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[Osteolysis in revision total knee arthroplasty: a comparative study of osteolysis with and without metallosis].

PURPOSE OF THE STUDY: Metallic debris from metallosis can compensate for the radiolucency resulting from bony destruction and compromise preoperative diagnosis of osteolysis. We compared the radiological findings in two groups of patients: those with pure osteolysis resulting from polyethylene debris and those with osteolysis associated with metallosis. MATERIAL AND METHODS: This study compared ten total knee arthroplasties free of metallosis at revision (pathology examination revealed only polyethylene debris) with ten total knee arthroplasties with pathologically confirmed metallosis of the synovium and periprosthetic bony tissue. Revisions were performed for loosening or a femoropatellar problem. At revision, the localization and the degree of tibial and/or femoral osteolysis were noted. Preoperative x-rays were analyzed to search for femoral, tibial or patellar osteolysis and were compared with operative findings. On the AP and lateral views, ten osteolysis zones were defined for each knee (four tibia, five femur, and one patella). RESULTS: Ten knees had osteolysis associated with polyethylene debris alone. Tibial osteolysis was found intraoperatively in 16 of the 40 theoretically possible localizations and was recognized on the preoperative x-rays in all 16. Femoral osteolysis was found intraoperatively in 18 of the 50 theoretically possible localizations was only recognized in 6 of the 18. For the ten knees with metallosis, tibial osteolysis was found intraoperatively in 22 of the theoretically possible localizations and was recognized on preoperative x-rays in 10 of the 22. Femoral osteolysis was found intraoperatively in 32 of the 50 theoretically possible localizations but was only recognized preoperatively in 5 of the 32. Comparisons between the two groups showed that femoral osteolysis was significantly more difficult to identify preoperatively than tibial osteolysis irrespective of the type of osteolysis (with or without metallosis). Furthermore, in patients with metallosis, it was significantly more difficult to recognize osteolysis preoperatively in both the tibial and femoral localizations. DISCUSSION: Metallosis can mask the diagnosis of femoral osteolysis and makes it very difficult to recognize tibial osteolysis. Arguments in favor of osteolysis (abnormal skin pigmentation, radio-opaque effusion, abnormal color and density of the joint fluid) are discussed. When the diagnosis of metallosis is established preoperatively, the chances of finding osteolysis intraoperatively are much higher than suggested by the preoperative x-rays.

Arthroplasty, Replacement, Knee↗

Restrictive dermopathy.

Restrictive dermopathy is an inherited syndrome characterized clinically by severe growth retardation, abnormal skin, characteristic facies, and multiple congenital contractures. Distinctive radiologic features include deficient mineralization of the clavicles and the skull, overtubulation and frequent modeling defects of the long bones, and occasional abnormalities of the ribs and scapulae.

Abnormalities, Multiple↗

Effect of helium-neon laser on musculoskeletal trigger points.

Cold lasers have been proposed recently as a therapeutic tool for treating a wide variety of pathological conditions, including wounds, arthritis, orthopedic problems, and pain. These proposed therapeutic effects largely have been unsubstantiated by research. A randomized, double blind study was undertaken to ascertain the effect of a helium-neon (He-Ne) laser on the resistance of areas of skin overlying musculoskeletal trigger points. These areas usually demonstrate decreased skin resistance when compared with the surrounding tissue. Thirty patients with musculoskeletal trigger points were assigned randomly to either an experimental or a placebo group. In addition to standard physical therapy, each patient received three 15-second applications of a He-Ne laser or placebo "stimulation" from an identical unit that did not emit a laser. The results of a two-way analysis of covariance with one repeated measure showed a statistically significant increase (p less than .007) in skin resistance. This increase in an abnormal skin resistance pattern may accompany the resolution of pathological conditions.

Adolescent↗

A mouse model for the basal transcription/DNA repair syndrome trichothiodystrophy.

The sun-sensitive form of the severe neurodevelopmental, brittle hair disorder trichothiodystrophy (TTD) is caused by point mutations in the essential XPB and XPD helicase subunits of the dual functional DNA repair/basal transcription factor TFIIH. The phenotype is hypothesized to be in part derived from a nucleotide excision repair defect and in part from a subtle basal transcription deficiency accounting for the nonrepair TTD features. Using a novel gene-targeting strategy, we have mimicked the causative XPD point mutation of a TTD patient in the mouse. TTD mice reflect to a remarkable extent the human disorder, including brittle hair, developmental abnormalities, reduced life span, UV sensitivity, and skin abnormalities. The cutaneous symptoms are associated with reduced transcription of a skin-specific gene strongly supporting the concept of TTD as a human disease due to inborn defects in basal transcription and DNA repair.

Animals↗

Skin manifestations of a patient with mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS syndrome).

Skin abnormalities in a patient with newly diagnosed MELAS syndrome are reported. He presented with scaly, pruritic, diffuse erythema with reticular pigmentation on his entire body. Moderate hypertrichosis was also noted on the lower extremities. Thickened arrector muscles with longitudinal and cross sections were seen in the dermis. Analysis of mitochondrial DNA in a biopsy specimen from the biceps brachii disclosed the presence of an A-to-G point mutation at nucleotide pair 3243. Electron microscopy revealed marked increase in the number of morphologically abnormal mitochondria in the arrector muscles of the involved skin. This is the first report of a MELAS syndrome patient with skin manifestations and evidence of morphologically abnormal mitochondria.

Adult↗

From colour to tissue histology: Physics-based interpretation of images of pigmented skin lesions.

Through an understanding of the image formation process, diagnostically important facts about the internal structure and composition of pigmented skin lesions can be derived from their colour images. A physics-based model of tissue colouration provides a cross-reference between image colours and the underlying histological parameters. It is constructed by computing the spectral composition of light remitted from the skin given parameters specifying its structure and optical properties. The model is representative of all the normal human skin colours, irrespective of racial origin, age or gender. Abnormal skin colours do not conform to this model and thus can be detected. Once the model is constructed, for each pixel in a colour image its histological parameters are computed from the model. Represented as images, these 'parametric maps' show the concentration of dermal and epidermal melanin, blood and collagen thickness across the imaged skin as well as locations where abnormal colouration exists. In a clinical study the parametric maps were used by a clinician to detect the presence of malignant melanoma in a set of 348 pigmented lesions imaged using a commercial device, the SIAscope. Logistic regression identified the presence of melanin in the dermis, the abnormal distribution of blood within the lesion and the lesion size as the most diagnostically informative features. Classification based on these features showed 80.1% sensitivity and 82.7% specificity in melanoma detection.

Colorimetry↗

Surgical correction of torsion of the penis.

Torsion of the penis is a rare anomaly, believed to be due to abnormal skin attachment and not to any structural abnormality of the corpora. The rotation is usually to the left in a counter-clockwise fashion. The urethral meatus is placed in a oblique position and the median raphe makes a spiral curve from the base of the penis towards the meatus. Three boys with congenital torsion of the penis are reported. A corrective operative for this condition is described. Penile torsion was first described by Verneuil in 1857, but in the past no operative correction was recommended, since attempts to move the skin around were believed not to correct the spiral alignment of the corpora cavernosa.

Child↗

[About "a new syndrome" associated with a familial translocation 13/14 (author's transl)].

The report describes the case of a 7,9-year-old boy who seems to have clinically the same syndrome described by Ruvalcaba et al. in 1971 and uncertified till now. The propositus in characterized by severe mental retardation, peculiar facies, osseous dysplasia (including clinodactilism), urogenital and skin abnormalities, congenital heart disease (missing to the mentioned author's cases). In contrast with the normal karyotype of Ruvalcaba et al. cases, the boy shows a familial 13/14 Robertsonian translocation, karyotype 45,XY,-13,-14, t (13q14q). The boy's father, not entirely clinically investigated, shows apparently only clinodactilism, but cytogenetically the same chromosomal aberration. The mother is clinically and cytogenetically normal. The boy's grandmother (father's side) has had clinically clinodactilism and heart disease; her karyotype is unknown. The syndrome of the propositus presented in our study is identical clinically, but differs cytogenetically to the one described in "a new familial syndrome with osseous dysplasia and mental deficiency" by R. H. A. Ruvalcaba et al. It is not out of the question that the father's and boy's translocation should be balanced, irrespective of the morphological abnormalities and fortuitous associated with them the more so as to the same karyotype, the boy's and father's phenotype have few common features.

Abnormalities, Multiple↗

Conjunctival eye signs in GM1 type 1 gangliosidosis.

Two cases of GM1 type 1 gangliosidosis demonstrated microvascular abnormalities of the conjunctiva, as well as skin abnormalities in one case. This abnormality was studied by light and electron microscopy of a conjunctival biopsy; cytoplasmic vesicles were noted in the endothelial cells, producing a mechanical narrowing of the lumen. This storage material is similar to that seen in the fibroblasts of skin and of visceral organs in GM1 gangliosidosis, as well as to the material described in the systemic mucopolysaccharidoses. The material probably represents a keratan sulfate-like material. The conjunctiva provides a ready source for biopsy and diagnostic evaluation.

Conjunctiva↗

Drug-induced cutaneous photosensitivity: some drugs warrant routine precautions.

(1) Drug-induced cutaneous photosensitivity is defined as excessive or abnormal skin reactions to light, linked to systemic or topical administration of a drug. (2) The lesions appear after exposure to sunlight or an ultraviolet source, and are limited to or predominate in exposed areas. (3) Some drugs can induce occasionally severe skin burns after moderate exposure to sunlight. Other types of drug-related skin lesion include eczematous or urticarial eruptions, pseudoporphyria, abnormal pigmentation and pseudolichen. Photo-induced or photo-aggravated contact dermatitis can occur after application of a photosensitising drug. (4) Some drugs are particularly photosensitising, such as psoralens, tetracyclines, amiodarone and quinolones. (5) Patients treated with drugs known to cause cutaneous photosensitivity should be warned of the risk of cutaneous reactions on exposure to light and be encouraged to protect their skin from intense exposure to sunlight. (6) The possible responsibility of a drug should be borne in mind when a patient presents with skin lesions with a distribution typical of cutaneous photosensitivity. Drug withdrawal and subsequent avoidance can lead to recovery and avoid recurrences.

Anti-Inflammatory Agents, Non-Steroidal↗

Epidermal-dermal interactions in adult skin.

Epidermal-dermal interactions are important determinants of embryonic development in skin. This review examines the role of such epidermal-dermal interactions in the conservation of epithelial specificity in adult skin. The basic epidermal keratinization program as defined as a proliferative basal cell population, orderly stratified cytodifferentiation of the cells and production of stratum corneum can be expressed by adult epidermis without the continued presence of a specific dermis. This is evidenced by the ability of epidermis to differentiate fully in association with nondermal connective tissues. Several other epithelia including cornea and esophagus express their specific differentiative characteristics without the continued presence of specific connective tissue. On the other hand, certain regional epithelial specificities in adult skin may be determined by the dermis. These regional epidermal specificities involve alterations in epidermal thickness, size of epidermal compartments including the stratum corneum, and the folding pattern at the epidermal-dermal interface. Possible mechanisms by which dermis could control these regional characteristics are discussed. Epidermal-dermal recombination techniques have been used to define the site of gene action in a variety of inherited skin abnormalities in animals. Similar studies are reported utilizing adult human skin in long-term cultivation on nude athymic mice. The abnormal gene in lamellar ichthyosis exerts its effect directly on the epidermis. Generalized exfoliative psoriasis was also studied by recombination techniques. Both epidermis and dermis were required for the maintenance of psoriatic morphology, suggesting a complex polygenic mechanism or one involving both genetic and environmental factors.

Animals↗

Epidermodysplasia verruciformis induced by a new human papillomavirus (HPV-8). Report of a case without immune dysfunction. Effect of treatment with an aromatic retinoid.

A new case of epidermodysplasia verruciformis (EV) is reported in a 35-year-old man characterized by multiple common warts, flat warts, psoriasis-form lesions, and pityriasis-versicolor-(PV) like lesions. There was no familial history, no mental retardation, and no malignant changes. Human papilloma virus type 8 was identified in PV-like lesions. Immunologic studies detected no abnormalities: Delayed skin tests, DNCB sensitization, levels of immunoglobulins, complement components, circulating immune complexes, number of circulating lymphocytes, lymphocyte membrane markers, proliferative responses to mitogens, Ts activity, and Ts subpopulations as detected by monoclonal antibodies were considered to be within normal limits. A treatment with a retinoid aromatic (RO 10-9359) improved the clinical status of the patient and did not modify the immune parameters.

Adult↗

Females have lower skin surface pH than men. A study on the surface of gender, forearm site variation, right/left difference and time of the day on the skin surface pH.

BACKGROUND/AIMS: It is of great interest to describe the many functions and properties of the skin in order to better understand reactions that result in different skin abnormalities, as a prerequisite in the development of skin products and topical medicines. Skin surface pH is considered a critical parameter of skin wellbeing and is typically studied on the forearm skin. Despite many previous investigations, this is an extensive field that still needs a great deal of research. The aim of our study was to investigate gender related differences, differences between right and left arms, anatomical variation and daytime variation in skin surface pH. METHODS: Skin surface pH was measured on the flexor surface of the forearm on eleven healthy volunteers (6 men and 5 women). A Mettler Toledo pH meter (pH meter 1140) was used. The subjects were measured once every hour from 8 a.m. to 3 p.m. in five areas from the elbow to the wrist. In each of the five areas, three measurements were performed next to each other, and the mean of these was used in subsequent calculations. RESULTS: A statistically significant difference in skin pH between men (mean pH=5.80) and women (mean pH=5.54) was found, with women being more acidic than men (P<0.01). No difference between right and left arm was found. In men, the area closest to the wrist had significantly lower pH values compared with the proximal sites. This was not the case in women. Skin surface pH decreased during normal working hours in both genders. CONCLUSION: Spontaneous skin surface pH was found to be significantly lower in women, as compared to men--albeit, the difference was small and of unknown relevance. Nevertheless, comparative studies on skin surface pH should be balanced with respect to gender. There appeared to be no right/left difference and no systematic change during the working day. Also, measurements should not be conducted close to the wrist.

Female↗

Epidermal abnormalities and increased malignancy of skin tumors in human epidermal keratin 8-expressing transgenic mice.

Keratins K8 and K18 are the major components of the intermediate filament cytoskeleton of simple epithelia. Increased levels of these keratins have been associated with invasive growth and progression to malignancy in different types of human and murine epithelial tumors (including skin tumors), and even in tumors from nonepithelial origin. However, it has not yet clarified whether K8/K18 expression in tumors is cause or consequence of malignancy. Given the increasing incidence of epidermal cancer in humans (40% of all tumors diagnosed), we generated a mouse model to examine the role of simple epithelium keratins in the establishment and progression of human skin cancer. Transgenic mice expressing human K8 in the epidermis showed severe epidermal and hair follicle dysplasia with concomitant alteration in epidermal differentiation markers. The severity of the skin phenotype of these transgenic mice increases with age, leading to areas of preneoplastic transformation. Skin carcinogenesis assays showed a dramatic increase in the progression of papillomas toward malignancy in transgenic animals. These results support the idea that K8 alters the epidermal cell differentiation, favors the neoplastic transformation of cells, and is ultimately responsible of the invasive behavior of transformed epidermal cells leading of conversion of benign to malignant tumors.

Aging↗

Collagen and elastin changes in D-penicillamine-induced pseudoxanthoma elasticum-like skin.

A patient with cystinuria who was treated with large doses of D-penicillamine for 19 years developed skin abnormalities resembling those seen in pseudoxanthoma elasticum. Biochemical and histological examination of the dermis showed that the collagen content, the ratio of the major genetic forms of collagen and the distribution of collagen types was normal. Light microscopy demonstrated the presence of vastly increased amounts of elastin in the dermis, and the individual elastin fibres were shown by electron microscopy to be abnormal; chemical analysis showed the elastin to be poorly cross-linked. Some of the collagen also appeared structurally abnormal, and biochemically resembled that seen in the dermis of a young child with respect to cross-linking and hexosyl-lysine content. The therapy led to an increased deposition of collagen and elastin fibres which appeared abnormal, and resulted in an increase in total skin surface area. These data indicate that D-penicillamine was not fully effective in inhibiting collagen and elastin cross-linking, and appeared to prevent or inhibit the natural maturation process of the collagen.

Aged↗

Abnormal vascular reactions in atopic dermatitis.

Vascular reactions to mechanical stroking, topical application of nicotinic acid ester, and methacholine chloride were examined in both the normal and abnormal skin of 100 patients with atopic dermatitis and 20 patients with allergic contact dermatitis. White dermographism, nicotinic acid blanching, and delayed blanch with methacholine consistently occurred in areas of skin with eczematous change of patients with atopic dermatitis and those with allergic contact dermatitis. Normal skin of atopic patients did not show the abnormal vascular reactions. It is suggested that white dermographism, nicotinic acid blanching, and delayed blanch with methacholine seen in atopic dermatitis are secondary phenomena that give no definite information concerning the diagnosis of this disease.

Adult↗