Characterization of hyaluronan and TSG‐6 in skin scarring: differential distribution in keloid scars,normal scars and unscarred skin

Background Hyaluronan (HA) is a major component of the extracellular matrix (ECM) with increased synthesis during tissue repair. Tumour necrosis factor‐stimulated gene‐6 (TSG‐6) is known to catalyze the covalent transfer of heavy chains (HC1 and HC2) from inter‐α‐inhibitor (IαI) onto HA, and resultant HC?HA complexes have been implicated in physiological and pathological processes related to remodelling and inflammation. Objective The aims of this study were to determine the expression of HA, TSG‐6 and the IαI polypeptides in unscarred skin, normal scars and keloid scars. Methods Formalin‐fixed paraffin‐embedded sections of unscarred skin, normal scars and keloid scars were prepared from patient samples collected during scar revision surgery. Haematoxylin and eosin, as well as immunofluorescent staining for HA, TSG‐6 and the three polypeptide chains of IαI (i.e. HC1, HC2 and bikunin) were performed. Results All skin types stained positive for TSG‐6, HC1, HC2 and bikunin, associated with keratinocytes, fibroblasts and skin appendages all in close proximity to HA. Keloid lesions showed altered HA organization patterns compared with unscarred skin and normal scars. TSG‐6 staining was significantly more intense in the epidermis compared with the dermis of all sample types. There was a significant reduction in TSG‐6 levels within keloid lesions compared with the dermis of unscarred skin (P = 0.017). Conclusion TSG‐6 is expressed in unscarred skin, where its close association with HA and IαI could give rise to TSG‐6‐mediated HC?HA formation within this tissue. A reduction in the beneficial effects of TSG‐6, caused by diminished protein levels in keloid lesions, could contribute to this abnormal scarring process.     

A case report of pulmonary coinfection of Strongyloides stercoralis and Pneumocystis jiroveci

A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muñiz Hospital. At diagnosis, the patient presented cough with mucopurulent expectoration, dyspnea, fever, bilateral pulmonary infiltrates on the chest X-ray, negative bacilloscopy for acid fast bacteria and a CD4⁺ T lymphocytes count of 52 cells/µL. The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage, while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates, pathognomonic of the pulmonary pneumocystosis. It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy. Other complementary stains (a rapid modification of Grocott, Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy. Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients, such as those with AIDS.     

Natural Orifice Transluminal Endoscopic Surgery

Natural orifice transluminal endoscopic surgery (NOTES) has generated healthy and vigorous debate about the introduction of an entirely novel method of surgical therapy. Although there are many reasons for scepticism, there is undoubted interest in this field from both the medical profession and general public. Those Associations currently involved in laparoscopic and endoscopic surgery wish to safeguard patients and the reputation of the profession by issuing clear guidance and support for those wishing to undertake NOTES. The purpose of this document is to review the current status of both NOTES and hybrid NOTES, while at the same time identifying obstacles in both clinical research and training. Furthermore, it aims to provide a consensus statement on behalf of the main UK specialty associations involved in this field of surgery. The primary aim of this consensus statement is to provide a framework within which to develop, safely and effectively, what must still be considered an experimental technique.     

Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

A simple measure to determine one-year mortality following hip fractures has its benefits. Where there is controversy over implant selection, such a scoring system can facilitate the decision-making process. We undertook a retrospective analysis of one-year postoperative mortality of our hip fracture patients and established their admission serum albumin levels to see if there was any correlation between this and one-year mortality. Our results showed one-year mortality was significantly higher (p=0.0049) for those patients with a serum albumin of <35g/dl. Of the patients with low albumin, we found that there was no statistical significance between one-year mortality and source of admission (p=0.0789). Prefracture serum albumin can be used as a simple predictor of one-year mortality in patients presenting with a fractured neck of femur, thereby aiding operative planning and implant selection with a view to likely survival and possible need for revision.