Cutaneous leishmaniasis control in Alta Verapaz (northern Guatemala): evaluating current efforts through stakeholders’ experiences

Background::Cutaneous leishmaniasis (CL), endemic in Guatemala, mostly affects poor people living in the northern region. A national control program that includ...     

皮肤非结核分枝杆菌感染三例

目的评价T-SPOT.TB在皮肤非结核分枝杆菌感染中的诊断价值。方法对3例拟诊为游泳池肉芽肿的患者在治疗前后进行T-SPOT.TB检测。结果例1显示相对分子质量6 000早期分泌靶向抗原(ESAT-6)阴性,相对分子质量10 000培养滤过蛋白肽段库(CEP-10)阳性;例2显示ESAT-6及CEP-10均阳性;例3显示ESAT-6阳性,CEP-10阴性。3例患者经过口服利福喷丁、乙胺丁醇和克拉霉素治疗4个月,皮损均获得痊愈。治疗后检测T-SPOT.TB,例1和例3阳性结果全部转阴。结论初步研究显示,在拟诊皮肤非结核分枝杆菌感染中检测T-SPOT.TB在快速和准确诊断方面有重要的参考意义。     

Cutaneous lymphadenoma is distinct from basal cell carcinoma

Background Cutaneous lymphadenoma is a recently recognized unusual tumor. It presents as an indistinct solitary non-ulcerating dermal nodule occuring mostly in the head and neck region of middle aged persons. Its histogenetic definition is controversial and recently it has been proposed that it might represent an unusual inflammatory basal cell carcinoma. We present clinical, hislological and immunohistochemistry data of two cases. For the first time lectin-imrnunohistochemisiry of cutaneous lymphadenoma is reported on. Observations One tumor was located on the eyebrow of a 37 years old, the other on the nose of a 75 years old male patient. Slow growth over years occured. Histology showed biphasic pattern of elongated and angulated lobules with peripheral rim of basaloid cells and central network of lymphohisltocytic cells with preponderance of protein S 100-positive cells. Peanut agglutinin (PNA) did not show peripheral staining around tumor lobules as seen in basal cell carcinoma. Conclusions Clinical and histological features as well as absence of peanut agglutinin staining argue in favor of the distinction of cutaneous lymphadenoma from inflammatory basal cell carcinoma. The former probably represents a benign growth of adnexal origin.     

Cyclosporin A in the treatment of cutaneous vasculitis. Clinical and cellular effects

Background Treatment of cutaneous vasculitis(CV) is an unsettled issue. Cyclosporin A (Cy-A) has been successfully used in dermatoses with immunologic background. some systemic vasculitides and Behcet's disease. Objective To check the therapeutic potential of Cy-A in severe or recalcitrant cases of CV was considered of interest. The effects on the in situ cell populations involved in the inflammatory-immune events were further investigated. Methods An open clinical trial (12 cases) was carried out. An immunohistochemical study was also performed, evaluating skin specimens from established lesions, before and 48 h after Cy-A first administration. The effect on endothelial adhesion molecules, integrin bearing leukocytes, T-cells, lymphomononuclear cells and dendrocytes in the dermis as well as on epidermal antiyenic determinants focused our interest. Results Reduced endothelial ICAM-1 expression was shown. Cy-A was proved to adversely affect b2 integrin expression and therefore adhesion pathways. T-cells, epidermal dendritic cells and dendrocytes were found decreased. On clinical grounds, a very early therapeutic response was noted. Tolerance was good in the dose of 5mg/kg/day. Relapses, however, have not been avoided. Conclusion Cy-A seems to be very effective on both the clinical and cellular level where inflammatory-immunologic events seem to be temporarily inhibited.     

Immunohistochemical evidence of α-, β- and γ3-melanocyte stimulating hormone expression in cutaneous malignant melanoma of nodular type

Opiomelanocortins are formed after cleavage of the larger precursor molecule, proopiomelanocortin (POMC), which contains several peptide residues, sharing certain amino acid homology, including adrenocorticotrophic hormone (ACTH) and α-, β- and γ-melanocyte stimulating hormone (MSH). The expressions of α-, β- and γ3-MSH in human cutaneous malignant melanoma of nodular type are demonstrated. For the MSHs, the immunolabelling was concentrated mostly in the tumour cellular cytoplasm, with occasional cells displaying a nuclear staining. Labelled tumour cells were dispersed throughout the epidermis and dermis as individual cells or in so-called 'pearl-like nests', most of which consisted mainly of round or oval shaped cells as well as a few pleomorphic or spindle-shaped cells. The fluorescence intensity seemed to increase in accordance with the development of the tumours. All cases examined were clearly stained with protein S-100, which provided us with a definite diagnosis. Considering the overall MSHs-related staining intensity of each section, the general perception we got was that the closer to the centre of the tumour parenchyma, the stronger was the staining and, furthermore the larger/more poorly differentiated the cells, the stronger was the staining. We also found the MSHs expressions to appear in the peripheral part of the tumour and the perilesional tissues including epidermis, sweat glands, sebaceous glands as well as hair follicles. Neurohypertrophic features were encountered including increases in both the number of nerve fibres and their diameter. Our results presented here strongly support the viewpoint earlier proposed that MSH peptides, by an autocrine and/or paracrine production from melanoma cells, are engaged in the regulation of melanogenesis, growth and proliferation of the tumour cells. We also conclude that, although α-, β- and γ3-MSH peptides do not provide as high a sensitivity for diagnosis as protein S-100, they appear as useful markers for supportive diagnosis and assessment of malignant melanoma.     

皮肤恶性黑素瘤凋亡相关基因Survivin Bax表达及其与端粒酶的关系

目的探讨凋亡相关基因Survivin,Bax及人端粒酶逆转录酶(hTERT)在皮肤恶性黑素瘤中的表达及其临床意义。方法SP免疫组化染色检测63例皮肤恶性黑素瘤和21例色素痣组织中Survivin,Bax蛋白水平;原位杂交技术检测上述组织中人端粒酶逆转录酶(hTERT)mRNA水平。结果①凋亡相关蛋白Survivin在皮肤恶性黑素瘤中的表达明显强于其在色素痣中的表达,Bax在二者中的表达无明显差异,hTERTmRNA表达与Survivin相似;②Survivin蛋白和hTERTmRNA表达均与恶性黑素瘤病理学类型、淋巴结转移、浸润深度及预后相关,Bax表达与之无相关;③hTERTmRNA在黑素瘤中的表达水平与Survivin呈高度正相关,与Bax表达无关,Survivin与Bax表达水平无明显相关性。结论皮肤恶性黑素瘤形成和发展与肿瘤细胞抗凋亡(Survivin)和促进增殖(hTERT)均密切相关;Survivin和hTERT对皮肤恶性黑素瘤的辅助诊断及预后评估具有重要的临床意义;Bax表达与皮肤恶性黑素瘤的发生发展无明显相关性。     

A Case of Primary Cutaneous Mucinous Carcinoma with Neuroendocrine Differentiation

Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.     

顽固性寻常性银屑病皮损在十二皮部分布规律初探

目的应用中医学十二皮部理论观察顽固性寻常性银屑病的主要皮损分布部位,分析其在十二皮部的分布规律以及血热证、血瘀证、血燥证3个基本证型之间皮损所在皮部的分布规律,为进一步完善银屑病辨证论治理论、提高临床疗效奠定理论基础。方法对顽固性寻常性银屑病患者皮损所在皮部进行观察,将主要皮损部位描画于"皮损所在皮部研究观察表",记录患者皮损所在的皮部。总结皮损在十二皮部出现的频数及百分率,并进行排序,分析其在十二皮部的分布规律以及不同证型间皮损所在皮部的分布规律。结果顽固性寻常性银屑病皮损在十二皮部分布的频率差异具有统计学意义(P0.05),皮损主要分布在足太阳膀胱经皮部、足阳明胃经皮部、足少阳胆经皮部、足厥阴肝经皮部和足太阴脾经皮部。顽固性寻常性银屑病各证型(血热证、血燥证、血瘀证)之间皮损在十二皮部分布的频率差异,以及各证型与总体相比较皮损在十二皮部分布的频率差异,尚均未发现具有统计学意义(P0.05)。结论顽固性寻常性银屑病皮损在十二皮部的分布具有一定规律性,足太阳膀胱经、足阳明胃经、足少阳胆经、足厥阴肝经和足太阴脾经等皮部皮损分布较多,提示以上经络脏腑可能与顽固性寻常性银屑病具有一定相关性;顽固性寻常性银屑病皮损在十二皮部的分布与银屑病"从血论治"的分型尚无明显相关性。     

Clustering of Pacinian corpuscle afferent fibres in the human median nerve

 To further study the functional organisation of human peripheral nerves, the intrafascicular arrangement of afferent fibres supplying Pacinian corpuscles (PCs) was explored by percutaneous microneurography using thin-calibre, concentric needle electrodes. In normal adults, 20 PC afferents were identified in 13 recording sites. Low-amplitude (less than 30 μm) vibratory stimuli to the skin were applied with tuning forks oscillating at 128 Hz or 256 Hz and response patterns of individual PC units were studied. In many recording sites, two, sometimes even three, PC afferents with adjacent or overlapping receptive fields in the hand were clustered in the nerve. The observed incidence in the records containing a certain number of PC units was compared with the expected probability calculated according to the hypothesis that all nerve fibres are randomly organised in peripheral nerves. The results suggested that PC afferents are partially segregated in the nerve. In addition, PC afferents were neighbouring on slowly adapting type II (SAII) units and skin sympathetic activity in individual fascicles. SAII units often innervated the same skin area as PC units, but did not respond to vibration. The data provided additional information regarding the functional organisation of the human peripheral nerve and the mechanisms underlying the sense of vibration in man with special regard to population behaviour of neighbouring PC mechanoreceptors. Received: 25 September 1998 / Accepted: 14 December 1998     

Peripheral reinnervation patterns and dorsal root ganglion cell topography in skin-grafted rana pipiens frogs

Behavioral responses to mechanical stimulation of the skin were observed in unoperated, 180° skin-rotated and sham-grafted Rana pipiens frogs before and after crushing various cutaneous nerve bundles. In the two control groups, wiping responses directed towards the animal's dorsum were mediated solely via dorsomedial (DM) and dorsolateral (DL) nerve trunks. In skin-rotated frogs, DM and DL nerve trunks were responsible for almost all of the misdirected responses elicited from dorsal cutaneous areas. Six frogs (2 sham- and 4 skin-rotated) possessed some areas of plical skin from which responses could only have been mediated via more ventrally located nerve trunks. However, such dorsal expansions of ventral receptive fields never included the midline skin areas from which misdirected responses had been elicited in the intact animal. The topographic arrangement of cells within the DRG appears to be weakly polarized in cobalt-stained sections, but with large individual variations in size and observed number of neuronal profiles. For the skin-rotated group the ratio of cobalt-filled profiles in the dorsal as compared with the ventral half of the ganglion was 1.6, which did not differ significantly from the control value of 1.9. Taken as a whole, the results of the present study indicate that selective (re)innervation of displaced skin by the original nerve fibers cannot explain the origin of misdirected responses in Rana pipiens.