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Single-stage defect repair with latissimus dorsi free flap after extensive resection of terebrant ulcer of the head: three case reports.

Three cases of advanced ulcerating basal cell carcinoma (terebrant ulcer or ulcus terebrans) of the head are reported. Neglected basaliomas had deeply destroyed larger parts of the skull in three women ages 78, 69, and 65 years when the patients were first admitted for treatment. Death due to meningitis, hemorrhage, or brain damage was imminent. Wide resection and coverage by free latissimus dorsi flaps was carried out in single-stage procedures. The latissimus dorsi, a versatile and very reliable free flap with its constant vascular anatomy and long pedicle, is the ideal flap for the coverage of large defects on the head. The donor site can usually be closed primarily, and the functional deficit is acceptable. All three patients recovered completely. Although only palliative resection could be achieved, the procedures could be justified by the increased survival time and gain in quality of life.

Aged↗

Cytogenetic investigations in a new case of Bloom's syndrome.

Cytogenetic studies of an 8-year-old caucasian girl with typical but mild manifestation of Bloom's syndrome showed a characteristic increase of homologous chromatid translocations and prematurely condensed chromosomes. The average frequency of sister chromatid exchanges (SCE) in lymphocytes with 133 was much higher than in skin fibroblasts with 49. The inter- and intrachromosomal distributions of SCE in lymphocytes were analyzed.

Abnormalities, Multiple↗

Sister chromatid exchange and cell cycle in fibroblasts of Bloom's syndrome.

Sister chromatid exchange (SCE) has been studied in the fibroblasts of five Bloom's syndrome patients, one heterozygote, and two normal individuals. The high frequency of SCE already known in the lymphocytes of Bloom's syndrome was also found in the fibroblasts of all five patients. However, populations with low and high frequency of SCE were not found. In addition, chromosome aberrations appeared with a lower frequency. The cell cycle duration in the Bloom's fibroblasts appeared to be similar to that in the normal cell line, and the difference in the growth pattern appeared to be due to the variation in the mitotic index. The cell cycle lasted about 24 h in at least four of the Bloom's lines studied during the present experiments.

Cell Cycle↗

[Bloom's syndrome].

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Abnormalities, Multiple↗

Sister chromatid exchanges and chromatid interchanges in bloom's syndrome.

A comparison is made between the incidences of sister chromatid exchanges (SCE) per chromosome and group of chromosomes and breakage, visible at metaphase like open gaps, breaks, and breaks involved in chromatid interchange formation (CI) in Bloom's syndrome. It can be shown that the two levels of breakage SCE and CI are not correlated as to the locations. The discussion deals with possible interpretations of preferential breakage and reunion at certain homologous chromosomes and the difficulties today to understand SCEs.

Chromosome Aberrations↗

Replication bypass model of sister chromatid exchanges and implications for Bloom's syndrome and Fanconi's anemia.

A model of the sister chromatid exchange (SCE) process is outlined as a replication mechanism to bypass DNA crosslinks. The model suggests that when normal bidirectional replication advances from both sides towards a crosslink along the two opposite parental strands, the complementary parental strand segments can be temporarily displaced at each contralateral 5' side from the crosslink. The free ends produced in this first step will be terminally aligned but will have opposite polarity. The second step of the bypass can, however, be completed by either of two rejoining processes--terminal ligation of the free ends via nascent Okazaki pieces or aberrant complementation by overlapping the free ends. This bypass mechanism (1) allows replication to continue past a crosslink leaving it intact but (2) results in the switching of parental strands and their attached incomplete nascent strands above and below the crosslink site producing an exchange between sister chromatids. This model is compatible with the findings of current SCE studies using the new BUDR/stain techniques as well as with previous autoradiographic studies. It also suggests that the chromatid breaks and deletions in Fanconi's Anemia represent a defect in step two of the replication bypass mechanism and that the high frequency of SCE's and quadriradials in Bloom's Syndrome represent the SCE overload effects of a defect in crosslink repair.

Anemia, Aplastic↗

Localization by Q-banding of mitotic chiasmata in cases of Bloom's syndrome.

The distribution of mitotic chiasmata from the lymphocytes of three patients with Bloom's syndrome was studied by Q-banding. An estimate was made of the average brightness of the human chromosomes and of the brightness and length of the Q-regions. A strong relationship was found between the average darkness of a chromosome and its chiasma density. The shorter and darker Q-regions contained more chiasmata, with the exception of the chromosome tips which had lower chiasma densities. A few "hot spots" had particularly high chiasma densities. Centric regions contained 17% of the chiasmata. The data are consistent with the assumptions that chiasmata are favored in darker regions and at borders between light and dark regions.

Abnormalities, Multiple↗

Mitotic chiasmata and other quadriradials in mitomycin C-treated Bloom's syndrome lymphocytes.

Mitotic chiasmata and other quadriradials (QRs) were studied by Q-banding in mitomycin C-treated and untreated lymphocytes from two sibs with Bloom's syndrome. The frequency of chiasmata was very significantly increased by the mitomycin treatment in cells from both sibs. Chiasmata occurred throughout the chromosomes, but were favored in Q-dark regions, particularly at borders between dark and light regions (Kuhn, 1976). No significant difference was found in the distribution of chiasmata among chromosome regions in treated and untreated material. This differs from the reported action of mitomycin C on cultured lymphocytes of normal persons, where chiasmata are concentrated at secondary constrictions and centromeres. Adjacent counterparts to mitotic chiasmata, and chromatid translocations between non-homologous chromosomes, also occurred in the treated material, but with a much lower frequency than mitotic chiasmata. This again differs from the effects of mitomycin C on lymphocytes of normal persons, where chiasmata account for 20% or less of total QRs.

Abnormalities, Multiple↗

Bloom's syndrome: DNA replication in cultured fibroblasts and lymphocytes.

Analysis of DNA fiber autoradiograms from Bloom's syndrome skin fibroblasts and blood lymphocytes shows a retarded rate of replication fork movement compared to normal adult controls. Other measurements from the autoradiograms--replication unit length, incidence of bidirectional replication, and degree of initiation synchrony--are normal in Bloom's syndrome cells. These results suggest that a slow rate of fork movement is a specific manifestation of defective DNA synthesis in all Bloom's syndrome cells.

Abnormalities, Multiple↗

On the occurrence of Microsporum persicolor in Montreal, Canada.

A case of Microsporum persicolor skin infection in a casual employee of a veterinary clinic in Montreal, Quebec, Canada, is reported. A survey of 80 wild rodents in the Montreal area resulted in the isolation of M. persicolor from two voles (Clethrionomys gapperi) and one deer mouse (Peromyscus maniculatus). One of the voles, heavily infested with parasites including ticks, had obvious lesions on the nose. This is the first report of M. persicolor in rodents in North America.

Adult↗

Facelift surgery: an adjunct in the treatment of capillary malformations (port wine stains).

Hemangiomas and lymphangiomas remain the most common benign tumors seen by the plastic surgeon that involve a neonate's skin and deeper tissues. A significant number of tumors undergo spontaneous regression and require no treatment. The port wine stain (PWS) remains one of the most difficult variants of hemangiomas to treat and continues to be psychologically traumatic throughout a patient's lifetime. Recently, advanced use of laser technology has yielded beneficial results for a significant number of these patients. This report illustrates the incorporation of facelift surgery as an adjunct in the overall management of older patients resulting in decreased use of cosmetics and great improvement in general well being.

Facial Dermatoses↗