Diffuse alopecia areata is associated with intense inflammatory infiltration and CD8+ T cells in hair loss regions and an increase in serum IgE level.

BACKGROUND: Mechanism leading to an abrupt hair loss in diffuse alopecia areata (AA) remains unclear. AIMS: To explore the characteristics of diffuse AA and possible factors involved in its pathogenesis. METHODS: Clinical and laboratory data of 17 diffuse AA patients and 37 patchy AA patients were analyzed retrospectively. Serum IgE level was evaluated in all diffuse and patchy AA patients, as well as 27 healthy subjects without hair loss to serve as normal control. Univariate analysis was performed using Fisher's exact test and Wilcoxon rank-sum test. Associations between inflammatory cell infiltration and laboratory values were analyzed using Spearman rank correlation test. RESULTS: The mean age of patients with diffuse AA was 27 years with a mean disease duration of 1.77 months. All of them presented in spring or summer with an acute onset of diffuse hair loss preceded by higher incidence of scalp pruritus. Although no statistically significant difference on the incidence of atopic disease among three groups has been found, serum IgE level in diffuse AA was higher than that in healthy controls, but was comparable to that in patchy AA group. Histopathology of lesional scalp biopsies showed more intense infiltration comprising of mononuclear cells, eosinophils, CD3 + , and CD8 + T cells around hair bulbs in diffuse AA group than in patchy AA group. Moreover, IgE level in diffuse AA patients positively correlated with intensity of infiltration by mononuclear cells, eosinophils, and CD8 + T cells. CONCLUSIONS: Hypersensitivity may be involved in pathogenesis of diffuse AA. The acute onset of diffuse AA may be related to intense local inflammatory infiltration of hair loss region and an increase in serum IgE level.

[Surgical techniques of open reduction and internal fixation for ankle fracture].

OBJECTIVE: To evaluate the surgical techniques of open reduction and internal fixation performed for ankle fracture retrospectively and the corresponding clinical outcomes. METHODS: From March 2001 to January 2006, 242 patients with ankle fracture were treated. A total of 85 patients with complete clinical data were analyzed. According to the Lauge-Hansen classification system, the fractures were classified into pronation-external rotation (grade II) in 12 cases and grade IV in 9 cases, supination-external rotation (grade II) in 34 cases and grade IV in 16 cases, supination-adduction (grade II) in 8 cases, and pronation-abduction in 6 cases. The reduction and internal fixation started with lateral malleolus, then medial malleolus and posterior malleolus, and distal tibiofibular syndesmosis in sequence. Among 10 cases, 5 of the distal tibiofibular syndesmosis were fixed with one screw through 3 layers of bone cortexes. All cases were auxiliarily fixed with plaster pad for 4 to 6 weeks after operation. RESULTS: The follow-up period varied from 6 to 36 months, with an average of 10 months. There were no local complications such as malunion or nonunion of the fractures and deformity of the ankle. The inserted screw to distal tibiofibular syndesmosis was not broken. The patients were evaluated with Baird-Jackson scoring system. The numbers of the patients who had excellent, good, fair and poor results were 53, 23, 6, 3, respectively. The excellent and good rate was 89.4%. CONCLUSION: Operative treatment may provide satisfactory clinnical outcomes for ankle fracture. Proper internal fixation and correct fracture pattern estimation are of importance to achieve and gain better long-term results.