No abstract

These findings have opened a new avenue for future research involving ACE inhibitors, AT2 agonists, and AT2 antagonists in Dupuytren's disease.

Background. The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. Aim. This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. Methods. A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. Results. 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease ( p > 0.05 ). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm ( p = 0.049 ). Conclusion. A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period.

Cold intolerance is a cause of signifi cant morbidity following trauma to the upper limb and hand, yet very little research has been undertaken to investigate the phenomenon following elective hand surgery. This retrospective study, incorporating a postal questionnaire and case note review, investigates incidence and risk factors of cold intolerance in a series of patients who underwent corrective surgery for Dupuytren's disease. The incidence of cold intolerance following surgery for Dupuytren's disease was 44%, and no association was found between the development of cold intolerance and either age, gender, smoking status or employment status. Further research investigating cold intolerance following surgery for Dupuytren's disease and other elective hand surgery is required. The present study demonstrates that cold intolerance is a signifi cant complication, not only following traumatic hand injury, but also following elective surgery for Dupuytren's disease.

The role of Angiotensin II as a pro-fibrotic mediator has been established in models of cardiac, hepatic and renal fibrosis. The administration of Angiotensin-Converting Enzyme (ACE) – inhibitors to these models results in a reduction in the myofibroblast population and collagen synthesis. In rodent excisionat wound-healing experiments, an ACE inhibitor reduced the rate of wound contraction, collagen deposition and angiogenesis. Using immunohistochemistry, the presence of Angiotensin I receptors was identified within tissue samples from patients with Dupuytren's disease. These were found to be co-localised with areas of myofibrobtast expression. This co-localisation has implications for the potential of pharmacological regulation of Dupuytren's disease. Further research is necessary to confirm whether the use of ACE-inhibitors can modulate this disease process, which until now has not been responsive to safe, effective pharmacological treatment.