Impact of Carpal Tunnel Syndrome Surgery on Early Diagnosis and Treatment of Transthyretin Cardiac Amyloidosis.

Background and Objectives: Cardiac amyloidosis is an infiltrative, progressive, and restrictive cardiomyopathy that leads to heart failure, reduces life quality, and causes death. This is a multisystem disorder caused by mutations of the transthyretin protein and is associated not only with cardiac diseases or carpal tunnel syndrome but also with nerve, liver, lung, gastrointestinal tract, kidney, or eye pathologies. Carpal tunnel syndrome is an early red-flag symptom of transthyretin (TTR) cardiac amyloidosis; therefore, screening for unsuspected cardiac amyloidosis can be performed through histological testing of flexor retinaculum specimens gathered during carpal tunnel release surgery. Our case highlights that early detection and accurate diagnosis of a disease are important factors for improving clinical outcomes in patients with TTR amyloidosis. Case Summary: We report the case of a 71-year-old man who presented with bilateral carpal tunnel syndrome. Amyloid deposits were detected after carpal tunnel release surgery through histological testing of the synovial tissue. The patient was sent for a cardiological evaluation. Physical examination, laboratory tests, and the ECG revealed no significant changes. The diagnosis of amyloidosis was confirmed with multimodality imaging in the early stage, which helped to start specific medicamental treatment with the transthyretin stabilizer tafamidis. Conclusions: Our objective is to highlight the early recognition and specific medicamental treatment of cardiac amyloidosis for better patient prognosis and outcomes.

Evaluation of WNT Signaling Pathway Gene Variants WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 in Patients with Dupuytren's Contracture.

Dupuytren's contracture (DC) represents a chronic fibroproliferative pathology of the palmar aponeurosis, which leads to flexion contractures of finger joints and hand disability. In recent decades, the WNT signaling pathway has been revealed to play a significant role in the manifestation and pathogenesis of DC. Our study aimed to evaluate the associations between Dupuytren's contracture and WNT-related single-nucleotide polymorphisms: Wnt Family Member 7B (WNT7B) rs6519955 (G/T), Secreted Frizzled Related Protein 4 (SFRP4) rs17171229 (C/T) and R-spondin 2 (RSPO2) rs611744 (A/G). We enrolled 216 patients (113 DC cases and 103 healthy controls), and DNA samples were extracted from the peripheral blood. Genotyping of WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 was performed using the Real-Time PCR System 7900HT from Applied Biosystems. WNT7B rs6519955 genotype TT carriers were found to possess a higher prevalence of DC (OR = 3.516; CI = 1.624-7.610; p = 0.001), whereas RSPO2 rs611744 genotype GG appears to reduce the likelihood of the manifestation of DC nearly twofold (OR = 0.484, CI = 0.258-0.908, p = 0.024). In conclusion, SNPs WNT7B rs6519955 and RSPO2 rs611744 are associated with the development of Dupuytren's contracture: WNT7B rs6519955 TT genotype increases the chances by 3.5-fold, and RSPO2 rs611744 genotype GG appears to attenuate the likelihood of the manifestation of DC nearly twofold. Findings of genotype distributions among DC patients and control groups suggest that SFRP4 rs17171229 is not significantly associated with development of the disease.

Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression.

Background and objectives: Dupuytren's contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren's contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren's contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the "Criteria for recognition of Dupuytren's contracture after acute injury" (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I-II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injury-induced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren's contracture seemed to suffer from injury-induced Dupuytren's contracture. We noted that injury to the wrist and hand seems to trigger the development of less progressive Dupuytren's contracture in younger age. Prospective randomized studies are required to confirm our findings.

Retraction Note to: Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study.

The Editor-in-Chief and the publisher have retracted this article [1]. An investigation by the Lithuanian Bioethics Committee concluded that, contrary to the statements in the article, the study described was not conducted in the Vilnius City Clinical Hospital and the Commission of Medical Ethics did not issue any approval for such a study.

Effectiveness of autologous platelet-rich plasma gel in the treatment of hard-to-heal leg ulcers: a randomised control trial.

OBJECTIVE: Regenerative medicine products such as autologous platelet-rich plasma (autologous PRP) gel may speed up the process of healing. Clinical studies show promising results in the treatment of diabetic foot ulcers (DFUs), however there is lack of scientific evidence of autologous PRP effectiveness in treating leg ulcers of other aetiology. This study evaluates the effectiveness of autologous PRP gel in the treatment of hard-to-heal leg ulcers compared with existing conventional treatment. METHOD: A prospective, randomised controlled, open-labelled clinical trial was carried out between 2014 and 2018. An eight-week study protocol was chosen or until 100% wound re-epithelialisation was observed. Wound size reduction, granulation tissue formation, microbiological wound bed changes and safety were evaluated. RESULTS: A total of 69 patients (35 in the autologous PRP group and 34 in the control group) were included in the study; 25.71% of the autologous PRP group and 17.64% of control group had ulcers completely re-epithelialised (p>0.05). Wound size reduction in the autologous PRP group was 52.35% and 33.36% in the control group (p=0.003). The autologous PRP group showed superiority over conventional treatment in wound bed coverage with granulation (p=0.001). However, more frequent wound contamination was observed at the end of treatment in the autologous PRP group (p=0.024). No severe adverse events were noted during the study. Both treatment methods were considered equally safe. CONCLUSION: Topical application of autologous PRP gel in leg ulcers of various aetiology show beneficial results in wound size reduction and induces the granulation tissue formation. However, it is associated with more frequent microbiological wound contamination.

Subacute Arterial Bleeding After Simultaneous Mastopexy and Breast Augmentation with Implants.

Breast augmentation with implants is one of the most commonly performed plastic surgery procedures. The goal of the operation is to increase the size, shape or fullness of the breast. It is accomplished by placing silicone, saline or alternative composite breast implants under the chest muscles, fascia or the mammary gland. This type of operation is no exception concerning the occurrence of complications. The most common early complications include an infectious process, a seroma, and a hematoma, and the late ones are capsular contracture, reoperation, implant removal, breast asymmetry, and rupture or deflation of the implant. The authors present a case of subacute arterial bleeding after simultaneous mastopexy and breast augmentation with silicone implants in a 27-year-old woman. The patient complained of worsening swelling and soreness in the right breast. The patient denied having had any traumas. Ultrasonography indicated 2.5 cm heterogeneous fluid sections around the implant. Therefore, revision surgery was performed, and a hematoma of 650 mL was removed. Hemorrhaging from a branch of an internal mammary artery was found. After the revision, the implant was returned to the lodge. The postoperative period was uneventful. This case report presents a description of a subacute hematoma after simultaneous mastopexy and breast augmentation with silicone implants, which is an extremely rare complication in esthetic surgery.

Split-thickness skin grafting: early outcomes of a clinical trial using different graft thickness.

OBJECTIVE: In clinical practice, split-thickness skin graft (STSG) transplantation remains the gold standard for covering large skin defects. Currently, there is no consensus on the optimal thickness of skin grafts. The purpose of our study was to compare the early healing processes of recipient and donor wounds after STSG transplantation using grafts of different thickness. METHOD: This prospective, randomised clinical trial included 84 patients that underwent STSG transplantation surgery for post-burn, post-traumatic or postoperative skin defects. Patients were randomised to receive a skin graft of either 0.2mm, 0.3mm or 0.4mm thickness. After skin transplantation, the wound healing parameters of both the recipient and donor wounds were evaluated after three days, one week, two weeks and one month. RESULTS: The greatest mean epithelialisation scores and highest rate of complete wound epithelialisation were identified in the recipient and donor wounds of the 0.2mm transplant group, at all time points. When the recipient wound pain scores were evaluated, the greatest visual analogue scale (VAS) values were found in the 0.2mm transplant group. The opposite result was found for the donor wound, where the highest VAS scores were identified in the 0.4mm transplant group. There were no significant differences, at any follow-up period, when wound secretion, erythema, swelling, localised warmth and fluctuation were compared. CONCLUSION: The early healing of recipient wounds after STSG transplantation with grafts of various thickness differed considerably, especially regarding wound epithelialisation and pain.

Comparison of non-surgical methods for the treatment of deep partial thickness skin burns of the hand.

This paper describes a randomized, controlled, parallel-group, single-center clinical trial designed to compare non surgical treatment methods of deep partial thickness skin burns of the hand. All patients were scanned with the Laser Doppler Imaging device to determine the depth of the burn wound. Viable keratinocytes sites were determined according to the established Perfusion Units (PU) measurement system. The trial enrolled 87 patients with hand burn wounds in the section of 260-600PU. Hand burn patients were divided into the following four groups: treated with hydrocolloid dressings; treated with mechanical debridement of monofilament polyester fibers pad and then applying silver sulfadiazine; treated with gauze dressings containing enzymatic collagenase preparation. The fourth group of patients was treated with silver sulfadiazine and gauze dressings. This group was considered as the control group. The wound healing status was assessed after 3, 7, 14 and 21 days. Burn scars and injured extremity function were assessed after six months according to the Vancouver Scar Scale and Disabilities of the Arm, Shoulder and Hand Outcome Measure. The fastest epithelialization of hand burn wounds was observed in the patients group treated with hydrocolloid dressings (15, 7 days, p<0,05). The patients of this group also had less scars and a better hand function.

Importance of sentinel lymphatic node biopsy in detection of early micrometastases in patients with cutaneous squamous cell carcinoma.

BACKGROUND: Cutaneous squamous cell carcinoma (CSCC) is the second most common malignant skin cancer with a tendency to spread through the lymphogenic pathway. Metastases are found in 2-6% of cases. The aim of this study was to determine CSCC micrometastases when non-invasive examination methods do not detect them. METHOD: A total of 88 patients were included in the study with clinically diagnosed, histologically confirmed CSCC and no distant or regional lymph node metastases detected during instrumental tests. The patients were grouped into low- and high-risk CSCC groups. They underwent one-stage surgery - radical tumour excision and sentinel lymph node/nodes biopsy (SLNB). Significance level of 0.05 was chosen for testing statistical hypotheses. RESULTS: One hundred and fifty-three sentinel lymph nodes (SLNs) were detected and excised in 88 patients. Micrometastases were found in five SLNs of three patients with high-risk CSCC. The rate of micrometastases was 3.4%; however, in the high-risk group it was 6.5%. The mean diameter of CSCC with micrometastases in SLN was 5.6 ± 3.5 cm, and that without micrometastases was 1.5 ± 1.1 cm (p = 0.003). The depth of CSCC according to Breslow in the patients with detected micrometastases in SLN was 3.5 ± 1.2 mm, and that without detected micrometastases was 2.2 ± 1.4 mm (p = 0.047). Patients with micrometastases in sentinel lymphatic nodes underwent radical lymphadenectomy. There was neither recurrence of CSCC metastases in regional lymph nodes nor distant metastases during the research period detected. CONCLUSIONS: In patients with CSCC the rate of micrometastases directly correlates with the depth and diameter of the tumour. In patients with high-risk CSCC the rate of micrometastases is 6.5%.

Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study.

BACKGROUND: Cell-based therapy is being explored as an alternative treatment option for critical limb ischemia (CLI), a disease associated with high amputation and mortality rates and poor quality of life. However, therapeutic potential of uncultured adipose-derived stromal vascular fraction (SVF) cells has not been evaluated as a possible treatment. In this pilot study, we investigated the efficacy of multiple injections of autologous uncultured adipose-derived SVF cells to treat patients with CLI. METHODS: This study included 15 patients, from 35 to 77 years old, with rest pain and ulceration. SVF cells were injected once or twice in the ischemic limb along the arteries. Digital subtraction angiography was performed before and after cell therapy. The clinical follow up was carried out for the subsequent 12 months after the beginning of the treatment. RESULTS: Multiple intramuscular SVF cell injections caused no complications during the follow-up period. Clinical improvement occurred in 86.7% of patients. Two patients required major amputation, and the amputation sites healed completely. The rest of patients achieved a complete ulcer healing, pain relief, improved ankle-brachial pressure index and claudication walking distance, and had ameliorated their quality of life. Digital subtraction angiography performed before and after SVF cell therapy showed formation of numerous vascular collateral networks across affected arteries. CONCLUSION: Results of this pilot study demonstrate that the multiple intramuscular SVF cell injections stimulate regeneration of injured tissue and are effective alternative to achieve therapeutic angiogenesis in CLI patients who are not eligible for conventional treatment. Trial registration number at ISRCTN registry, ISRCTN13001382. Retrospectively registered at 26/04/2017.

Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: Analysis of recurrence-free survival.

BACKGROUND AND AIM: Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%-6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization of primary tumor. The aim of this study was to evaluate the recurrence-free survival of patients with CSCC after tumor excision and SLNB as well as to analyze morphologic CSCC features related to patient recurrence-free survival. MATERIALS AND MATERIALS: A retrospective analysis of 51 patients with CSCC, who underwent surgical treatment between January 1, 2012, and December 31, 2014, in the Clinic of Plastic and Reconstructive Surgery, Hospital of the Lithuanian University of Health Sciences, was done. The diagnosis of CSCC was verified on a histological examination, and all patients had no clinical evidence of nodal or distant metastases on a physical examination or imaging studies. Sentinel lymph node biopsy (SLNB) was performed for low- and high-risk CSCC patients. RESULTS: A total of 51 patients were enrolled into the study (34 women and 17 men). Total of 68 lymph nodes were removed during sentinel lymph node biopsy. No micrometastases were identified. Until April 1, 2015, no relapse event was documented. The mean time after operation was 27.5 months. During the follow-up period, no distant metastases were identified. CONCLUSIONS: No patient who had no micrometastases in sentinel lymph nodes developed local and distant CSCC metastases during the follow-up period. Our report supports the concept that SLNB can be applied for CSCC. It is obvious that larger prospective studies with longer follow-up period are needed to establish the efficacy of SLNB and define the optimal treatment of occult nodal metastasis for CSCC.

MODELING AND BIOPHARMACEUTICAL EVALUATION OF SEMISOLID SYSTEMS WITH ROSEMARY EXTRACT.

Scientific literature provides a great deal of studies supporting antioxidant effects of rosemary, protecting the body's cells against reactive oxygen species and their negative impact. Ethanol rosemary extracts were produced by maceration method. To assess biological activity of rosemary extracts, antioxidant and antimicrobial activity tests were performed. Antimicrobial activity tests revealed that G+ microorganisms are most sensitive to liquid rosemary extract, while G-microorganisms are most resistant to it. For the purposes of experimenting, five types of semisolid systems were modeled: hydrogel, oleogel, absorption-hydrophobic ointment, oil-in-water-type cream and water-in-oil-type cream, which contained rosemary extract as an active ingredient. Study results show that liquid rosemary extract was distributed evenly in the aqueous phase of water-in-oil-type system, forming the stable emulsion systems. The following research aim was chosen to evaluate the semisolid systems with rosemary exctract: to model semisolid preparations with liquid rosemary extract and determine the influence of excipients on their quality, and perform in vitro study of the release of active ingredients and antimicrobial activity. It was found that oil-in-water type gel-cream has antimicrobial activity against Staphylococcus epidermidis bacteria and Candida albicans fungus, while hydrogel affected only Candida albicans. According to the results of biopharmaceutical study, modeled semisolid systems with rosemary extract can be arranged in an ascending order of the release of phenolic compounds from the forms: water-in-oil-type cream < absorption-hydrophobic ointment < Pionier PLW oleogel < oil-in-water-type eucerin cream < hydrogel < oil-in-water-type gel-cream. Study results showed that oil-in-water-type gel-cream is the most suitable vehicle for liquid rosemary extract used as an active ingredient.

EWMA Document: Home Care-Wound Care: Overview, Challenges and Perspectives.

This document provides an overview of the main approaches to the organisation of wound care within homecare settings across Europe with case exemplars from England, Germany and the Nordic Countries. By identifying possible barriers to best practice wound care in home care settings and uncovering the preconditions needed to provide safe and high quality care for wound patients and support for their families, the authors provide a list of minimum recommendations for the treatment of patients with wounds in their own homes.

Laser Doppler imaging as a tool in the burn wound treatment protocol.

INTRODUCTION: The main treatment of burns is early excision of injured tissues. AIM: TO COMPARE TWO DIFFERENT METHODS OF EXAMINATION OF BURNED PATIENTS: clinical burn depth examination (CDE) and laser Doppler imaging (LDI). MATERIAL AND METHODS: A prospective randomized study of 57 burn patients treated in 2009-2011 was carried out. The burned patients were randomized into a CDE group and an LDI group. The CDE and LDI scan were performed 72 h after injury, with the second and third CDE and LDI scan on the 7(th) and 14(th) day after the burn. Age, sex, length of inpatient stay, cost of burn treatment, burn depth, cause and localization of the burns were analyzed between the two groups. RESULTS: Fifty-seven patients were treated during 2 years. Thirty-two patients were in the CDE group and 25 patients were in the LDI group. Most of the patients were male (45 male vs. 12 female, p < 0.001). The age was similar between the males and the females (female: 46.4 ±16.9 years vs. male: 46.3 ±12.5 years; p = 0.11). The mean length of stay in hospital was significantly higher in the CDE group (47 ±34.4 day vs. 25 ±10.8 day; p = 0.005). The mean cost of treatment of burned patients was significantly higher in the CDE group. CONCLUSIONS: The length of stay and cost of treatment of burn patients depends upon early diagnosis of the deep burns and well-timed surgical treatment of burn wounds.

Epidemiology of paediatric burns in Lithuania: focus on a vulnerable population exposed to the risk of scalds at home without hot tap water supply.

OBJECTIVE: To describe the epidemiology of paediatric burns in Lithuania, identify the trends of burn occurrence, the vulnerable population and aetiology. METHODS: This study was based on all inclusive national information obtained from the National Health Insurance database for the period of 2001-2010. Information on the burns aetiology was collected in the Hospital of Lithuanian University of Heath Sciences Kauno Klinikos. FINDINGS: 7146 children in the age group of 0-14 were hospitalized in Lithuania and constituted 44% of all admissions due to burns. The incidence among boys was 149.8 and among girls 99.9 per 100,000. The highest risk of burns was observed from 11 to 15 months of age. Scalding in 0-1 years age group composed 96% of all burns in this age group. CONCLUSION: Children younger than 2 years of age are a vulnerable population of burns in Lithuania. Scalding was main cause of their burns. The aetiological subgroups of scalding were scalding with hot drinks/food and scalding with hot water meant for household. The major part of scalding with hot drinks was due to scalding with parents' drinks. Scalding with hot water meant for household is associated with the lack of hot water supply.

Risk factors and outcomes in patients with carbapenem-resistant Acinetobacter infection.

INTRODUCTION: Acinetobacter spp. are important pathogens increasingly reported as the cause of outbreaks of nosocomial infections. The aim of our study was to identify the risk factors and assess their influence on outcomes in patients with infections caused by carbapenem-resistant Acinetobacter spp. METHODS: A retrospective data analysis was performed to evaluate risk factors and mortality in patients with Acinetobacter spp. infections. Methods used for the statistical analysis were the Student's t-test, Chi-square test, and multivariate analysis; p < 0.05 was considered statistically significant. RESULTS: A total of 99 patients with an Acinetobacter spp. infection were identified. Comparing patients with carbapenem-sensitive and carbapenem-resistant Acinetobacter spp. infection, significant differences were found in the mean length of intensive care unit stay (4.17 ± 3.61 vs 7.92 ± 6.74 days, p = 0.038) and mechanical ventilation (3.25 ± 2.61 and 7.07 ± 5.79 days, p = 0.009). The previous use of carbapenems (odds ratio (OR) 10.1, 95% confidence interval (CI) 1.16-87.20) and fluoroquinolones (OR 3.6, 95% CI 1.13-11.51) was independently associated with resistance to carbapenems. Of the Acinetobacter spp. strains, 94.9% (n = 94) were resistant to piperacillin-tazobactam, 88.9% (n = 88) to ceftazidime, 85.9% (n = 85) to ciprofloxacin, 83.8% (n = 83) to gentamicin, 79.8 (n = 79) to amikacin, and 48.5% (n = 48) to cefepime. CONCLUSIONS: Intensive care unit stay before infection and source of infection in the respiratory tract were independently associated with patient mortality. Resistance to carbapenems had no impact on mortality rates. Carbapenem-resistant Acinetobacter spp. isolates had high resistance rates to other antimicrobial drugs.

Associations between the fracture type and functional outcomes after distal radial fractures treated with a volar locking plate.

OBJECTIVE. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. MATERIAL AND METHODS. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. RESULTS. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. CONCLUSIONS. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

Study of tolnaftate release from fatty acids containing ointment and penetration into human skin ex vivo.

Five fatty acids (oleic, linoleic, myristic, lauric and capric) were incorporated in 10% (w/w) into ointment formulation and their influence on lipophilic model drug tolnaftate release in vitro and enhancing effect on tolnaftate penetration into epidermis and dermis of human skin ex vivo were investigated. The prepared ointments were tested for homogeneity, pH and theological properties. In vitro release studies and ex vivo skin penetration experiments were carried out using Hanson and Bronaugh-type flow-through diffusion cells, respectively. Tolnaftate cumulative amount liberated from semisolids was assayed using UV-Vis spectrophotometer. After in vitro skin penetration studies, appropriately extracted human skin layers were analyzed for tolnaftate content using a validated HPLC method. Statistical analysis revealed that release rate of tolnaftate from control ointment and ointments with fatty acids was not significantly different and only 7.34-8.98% of drug was liberated into an acceptor medium after 6 h. Tolnaftate amount penetrating into 1 cm2 of epidermis from ointments containing oleic, linoleic, myristic and lauric acids was significantly greater (p < 0.05) than from the control ointment. Penetration enhancing ratios for these fatty acids for tolnaftate penetration into epidermis ranged from 1.48 to 1.75. In conclusion, fatty acids did not increase the liberation of tolnaftate from ointment formulation, but demonstrated their enhancing effect on tolnaftate penetration into human epidermis in vitro. Results from in vitro release experiments do not suit for prediction of the situation in the skin in vitro, if chemical penetration enhancers are incorporated into the ointment formulation.

Measurement of melanoma thickness--comparison of two methods: ultrasound versus morphology.

OBJECTIVE: The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy. METHODS: Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study. Melanoma depth was measured using a linear 14-MHz frequency ultrasound sensor (Toshiba Xario XG). Surgically removed fragments of skin-subcutaneous tissue were fixated using 10% formalin solution in the operating theatre, and sent to KUMH Clinic of Pathological Anatomy. The most informative sections were analysed for tumour thickness, according to Breslow, as well as tumour type, vascular and lymphatic invasion and dissemination. A comparative data analysis of melanoma thickness measured by ultrasound (T) preoperatively and histologically estimated cutaneous melanoma (CM) thickness according to Breslow (pT) using the Bland-Altman method was performed. RESULTS: Higher mean difference of melanoma thickness (60 µm) between T and pT measurements was found when tumour thickness matched pT1 and pT2 categories. In cases of CM depth exceeding 2mm, mean difference of measurements between CM thickness determined by ultrasound and histological examination was lower (30 µm). Data regression analysis showed that correlation between T and pT measurements was lower when CM was thinner (1-2 mm) (Pearson's correlation coefficient, r: 0.283). In cases of thicker melanoma (>2 mm), strong and statistically significant (p<0.0001) correlation (r: 0.869) was observed. CONCLUSIONS: Correlation between melanoma thickness measured using a linear 14-MHz frequency ultrasound sensor and histologically estimated melanoma thickness according to Breslow was lower if melanoma was thinner (1-2 mm). However, in cases of thicker melanoma (>2 mm), very strong correlation between measurements was observed.