bromochloroacetic-acid and Ulcer

To determine the effect of a keratin dressing for treating slow-to-heal venous leg ulcers (VLU) on VLU healing.. Pragmatic parallel group randomised controlled trial.. Community-dwelling participants.. People aged 18 or more years with VLU (either present for more than 26 weeks or ulcer area larger than 5 cm. Wool-derived keratin dressing or usual care formulary of non-medicated dressings, on a background treatment with compression.. Healing at 24 weeks based on blinded assessment of ulcer photographs. Other outcomes included time to complete healing, change in ulcer area to 24 weeks, change in health-related quality of life and incidence of adverse events.. We screened 1068 patients with VLU and randomised 143 participants (51.1% of target recruitment), 71 to the keratin dressing group and 72 to the usual care group.The mean age was 66.1 years (SD 15.9) and 53 participants (37.1%) were women. There were no significant differences between the groups on the primary outcome (risk difference -6.4%, 95% CI -22.5% to 9.7%), change in ulcer area (-1.9 cm. The effect of adding a keratin dressing to the treatment regimen for prognostically slow-to-heal VLU remains unclear.. NCT02896725.

Topics: Adolescent; Aged; Animals; Bandages; Female; Humans; Keratins; Leg; Male; Quality of Life; Ulcer; Wool

Topics: Aminocaproic Acid; Animals; Cytoskeleton; Endoscopy; Female; Fluorescent Dyes; Gastric Juice; Hair; Humans; Keratins; Mice; Mice, Inbred BALB C; Regeneration; Spectroscopy, Fourier Transform Infrared; Stomach Ulcer; Ulcer; Viscosity; Wound Healing

We describe 3 cases of nonneoplastic signet-ring cell change in ulcerated mucosa, 2 of them in the gallbladder and 1 in an endocervical polyp. In the gallbladder cases, there were focal collections of signet-ring cells both on the mucosal surface and within the lumen of tubules, whereas in the endocervical polyp, the signet-ring cell aggregates were entirely confined to the mucosal surface. In all 3 cases, the signet-ring cells were positive for Mayer's mucicarmine and immunoreactive for keratin AE1/AE3. The lack of nuclear atypicality, the arrangement in superficial and intraluminal nests, and the admixture with histiocytes and other inflammatory cells are in keeping with the interpretation that the signet-ring cells are disrupted mucosal goblet cells exhibiting hyperplastic and degenerative changes. A review of the literature disclosed only other 2 previously reported cases of benign signet-ring cell changes in the gallbladder and none--to the best of our knowledge--in an endocervical polyp. Awareness of this phenomenon is of importance to avoid a potential overdiagnosis of signet-ring cell adenocarcinoma.

Topics: Adult; Carcinoma, Signet Ring Cell; Cervix Uteri; Diagnosis, Differential; Diagnostic Errors; Female; Gallbladder Diseases; Humans; Hyperplasia; Keratins; Male; Middle Aged; Mucous Membrane; Polyps; Ulcer; Uterine Cervical Diseases; Young Adult

An 81-year-old man presented with epigastric pain and weight loss for one month. He had a past history of pulmonary tuberculosis, 10 years ago. We performed a gastroscopy, which showed a linear depressed whitish gastric ulcer scar (0.8 cm in length) in the posterior wall of the prepyloric antrum. The result of biopsy was reported as squamous epithelium. Immunohistochemical staining using an antibody to high molecular weight cytokeratin (HMC) revealed positive staining in the squamous epithelium. Two years later, the lesion was followed up. The lesion remained at same site endoscopically, but no squamous epithelium could be seen microscopically.

Topics: Abdominal Pain; Aged, 80 and over; Biopsy; Epithelium; Humans; Immunohistochemistry; Keratins; Male; Metaplasia; Molecular Weight; Stomach Ulcer; Treatment Outcome; Ulcer

Keratinization of the epidermal cells of the bovine claw generates the horn that gives the tissue its mechanical strength. Disruption of keratinization is likely to have a detrimental effect on the strength and integrity of the horn, and could lead to solar lesions and lameness. As part of a wider investigation of the cell biological causes of lameness in dairy animals, we have compared keratin synthesis and distribution in healthy bovine claw tissue with those in hooves with solar ulcers. Protein synthesis was measured by [35S]-labelled amino acid incorporation in claw tissue explant cultures. [35S]-labelled protein synthesis was higher in tissue from diseased claws than in healthy claws, and highest at the ulcer site. The identity of proteins synthesised in vitro did not differ between healthy and diseased tissue. DNA synthesis indicative of cell proliferation was also elevated in diseased tissue. Immunoblotting after one- or two-dimensional electrophoresis showed cytokeratins (CK) 4, 5/6, 10 and 14 to be amongst those expressed in healthy claw tissue. The relative abundance of these keratins was not altered in healthy regions of ulcerated hooves, nor at the ulcer site, but CK16, not usually found in healthy tissue, was detected in the sole of diseased claws. CK5/6 and CK14 were shown by immunohistochemistry to be present in the basal epidermis of healthy tissue, whereas CK10 was found in supra-basal layers. In healthy tissue from ulcerated claws, this distribution was unaltered, but at the site of solar ulcers, CK5/6 and CK14 were each found in both basal and supra-basal epidermis. The study suggests that solar ulceration of the bovine claw is not associated with gross alteration in the keratin composition of the tissue, but causes abnormal distribution of cytokeratins, perhaps as a result of loss of positional cues from the basement membrane. Ulceration did, however, stimulate cell repair involving epidermal protein synthesis (including keratins), and keratinocyte proliferation.

Topics: Animals; Cattle; Cattle Diseases; Epidermis; Female; Foot Ulcer; Hoof and Claw; Immunohistochemistry; Keratins; Lameness, Animal; Ulcer

Patients with solitary rectal ulcer syndrome (SRUS) frequently present with a mass that can be misinterpreted as cancer. In contrast, the occurrence and characteristics of SRUS-like histopathology produced by underlying malignancy have not been reported in detail. We report seven patients whose rectal mass that was induced by infiltrating carcinoma showed only histopathologic changes of SRUS on initial mucosal biopsy specimens. Carcinoma was evident in subsequent specimens after one to five repeat biopsies with delay in diagnosis from 1 week to 18 months in six patients. In one patient, infiltrating carcinoma was suggested on the first biopsy specimen by immunohistochemistry for cytokeratin. Three of the patients had primary rectal adenocarcinoma, two had metastatic carcinoma from stomach or ovary, and two had direct invasion of anal squamous cell carcinoma or prostatic adenocarcinoma. We conclude that the histopathology of SRUS may occasionally represent a characteristic but nonspecific mucosal reactive change to a deeper seated malignancy. The terminology "solitary rectal ulcer syndrome/mucosal prolapse changes" with a cautionary note may be useful for reporting biopsy results to emphasize the possibility of underlying primary or metastatic malignancy in the differential diagnosis.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Proctoscopy; Prostate-Specific Antigen; Rectal Diseases; Rectal Neoplasms; Rectal Prolapse; Retrospective Studies; Ulcer

50 patients with oral lichen planus (LP) were investigated for current anxiety and depression and for related personality factors. Anxiety levels, as measured on the Hospital Anxiety and Depression (HAD) Scale, were elevated in 50% of cases while depression scores, measured on the same scale, were low in all but a few. The sample profile showed a slight tendency towards anxiety, as measured by the Cattell 16 PF Questionnaire, but did not confirm previous reports of high intelligence and intellectual orientation. There were no statistically significant associations between erosive oral LP and either anxiety or depression, as measured on the HAD Scale, or anxiety as measured by the Cattell 16 PF Questionnaire.

Topics: Adult; Aged; Anxiety; Depression; Epithelium; Erythema; Female; Humans; Intelligence; Keratins; Lichen Planus, Oral; Lymphocytes; Male; Middle Aged; Personality; Personality Inventory; Ulcer

Formalin-fixed, paraffin-embedded biopsy specimens of 17 cases of squamous cell carcinoma of Marjolin's ulcer (SCC-MU), 6 cases of common SCC (SCC), and 5 cases of basal cell carcinoma (BCC) were stained with three monoclonal antikeratin antibodies (CAM 5.2, MAK-6, and MA-903), a monoclonal antivimentin antibody (V9), and a polyclonal anticarcinoembryonic antigen antiserum (A115). Neoplastic cells of SCC-MU, SCC, and BCC showed consistently negative staining for CAM 5.2. A wide range of reactivity, from negative to diffuse strong positivity, among neoplastic cells of SCC-MU and SCC was noted with MAK-6. Alternatively, neoplastic cells of SCC-MU, SCC, and BCC consistently showed diffuse moderate to strong reactivity with MA-903. These findings imply that SCC-MU has largely high-molecular-weight keratins. They also showed a wide range of reactivity with V9. However, neoplastic cells of five of the six SCC and five cases of BCC were negative for V9. These findings suggest that neoplastic cells of SCC-MU contain vimentin in higher frequency than in the more usual SCC.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Biopsy; Carcinoembryonic Antigen; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cicatrix; Female; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Skin; Skin Neoplasms; Ulcer; Vimentin

Sixty consecutive cases of dermis-fat grafts for anophthalmic socket reconstruction were reviewed to examine the frequency, severity, and management of postoperative complications. In seven patients, the conjunctiva failed to resurface the graft and central ulceration developed. Ten cases resulted in enophthalmos. Two patients developed keratinized sockets with chronic discharge and desquamation. Three patients required excision of conjunctival granulomas. One patient developed a primary graft infection. A donor site hematoma occurred in one patient. Secondary surgical intervention was required in ten patients. Nine complications in eight patients were managed in the office; five complications in four patients were observed and subsequently resolved without surgical intervention. Most complications occurred in patients with severely traumatized sockets who had undergone extensive earlier ocular surgery, or who had a systemic disease contributing to defective wound healing.

Topics: Adipose Tissue; Adult; Aged; Anophthalmos; Child; Conjunctiva; Conjunctival Diseases; Eye Diseases; Granuloma; Hematoma; Humans; Infant; Keratins; Middle Aged; Postoperative Complications; Skin Transplantation; Surgery, Plastic; Surgical Wound Infection; Ulcer

The distribution of intracellular keratin proteins was examined in a variety of urinary bladder lesions of the rat using the immunoperoxidase staining technique. In ethanol-fixed sections, the normal epithelium was strongly positive for keratin staining. Focal regenerative hyperplasia of the bladder epithelium induced by freezing exhibited relatively weak staining. However, diffuse regenerative hyperplasia induced by a single intraperitoneal injection of cyclophosphamide (CP) showed an intensely positive reaction throughout the epithelium. Of the sections fixed with Bouin's solution, the staining reaction was drastically reduced in the normal bladder and the staining was totally negative in the regenerative hyperplasia caused by freezing. Simple hyperplasia induced by a 4-week feeding of N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide (FANFT) as 0.2% of the diet exhibited strong reactivity, and nodular and papillarly hyperplasia induced by a 10-week feeding of FANFT was also positive for keratin throughout the lesions. In contrast to the preneoplastic lesions, FANFT-induced transitional cell carcinoma showed differential staining within the tumors. These results suggest that different keratin expression is involved in the proliferative bladder lesions induced mechanically by freezing and chemically by CP or by the carcinogen FANFT.

Topics: Animals; Cyclophosphamide; Epithelium; FANFT; Freezing; Histocytochemistry; Hyperplasia; Immunoenzyme Techniques; Keratins; Male; Rats; Rats, Inbred F344; Thiazoles; Ulcer; Urinary Bladder

Within a one-year period seven patients were observed who had developed ulcers of the upper and mid oesophagus after treatment with doxycycline hydrochloride (n = 3), emepronium bromide (n = 3) or Pantogar (n = 1). In each instance the drug had apparently been swallowed dry. The typical symptoms were a sudden onset of retrosternal chest pain and odynophagia during bed rest. Once the drug had been discontinued and treatment with antacid combined with topical anaesthetics and/or alginic acid instituted the symptoms disappeared within a few days. The authors stress that drugs should be swallowed only with good amounts of fluid and generally not immediately before bed rest.

Topics: 4-Aminobenzoic Acid; Adult; Cystine; Doxycycline; Emepronium; Esophageal Diseases; Female; Humans; Keratins; Male; Pantothenic Acid; Saccharomyces; Saccharomyces cerevisiae; Thiamine; Ulcer