Biomedical subjects
Publications and source records attributed to E Uchinuma.
Three cases of pyodermia chronica were successfully treated with ideal split-thickness skin grafts. This method offers appropriate wound coverage after radical surgical excision in cases of extensive pyodermia chronica.
Recently, various types of allogeneic skin substitutes including cultured epidermal substitute (CES), cultured dermal substitute (CDS), and cultured skin substitute (CSS), which are composed of keratinocytes and/or fibroblasts as the cellular component(s), have been used as biological wound dressings. In our study, the allogeneic CDS was prepared by plating fibroblasts on a spongy collagen. The clinical evaluation was conducted using fresh or cryopreserved allogeneic CDS. In 145 of our clinical cases, 95% (138/145) of various wounds were evaluated as achieving good or excellent results, including 96% (22/23) of deep dermal burns (DDB) and dermal burns (DB), 100% (53/53) of partial-thickness donor wounds, 91% (21/23) of traumatic skin defects, 100% (5/5) of pressure ulcers, 82% (9/11) of chronic skin ulcers, 100% (6/6) of coverage for debrided DB, and 92% (22/24) of coverage for autologous meshed graft. The results obtained in our study suggest that the allogeneic CDS is able to provide an effective therapy for patients with partial and/or full-thickness skin defects.
Three multiple-finger degloving injuries were successfully resurfaced with thin abdominal flaps. This method offers immediate total wound coverage in multiple-finger degloving injuries.
Recently, mutations of the fibroblast growth factor receptor ( FGFR ) genes have been detected in syndromic craniosynostosis. We examined nucleotide sequences of FGFR2 in Japanese craniosynostosis patients (Crouzon syndrome: 9 cases; Apert syndrome: 6 cases; scaphocephaly: 3 cases as non-syndromic patients) by polymerase chain reaction (PCR) followed by direct sequencing methods. The results demonstrated FGFR2 heterozygous mutations at codons 252, 290 of exon 7, and at codon 342, 354 of exon 9 in Crouzon syndromes. In Apert syndrome patients, Ser252Trp and Pro253Arg were detected in five and one patients, respectively. No mutation was detected in one case of Crouzon, all cases of scaphocephaly and healthy individuals. Thus far sequence analysis of FGFR2 in syndromic craniosynostosis has been reported in many white patients, whereas in Japanese only several cases have been studied. The current study with 18 patients confirmed that a similar series of mutations occur in Japanese patients as in white patients regardless of ethnicity and environment. The frequency of the mutation was 82% (9/11 cases) in Japanese Crouzon patients. The ratio of S252W:P253R was 5 : 1 in Japanese Apert patients. Moreover, in Japanese Apert patients, complication rate of cleft palate was 60% for mutation of Ser252Trp and 0 of 2 patients for Pro253Arg, with their syndactyly score being 4.90 and 5.50, respectively.
Laminin 5 is essential in epithelial attachment to stromal tissues, suggesting that it might improve keratinocyte attachment in a variety of clinical situations. In this study, we examined the effect of exogenous laminin 5 upon the efficiency of transplantation of keratinocyte sheets in animal models. Keratinocyte sheets were prepared according to the method of Rheinwald & Green (1975). Purified laminin 5 was added to the sheets of group 1 (1.0 microg per cm2), Dulbecco's modified Eagle's medium alone was added to group 2. The sheets were grafted to the panniculus carnosus of nude mice (BALB/C nu/nu) (n = 12) and nude rats (Fisher 344) (n = 15). The take rate was assessed by measurement of the area of surviving epithelium at 7 d postgrafting. Laminin 5 bound the keratinocyte sheets of group 1. At 7 d postgrafting, the area of epithelialization of group 1 was significantly larger than that of group 2. Immunohistochemistry staining showed that collagen IV, laminin 5, and collagen VII stained more strongly at the dermal-epidermal junction in group 1 than in group 2. Integrin chains alpha6 and beta4 were similar in both groups. Electron microscopy at day 3 after grafting, showed the lamina densa of group 1 to be more continuous than in group 2. Pretreatment of cultured human keratinocyte sheets with laminin 5 improved the extent of epithelial coverage and increased the rate of neobasement membrane formation. The results suggest that laminin 5 promotes epithelial attachment by increasing the rate of basement membrane assembly.
We have developed an allogeneic cultured dermal substitute (CDS) that was prepared by plating fibroblasts on to a spongy collagen matrix and culturing them for 7 to 10 days. The matrix was freeze-dried from a 1% aqueous solution of bovine-hide atelocollagen. This study was designed to evaluate the efficacy of promoting epithelialisation clinically on 26 donor-site wounds for split-thickness skin grafts. One half of a wound was covered with an allogeneic CDS and the other half side was covered with a commercially-available freeze-dried porcine dermis (FPD). Both macroscopically and histologically the epithelialisation on the area of the donor site that was covered with allogeneic CDS was more rapid than that covered with FPD. In a representative donor-site wound covered with allogeneic CDS, there was a stratified structure of epithelial cells on the underlying connective tissue on day 5, and the epithelium had matured by day 12. When covered with FPD a stratified structure of epithelial cells was noted on day 8, and the epithelium had matured by day 15. We conclude that allogeneic CDS provides a good environment for epithelialisation.
As promising new therapy for congenital giant pigmented nevi, the authors investigated the potential use of an acellular autograft nevi-dermal matrix in combination with a split-thickness skin graft. To address whether the processed acellular nevi-dermal matrix from frozen skin could be reconstituted as a viable dermal base, the authors grafted it onto full-thickness skin defects in nude rats. Fibroblast infiltration and neovascularization into the acellular nevi-dermal matrix were observed. However, because the disappearance of the residual melanotic granules of the grafted dermis took 16 weeks, the authors excised with scissors the superficial layer of the acellular nevi-dermal matrix containing a large quantity of melanin. The appearance after using this method was relatively superior even compared with the full-thickness skin graft. The success of their experimental animal model using the acellular nevi-dermal matrix covered with split-thickness skin grafts confirms the potential value for the clinical application of this treatment for congenital giant nevi.
The validity of Seifert's hypothesis about growth pattern of adenolymphomas has been evaluated in three of five patients with adenolymphomas of the parotid gland, who at the time of a parotidectomy, were found to have multiple unilateral adenolymphomas in the intraglandular lymph nodes. This evaluation, which was based on assessing the epithelial: lymphoid tissue ratio in excised adenolymphomas and the growth in tumor size, showed that there was no association between the histological changes in the epithelial:lymphoid tissue and the tumor size. Adenolymphomas seem to have no consistent growth pattern and develop independently. However, as multiple tumors were detected histopathologically in lymph nodes as small as 5 mm in diameter the importance of a detailed examination of patients with adenolymphomas is stressed, so that other tumours are not overlooked.
The cultured skin substitute was created through successive cultivation of fibroblasts and keratinocytes that were combined within a collagen matrix. This collagen matrix was composed of a collagen spongy sheet and a collagen gel. The collagen spongy sheet was designed to produce a honeycomb structure having many holes in which all holes through the sheet were filled with collagen gel. This specific structure thereby allows for the nourishment of the cultured keratinocytes on the surface of the matrix when placed on the graft bed. In this study, autologous cultured skin substitute was applied to a 51-year-old man who had sustained a burn injury. Three sheets of the cultured skin substitute (6 x 9.5 cm) were grafted onto the full-thickness excised wound in the right anterior chest wall. One week after grafting most of the matrix disappeared and stratified keratinocytes were seen to have firmly attached to the underlying tissue. Five weeks after grafting a cornified epidermal layer was seen. Ten months after grafting a mature epidermis and a well-differentiated papillary and reticular dermis replacement were observed. The physical properties and color of this grafted area resemble those of normal skin. In the second test case, autologous cultured skin substitute was applied to a 30-year-old man with a scar remaining after tattoo removal. Eight sheets of the cultured skin substitute (10 x 18 cm) were applied on an excised wound (thickness, 0.02-0.025 in.) of both the fore- and upper arms. The histological appearance of a biopsied skin specimen from the grafted area at 3 months after grafting showed a mature epidermis and a well-differentiated reticular dermis replacement. The regenerated skin at 14 months after grafting showed an excellent result.
The development of movable skin flaps appears to be a popular aspiration of contemporary plastic surgeons, although it seems to us that the classic skin flap, devised by pioneers a century ago, still remains worthy of application.
Malignant lymphoma of the parotid gland region, especially Hodgkin's disease of the gland, is an extremely rare disorder. We have recently experienced a case initially suspected of being pleomorphic adenoma and later, on postoperative histopathological examination, diagnosed as Hodgkin's disease. The present report describes this case of Hodgkin's disease arising from an intraglandular lymph node in the parotid gland.
Human dermal fibroblasts were cultured with blister fluid and 3 of their properties were investigated: cell shape, growth rate, and ability to contract collagen fibrils. In the medium containing the blister fluid, fibroblasts became attached to the tissue culture plastic and became well elongated to a spindle form. The blister fluid demonstrated a potent fibroblast growth-promoting activity comparable to that observed in the serum obtained from the same patient. This activity was independent of the patient's age and the time elapsed since the burn. The growth rate of cells increased as the concentration rose to 20% in the case of serum. Growth promotion by the blister fluid, however, was maximum at the concentration of 2.5%, leveling off thereafter, a fact which suggests the presence of some other factor possessing an inhibitory action on fibroblast growth. The growth-promoting activity of the blister fluid was not destroyed by tryptic digestion. The blister fluid promoted a fibroblast-mediated contraction of collagen fibrils to an extent comparable to that of the serum. The protein-banding pattern of the fluid, obtained by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, was similar to that of the serum. These results suggest that the fluid is an exudate mainly from the vascular system, that is provides a good environment for the fibroblasts in the damaged site, and that it facilitates the healing process.
We have improved the sternal turnover surgical procedure by using a vascular pedicle for a funnel chest. Rather than performing a simple sternal turnover, we thought it better to use the sternum with the vascular pedicle attached, anticipating that this would lead to fewer postoperative complications and a more desirable result. The following method for performing the operation was devised: (1) cutting the deformed sternum at the second intercostal position; (2) cutting the second costal cartilages to allow a repositioning of the vascular pedicle onto the presternal surface; (3) turning the sternum over, placing one end on the other, and attaching one end to the other; and (4) making a groove in the turned-over sternum to prevent the decussated vascular pedicle from becoming constricted. By using this method, it is easily possible to keep the bilateral internal thoracic vessels intact. We used this surgical technique on a 17-year-old boy and obtained very favorable results.
In recent years contact lenses have become more popular from the ophthalmological viewpoint and because they are easy to wear and aesthetically more acceptable than eyeglasses. One of the complications produced by wearing contact lenses, however, is ptosis. We have had a patient with ptosis possibly due to the long-term wearing of a contact lens in one eye. We performed a skin resection together with repair of the aponeurosis of the levator muscle of the upper eyelid. According to our investigations, there has been only one report on the repair of aponeurosis of the levator muscle of the upper eyelid for this type of problem, and the approach and findings were similar to ours.
The authors describe a simple, inexpensive, Teflon shaft and silicone ring device that keeps a pierced hole in an infected earlobe intact while an infection is being treated.
The conventional theory is that Occidentals have a terminal insertion of the levator aponeurosis at the anterior portion, resulting in a double eyelid, whereas in Orientals this fiber is not present, and therefore results in a single eyelid have been anatomically demonstrated. However, there have been more than a few reports indicating that the anatomical difference between a single eyelid and double eyelid in Orientals cannot be explained by this theory. Therefore, in order to verify the direction of the levator aponeurosis in the eyelids of Orientals, we observed Japanese eyelids using a scanning electron microscope (SEM). As a result of three-dimensional, cross-sectional observations using SEM, we were able to confirm the existence of a branch of the levator aponeurosis that runs through the layer of the orbicularis oculi muscle and connects with the levator aponeurosis in the double eyelid, as in the occidental eyelid. This was not seen in the single eyelid. It is thought that this new anatomical finding will become an important fundamental for double eyelid operations in Orientals.
Opinions on the direction and insertion of the muscle and tendon of the medial canthus not only differ depending on the reporter, but, to date, have lacked objectivity. The direction and insertion of the muscle and tendon of the medial canthus have, therefore, not been clear to surgeons operating on the medial canthus. In order to fully grasp the anatomy of this construct three-dimensionality, we constructed a 3D model of successive sections of the medial canthus in a frontal direction using five cadavers, and then studied this model. The pretarsal part of the orbicularis oculi muscle is formed from a single muscle bundle of both the upper and lower eyelids, and runs into the medial palpebral tendon. This muscle bundle further branches off along the outside of the lacrimal sac, internally. It surrounds the back of the lacrimal sac without entering it. The preseptal part of the orbicularis oculi muscle consists of a single muscle bundle for both the upper and lower eyelids. The muscle fibers on the side of the skin run into the medial palpebral tendon. The muscle fibers posterior to this muscle bundle run into tendinous fibers, and, in all of the upper eyelids examined, they stop at the lacrimal fornix. In three out of the five lower eyelids examined the muscle fibers stop at the anterior surface of the lacrimal sac, while in the remaining cases they run into the medial palpebral tendon, as with the muscle fibers on the side of the skin. The medial palpebral tendon traverses the anterior surface of the lacrimal sac in an internal direction without branching off anteroposteriorly.
Basal cell carcinoma, which accounts for 70%-80% of all cutaneous malignancies in the United States, has increased recently in Japan. We compared methods for reconstruction after surgery for basal cell carcinoma, which is expected to increase further in the future. Thus patients who underwent reconstruction after surgery for basal cell carcinoma of the nose using medial forehead flaps and nasolabial flaps were selected, and the effectiveness of these flaps was compared by taking the size and location of the tissue defect into consideration. As a result, possibly because of anatomical and histological differences of the face between Caucasians and Asians, better results were obtained with nasolabial flaps than with median forehead flaps.