Pigmented Basal Cell Carcinoma of the Nipple-Areola Complex in an Elderly Woman

Basal cell carcinoma (BCC), which frequently occurs in sun-exposed areas of the head and neck region, is the most common cutaneous malignancy. The nipple-areola complex (NAC) is an uncommon site for BCC to develop. BCCs in this region display more aggressive behavior and a greater potential to spread than when found in other anatomical sites. This paper outlines the case of 67-year-old female with a solitary asymptomatic black plaque on the right areola. The lesion was initially recognized as Paget's disease of the nipple by a general surgeon. However, the histopathological features showed a tumor mass of basaloid cells, a peripheral palisading arrangement and scattered pigment granules. Finally, the patient was diagnosed with pigmented BCC of the NAC and was referred to the department of dermatology. Positron emission tomography-computed tomography revealed the absence of distant metastasis. A wide excision was done. The lesion resolved without recurrence or metastasis during 14 months of follow-up

Parry-Romberg Syndrome with En Coup de Sabre

Parry-Romberg syndrome (PRS) is a relatively rare degenerative disorder that is poorly understood. PRS is characterized by slowly progressing atrophy affecting one side of the face, and is frequently associated with localized scleroderma, especially linear scleroderma, which is known as en coup de sabre. This is a report of the author's experiences with PRS accompanying en coup de sabre, and a review of the ongoing considerable debate associated with these two entities. Case 1 was a 37-year-old woman who had right hemifacial atrophy with unilateral en coup de sabre for seven years. Fat grafting to her atrophic lip had been conducted, and steroid injection had been performed on the indurated plaque of the forehead. Case 2 was a 29-year-old woman who had suffered from right hemifacial atrophy and bilateral en coup de sabre for 18 years. Surgical corrections such as scapular osteocutaneous flap and mandible/maxilla distraction showed unsatisfying results

Actual long-term survival after resection of stage III soft tissue sarcoma

Background Actuarial survival based on the Kaplan–Meier method can overestimate actual long-term survival, especially among those with factors of poor prognosis. Patients with American Joint Committee on Cancer stage III soft tissue sarcoma (STS) represent a subset with a high risk of STS-specific mortality. Therefore, we aimed to characterize the clinicopathological characteristics associated with actual long-term survival in patients with stage III STS. Methods We retrospectively reviewed 116 patients who underwent surgical resection for stage III STS with curative intent between March 2000 and December 2013. Long-term survivors (n = 61), defined as those who survived beyond 5 years, were compared with short-term survivors (n = 36), who died of STS within 5 years. Results Multivariate logistic regression analyses showed that a tumor size  10 cm and 48% had a histological grade of 3. Leiomyosarcoma (3 of 10) was negatively associated with actual long-term survival. Conclusions Actual 5-year survival after resection of stage III STS was associated with tumor size, histological grade, and ASA score. However, majority of the actual 5-year survivors exhibit factors of poor prognosis, suggesting that aggressive treatment should be offered for a chance of long-term survival in these patients

Variability between the trial and final implant measurements during the sensor-guided total knee arthroplasty

© 2021, The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).Purpose: Compartmental load-sensing technology has been used in the attempt to achieve optimal soft tissue balance during total knee arthroplasty (TKA). This study was conducted to investigate the validity of such use of intraoperative sensing technology. Methods: Ninety-three knees scheduled to undergo total knee arthroplasty for knee osteoarthritis with a tibial sensor were prospectively enrolled. Measurements were divided into three groups according to the three different time points of intraoperative load testing: group Trial (with the trial components), group Final (with the definitive cemented implants and an open joint capsule), and group Closed (with the definitive cemented implants and a closed joint capsule). Load measurements and component rotational alignments were documented at 10°, 30°, 45°, 90°, and 120° of flexion for all three groups, and compared. One year postoperatively, the joint line obliquity angle was obtained radiographically in the valgus and varus stress views at 10° and 30° flexion to evaluate the clinical instability. The Knee Society, Hospital for Special Surgery, and Western Ontario McMaster Universities Osteoarthritis Index scores were used to determine functional outcomes. The correlations of the above outcomes with intraoperative load were evaluated. Results: There were significant differences in medial and lateral loads at all flexion angles (except at a 120° lateral load) between group Trial and group Final (p < 0.05). Tibial trays were internally rotated to a significantly higher degree in group Final than in group Trial (p = 0.010). The lateral compartmental load significantly decreased after patellar inversion (p = 0.037). There were no correlations of intraoperative load with clinical instability and functional outcomes. Conclusion: Significant variability was observed between the trial and final implant measurements and intraoperative sensing data were not correlated with instability or functional outcomes over a 1-year period. Therefore, intraoperative sensor technology provides limited feedback and clinical efficacy in the adjustment of the soft tissue balance during TKA. Level of evidence: Level II.N

Expression of inflammatory biomarkers from cultured sebocytes was influenced by treatment with vitamin D

Background: Inflammatory cytokines are the key factor in the pathophysiology of acne. It is well known that keratinocytes synthesize many kinds of inflammatory cytokines. In addition, it is reported that inflammatory cytokines are also expressed from sebocytes, which originate from the same stem cells with keratinocytes. Aim: To clarify changes in the expression of inflammatory biomarkers from cultured sebocytes after treatment with vitamin D. Materials and Methods: Reverse transcription-polymerase chain reaction (RT-PCR) was done to measure changes in the expression of inflammatory biomarkers, including interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor-α (TNF-α), and several subtypes of matrix metalloproteinases (MMPs) after treatment of a group of cultured sebocytes with vitamin D. Vitamin D receptor (VDR) small interfering RNA (siRNA) was added in the other group of cultured sebocytes to assure the role of vitamin D on the expression of inflammatory biomarkers. Enzyme-linked immunosorbent assay (ELISA) was also performed in the vitamin D-treated sebocytes. Results: Cultured sebocytes showed non-significant changes in the gene expression of inflammatory biomarkers after treatment with vitamin D. In cultured sebocytes treated with a VDR siRNA, the expression of inflammatory biomarkers was not blocked after treatment with vitamin D. ELISA showed a significant decrease in the expression of IL-6, IL-8, and MMP-9, but a significant increase in the expression of MMP-1 and MMP-3, after treatment with vitamin D (10 -6 M). Conclusion: Expression of inflammatory biomarkers is influenced by treatment with vitamin D in cultured sebocytes, but not through VDR

Dept Soil Fertilizer, NARC Tsukuba, Ibaraki, Japan E-Mail : [email protected]

ABSTRAC

Effective period of conservative treatment in patients with acute calcific periarthritis of the hand

Abstract Background Acute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective. Methods We retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3 months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9 months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval. Results All 10 patients with 17 affected joints continued conservative treatments for an average of 11.1 months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9 months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6 months, but not at 9 months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6 months, but not at 9 months (P values = 0.020, 0.034, and 0.083, respectively). Conclusions Patients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6 months. These results suggest that conservative treatment could be tried for at least 6 months before considering the surgical treatment of calcific periarthritis of the hand

Effect of corn grain particle size on ruminal fermentation and blood metabolites of Holstein steers fed total mixed ration

Objective This study was conducted to investigate the effect of corn grain particle size on ruminant fermentation and blood metabolites in Holstein steers fed total mixed ration (TMR) as a basal diet to explain fundamental data of corn grain for cattle in Korea. Methods Four ruminally cannulated Holstein steers (body weight 592±29.9 kg) fed TMR as a basal diet were housed individually in an auto temperature and humidity modulated chamber (24°C and 60% for 22 h/d). Treatments in a 4×4 Latin square design were TMR only (control), TMR with whole corn grain (WC), coarsely ground corn grain (CC), and finely ground corn grain (FC), respectively. The corn feeds substituted for 20% energy intake of TMR intake. To measure the ruminal pH, ammonia N, and volatile fatty acids (VFA), ruminal digesta was sampled through ruminal cannula at 1 h intervals after the morning feeding to determine ruminal fermentation characteristics. Blood was sampled via the jugular vein after the ruminal digesta sampling. Results There was no difference in dry matter (DM) intake between different corn particle size because the DM intake was restricted to 1.66% of body weight. Different corn particle size did not change mean ammonia N and total VFA concentrations whereas lower (p<0.05) ruminal pH and a ratio of acetate to propionate, and higher (p<0.05) propionate concentration were noted when the steers consumed CC compared with WC and FC. Concentration of blood metabolites were not affected by different particle size of corn grain except for blood triglyceride concentration, which was significantly (p<0.05) increased by FC. Conclusion Results indicate that feeding CC may increase feed digestion in the rumen, whereas the FC group seemed to obtain inadequate corn retention time for microbial degradation in the rumen