Nodular basal cell carcinoma is associated with increased hyaluronan homeostasis.

BACKGROUND: Basal cell carcinoma (BCC) is one of the most frequent forms of malignancy in humans. Although BCC is a tumour of low degree of malignancy, if left untreated, it can be locally aggressive, eat away at tissues and cause ulceration. Nodular is the most common subtype of BCC (>50%). Although apparently non-invasive, micronodular, a certain subgroup of nodular, is likely to recur. Glycosaminoglycans (GAGs), such as hyaluronic acid (HA), are extracellular matrix molecules of high importance in malignant transformation, metastasis and other complex remodelling processes. OBJECTIVES: To investigate the expression of GAGs and their metabolizing enzymes in nodular BCC, when compared with adjacent healthy human skin tissue specimens. METHODS: Total GAGs were isolated and purified from nodular BCC and normal adjacent human skin tissue specimens. GAGs were subsequently fractionated by electrophoresis on cellulose acetate membranes and characterized using specific GAG-degrading enzymes. The content of HA in total GAGs was measured using ELISA and the expression of HA synthases (HAS), hyaluronidases (HYAL) and HA receptors (CD44 and receptor hyaluronic acid-mediated motility (RHAMM) was assessed using RT-PCR. RESULTS: Nodular BCC is associated with increased levels of HA concomitant with upregulation of gene expression of HAS3, HYAL3 and RHAMM, when compared with normal adjacent skin. CONCLUSION: These results indicate that HA homeostasis in nodular BCC shows distinct features which may be helpful in understanding the complex behaviour of nodular subtype of BCC, thus eventually leading to new treatment strategies.

Extrinsic ageing in the human skin is associated with alterations in the expression of hyaluronic acid and its metabolizing enzymes.

Extrinsic skin ageing or 'photoageing', as opposed to intrinsic skin ageing, is the result of exposure to external factors, mainly ultraviolet irradiation. Glycosaminoglycans (GAG) and particularly hyaluronic acid (HA) are major components of the cutaneous extracellular matrix involved in tissue repair. However, their involvement in extrinsic skin ageing remains elusive. In this study, we investigated the expression of HA and its metabolizing enzymes in photoexposed and photoprotected human skin tissue specimens, obtained from the same patient. Total GAG were isolated, characterized using specific GAG-degrading enzymes and separated by electrophoresis on cellulose acetate membranes and polyacrylamide gels. Quantitation of HA in total GAG was performed using ELISA. Gene expression of hyaluronan synthases (HAS), hyaluronidases (HYAL) and HA receptors CD44 and receptor for HA-mediated motility (RHAMM) was assessed by RT-PCR. We detected a significant increase in the expression of HA, of lower molecular mass, in photoexposed skin as compared with photoprotected skin. This increase was associated with a significant decrease in the expression of HAS1 and an increase in the expression of HYAL1-3. Furthermore, the expression of HA receptors CD44 and RHAMM was significantly downregulated in photoexposed as compared with photoprotected skin. These findings indicate that extrinsic skin ageing is characterized by distinct homoeostasis of HA. The elucidation of the role of HA homoeostasis in extrinsic skin ageing may offer an additional approach in handling cutaneous ageing.

Trichoblastic carcinoma of the pinna. A rare case.

Adnexal tumors of the hair follicle can be regarded as lesions that show similar differentiation to one or more portions of the hair follicle. Trichoblastic carcinoma is a rare malignant adnexal tumor, which usually occurs on the scalp. There have been reported cases with regional lymph node metastasis. We report a case of a 65 years old man with a painless irregular mass of the posterior surface of the right pinna, which was slowly growing over a 5-year period. He had a history of a similar lesion on the same site, which was removed 8 years before he presented to us. We excised the lesion and the defect was covered with an advancing flap. Because of the histology result the patient was re-operated and reviewed for over 3 years and there wasn't any sign of recurrence.

[Estimating the prognosis of peripheral facial paralysis: is the minimal nerve excitability test still up to date?]. / Prognoseabschätzung der peripheren Fazialisparese: Ist der Minimal-Nerve-Excitability-Test noch zeitgemäss?

BACKGROUND: In this retrospective study, we assessed the long-term prognostic value of the minimal nerve excitability test (NET) by comparing the results it yielded with the House-Brackmann (HB) index in patients with the most common types of facial paralysis, Bell's palsy and traumatic facial palsy. PATIENTS AND METHODS: Three hundred and fifty patients aged 9-85 years (mean age 42.4 years; 156 male and 194 female), all of whom were treated initially with the same steroid therapy, entered on study. Patients in whom decompression surgery had been performed were excluded so as to avoid falsely optimistic prognoses. The 350 study patients were divided into two groups: group 1 was made up of 250 with Bell's palsy and group 2, of 100 with nonpenetrating traumatic facial palsy following temporal bone fracture. The NET was conducted repeatedly in all patients for 3 weeks from the start of day 3 of treatment, the value recorded on day 14 being used in the evaluation. For each patient, the result of the NET was recorded as 'normal', 'diminished' or 'without response' according to the difference between the two sides of the face. The final HB grading was determined after 1 year to check for the agreement between the electrical prognosis and the clinical outcome and thus the reliability of the prognosis indicated by the NET. RESULTS: The results indicate that a normal NET forecast a satisfactory outcome that could be classed as HB I-II in almost all the patients in both groups. Among patients who had no response on NET, 85% of those with Bell's palsy and 90% of those with traumatic facial palsy failed to recover nerve function. Diminished nerve excitability proved to be a sign of a relatively favourable prognosis: 74% of patients in each group recovered normal facial function. CONCLUSION: The NET is a method of investigation that is easily applied and can make a positive contribution to the assessment of prognosis in Bell's palsy and in traumatic facial palsy, reflecting the functional state of the facial nerve reliably in most of cases.

Assessment of patient benefit from septo-rhinoplasty with the use of Glasgow Benefit Inventory (GBI) and Nasal Symptom Questionnaire (NSQ).

Septorhinoplasty is the most difficult and complicated procedure in facial plastic surgery. Because of the complex interdependency of the anatomical parts, alteration of one may have an impact on another. Form and function are completely interwoven in septorhinoplasty. The selection of appropriate candidates involves an understanding of their expectations. Outcome research is a new concept in clinical medicine and its importance is increasingly recognized for the patient management and policy decisions. This study includes an analysis of patients' subjective opinion of the surgical outcome after septo-rhinoplasty, with the use of Glasgow Benefit Inventory (postoperatively) and the Nasal Symptom Questionnaire (pre- and postoperatively). In this study we analyze the patient subjective rating of benefit in 41 consecutive patients who underwent septo-rhinoplasty within the first 8 months of 2001, and had completed a follow up period of more than 6 months postoperatively. The early complication rate was recorded and analyzed along with data regarding the patient satisfaction rate using GBI and NSQ. The response rate was 80%, which is high. Patients had significant improvement in all subscales of GBI (General, Social, Physical) related with a decreased number of nasal symptoms postoperatively and a good aesthetic result.