearance at early stage of the tumor

We report a case of dermatofibrosarcoma protuberans (DFSP) which had looked like an atrophic plaque on the face for 20 years and been diagnosed as morphea. At the late stage after subsequent development of a nodule, histopathological examinations including immunohistochemical stainings revealed the final diagnosis of DFSP. While DFSP is given typical “protuberant” morphology, our case indicates that DFSP sometimes appears as a non‐protuberant lesion. Some reported variants of non‐protuberant DFSP are suspected to be preceding features at the early stage of DFSP before the protuberant feature occurs. We should take this preprotuberant stage of DFSP into consideration of different diagnoses with non‐protuberant lesions. Histopathological examination and immunohistochemical stainings are necessary for an accurate and early diagnosis of DFSP.

Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips

UNLABELLED The treatment of whistling deformity in patients with cleft lip remains controversial. Previous reconstruction methods of whistling deformity have been limited in volume due to the necessity for primary closure of the donor site. This article presents a new method for secondary reconstruction of the vermilion deformity in patients with cleft lip. Our method is very simple and advantageous, in that primary closure after correction is not required. A rectangular mucosal flap is designed at the wet mucosal aspect of the upper lip. Inferiorly, this flap is based at the junction of the vermilion and mucosa, while the upper incision line should be at the buccal sulcus. This rectangular flap is advanced sagittally, and a labial thickness is reconstructed. Artificial dermis is grafted to the mucosal defect after flap advancement and mucosa regenerates secondarily. We applied this technique to secondary reconstruction in 32 patients with cleft lip between January 2001 and January 2005. Major complications (necrosis of mucosal flap and recurrence of whistling deformity) did not occur in any of the patients. Four patients required minor operations to reduce the volume. CONCLUSIONS This rectangular mucosal flap with artificial dermis offers many advantages, including easy technique and minimal sacrifices. The combination of mucosal flap and artificial dermis prevents postoperative scar contracture and reduces the limitations of using the available volume of flap. We believe that this procedure is versatile and reliable not only for whistling deformity in cleft lip patients, but also for tissue defects of the lip resulting from other causes.

Aggressive conservative therapy for refractory ulcer with diabetes and/or arteriosclerosis

A foot ulcer due to diabetes and/or arteriosclerosis obliterans (ASO) frequently results in an intractable condition that resists treatment. To cope with this condition, we have developed a combination therapy that includes conventional conservative therapy plus surgical therapy. This aggressive conservative therapy using aggressive debridement, trafermin (Fiblast Spray, Kaken, Japan) treatment and vacuum‐assisted closure (VAC) therapy was adopted to treat seven patients suffering from diabetes and ASO‐related refractory foot ulcer accompanied by bone exposure. With the exception of one patient who died during the treatment, the remaining six patients obtained limb salvage. The mean time to cure was 8.3 months. This approach should be considered before amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be employed as a highly useful and reproducible technique requiring simple techniques.

Accumulation of glucose in keloids with FDG-PET

ObjectiveGlucose metabolism has not been investigated in human (in vivo) keloids. In the present study, we performed positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) to examine glucose metabolism in keloids.Materials and MethodsFive patients (2 men and 3 women) with typical keloids having a thickness of more than 5 mm were studied. HEADTOME-IV SET-1400W-10 (Shimadzu, Tokyo, Japan) was employed for PET studies. Transmission scanning was performed on each patient. After fasting for more than 4 hours, the patients were injected intravenously with FDG 185–370 (MBq) following each transmission scan. Emission scans were performed 40–55 min after injection. For quantitative evaluation, the regions of interest (Circles ROIs: 6 mm in diameter) were placed on all the keloid lesions and surrounding tissues, and then their standardized uptake value (SUV = the tissue concentration/the activity injected per body weight) was calculated.ResultsFDG was defined as showing the accumulation in keloids when its uptake was relatively higher in the keloid than that in the surrounding tissue. The SUV of the keloids ranged from 1.0 to 2.74, with a mean of 1.79.ConclusionFDG-PET was performed in 5 patients with keloids and low-grade accumulation of FDG was observed in all lesions. This indicated that glucose metabolism was accelerated in keloids.

Comparison of regional efficacy and complications in the treatment of aberrant Mongolian spots with the Q-switched ruby laser

Abstract Background and objective: Aberrant Mongolian spots (AMS) distal from the lumbosacral region are said to be more apt to persist than the typical sacral AMS, so the Q-switched ruby laser (QSRL) has been the treatment of choice for AMS. However, so far as we could determine, there is no statistical analysis of the treatment of AMS. This paper shows statistical comparisons of the efficacy and complications in the treatment of AMS with QSRL. Methods: Fifty-three patients (16 males and 37 females) with 57 AMS regions were treated with the QSRL from March 1999 to April 2007, and we divided the diseased areas into exposed regions that could not be concealed by clothing and non-exposed regions that could be concealed by clothing, and performed a statistical analysis. Results: The results indicated that QSRL treatment of AMS in the exposed regions showed significantly improved coloration and caused less pigmentation when compared with the non-exposed regions. Conclusion: We concluded that QSRL treatment of AMS in the exposed regions is more effective than that of AMS in the non-exposed regions.

Giant epidermal cyst extending from sole to dorsum of the foot by penetrating the interosseous muscles

We present a 65‐year‐old man with a giant epidermal cyst extending from sole to dorsum of the foot by penetrating the interosseous muscles. This epidermal cyst extending from the sole to the dorsum of the foot was big and an extremely rare lesion.

Clinical results of OK-432 injection therapy for ganglions.

We performed a study of intralesional OK‐432 injection therapy for the non‐surgical treatment of ganglions. OK‐432 is an agent made from penicillin‐killed and lyophilized preparations of a low‐virulence strain of group A streptococcus pyogenes, which has been developed as an immune‐augmentation agent for cancer therapy. Derived from an extract of bacterial culture it, induces an immunological response and causes local inflammation and subsequent tissue shrinkage following intralesional injection. After skin anesthesia and aspiration of the ganglion contents, OK‐432 was injected into the ganglion cavity. When the ganglion recurred, this procedure was repeated usually up to a total of three times. Clinical evaluations six months after the last injection were: 56.6% complete cure, 35.3% incomplete cure with size reduced, 7.5% no change. Complications were as follows. There were no cases of shock. High fever was seen in five patients (9.4%); two patients suffered a high fever up to 39.0°C for one day, and the others had fevers from 1 to 3 days. Thirty‐two patients (60.4%) complained of local swelling that persisted for 1 to 7 days, and 11 (20.8%) complained of continuous pain for 1 to 3 days. Intralesional OK‐432 injection therapy is thought to be a safe and convenient alternative to surgical treatment.

Nostril suspension and lip adhesion improve nasal symmetry in patients with complete unilateral cleft lip and palate

BACKGROUND There is a difference between complete and incomplete cleft lip with regard to the nasal shape. Severe nasal deformity is found in almost all cases of complete cleft lip. This problem has been approached by preoperative nasoalveolar moulding, primary nasal correction and the use of a nostril retainer. We corrected the nasal deformity associated with complete cleft lip by using the combination of a nostril suspender and lip adhesion before cleft lip repair. The present article outlines this treatment strategy and assesses the effects of our treatment on nasal deformity. METHODS Fourteen patients with complete cleft lip and palate were assigned to two groups for retrospective analysis: group A comprised seven patients, who underwent cleft lip repair after a combination of nostril suspension and lip adhesion, while group B had seven patients, who received cleft lip repair alone. In group A, a nostril suspender was fabricated and fitted to each patient at the initial visit, while lip adhesion was done at 1 month of life. At 1 year postoperatively, four parameters (nostril symmetry, alar cartilage slump, alar base level and columellar tilt) were scored on a scale of 1-4 to compare nasal shape between the two groups. RESULTS With respect to nostril symmetry, alar cartilage slump and columellar tilt, group A showed less deformity compared with group B and the difference between the two groups was statistically significant. CONCLUSIONS The use of a nostril suspender and lip adhesion can achieve dynamic correction of the nasal deformity associated with complete cleft lip.

The use of test skin grafting in pemphigus vegetans

1748-6815/