Polo-like kinase 1 (Plk1) in cutaneous T-cell lymphoma.

BACKGROUND: Polo-like kinase 1 (Plk1) has multiple functions throughout mitosis. Plk1 levels are high in a number of cancers and haematological malignancies while being low in most differentiated tissues. OBJECTIVES: To assess the immunoreactivity of Plk1 in cutaneous T-cell lymphoma (CTCL) as a potential therapeutic target, to differentiate Plk1 levels among lesion types and to compare the detection level of Plk1 in fresh frozen (f) vs. paraffin-embedded (p) tissue. METHODS: Immunohistochemical staining of CTCL skin lesions with anti-Plk1 antibody was performed in a total of 65 biopsies from 49 patients with CTCL. Both f and p tissue was available for comparison in 46 biopsies. RESULTS: Tumour-stage CTCL lesions displayed significantly more Plk1 (mean f 7·7%, p 8·8%) than patch (mean f 0·7%, p 2·0%) and plaque-stage lesions (mean f 1·1%, p 2·0%) (P < 0·05). Plk1 ranged from 0% to 18% in f and 0% to 24% in p samples. p tissue revealed a higher mean Plk1 detection rate of 4·4% compared with 2·9% in f tissue with no statistical significance. CONCLUSIONS: Our results indicate that in CTCL, Plk1 is increased mainly in advanced lesions. Several Plk1 inhibitors have already shown promising results in preclinical and clinical phase I and II trials for different types of cancers with low adverse effects. Immunohistochemical detection of high Plk1 levels in patients with CTCL could help select individuals who might benefit from treatment with small molecule Plk1 inhibitors.

Nurses' perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group.

BACKGROUND: Nurses have a high risk of developing hand eczema due to hand disinfection procedures. OBJECTIVES: To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). METHODS: A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. RESULTS: The majority (PS 60.1%; MC 69.5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79.2%/52.1%; HW 65.5%/36.2%) compared with an allergenic potential (ADI 10.4%/5.8%; HW 7.8%/3.9%). The prevalence of hand dermatitis in the MC was 13.4% by self-diagnosis and 22.4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. CONCLUSIONS: Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards.

[Results after revision surgery for carpal tunnel release]. / Ergebnisse von Karpaltunnel-Revisionseingriffen.

PURPOSE: The aim of this study was to assess the clinical results of revision surgery due to persistent neurological disturbances after carpal tunnel release. PATIENTS AND METHOD: In a previous study we showed the reasons for persisting neurological symptoms after carpal tunnel release on the basis of the intraoperative findings in 200 patients who underwent revision surgery in the years 2001 - 2003. We classified them into four groups (1: incomplete release of the retinaculum flexorum, 2: traction neuropathy, 3: real recurrent carpal tunnel syndrome, and 4: nerve lesions). 122 of these patients have been investigated regarding the clinical results using two questionnaires in the year 2004. We used the DASH questionnaire as well as an additional self-assessment questionnaire asking about remaining symptoms of median nerve irritation and the subjective results of revision surgery. The completely filled-out forms were assigned to the four groups, analysed and the results compared with each other. RESULTS: Within group 1 (incomplete release), 78 % reported only one persistent neurological symptom, 89 % described a benefit from revision surgery and 84 % were satisfied with a median DASH score of 11. Within group 2 83 % complained about at least one persistent neurological problem and only 60 % reported on an improvement following revision surgery. The DASH score within group 2 averaged 30. 87 % of group 3 patients reported of an improvement following the revision operation (DASH score 24), whereas this was the case for only 55 % (DASH score 37) of group 4 patients. CONCLUSION: The incomplete release of the flexor retinaculum is the most common reason for revision surgery. In most of these patients the clinical symptoms can be resolved with revision surgery leading to a very high satisfaction of the patients. A similarly high satisfaction can be expected following revision surgery of a true recurrent carpal tunnel syndrome although in most patients a significant degree of functional deficit will remain. Revision surgery due to fibrotic adhesions of the median nerve, leading to a traction neuropathy, or iatrogenic nerve lesions during the primary surgery will definitely lead to unsatisfactory overall results.

Revision surgery after carpal tunnel release--analysis of the pathology in 200 cases during a 2 year period.

Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.

Ring avulsion injury with rupture of both digital arteries despite a completely intact skin envelope.

A rare case of ring avulsion injury with avulsion of both digital arteries yet without external soft tissue, tendon or skeletal injury in a 29 year-old man is reported.

[Lightning injuries: case report of a 17-year-old man and a brief review of the literature]. / Verletzungen durch Blitzschlag : Fallbeschreibung eines 17-jährigen Patienten und kurze Literaturübersicht.

Lightning injury is one of the most frequent injuries caused by a natural phenomenon, but the risk of being struck by lightning is low. The most vulnerable subjects for lightning injuries are individuals who work in open fields. Although lightning injuries may involve all organ systems, injuries to the cardiovascular system and central nervous system are the most frequent. Burns, tinnitus, blindness and secondary blunt trauma have also been reported. Even though immediate death through lightning-induced cardiac arrest is well documented, the majority of cases reported in the literature describe infrequent and enormously disparate sequelae.A 17-year-old man was admitted to our hospital approximately 3 h after a lightning strike. The Glasgow coma scale was recorded as 15/15 and partial thickness burns totaling of 11% were present on the chest, stomach and right and left lower leg. The entry point was approximately the right side of the neck and the current exited through the right foot. On arrival, the patient's vital signs were normal. Cardiac and pulmonary examinations were within normal limits. The patient suffered transient symptoms, including pain, loss of consciousness, tinnitus, iritis and paresthesia. The laboratory data obtained on admission were within normal limits except serum for WBC, CK, CK-MB, troponin and CRP. We postulate that the mechanism by which lightning caused injury to this patient was a flash discharge (side splash). During his stay in hospital, a debridement of the burn surface following graft coverage and Z-plasty to close the dehiscent wound on the right neck was performed. The patient was discharged from the hospital after 14 days.

[Pyrocarbon prosthesis for finger interphalangeal joint replacement. Experience after one year]. / Ersatz von Fingermittelgelenken mit Pyrocarbonprothesen. Erfahrungswerte nach 1 Jahr.

The long-term results of finger joint replacement, particularly the proximal interphalangeal (PIP) joint, have mostly been disappointing according to a review of the international literature and our own experiences. The recently developed pyrolytic carbon implants (Ascension Orthopedics, Austin, Texas) for replacing the PIP joint were evaluated retrospectively regarding range of motion, functionality, and relief of pain. In our hospital 17 PIP joints were replaced with pyrolytic carbon implants in 16 patients by an offset stem technique inserted without cement. This study included 13 patients; we excluded three patients because of follow-up <3 months. Prerequisites were adequate collateral ligaments, bone stability, and sufficient or at least reconstructable extensor tendons. The purpose of this study was to evaluate the 1-year outcome (minimum 270, maximum 360 days) regarding range of motion, implant stability based on radiological and clinical parameters, and relief of pain using a pre- and postoperative visual and verbal analogue scale.There was an improved range of motion of the PIP joint from 0-28-51 preoperatively to 0-22-77 postoperatively (average value). On the visual analogue scale (0 no pain, 10 incapacitating pain) we achieved pain relief at rest and in motion of 80%. On the verbal analogue scale there was an improvement of 62%. The results of this study demonstrate that pyrolytic carbon implants reduce pain and are functionally superior to arthrodesis. A precise and individual postoperative protocol is necessary for beneficial results.