Dermatofibrosarcoma protuberans: a population-based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year. OBJECTIVE: To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002. METHODS: Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied. RESULTS: The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P=0.004; OR=0.229 (95%, CI=0.103-0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable. CONCLUSION: Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.     

Modified Nile red staining method for improved visualization of neutral lipid depositions in stratum corneum.

The neutral lipids existing in the intercellular spaces of the stratum corneum (SC) provide a permeability barrier to prevent water loss. Nile red is the most sensitive lipid stain for tissue sections. However, due to the extremely flattened morphology of corneocytes and the resolution limits of the light microscope, Nile red staining is seldom used as a fluorescent probe for the lipid-rich SC. In this study, we modified the traditional method for visualization of intracellular lipid by adding 4% potassium hydroxide after Nile red staining. This modified method not only allowed visualization of lipids existing in the intercellular membrane regions and the lateral junctions of the adjoining corneocytes, but also clearly demonstrated small lipid droplets within pathological corneocytes. These features were not observed with the traditional staining method. Thus, this modified Nile red staining method greatly improved the resolution of the SC lipids under light microscopy and should be useful for studying lipid depositions in both normal and pathological SC.     

Pediatric traumatic brain injuries in Taiwan: an 8-year study.

Background. This study is intended to determine the causes of pediatric traumatic brain injuries (PTBI) in children aged 14 years or less, and to identify various types of craniocerebral damage resulting from different mechanisms of injury.Methods. From July 1, 1993 to June 30, 2001, a survey on PTBI was conducted in Taiwan. The data of patients used in this study were collected from 56 major hospitals among the age group of 0-14 years. The items in the traumatic brain injury survey included sex, age, causes of injuries, severity, and the eventual outcome.Results. A total of 5349 cases were identified. The male-to-female ratio was 1.69: 1. The incidence rate was higher in the age groups of 4-9 years and 10-14 years. The main cause of PTBI was traffic injury, which accounted for 2537 of the cases (47.3%), followed by falls, 2160 (40.3%). Of all traffic injuries, motorcycle-related injury had the highest incidence, followed by the pedestrian and bicycle-related injury. This study also showed that 83.2% of the patients had mild injury, 9.8% had moderate injury, and 7.0%, severe injury.Conclusions. The results of this study suggest that it is important to decrease all the risk factors in the environment of homes and public areas as much as possible. Helmet wearing and the development of public transportation are essential for the prevention of head injury.     

Stress selectively influences center region activity of mice in an open field

Effects of immobilization and footshock stress on locomotor activity in different areas of an open field were examined in mice. Center region activity, peripheral region activity and total activity were used as measurement indices. These results indicate that both immobilization and footshock stress significantly increased total activity across 24 min of behavioral testing. Further analyses revealed that the difference in total activity between the experimental and control groups were mainly attributal to an increase in center region activity. Both stress manipulations markedly augmented peripheral region activity for only the first 6 min. More important, when the proportion of center to peripheral activity was used as an index, both experimental groups manifested an inverted U shape relationship with the maximum effect occurring between 13-18 min of behavioral testing. Similarities of these activity measures in response to different stressors suggests that common neurochemical and/or neurohormonal mechanisms may mediate these behavioral changes.     

Anatomic study of a new axial skin flap based on the cutaneous branch of the medial plantar artery

A new axial skin flap based on the middle cutaneous branch of the medial plantar artery was evaluated in 33 fresh cadaver legs. The vascular pedicle of the skin flap is based on the middle cutaneous artery, its venae comitantes, and segments of the great saphenous vein, if necessary. The middle cutaneous artery is the largest cutaneous branch, arising from the medial plantar artery 2.5 cm distal to its origin. The diameter of its origin is 1.2 mm, and its pedicle is 2 cm long. The midline of the flap runs from the first web space to the heel tip. The upper and lower borders of the flap are 3 to 4 cm on either side of this line. The upper border is medial to the extensor hallucis tendon, and the lower border is medial to the abductor hallucis. Distally, the border begins 2 cm proximal to the metatarsalphalangeal joint; proximally, the border is at the middle of the medial malleolus. The flap diameter can be up to 8 × 12 cm. The middle cutaneous branch of the medial plantar artery was found in all cadaver specimens, except for one with a common trunk. The new flap design leaves the major blood supply to the foot and the plantar aponeurosis intact. It is easy to harvest and may be used either as an island flap or free flap. © 1995 Wiley-Liss, Inc.     

Emergency free flaps to the type IIIC tibial fracture

Type IIIC tibial fractures are complex injuries involving extensive bone and soft-tissue devascularization that result in a high percentage of complications and ultimate amputation. An emergency free flap transfer not only may salvage the limb but also may improve the aesthetic and functional results of reconstruction by placing the injured structures in a well-vascularized bed. Two cases of type IIIC tibial fracture were treated in this manner, and we present our experience with a 30-month follow-up of one patient and a 6-month follow-up of another patient.     

Anabolic and catabolic hormonal response of elite runners to training at high altitude

A 2-week training period 2000 meters above sea level performed by 6 male elite Swedish runners influenced neither basal anabolic (total and non-sex hormone-binding globulin (SHBG)-bound testosterone (NST) and insulin-like growth factor-1 (IGF-1) nor catabolic (cortisol) hormones when comparing serum levels prior to and after the training camp. The anabolic vs catabolic hormone balance, expressed as the NST: cortisol ratio, also remained unchanged as well as SHBG and body mass. Thus, training at 2000 meters above sea level, often practised by elite runners to improve performance in competition at sea level, does not result in a catabolic situation after return to sea level, as measured by peripheral hormones. However, the adaptation to high altitude was associated with a slight (NS) decrease in testosterone as well as in anabolic vs catabolic balance as measured the third day at high altitude. Simultaneously, a decrease in subjective performance was claimed by the runners, but could not be shown by objective measurements. From day 3 to day 9 at high altitude, all runners claimed a subjective recuperation of performance. Total and non-SHBG-bound testosterone increased significantly from day 3 at high altitude to the first post-camp sea-level test. The results reflect the necessity of adaptation when travelling to races at different altitudes. The Swedish runners had significantly higher cortisol, total testosterone and NST levels compared with basal values of a group of 17 elite Kenyan runners living and training at high altitude. Since the NST cortisol and IGF-1 values were not lower, a catabolic state or malnutrition was not likely to be present. The results might reflect an adaptation to altitude or ethnic variations.