Treatment of scarring alopecia from trauma and surgical procedures in young patients using follicular unit hair transplantation.

INTRODUCTION: Hair loss due to scarring as a consequence of surgical procedures and trauma can impact young patients socially and emotionally. Recently follicular unit extraction (FUE) hair transplantation has been applied to scar treatment. PATIENTS AND METHODS: This report included four patients with scarring alopecia. All patients were female with a mean age of 12.5 years. Previous operations that caused scarring were sebaceous nevus excision with direct closure (n = 2), an extensive burn scar treated using an expander (n = 1) and cauterization for a congenital pigmented nevus (n = 1). The average size of the affected area was 10.5 cm2 . The FUE transplantation procedure was performed under local anesthesia. The number of grafts was set at approximately 25-30 grafts/ cm2 of scar. An electronic punch with a diameter of 0.8 mm was used for graft harvesting, and a 0.6-mm electronic punch was used to make cylindrical holes on recipient site. The donor sites were shaved followed by graft harvesting in two cases. For the other two cases, harvesting was done without shaving. RESULTS: The number of transplanted grafts was 60 to 600 (mean 288), and surgical time was 38 to 220 minutes (mean 108). The average dose of lidocaine was 1.4 mg/kg. The average survival rate of the grafts was 85%. CONCLUSION: Our experience in these cases suggests that this technique may be a viable option for the treatment of certain causes of scarring alopecia in the pediatric age group.

[Virus-associated hemophagocytic syndrome (VAHS) as an initial manifestation in HIV infection].

A 21-year-old man admitted for idiopathic fever and sore throat was diagnosed with virus-associated hemophagocytic syndrome (VAHS) when bone marrow aspirate showed hemophagocytosis. ELISA for HIV antibodies was negative, although HIV RNA was positive. VAHS is extremely rare as an initial manifestation in HIV infection, being reported, to our knowledge, in only 4 subjects in Japan. Hemophagocytic syndrome (HPS) features fever and hepatosplenomegaly associated with pancytopenia, hypertriglyceridemia, and hypofibrinogemia, due to hypercytokinemia. Physicians should thus be aware that primary HWV infection may involve glandular-fever-like illness and should start prompt diagnosis to contain AIDS spread.

Development of distortion product otoacoustic emissions in C57BL/6J mice.

Distortion product otoacoustic emissions (DPOAEs) have been used to examine the development of hearing in the rat and gerbil. However, no reports of DPOAE measurement from the onset of hearing in mice are available. Commercially-available components were assembled and adapted to provide a suitable probe microphone and sound delivery system for measuring DPOAE in developing C57BL/6J mice. Furthermore, DPOAE data were compared with the findings of the auditory brainstem response (ABR). DPOAEs were obtained at 8 kHz from 11 days after birth, 20 kHz from 12 days, and 30 kHz from 13 days. Adult-like patterns of DPOAE were obtained 21 days at 8 and 20 kHz, and 28 days at 30 kHz. On the other hand, the ABR thresholds at 12 to 36 kHz appeared between 11 and 12 days and were saturated at 14 days. Based on these data, the onset of measureable DPOAEs in the mouse were earlier than in the rat and gerbil. The maturation of DPOAE in the mouse begins at a lower frequency in the high frequency range. In addition, the ABR threshold reached maturation earlier than DPOAE.

Bacterial contamination of multiple-use atomizers commonly used in Japan.

Before performing transnasal fiberscopy to observe the nasal cavity, pharynx and larynx in outpatient clinics, nasal anesthetics and vasoconstrictive agents are routinely sprayed into the nares in order to improve patients' comfort. Bacterial contamination of the nozzles of Venturi principle atomizer barrels and their solutions after being used for multiple patients over a long-term period without cleaning is controversial. We evaluated the potential risk of atomizer-associated cross-infection by using atomizers commonly available in Japan that use compressed air to atomize medication. Eighteen of the 23 samples (78.3%) from the external nozzle tips of the atomizers resulted in positive bacterial cultures. These detected bacteria are suggested to be colonized in the nares and to cause bacterial contamination of the atomizer. Of the 25 samples obtained from the spray of the drug solutions, 11 samples showed positive bacterial culture, whereas 16 control samples produced no growth of bacteria. The present study demonstrated that the atomizer widely used in the outpatient ENT clinics in Japan has a potential risk of causing cross-infection of patients.

Clinical effectiveness of ototopical application of mupirocin ointment in methicillin-resistant Staphylococcus aureus otorrhea.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) otorrhea has become an increasing problem with regard to infection through the tympanic membrane perforation and postsurgical infection. In particular, dry ear, at the preoperative stage, is considered to be a crucial factor in surgery. We evaluated how to control MRSA otorrhea before and after ear surgery. PATIENTS AND METHODS: Twenty-six patients having MRSA otorrhea were enrolled in the present study and randomly divided into 2 groups, namely, mupirocin ointment therapy for 16 patients and ofloxacin ear drops for 10 patients. Approximately 0.6 mg of mupirocin ointment was administered locally to the tympanic membrane and the promontory around and through the perforation with its adjacent external ear canal 1 to 4 times for 2 or 3 weeks at the clinic. On the other hand, ofloxacin ear drops were administered daily by the patients for 2 or 3 weeks at home. RESULTS: Complete elimination of MRSA from the ear was obtained in all patients of the mupirocin group. This showed a significant improvement (p < 0.001) as compared with the ofloxacin group (improvement + cure rate, 40%). Local application of mupirocin did not aggravate hearing acuity of any patients who were evaluated by pure-tone audiometry before and after treatment. CONCLUSION: The present findings first indicate that minimally essential application of mupirocin ointment is an extremely useful ototopical agent against MRSA otorrhea without ototoxicity.

Noninvasive in vivo delivery of transgene via adeno-associated virus into supporting cells of the neonatal mouse cochlea.

There are a number of genetic diseases that affect the cochlea early in life, which require normal gene transfer in the early developmental stage to prevent deafness. The delivery of adenovirus (AdV) and adeno-associated virus (AAV) was investigated to elucidate the efficiency and cellular specificity of transgene expression in the neonatal mouse cochlea. The extent of AdV transfection is comparable to that obtained with adult mice. AAV-directed gene transfer after injection into the scala media through a cochleostomy showed transgene expression in the supporting cells, inner hair cells (IHCs), and lateral wall with resulting hearing loss. On the other hand, gene expression was observed in Deiters cells, IHCs, and lateral wall without hearing loss after the application of AAV into the scala tympani through the round window. These findings indicate that injection of AAV into the scala tympani of the neonatal mouse cochlea therefore has the potential to efficiently and noninvasively introduce transgenes to the cochlear supporting cells, and this modality is thus considered to be a promising strategy to prevent hereditary prelingual deafness.