The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

BACKGROUND

Skin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging.

PATIENTS AND METHODS

We retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect.

RESULTS

Twenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n=6), basal cell carcinoma (n=9), melanoma (n=9) and Bowen's disease (n=1). Three local complications were observed. No cases of recurrence were observed.

CONCLUSION

Keystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.

[Angiosarcoma in primary lymphoedema: A rare complication]

BACKGROUND

Chronic lymphoedema is classically complicated by recurring episodes of cellulitis. Degeneration to the angiosarcoma form (Stewart-Treves syndrome) is much less common. It occurs mainly in the upper limbs following surgery or radiotherapy for mammary neoplasia. Herein we report a rare case of Stewart-Treves syndrome (STS) of the lower limb as a complication of congenital lymphoedema.

PATIENTS AND METHODS

A 69-year-old woman treated for bilateral lower-limb oedema present for 30years developed painful necrotic lesions in her left lower limb. A diagnosis of angiosarcoma was made based on biopsy of a nodular lesion. Since surgical excision was precluded by the extent of the lesions, chemotherapy was initiated with paclitaxel 175mg/m² every 21days. The outcome was rapidly unfavourable and the patient died at her home during the third course of treatment.

DISCUSSION

Angiosarcoma is an extremely rare complication of primary lymphoedema; treatment is poorly codified and the prognosis is unfavourable.

[Zika fever]

Zika virus infection is an emerging arboviral disease which presented as a mild flu-like or algo-eruptive syndrome with fever, arthralgia, myalgia and a maculopapulous eruption. Severe neurological and fetal complications have recently been highlighted. Diagnosis is established by detection of viral RNA by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Many publications report on the progress of knowledge on zika and its complications. Treatment is symptomatic, mainly with analgesics. Prevention is essential through individual and collective vector control. Faced with this emerging arbovirus, health authorities of many countries have implemented significant resources to accelerate research efforts including on diagnostic tests and on the development of vaccines. In Europe, the presence of Aedes albopictus, a mosquito vector of the virus zika, runs the risk of autochthonous cases as well as autochthonous dengue or chikungunya fever. Hence, autochthonous zika fever is not excluded to appear during the warmest months in metropolitan French departments colonized by A. albopictus.

[Traumatic optic neuropathy: Report of 8 cases and review of the literature]

Although underestimated, visual involvement is among the most frequent neurological complications of head trauma. There is no consensus in the management of these patients and visual recovery is uncertain. The goal of our study is to describe the clinical presentation and the clinical course of traumatic optic neuropathy in patients with head or maxillo-facial trauma. The clinical records of 8 patients, treated from November 2007 to March 2012, were reviewed in the department of ophthalmology (visual testing) of the university regional medical center in Lille. The most frequent cause of injury was traffic accidents. Unilateral optic neuropathy was observed in 6 cases, and bilateral in two cases, for a total of 10 eyes. Eight presented a significant visual loss<6/12. Improvement of visual acuity was achieved in 5 cases to 9/10 distance acuity without any medical or surgical treatment. One patient required surgical decompression, without improvement of visual acuity, and with persistent oculomotor disturbance and unreactive mydriasis. Traumatic optic neuropathy can cause profound visual acuity loss, especially if it is already significantly decreased on presentation.

[Severe cutaneous drug reactions to misused griseofulvin: 2 cases]

BACKGROUND

Griseofulvin is an antifungal drug known to cause drug rash. However, it is widely prescribed outside its classic indications. Herein, we describe 2 cases in which griseofulvin was prescribed for off-label indications.

PATIENTS AND METHODS

Case No. 1. A 51-year-old woman was referred to the department of internal medicine for management of Stevens-Johnson Syndrome (SJS). The symptoms appeared 17 days after she had taken griseofulvin for inguinal intertrigo. Case No. 2. A 19-year-old female patient consulted for toxic epidermal necrolysis (TEN) affecting 30% of her body surface, with a positive Nikolsky sign and severe mucosal lesions. These symptoms appeared 9 days after she began taking griseofulvin, which had initially been prescribed for her husband for mycosis.

DISCUSSION

Toxic epidermal necrolysis, a condition chiefly of drug-related origin, is a severe mucocutaneous syndrome characterized by massive keratinocytic apoptosis. Although there are few scientific publications referring to griseofulvin-induced drug eruption, they deserve to be mentioned since this drug is widely used for purposes other than the approved indications and can cause life-threatening reactions.

CONCLUSION

We report two cases of toxic epidermal necrolysis related to the misuse of griseofulvin. It is important to bear in mind the precautions for use of oral antifungal drugs, which are strictly reserved for use against resistant or diffuse forms of mucocutaneous fungal infections.

Antibodies against synthetic peptides and the topology of LamB, an outer membrane protein from Escherichia coli K12

LamB, an outer membrane protein from Escherichia coli K12, is involved in the transport of maltose and maltodextrins across the outer membrane and constitutes a receptor for a number of bacteriophages. A recent folding model proposes that LamB spans the outer membrane through a number of transmembranous segments separated by regions exposed either to the cell exterior or to the periplasm. This model is essentially based on predictions of structure and genetic arguments relying on the hypothesis that the mutations studied did not alter the folding of the protein. In order to obtain direct evidence with the unaltered protein, we elicited polyclonal antibodies against synthetic peptides corresponding to several LamB sequences. We chose four regions. Three of them [aa 147-161 (peptide 2), aa 371-385 (peptide 3), and aa 399-413 (peptide 4)] are predicted to face the outside of the cell, and the fourth (aa 19-33 (peptide 1)] is predicted to be periplasmic. By immunoblotting against extracts of various mutants, these antibodies were shown to be specific for LamB and targeted to the selected regions. In some cases, the recognition sites for antibodies were narrowed down to parts of a region. In vivo, on intact cells, anti-peptides 2, 3, and 4 reacted with LamB in an ELISA; this confirmed that regions of peptide 2 and 3 are located, at least in part, at the cell exterior and provided the first proof for a similar, situation of the region of peptide 4. Under the same conditions, anti-peptide 1 did not react with LamB.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of a monoclonal antibody specific for the HIV-1 precursor glycoprotein

HIV-1 infected Molt4-T4 cells provide an efficient system for the production of cellular precursor gp160 of HIV envelope glycoproteins, gp120 and gp41. The precursor gp160 was purified on an immuno-affinity column containing antibodies from sera of HIV-1-seropositive patients. The precursor gp160 was then isolated by preparative polyacrylamide gel electrophoresis. Two out of four Balb/c mice, immunized with these purified preparations of gp160, developed specific circulating antibodies. A hybridoma cell line was subsequently isolated producing monoclonal antibody KL49/19 (IgG1, K) specific for gp160. This monoclonal antibody can specifically immunoprecipitate gp160, existing in HIV-1-infected cells. In an immunoblotting assay, it identifies mainly gp160 and shows a slight affinity for the mature glycoprotein, gp120. The monoclonal antibody is probably directed against an epitope in the polypeptide residue of gp160 since it can recognize a deglycosylated polypeptide of molecular weight 90,000, a product of gp160 digestion by endoglycosidase H (Endo H). It does not cross-react with any protein of HIV-2 by immunoblot or immunoprecipitation assays. By virtue of its specificity, the monoclonal antibody KL49/19 might provide a powerful probe with which to detect gp160 in cells which might partially express the HIV-1 genes.

A monoclonal antibody directed against a synthetic peptide reacts with a cell surface rabbit class I MHC molecule

Monoclonal antibodies were prepared against synthetic peptides synthetized on the basis of nucleotide sequence from cDNA and genomic clones encoding a class I antigen expressed by the rabbit RL-5 cell line. Using a peptide corresponding to positions 61-73 of the N domain, we were able to obtain an hybridoma producing monoclonal antibody which recognized the peptide as well as the native class I antigen. This hybridoma, designated anti-61, reacted with cell surface molecules on RL-5 cells and on human HeLa cells transfected with the 19-1 gene encoding RL-5 class I antigen. No reactivity with HeLa cells prior to transfection could be detected by radioimmunoassay or by fluorescent activated cell sorter analyses, although these cells were strongly positive in both assays with anti-human class I reagents. Antibody reaction to positive cells could be inhibited by the homologous peptide but not by unrelated peptides. Anti-61 antibody precipitated a 41,000 mol. wt molecule from RL-5 cells with an N-terminal amino acid sequence corresponding to the RL-5 class I antigen.

Monoclonal antibody detection of 2-acetyl-aminofluorene-modified DNA probes for the specific detection of nucleic acids in hybridization procedures

We describe the use of acetoxy-acetyl-aminofluorene-modified DNA probes in several hybridization techniques. Hybrids were detected with the help of a monoclonal antibody raised against AAF-guanosine and a second antibody coupled to an enzyme. The sensitivity achieved with AAF-DNA probes routinely detected 0.25 pg DNA bound to a filter. AAF-DNA probes were highly stable and were prepared by simple chemical modification of DNA. Their use as a possible diagnostic tool is discussed.

Preliminary crystallographic study of the complex between the Fab fragment of a monoclonal anti-lysozyme antibody and its antigen

Preliminary crystallographic data are given for the complex between the Fab fragment of a monoclonal anti-lysozyme antibody and its antigen. This crystalline complex was found by screening a number of Fab-lysozyme complexes prepared from monoclonal anti-lysozyme antibodies produced by hybrids of BALB/c immune spleen cells with a non-secreting mouse hybrid myeloma line. The complex crystallizes in the monoclinic space group P21 with a = 55.5 (+/- 0.1) A, b = 143.5 (+/- 0.3) A, c = 49.1 (+/- 0.1) A, beta = 120 degrees 20' (+/- 10'). X-ray photographs show reflections extending to a resolution of 2.7 A. The crystals are suitable for high-resolution X-ray diffraction studies.

[In vitro aromatization of androgens in the presence of testosterone binding proteins from human placenta or serum]

Two related 17 beta hydroxy steroid binding proteins of serum and placental origin respectively are shown to inhibit significantly the aromatization of testosterone and androstenedione by isolated human placenta microsomes. Quantitative correlations suggest that this inhibitory effect is due to the fixation of the testosterone substrate (or androstenedione previously converted to testosterone) on the binding proteins. A possible role for these macromolecules in the steroidogenic activity of the placenta is discussed.