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In the contemporary medicine, undifferentiated progenitor cells of various origin and various degree of plasticity have become highly promising. Their most abundant, renewable and uncontroversial sources are placental tissues and umbilical blood. The only epithelial cells in this group come from the amnion which is used as a whole as an allogenic biological dressing. They have a range of unusual properties, such as the relative lack of histocompatibility antigens, plasticity (enabling their differentiation into a number of epithelial and mesenchymal cells) and the lack of neoplastic capacity. Amniotic epithelial cells are the only epithelial cells of the placenta. It is believed that they retain their progenitor (pluripotent) properties even in term pregnancies. This probably results from the fact that they omit the differentiation that accompanies gastrulation. Such features are typical of all placental cells which differ from amniotic epithelial cells only in their non-epithelial origin. In culture conditions, amniotic epithelial cells are characterized by a considerable plasticity: they can be stimulated to differentiate into adipocytes, chondrocytes, osteocytes, myocytes, cardiomyocytes, neurocytes, pancreatic cells and hepatocytes. To date, however, the attempts to direct their development towards the epidermis have not been successful. Obtaining multilayer epidermis in amniotic epithelial culture would be of considerable importance for tissue engineering of biological dressings. Amniotic membranes have been used for this purpose for many years, but because of their complex structure and metabolic requirements, they do not heal but dry up when applied to the wound. Some reports, however, indicate that the epithelium isolated from the amnion could be able to heal thus being suitable for allogenic grafts.
Współczesna medycyna coraz większe nadzieje pokłada w niezróżnicowanych komórkach progenitorowych różnego pochodzenia i o różnym stopniu plastyczności. Ich najbardziej zasobnym, odnawialnym i niekontrowersyjnym źródłem wydają się tkanki łożyska i krew pępowinowa. Jedyne w tej grupie komórki nabłonkowe pochodzą z owodni, wykorzystywanej często w całości jako allogeniczny opatrunek biologiczny. Mają one szereg niezwykłych cech, takich jak względny brak ekspresji antygenów zgodności tkankowej, plastyczność (umożliwiająca różnicowanie w cały szereg komórek nabłonkowych i mezenchymalnych) oraz brak zdolności do nowotworzenia. Komórki nabłonka owodni są jedynymi nabłonkowymi komórkami łożyska. Uważa się, że nawet w donoszonej ciąży zachowują właściwości progenitorowe (pluripotencjalne). Wynika to prawdopodobnie z faktu, iż pomijają różnicowanie towarzyszące gastrulacji. Cechy te przejawiają zresztą wszystkie komórki łożyska, różniące się od komórek nabłonka owodni jedynie nienabłonkowym pochodzeniem. W hodowli komórki nabłonka owodni charakteryzują się dużą plastycznością: ulegają stymulacji do różnicowania w kierunku adypocytów, chondrocytów, osteocytów, miocytów, kardiomiocytów, neurocytów, komórek trzustki i hepatocytów. Dotychczas nie udało się jednak skierować ich rozwoju w kierunku naskórka. Uzyskanie nabłonka wielowarstwowego w hodowli komórek nabłonka owodni miałoby ogromne znaczenie dla inżynierii tkankowej opatrunków biologicznych. Błony owodniowe wykorzystywane są w tym celu od wielu lat, jednak wskutek złożonej struktury i wymagań metabolicznych nie ulegają wgajaniu – wysychają po położeniu na powierzchni rany. Niektóre badania wskazują natomiast, że nabłonek izolowany z owodni mógłby się wgajać, nadawałby się zatem do allogenicznych przeszczepów.
The protein p63 plays a significant role in the development of animal epithelium. p63 is a regulator of differentiation, senescence and adhesion programs in numerous mature epithelial tissues. In patients with a healthy epidermis, p63 maintains cell progenitor potential - the ability for cellular division to occur using the delayed differentiation program. It is also responsible for the protecting the epithelial phenotype from depletion in migrating cells, thus resulting in invasion and infiltration after altering its endogenous expression.The aim of the study was to compare the number of cells with p63 protein expression and the presence of Ki67 proliferation marker in the epidermis in patients with chronic venous ulcerations versus those with properly healing wounds.Material and methods. Study materials were comprised of biopsy samples collected from healthy volunteers and patients treated for venous ulcerations. The specimens were subjected to immunohistochemical staining using available monoclonal antibodies and were analyzed with an imaging analysis program which evaluated the expression indices of both proteins in areas of intensified cellular division, i.e. wound edges.Results. The number of cells displaying protein expression in patients with chronic venous ulcerations was significantly lower in comparison to the values observed in healthy volunteers. This was determined during the intermediary phase of wound healing, the most pronounced phase of cellular response to injury.Conclusions. Decreased epidermal p63 expression in patients with venous ulcerations suggests insufficient protein production for the maintenance of autoregeneration and long-lasting division; both are required for the supplementation of migrating cells. The above-mentioned phenomenon suggests that there may be a role for p63 in regulation of the healing process and pathophysiology of chronic venous leg ulcerations.
Content available remote Simple Clinical Tests in Severe Carpal Tunnel Syndrome
Patients with severe carpal tunnel syndrome may be characterised by an atypical clinical picture. They assess complaints as becoming less bothersome than in the past. It seems that this may influence the diagnostic value of some clinical tests used in physical examinations. was the selection of the most reliable clinical tests in a group of patients with severe carpal tunnel syndrome. Material and methods. The material comprised 38 cases of severe form of the disease in a group of 37 prospective patients. The methods consisted in the evaluation of the rate of positive results of selected clinical tests, and in the comparison of their statistical correlation with selected parameters of median nerve conduction. Results. The study results indicated that high incidence of two-point discrimination disorders showed a correlation with the sensory conduction parameters, including the median-ulnar sensory latency difference. The Durkan's and Phalen's tests were positive in almost all patients with advanced carpal tunnel. The Katz hand diagram revealed significantly enhanced sensitivity in the “probable” pattern. Conclusions. We speculate that the two-point discrimination, evaluated with the use of a simple paper clip, enables the selection of a group of patients with severe form of the syndrome for further differentiation. The tool used for facilitating the differential diagnosis is the Katz hand diagram. The Durkan's and Phalen's tests have an equally high value. However, they show no correlation with the conduction parameters, as measured by EMG.
Content available remote Surgical Treatment in Epidermolysis Bullosa
Content available remote Gene Therapy in Patients with Epidermolysis Bullosa
Content available remote Fat grafts in the reconstruction and treatment of chronic wounds
Use of small autologous skin grafts or leaving the defects and waiting for their spontaneous reepidermization are one of the methods of wound management after surgical treatment of hand contractures in Epidermolysis bullosa. This techniques are believed to allow quick wound healing, however this does not seem universally possible.The aim of the study was to assess healing rate and incidence of early recurrence after using of both techniques.Material and methods. Eleven operations of hand contracture were performed, including two recurrent cases after previous surgeries. Skin grafts were used in eight cases. Kirshner wires were not used and the fingers were stabilized in an extended position only with a supportive dressing. In the early postoperative period, dressings were made in the operation room and patients were admitted for 24-hour hospitalizations no more than once a week.Results. Complete healing before day 35 was achieved only in five cases. In the remaining cases, dressings in the operating room were abandoned between day 35 and 40 and the patients were referred to further treatment in the outpatient setting. Outpatient dressings were done without anesthesia which in the event of unhealed spaces between the fingers, seemed to impair their separation and facilitate early recurrences of syndactyly. Two cases of early recurrence (18%), during the first year after the operation, were noted in one patientConclusions. Our results indicate that the postoperative wound healing does not depend on the use of skin grafts and can be much longer than some previous studies suggested. This shortens the period of full efficiency between the recurrences. Clinical observations also indicate that this affects the risk of early recurrences. Despite that, their number is similar to the value considered good in the literature.
The aim of the study was to evaluate the efficacy and safety of liposomal heparin spray-gel in the treatment of superficial thrombophlebitis.Material and methods. The presented study is an analysis of two clinical investigations performed during the period between March 1999 and May 2002, which evaluate the efficacy and safety of liposomal heparin spray-gel (Lipohep) in the treatment of superficial thrombophlebitis, as well as a comparison with results obtained following subcutaneous enoxaparin injections. The study group comprised 88 patients, including 43 on Lipohep treatment and 45 on low molecular weight heparin.Results. Two patients withdrew from the investigation before the control visit. After seven days, therapy was stopped in the case of 16 Lipohep patients and 18 low molecular weight heparin patients. After 14 days, therapy was stopped in 21 and 25 patients, respectively. One low molecular weight heparin and five Lipohep patients did not finish the investigation. This was connected with a lack of clinical improvement and development of side-effects. A statistically significant reduction of pain and the appearance of erythema was observed in both patient groups during the initial seven days of treatment. One patient on low molecular weight heparin was diagnosed with superficial thrombophlebitis recurrence. Ten patients developed complications, with deep venous thrombosis being most significant (two patients were treated with Lipohep and one with enoxaparin). One patient on Lipohep treatment developed superficial thrombophlebitis of the upper extremity.Conclusions. Liposomal heparin spray-gel is safe and effective in the treatment of local superficial thrombophlebitis symptoms. The initial results considering the use of Lipohep are promising and should be confirmed in a larger group of patients.
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