33 research outputs found
TELDOM: international network for diagnosis of pigmented skin lesions
TELDOM je naslov projekta, ki predvideva razvoj računalniške infrastrukture, ki bo zagotovila kvalitetno, uporabniku dostopno in preprosto uporabno modernoin natančno diagnostiko pigmentnih sprememb kože v ambulanti družinskega zdravnika. Digitalni posnetki, ki jih bo ta napravil, bodo po omrežju varno preneseni v specializirano ustanovo, kjer bodo postavili diagnozo in odgovor posredovali v zdravnikovo ambulanto. TELDOM bo omogočil tudi tesnejši kontakt med specialistom in družinskim zdravnikom in širjenje znanja iz specializiranih centrov na periferijo.TELDOM will provide a network infrastructure for delivering innovative, high quality, user friendlly and easy accessible medical services to citizens for diagnosis of pigmented skin lesions and tumors at the point of care regardlessof location by using advanced information technologies. Digital images will be send to th ecentres of excellence for diagnoses and returning to th e points of care. Contact between general physicians and specialists will be strenghtened and the transfer of medical knowledge from centers to remote areas intensified
Rudimentary meningocele: remnant of a neural tube defect?
Background: Rudimentary meningocele, a malformation in which meningothelial elements are present in the skin and subcutaneous tissue, has been described in the past, under a variety of different terms and has also been referred to as cutaneous meningioma. There has been debate as to whether rudimentary meningocele is an atretic form of meningocele or results from growth of meningeal cells displaced along cutaneous nerve
IgE Mediated Autoallergy against Thyroid Peroxidase – A Novel Pathomechanism of Chronic Spontaneous Urticaria?
Chronic spontaneous urticaria (csU), which is characterized by recurrent episodes
of mast cell-driven wheal and flare-type skin reactions, is often associated with
elevated total IgE levels and thyroid autoimmunity. We speculate that some csU
patients express IgE autoantibodies against thyroid antigens such as thyroid
peroxidase (TPO), which could bind to skin mast cells and induce their
activation.We developed and used a site-directed human IgE capture ELISA to quantify
IgE-anti-TPO. We used this assay and investigated csU patients
(n = 478) and healthy control subjects
(n = 127) for IgE-anti-TPO and then assessed
IgE-anti-TPO-positive and -negative csU patients for clinical and serological
differences. ( = 61%, IgE-anti-TPO:
median 6.67, interquartile range 5.39–8.24). IgE-anti-TPO-positive and
-negative csU patients had very similar distributions of age and gender as well as
disease activity and duration. IgE-anti-TPO-positive csU patients exhibited
significantly higher IgG-anti-TPO levels and lymphocyte counts as well as
decreased C4 complement levels.Our findings show that a sizeable subgroup of csU patients expresses IgE
antibodies against thyroid peroxidase. These autoantibodies could cause
“autoallergic” mast cell activation, a novel pathomechanism of chronic
spontaneous urticaria
Intradermal Indocyanine Green for In Vivo Fluorescence Laser Scanning Microscopy of Human Skin: A Pilot Study
BACKGROUND: In clinical diagnostics, as well as in routine dermatology, the increased need for non-invasive diagnosis is currently satisfied by reflectance laser scanning microscopy. However, this technique has some limitations as it relies solely on differences in the reflection properties of epidermal and dermal structures. To date, the superior method of fluorescence laser scanning microscopy is not generally applied in dermatology and predominantly restricted to fluorescein as fluorescent tracer, which has a number of limitations. Therefore, we searched for an alternative fluorophore matching a novel skin imaging device to advance this promising diagnostic approach. METHODOLOGY/PRINCIPAL FINDINGS: Using a Vivascope®-1500 Multilaser microscope, we found that the fluorophore Indocyanine-Green (ICG) is well suited as a fluorescent marker for skin imaging in vivo after intradermal injection. ICG is one of few fluorescent dyes approved for use in humans. Its fluorescence properties are compatible with the application of a near-infrared laser, which penetrates deeper into the tissue than the standard 488 nm laser for fluorescein. ICG-fluorescence turned out to be much more stable than fluorescein in vivo, persisting for more than 48 hours without significant photobleaching whereas fluorescein fades within 2 hours. The well-defined intercellular staining pattern of ICG allows automated cell-recognition algorithms, which we accomplished with the free software CellProfiler, providing the possibility of quantitative high-content imaging. Furthermore, we demonstrate the superiority of ICG-based fluorescence microscopy for selected skin pathologies, including dermal nevi, irritant contact dermatitis and necrotic skin. CONCLUSIONS/SIGNIFICANCE: Our results introduce a novel in vivo skin imaging technique using ICG, which delivers a stable intercellular fluorescence signal ideal for morphological assessment down to sub-cellular detail. The application of ICG in combination with the near infrared laser opens new ways for minimal-invasive diagnosis and monitoring of skin disorders
The confocal story
Dermatologic diagnosis is primarily based on interpretation of morphological information by visual inspection, confirmed by histopathological diagnosis if necessary. The challenge is to establish a correct diagnosis and to identify all malignant lesions while minimizing unnecessary surgical procedures. In this context, several non-invasive imaging modalities have emerged in recent years that are aimed at increasing accuracy of in vivo diagnosis. Of those, reflectance confocal microscopy has shown the most promising results. In vivo reflectance confocal microscopy produces horizontal images of the skin at a cellular resolution from the surface to the upper dermis. It enables to visualize tissue in its physiological state avoiding retraction bias due to fixation, staining and sectioning procedures that are a prerequisite to conventional light histopathology. Moreover, RCM enables observation of changes over time
Tubulin expression in melanocytic skin tumors - an immunohistochemical study
The microtubulus system as a part of the cellular cytoskeleton contributes to cell movement. Microtubulus assembly and disassembly is considered to be essential for tumor invasion and serves as a target for tumor chemotherapy. Using immunohistochemical methods, we investigated the distribution of tubulin in normal skin and 34 melanocytic skin tumors. In normal skin, tubulin was strongly expressed in dermal nerves, melanocytes, fibroblasts within the papillary dermis and in myoepithelial cells. In melanocytic skin tumors, nevus cells and melanoma cells stained positive, particularly at the periphery of the lesions, where there were single cells and small nests. The main difference between benign and malignant melanocytic tumors was found in the stromal cells: In melanocytic nevi, the stromal fibroblasts were entirely tubulin negative; whereas, adjacent to the invasive edge in primary and metastatic malignant melanoma, the stroma fibroblasts were strongly positive. Our results show that tubulin is regularly expressed in melanocytic skin tumors and may serve as a prerequisite for cell movement. The pronounced expression of tubulin in fibroblasts surrounding malignant melanocytic skin lesions reflects a stromal alteration that might contribute to tumor invasion
Semeiology and pattern analysis in melanocytic lesions
Melanocytic lesion exploration is conducted by the examination of mosaics and/or series of consecutive high-resolution images from the surface to the dermis up to the loss of resolution (approximately up to 200 ÎĽm). Mosaics are usually acquired at three levels (superficial layers, dermal-epidermal junction, upper dermis) for the evaluation of general epidermal pattern, frequencies and distribution of pagetoid cells, regularity of the DEJ architecture, presence and distribution of nests, and structures within the papillary dermis. High-resolution images are employed for the evaluation of cyto-architectural aspects
Natural history of atypical and equivocal melanocytic lesions in children: An observational study of 19 cases
Digital dermoscopy follow-up helps to identify patterns of change typical of common atypical nevi and early melanoma and improves the follow-up of patients with atypical nevi. We report the morphologic changes observed over time in 19 atypical or equivocal acquired melanocytic nevi that underwent dermoscopic follow-up. Two observers retrospectively examined digitalized dermoscopic images of 19 atypical melanocytic nevi from 15 children and young adults (median age 12 years, range 3-26 years). The images were assessed for global dermoscopic patterns at baseline and after a median 25-month (range 6-138 mos) follow-up. Ten (52.6%) nevi changed and nine (47.4%) retained a stable dermoscopic pattern. Of the 10 changing lesions, 2 of 4 homogeneous nevi evolved into a reticular pattern and 2 into a mixed pattern; 1 of 2 nevi with a mixed pattern evolved into a homogeneous nevus and 1 into a regressing nevus; 1 of 2 nevi with "other" patterns, such as negative pigment network and peppering throughout the lesion, evolved into a mixed nevus and 1 into a regressing nevus; 1 globular nevus evolved into a mixed pattern; and 1 starburst nevus evolved into a homogeneous nevus. The most striking results of our study were that atypical nevi can evolve into common nevi or they can regress, as documented by long-term dermoscopic follow-up. In children and young adults, dermoscopic follow-up of atypical nevi might be a valid alternative to surgical excision and enables us to achieve new insights into the natural history of these nevi