Procollagen type I gene expression and cell proliferation are increased in lipodermatosclerosis.

BACKGROUND: Lipodermatosclerosis (LDS) is characterized by a hardening and hyperpigmentation of lower leg skin as a consequence of chronic venous insufficiency. The degree of skin hardening or fibrosis associated with LDS is proposed to relate directly to skin breakdown and venous ulcer formation as well as to a subsequent delay in ulcer healing. OBJECTIVES: To determine whether elevated procollagen type I gene expression and increased cell proliferation are responsible for the fibrotic changes associated with LDS. METHODS: Skin biopsies were obtained from the legs of patients with varying degrees of chronic venous disease and were assessed for procollagen gene expression by in-situ hybridization and for cell proliferation by immunolocalization of proliferating cell nuclear antigen. RESULTS: The number of cells expressing procollagen type I mRNA (COL1A1) was significantly higher in the dermis of LDS-affected skin compared with samples from the other patient groups. In addition, there was a significant increase in the number of dermal fibroblasts undergoing proliferation in both LDS samples and skin samples prior to LDS changes compared with control samples. However, there was no significant difference in level of inflammation in biopsy samples between patient classes. CONCLUSIONS: These results suggest that enhanced cell proliferation and procollagen gene expression are both involved in LDS development. Furthermore, fibrotic changes may occur in the absence of, or subsequent to, any significant inflammatory response, indicating that additional profibrotic factors produced in the skin as a consequence of chronic venous insufficiency may play a role in LDS formation.

Mandatory bone scans for the assessment of extremity loss in meningococcal septicaemia?

Meningococcal septicaemia can cause progressive necrosis of skin, soft tissue and bone. Successful limb reconstruction following the disease depends on an accurate assessment of the viability of these tissues and on a multidisciplinary team approach to ensure optimal care. However, bone scanning is not commonly performed in these patients. We present a case of meningococcal septicaemia where bone scanning significantly altered the management by demonstrating an extensive area of bone necrosis proximal to the soft-tissue necrosis. In view of this finding, we propose that bone scanning should be considered in all cases of meningococcal septicaemia where there is tissue necrosis affecting a limb, and that the radiologist should be considered a vital member of the multidisciplinary team.

The initial management of acute burns.

The initial management of burns, in common with all trauma, follows the ABCDE approach. The outline management plan detailed above assumes the availability of certain medical supplies but even simple measures are invaluable in burn care if they are all that are available. The most basic supplies required to resuscitate a casualty are oral salt and water in appropriate volumes. Similarly it should be possible in field conditions to monitor vital signs and urine output, dress the burns with clingfilm or plastic bags and wrap the casualty in absorbent materials.