Clinical study of a retinoic acid-loaded microneedle patch for seborrheic keratosis or senile lentigo.

AIMS: Pigmented lesions such as of seborrheic keratosis and senile lentigo, which are commonly seen on skin of people>50years of age, are considered unattractive and disfiguring because of their negative psychological impact. Drug therapy using all-trans retinoic acid (ATRA) is an attractive option for self-treatment at home. We have developed an ATRA-loaded microneedle patch (ATRA-MN) and confirmed the pharmacological effects of ATRA-MN application in mice. Here, we describe a clinical study to evaluate the safety and efficacy of ATRA-MN in subjects with seborrheic keratosis or senile lentigo. MAIN METHODS: ATRA-MN was applied to the lesion site of each subject for 6h once per week for 4weeks. The skin irritation reaction was scored to assess adverse reactions and blood tests were performed to evaluate the presence of systemic adverse reactions. To assess the treatment effect using ATRA-MN, the desquamation and whitening ability of the investigational skin was observed. KEY FINDINGS: Desquamation of the stratum corneum was observed following four ATRA-MN applications at 1-week intervals, but ATRA-MN applications did not induce severe local or systemic adverse effects. SIGNIFICANCE: These results showed that ATRA-MN treatment is promising as a safe and effective therapy for seborrheic keratosis and senile lentigo.

A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel Patch.

INTRODUCTION: In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia. PRESENTATION OF CASE: The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap. DISCUSSION: Enterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted. CONCLUSION: Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.

Development of a novel therapeutic approach using a retinoic acid-loaded microneedle patch for seborrheic keratosis treatment and safety study in humans.

Seborrheic keratosis is one of the most common skin benign tumors in humans with a high occurrence rate of 80%-100% in people > 50 years of age; however, its pathogenesis is still unclear. The standard treatment includes cryotherapy and laser surgery for physically removing lesions. Drug therapy for this condition has not been well established. We aimed to evaluate the use of all-trans retinoic acid (ATRA)-loaded microneedle (MN) patches as a simple, alternative therapeutic option to traditional surgical treatments. This therapeutic strategy was designed to induce the proliferation of basal keratinocytes and accelerate stratum corneum turnover, leading to the lesion falling off the surface of the skin. The MN patch induced epidermal hyperplasia and marked expression of heparin-binding epidermal growth factor-like growth factor mRNA and protein corresponding to ATRA activity in the skin of HR-1 hairless mice. The acceleration of stratum corneum turnover was also observed by the dansyl chloride method. The skin irritation study in mice and safety study in humans support the safety findings of our study. Overall, MN patches can offer an effective and safe means of ATRA delivery into the skin, and the ATRA-loaded MN patch appears to be an effective pharmaceutical product providing a novel therapeutic option for seborrheic keratosis.

Aesthetic reconstruction of a defect in the skin of the upper lip using a hatchet flap.

Reconstruction of the upper lip requires symmetrical reconstruction of the free border according to the aesthetic principle. We have reconstructed this area with a hatchet flap, so that the scars match the subunit line as far as possible by rotation and advancement of the flap. We operated on six patients. The lower pedicled flap was used in 4 cases and the upper pedicled flap in 2, who also needed reconstruction of the vermillion. In one patient the scar did not match the nasolabial fold. For the upper pedicled cases, scars made on the vermillion were not conspicuous. However, trap door deformity occurred in half, which was a disadvantage. We think that our flap is useful, because it leaves a minimal scar in an inconspicuous area.

Rare complication after stripping operation: a case report of mycobacterium abscessus infection.

Mycobacterium abscessus is an acid-fast nontuberculous mycobacterium that grows rapidly in culture. The organism is found in dust, soil, and water and after trauma, it may infect skin and soft tissue. The organism is rarely found in humans, and infections occurring after cardiovascular surgery are rare clinical events. To our knowledge, only a few cases of hemodialysis arteriovenous graft infection and endocarditis caused by M. abscessus have been described. We reported a first case of patient with M. abscessus graft infection after a stripping operation and skin grafting to a left lower leg ulcer.

Chronic expanding hematoma in the temporal region.

We report a rare case of chronic expanding hematoma in the right temporal region that developed into a large mass during 12 years. The patient, who had a history of blunt trauma in her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site in the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, this tumor was confirmed in the diagnosis of chronic expanding hematoma.

Perforating pilomatricoma on the upper eyelid.

We report a rare case of perforating pilomatricoma. A 50 x 40-mm oval nodule, with a whitish scale on its tip, developed on the left upper eyelid of a 43-year-old Japanese woman. There was no history of injury to the left upper eyelid. Histologic examination revealed typical microscopic features of pilomatricoma. In addition, however, an interesting phenomenon was observed: a portion of the tumor mass had extruded from the upper dermis to the skin surface through a perforating epidermal channel in the middle of the tumor. These findings are consistent with the diagnosis of perforating pilomatricoma.

Histological evaluation of grafted hard palate mucosa in the reconstruction of the upper eyelid.

We have used a hard palate mucosal graft for reconstruction of the posterior lamella of the eyelid and in only one case was replacement required because of discomfort and pain. The stratum corneum of the hard palate mucosa may have been the cause.

Lymphoma of mucosa-associated lymphoid tissue (MALT) arising in the parotid gland.

Malignant lymphoma of the parotid gland is a rare condition. The authors present the case of a 59-year-old woman with primary malignant lymphoma arising from the parotid gland, in which they resected the tumors and surrounding lymph nodes. Histopathologic examination of the tumor demonstrated a lymphoma of mucosa-associated lymphoid tissue (MALT). Chemotherapy and radiotherapy were performed after surgery. The clinical manifestation, treatment, and postoperative course are described.

Mortality and recurrence rate after pressure ulcer operation for elderly long-term bedridden patients.

We operated on 16 sacral pressure ulcers in elderly and long-term residential patients who were immobile as a result of cerebral vascular disease. The mean age of patients was 76 years. Eight ulcers were treated with local fascial flaps and 8 by simple closure. The follow-up period was from 1 to 4 years. Recurrence and mortality rates were examined retrospectively. In the 16 patients, recurrence occurred in 37.5%, and 43.8% died without recurrence. The recurrence rate was 37.5% for local fascial flaps and 37.5% for simple closure. Overall mortality was 68.8% in the follow-up period. Because postoperative death was common, we should not only focus on reducing local pressure but also pay attention to any underlying disease. Because of this high mortality rate, the least invasive procedure possible should be used. Because the recurrence rate of simple closure was the same as for local fascial flaps, simple closure should be considered as a reconstructive method.

The use of calcium phosphate cement paste for the correction of the depressed nose deformity.

The authors report the use of calcium phosphate cement paste as a material for correction of depression after nasal bone fracture, and evaluate its usefulness. Biopex R (Mitsubishi Material Corporation, Tokyo, Japan) was used in this study as calcium phosphate cement (CPC), which was developed in Japan. CPC injection was used in six patients (four women and two men) with depressed nose deformity after nasal bone fracture. The patients' ages ranged from 29 to 67 years (mean, 49 years), and the follow-up period ranged from 12 to 27 months. The amount of injected cement varied from 0.5 to 2.5 mL, approximately. There was no postoperative infection or allergic reaction in any patient. Clinical and X-ray photography findings showed that a reduction in volume of the injected cement occurred gradually as long as 7 to 8 months after surgery. After that period, the volume was mostly maintained. It seemed that the degree of reduction was approximately 10% to 15% of the original volume. Satisfactory results were obtained in all cases. The authors conclude that the use of CPC is an option for the correction of depressed nose deformity and that its application must be determined in each case, considering its advantages and disadvantages.

Chronic expanding hematoma in the temporal region.

A rare case of chronic expanding hematoma in the right temporal region that developed into a large mass over the course of 12 years is reported. The patient, who had a history of blunt trauma to her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site over the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, the diagnosis of chronic expanding hematoma was confirmed.

Use of calcium phosphate cement for bone defect after harvesting radial forearm osteocutaneous flap.

To resolve esthetic and psychologic discomfort of patient due to the lack of radius after harvesting radial forearm osteocutaneous flap, we filled the bone defect and recreated its contour using calcium phosphate cement (CPC; Biopex; Mitsubishi Material Corporation, Tokyo, Japan). Injection of CPC was performed in 5 patients (3 women and 2 men). The patients' age ranged from 61 to 72 years (mean, 65 years), and the follow-up period ranged from 8 to 18 months. The size of the radius harvested varied from 10 x 35 mm to 10 x 50 mm. The width of the harvested bone was approximately 25% to 35% of the circumference of radius. Injected CPC volume varied from 3 to 4 mL, approximately. There was no postoperative infection or allergic reaction in any patient, and movement of hand was also with no problem. The X-P findings showed that the bone defect was filled with a uniform, high-density mass. The injected cement reduced in volume gradually during the fourth or fifth postoperative months, but the degree of reduction was mild in any case, which is probably less than 5% of the injected amount, allowing successful recreation of the contour of the radius. We conclude that the use of CPC for filling the defect of the bone donor site after harvesting radial osteocutaneous flap is valid method to keep a patient free from esthetic and psychologic discomfort due to the lack of the radius.

Expression of N-cadherin by skeletal muscle in the degeneration and the degeneration/regeneration processes after nerve injury.

We investigated the expression of N-cadherin by skeletal muscle during the degeneration and degeneration/regeneration processes using the rat sciatic nerve and gastrocnemius muscle model. The right sciatic nerve was exposed in the mid-thigh region, and the nerve was transsected with small scissors. After then, nerve was sutured (sutured group), or both edges of the resected nerve were turned and sutured to the muscle of each side (unsutured group). At various periods up to 24 weeks after the operation the middle portion of the gastrocnemius muscle of the treated hindlimbs was removed. Expression of N-cadherin was detected by western blot analysis and immunofluorescent staining with an anti N-cadherin antibody. In the both groups, the degree of expression had already increased by the end of the first postoperative week, but there were no significant differences between the first and second postoperative weeks between the two groups. However, the values recorded at the fourth, sixth, ninth, and twelfth postoperative weeks were significantly higher in the unsutured group than in the sutured group. Immunofluorescent staining was present around the muscular membrane in all specimens including the control. These results indicated that there was a difference in the kinetics of expression of N-cadherin in skeletal muscle between the degeneration and degeneration/regeneration processes of the muscle after injury to the nerve. It was also clear that N-cadherin has a role at the surface of the muscle cell in skeletal muscle, not in the satellite and inflammatory cells, in both groups.