The comparison of hair from gastric cancer patients and from healthy persons studied by infrared microspectroscopy and imaging using synchrotron radiation

Objective: The objective is to apply synchrotron-based FTIR microspectroscopy and imaging to human hair tissue and investigate the possibility of the method in gastric cancer research and diagnosis. Methods: Human hair from gastric cancer patients’ scalp and normal persons’ scalp were studied by synchrotron-based FTIR microspectroscopy and imaging. Results: The micro-spectra and imaging show the difference between the normal and malignant hair tissues. Obvious peak shift of symmetric phosphate band is observed in micro-spectra of medulla region for the hair tissue of gastric cancer patients. Chemical imaging shows the distributions of lipid and amide II/v_sPO₂^? have changed in the gastric cancer cases. Conclusions: The study indicates that the hair tissue's infrared microspectroscopy and imaging using synchrotron will be a potentially useful method for rapid early gastric cancer diagnosis.     

Isolations of dermatophyte from clinically normal scalps inM. Canis infections using the hairbrush method

The scalp hair of patients with dermatophytosis due toM. canis but without scalp lesions, and that of their family members without dermatophytosis were examined using the hairbrush method. The dermatophyte was detected in 93.8% of the scalps of those who lived in homes where cats were kept, and in 25% of those without cats. After the source of infection had been treated, the dermatophyte showed a gradually decreasing presence, finally disappearing altogether, so that no case of the disease on the scalp hair could be found.We inferred from the above findings inM. canis infections that, since the dermatophytes are seen in a high proportion of cases without scalp lesions, the dermatophytes, in many cases, exist only as saprophytes on the hair.     

Histomorphologic changes of hair follicles in human expanded scalp

To obtain information about changes that occur in hair follicles when tissue expansion is performed on the scalp, punch biopsy samples were taken from normal scalp (stage I) and the top of the expander immediately before removal (stage II) and 12 weeks after the second operation (expander removal and flap transposition, stage III) in 10 consecutive patients. We compared histologic and quantitative changes of hair follicles in transverse sections of the expanded scalp and long-term changes with those in normal controls using three specimens from each patient. Both the proportion of terminal hair to vellus hair and the proportion of anagen hair to telogen hair were significantly increased during stages II and III (p < 0.05). Perifollicular inflammation and fibrosis were observed during stage II but disappeared during stage III. All these findings imply that tissue expansion at the hair-bearing scalp made the telogen period short, possibly because of active epidermal mitosis.     

Cranial reconstruction for metastatic breast cancer

All women with advanced breast cancer who are medically stable despite their disease are candidates for tumor extirpation and reconstruction. Advanced breast cancer today is incurable, and many prognostic factors can be used to try to predict a clinical course and response to therapy; however, no guidelines are available. Our case report most likely represents a metastasis to the calvarium with intracranial extension, reported to occur in about 3 percent of primary breast cancer patients. As demonstrated here, tumor ablation with immediate, one-stage reconstruction of large scalp defects is possible without the need for free tissue transfer or a delay in adjuvant therapy. Local tissue rearrangement has been employed for coverage of defects up to 50 percent of the cranium. The resulting donor defects can be closed with split-thickness skin grafts over pericranium. Serial tissue expansion and rearrangement can be used secondarily to replace skin grafts with hair-bearing scalp. Bony defects can be managed with either autogenous or alloplastic materials. Split-calvarial bone grafts can be harvested from the same operative field and cover small to medium-sized defects. Other sources of autogenous grafts include split ribs and iliac bone. Metals, calcium ceramics, and polymers such as methylmethacrylate can be used to cover intracranial contents and restore calvarial contour when defects are large or when autogenous material is not available. Palliation from tumor burden, prevention of pathologic fracture and oncologic emergencies, controlling pain, and enhancing quality of life are the goals of the oncologic and reconstructive surgeons in cases of advanced breast cancer. These goals are becoming even more important as new forms and combinations of chemotherapy, radiation, and gene therapy are extending the life expectancy of women with breast carcinoma.     

Fine needle aspiration cytology of metastatic scalp nodules

OBJECTIVE: To analyze cases of palpable cutaneous/ subcutaneous scalp nodules and evaluate the clinical features and role of fine needle aspiration cytology (FNAC) in their diagnosis. STUDY DESIGN: A total of 1,022 cases of metastatic malignancies at various sites were analyzed over a period of two years. FNAC was performed as a routine outpatient procedure for palpable lesions and under ultrasound or computed tomographic guidance for nonpalpable, internal sites. Histologic correlation was done when possible. RESULTS: Eighteen cases were found to be metastatic scalp nodules. The scalp as a metastatic site constituted 1.76% of all metastatic sites, 7.72% of extranodal sites, and 15.3% of extranodal and extrahepatic sites. Of the 18 cases, 7 (38.9%) had primaries in the head and neck region (thyroid, 3; orbit, 1; tonsil, 1; tongue, 1; and parathyroid, 1). Cutaneous/subcutaneous metastasis was encountered in 58 patients, and the 18 cases of scalp metastasis constituted 31.03% of all cutaneous sites. CONCLUSION: Careful examination of the skin on the entire body, with particular attention to the scalp, should be done when a primary internal malignancy or recurrence is suspected. FNAC is a very helpful and cost-effective modality in determining the nature of such lesions.     

Unusual aspects of granulomatous dermatophytosis

Described are three male patients showing bizarre manifestations of granulomatous dermatophytosis, all in the hand region. One had a small infiltrated nodular lesion near the thumb which was mistaken for a common insect bite. The second had a violaceous-yellowish plaque, also on the thumb, composed of 2–3 small subcutaneous nodules. The third case had five reddish intracutaneous nodules on the dorsum of the hand. Puncture of these nodules revealed the presence of fungal elements and culture yielded T. rubrum in all cases. Each patient was also found to have a fingernail affected by the same agent. Histologic sections in each case showed granulation tissue in the dermis and hypodermis, mainly in the vicinity of hair fragments with spores. These lesions appeared to be variants of Majocchi's granuloma trichophyticum.     

Clinical and mycological study of scalp white piedra in the State of Paraíba,Brazil

White piedra is a superficial mycoses characterized by nodules on the hair shaft, caused by the basidiomycetous yeasts. In the present study, clinical and mycological findings of scalp white piedra caused by Trichosporon spp. are related. Twenty three cases of scalp white piedra were observed with a high incidence in women (87%) and preschool children from 2 to 6 (74%) years old. These groups presented a relationship of dependence with this infection. Despite the low socio-economic status, poor standards of hygiene, (48% of the patients) as well as the fact that 30.4% of the children shared the same nursery, these factors were not significant for the transmission of the mycosis. These were the first reports of scalp white piedra in Jo?o Pessoa city, Paraíba, Brazil.     

Revision surgical hair restoration: repair of undesirable results

Surgical hair restoration has been performed as a treatment for male pattern hair loss for more than 40 years. Although techniques have changed dramatically over the past several years, making it possible to achieve natural-appearing results, there are still many patients with unacceptable outcomes. These patients may have had procedures performed in the past with antiquated techniques or performed recently with substandard techniques. The causes of unfavorable results can be classified into one of three categories: technical errors, poor planning, or complications. The results in these patients can be dramatically improved through a number of different reparative surgical techniques. The majority of these techniques can be performed in an office outpatient setting. More than 40 patients unsatisfied with previous surgical hair restoration have been treated with the different techniques reviewed in this article. All patients had successful outcomes with significant improvement in appearance. Despite the increased challenges when performing reparative surgery, outcomes were favorable in all patients, with small to significant improvements in appearance achieved. Some of these challenges include the limited supply of donor hairs, reduced scalp laxity, and theoretically reduced vascularity due to scarring and transected blood vessels, and patient skepticism. Furthermore, the few complications that occurred were minor and correctable, including one case each of poor hair growth associated with extensive small graft (consisting of one to four hairs) transplanting, and of scalp scarring associated with the removal and primary closure of a large number of "plug" grafts (typically grafts 3 to 4 mm in size consisting of seven or more hairs) in a single procedure.     

颅内原发性黑色素瘤的影像学诊断

目的：探讨颅内黑色素瘤的影像学特点。方法：回顾性分析5例经手术病理及临床证实的颅内原发性黑色素瘤的CT和MR影像学表现。结果：CT表现为类圆形高密度影4例,低密度影1例。增强扫描肿瘤出现不均匀强化。MR检查,4例T1WI肿瘤表现为高信号,1例T1wI肿瘤表现为不均匀低信号;5例增强扫描肿瘤明显增强。结论：MRI有助于颅内黑色素瘤的诊断,在一定程度上可以区分原发性和转移性黑色素瘤。     

Fine needle aspiration cytology of pseudosarcomatous reactive proliferative lesions of soft tissue

OBJECTIVE: To summarize the diagnostic features of fine needle aspiration cytology (FNAC) of pseudosarcomatous reactive proliferative lesions of soft tissue and to establish the criteria for differentiating these lesions from true sarcoma, thus allowing conservative management. STUDY DESIGN: FNA of 17 cases (13 nodular fasciitis, 2 proliferative fasciitis, 2 proliferative myositis), from 1994 to 2001, were reviewed in correlation with the clinical course or results of biopsy. RESULTS: The FNAC features of pseudosarcomatous reactive proliferative soft tissue lesions were characterized by a pleomorphic pattern of proliferative cells and the presence of ganglion cell-like cells. The proliferative cells varied widely from spindle shaped, with long cytoplasmic processes, to more plump cells, with round to oval nuclei. In spite of the large nuclei and prominent nucleoli in ganglion cell-like cells, the nuclei were cytologically benign, with thin and smooth nuclear membranes and fine chromatin. Clinically, all lesions appeared as small, superficially located, rapidly growing nodules with a short duration of symptoms. Ten cases of nodular fasciitis, one case of proliferative fasciitis and two cases of proliferative myositis had a spontaneous resolution in 1-12 weeks (mean, 4.7) following diagnosis by FNAC. All patients were well and devoid of any symptoms or signs of recurrence or metastasis in a follow-up period of 1-64 months after FNAC or biopsies. CONCLUSION: It is possible to differentiate pseudosarcomatous reactive proliferative soft tissue lesions from true sarcoma based on cytologic criteria in FNAC together with clinical correlation. All such lesions diagnosed by FNAC should be managed nonsurgically first, with follow-up. If regression does not occur within four to eight weeks, surgery should be performed.     

Antioestrogens in Treatment of Breast Cancer: Value of Nafoxidine in 52 Advanced Cases

The synthetic non-steroidal antioestrogen nafoxidine (U-11, 100A) was given by mouth to 52 women with locally advanced or metastatic breast cancer, in 85% of whom the disease had become resistant to, or relapsed after, previous endocrine treatment. The objective response rate (complete or partial regression of disease) among 48 cases treated for at least four weeks was 37%. Tumours in soft tissue seemed to respond better than skeletal metastases. The patients in all but one of the 52 cases were postmenopausal. Those who had had an objective response to previous hormone treatment had a greater chance of deriving benefit from nafoxidine than those who had been resistant to hormone treatment.Side effects of nafoxidine were dryness of skin, increased loss of scalp hair, and heightened sensitivity to sunlight. None were serious, and they could be lessened by protection from solar radiation or a decrease in dosage. No obvious depression of thyroid or adrenal function or obvious water retention or masculinization was seen. Cataract was a possible complication.This clinical trial was preceded by laboratory studies in which a transplantable oestrogen-dependent tumour in the Syrian hamster was notably inhibited by the administration of nafoxidine. This experimental model may prove useful in screening potentially useful antioestrogenic agents against breast cancer before a human trial.     

Simulation of scalp cooling by external devices for prevention of chemotherapy-induced alopecia

Hypothermia of the scalp tissue during chemotherapy treatment (scalp cooling) has been shown to reduce or prevent chemotherapy-induced hair loss. In this study, numerical models are developed to investigate the interaction between different types of external scalp cooling devices and the human scalp tissue. This work focuses on improving methods of modeling scalp cooling devices as it relates specifically to the prevention of chemotherapy-induced alopecia. First, the cooling power needed for any type of device to achieve therapeutic levels of scalp hypothermia is investigated. Subsequently, two types of scalp cooling devices are simulated: a pre-cooled/frozen cap design and a liquid-cooled cap design. For an average patient, simulations show that 38.5 W of heat must be extracted from the scalp tissue for this therapy in order to cool the hair follicle to 22 °C. In practice, the cooling power must be greater than this amount to account for thermal losses of the device. Simulations show that pre-cooled and liquid-cooled cap designs result in different tissue temperatures over the course of the procedure. However, it is the temperature of the coolant that largely determines the resulting tissue temperature. Simulations confirm that the thermal resistance of the hair/air layer has a large impact on the resulting tissue temperatures. The results should be correlated with experimental data as an effort to determine the optimal parameter choices for this model.     

Magnetic resonance imaging findings of vascular malformations of the lower extremity

Vascular malformations are congenital lesions resulting from a defect during embryogenesis. Magnetic resonance imaging (MRI) is a very effective method for demonstrating detailed information regarding involved structures, extent, and flow characteristics of vascular malformations. In previous MRI studies, most of the emphasis is laid on the difference between high- and low-flow lesions, whereas little detailed information is available about the extent of local tissue involvement. These additional characteristics may influence the approach in treating these malformations and improve understanding of the pathogenesis. We retrospectively reviewed MRI scans of 40 patients with vascular malformations of the lower extremity. Thirty-four patients had low-flow lesions, and six had high-flow lesions. Of the low-flow lesions, 23 patients (67.6 percent) had muscle infiltration, with four of the six high-flow lesions having muscle infiltration. Nine of the 11 male patients (81.8 percent) with low-flow lesions had associated muscle infiltration, in comparison with 14 of the 23 female patients (60.9 percent) with low-flow lesions (p = 0.206). Eighty percent of the vascular malformations located on the thigh with muscle involvement had involvement of the anterior muscle group, whereas 86.6 percent of the patients with a vascular malformation located on the leg and with associated muscle involvement had at least the posterior muscle group involved (p = 0.0049). Ten patients (25 percent) of the whole group had bone infiltration. Low-flow lesions often had multifocal lesions (20.6 percent), whereas associated muscle atrophy was visible in 10 low-flow lesions and in two high-flow lesions. In low-flow lesions with muscle infiltration (n = 23), 43 percent (n = 10) had associated surrounding muscle atrophy (p = 0.009). Hypertrophy of the subcutaneous tissue was visible in 11 low-flow patients (32.4 percent). The high amount of muscle and bone involvement in vascular malformations of the lower extremity is emphasized with this study. Of particular interest was the difference in affected muscle groups. The angiosome concept is used to explain this preponderance, and we feel the angiosome concept could also be used when assessing possible intervention. The surrounding muscle atrophy and multifocal nature of these anomalies are further important considerations when assessing the possibility of intervention.     

Assessing the potential of a "color effect" for hair analysis of 11-nor-9-carboxy-delta(9)-tetrahydrocannabinol: analysis of a large sample of hair specimens

It has been hypothesized that hair color may play a role in the concentration of various drugs of abuse in hair. Several studies have shown that melanin in hair appears to play a binding role for at least some commonly abused drugs. However, these studies have been limited by a number of factors when assessing the clinical significance of a hypothesized melanin or color effect. This study evaluates the possible effect of hair color on the concentration of 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (c-THC) in human hair. The analysis is based on 3886 positive c-THC hair specimens drawn from a universe of approximately 80000 specimens of scalp hair harvested from the posterior vertex of the head. Analysis of variance of color categorization by c-THC concentration shows that c-THC concentration does not have a significant association with hair color (Hair Color F = 1.148, p =.332) and therefore does not have a demonstrable "color effect".     

In-hospital cerebrovascular complications following orthotopic liver transplantation: A retrospective study

Background

Cerebrovascular complications are severe events following orthotopic liver transplantation (OLT). This study aimed to observe the clinical and neuroimaging features and possible risk factors of in-hospital cerebrovascular complications in the patients who underwent OLT.

Patients and methods

We retrospectively reviewed 337 consecutive patients who underwent 358 OLTs. Cerebrovascular complications were determined by clinical and neuroimaging manifestations, and the possible risk factors were analyzed in the patients with intracranial hemorrhage.

Results

Ten of 337 (3.0%) patients developed in-hospital cerebrovascular complications (8 cases experienced intracranial hemorrhage and 2 cases had cerebral infarction), and 6 of them died. The clinical presentations were similar to common stroke, but with rapid deterioration at early stage. The hematomas on brain CT scan were massive, irregular, multifocal and diffuse, and most of them were located at brain lobes and might enlarge or rebleed. Infarcts presented lacunar and multifocal lesions in basal gangliar but with possible hemorrhagic transformation. The patients with intracranial hemorrhage had older age and a more frequency of systemic infection than non-intracranial hemorrhage patients. (P = 0.011 and 0.029, respectively).

Conclusion

Posttransplant cerebrovascular complications have severe impact on outcome of the patients who received OLT. Older age and systemic infection may be the possible risk factors of in-hospital intracranial hemorrhage following OLT.     

肺隐球菌病12例临床分析

目的 提高对隐球菌病的认识.方法 对确诊为肺隐球菌病的12例病例的临床资料进行回顾性分析.结果 12例病例中,男性8例,女性4例,年龄31～68岁,平均年龄(51.8±12.6)岁,6例伴有基础疾病,但无1例有鸟类接触史;有临床症状者10例,其中咳嗽8例,咯痰3例,胸痛4例,发热2例,有体征者仅2例;胸部影像表现为:1...     

Comparison of Trace Elements in the Scalp Hair of Malignant and Benign Breast Lesions Versus Healthy Women

Trace elements including Al, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, Sb, Sr, and Zn were analyzed in the scalp hair samples of women with malignant breast lesions, women with benign breast lesions, and healthy donors using atomic absorption spectrophotometric method. In the scalp hair of malignant-tumor patients, the highest average concentration was shown by Ca (1,187 μg/g), followed by Na (655 μg/g), Mg (478 μg/g), Zn (391 μg/g), Sr (152 μg/g), Fe (114 μg/g), and K (89.8), while in the case of benign-tumor patients, the average estimated element levels were 1,522, 1,093, 572, 457, 217, 80.4, and 74.7 μg/g, respectively. Most of the elements exhibited non-normal distribution evidenced by large spread, standard error, and skewness values. Mean concentrations of Ca (634 μg/g), Zn (206 μg/g), Mg (162 μg/g), Fe (129 μg/g), and Na (82.1 μg/g) were noteworthy in the scalp hair of healthy women. Average levels of Na, Sr, K, Cd, Co, Pb, Mg, Ca, Zn, Ni, Sb, and Mn were revealed to be significantly higher in the hair of malignant and benign patients compared to the healthy women; however, Fe, Cu, Al, and Cr were not significantly different in the scalp hair of the three groups. The quartile distributions of Ca, Cd, Co, Cr, K, Mg, Mn, Na, Ni, Pb, Sb, and Sr revealed maximum spread in the scalp hair of malignant and benign groups; nevertheless, Al, Cu, Fe, and Zn exhibited almost comparable quartile levels in the three groups. Strong correlation coefficients were found between Fe and Cd, Al and Na, Mn and Sr, Co and Cr, Cd and Cr, Pb and K, Pb and Mn, Cu and Na, and Al and Fe in the scalp hair of malignant-tumor patients, while Fe and K, Cd and Co, Na and Co, and Cr and Pb showed strong correlations in the scalp hair of benign-tumor patients, both of which were significantly different compared with the healthy subjects. Multivariate cluster analysis also revealed divergent clustering of the elements in the scalp hair of malignant and benign patients in comparison with the healthy women.     

Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations

Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.     

Tactile and thermal detection thresholds of the scalp skin

The tactile and thermal sensitivity of diverse regions of the human body have been documented extensively, with one exception being the scalp. Additionally, sensory changes may accompany the hair loss from the scalp in androgen-related alopecia (ARA), but formal quantitative sensory testing (QST) has not been reported in respect of this. Therefore, light touch detection thresholds were obtained at nine scalp sites and one forehead site, using Semmes-Weinstein filaments (Von Frey hairs), and for warming and cooling from skin baseline temperature, using 28 and 256 mm(2) thermodes. Affective, thermal, and nociceptive sensations experienced at thermal detection threshold were quantified. Thirty-two male participants were recruited, 10 of whom had normal hair coverage, 12 of whom had shaved scalp but with potentially normal hair coverage, and 10 of whom exhibited ARA to some extent. The scalp was relatively insensitive to tactile and thermal stimulation at all tested sites, especially so along the midline and near the apex of the skull. Threshold level warm stimuli were rated less pleasant, the less sensitive the test site. After correction for age-related changes in sensitivity, bald scalp sites were found more sensitive to cooling than the same sites when shaved, consistent with prior informal reports of increased sensitivity for some scalp sensations in ARA. QST on hair-covered sites was subject to methodological issues that render such testing non-ideal, such as bias in measurement of resting skin temperatures, and the near impossibility of delivering filament stimuli to the scalp skin without disturbing neighboring hairs.