Punch biopsies

Useful with icepick and narrow-deep boxcar scars that are excised with a 1.5-mm punch biopsy and sutured with a 6.0 or smaller suture. Nonabsorbable sutures are preferred to avoid inflammation and must be removed within 5 days. 

Since these studies utilized autoradiographic techniques, it was important to determine the chemical nature of the material measured using radiochemical procedures. Using punch biopsies of the brain slices which were measured autoradiographically, it was shown using thin-layer chromatography that about 30% of the radioactivity was associated with unchanged BCNU (14). It was therefore concluded that the measurements described above accurately reflect brain concentrations of BCNU. 

A 57-year-old man in good health took atorvastatin 5 mg and aspirin 75 mg/day and had progressive numbness and burning in both feet for 6 months (8). Muscle punch biopsies showed a neuropathic process affecting small-caliber sensory nerve fibers. The symptoms resolved 3 months after withdrawal of atorvastatin. 

The generic procedure for collecting either confocal Raman micrographs or IR images from a healing wound is shown in Fig. 15.10a. The wound is generated with a punch biopsy and the residual tissue is retained for spectroscopic examination. 

Figure 7.3 A. Human psoriatic tissue (200x). B. Normal human skin (200x). Both samples were immunostained with caspase 14 antibody. Punch biopsies (4 mm) of normal and psoriatic skin samples were obtained from different patients who provided written, informed consent under an IRB-approved protocol. Samples were fixed in 10% neutral-buffered formalin, paraffin embedded, cut to 5-pm sections, and stained with caspase 14 antibody by immunohistochemistry.

There is evidence that protein structures are also responsible for cell cohesion in nonpalmo-plantar stratum corneum. When punch biopsies of normal human gluteal skin were incubated in a buffer containing a mixture of the zwitterionic surfactant /V,/V,-dimethyldodecylamine and the anionic surfactant sodium dodecyl sulfate,11 there was dissociation of cells in the stratum corneum but not in the rest of the epidermis. The cell dissociation took place only in the presence of EDTA and was inhibited by the serine protease inhibitor aprotinin.12 Suzuki et al.13,14 presented evidence that spontaneous cell dissociation in nonpalmo-plantar stratum corneum could be inhibited by a combination of inhibitors of trypsin-like and chymotrypsin-like enzymes. Thus, nonpalmo-plantar stratum corneum contains endogenous proteases that mediate cell dissociation. 

Although the (3-glucosidase assay can be performed on any tissue, the tissues of choice are peripheral blood leukocytes or cultured fibroblasts grown from a punch biopsy of the skin. Antenatal diagnosis can be made using extracts of cultured amniotic cells obtained from amniocentesis. There are several different (3-glucoside substrates that can be used in the assay the natural substrate glucocerebroside or structurally similar, artificial substrates. 

Fibroblasts were selected because they are readily cultivated and radio-labeled and are available from skin explants of a variety of species. Autoradiograms of radiolabeled cellular proteins are more diverse and easily analyzable for molecular systematics than alternatives such as silver-stained serum or erythrocyte protein patterns. We have achieved nearly 100% success rates at minimal discomfort and risk to human subjects by establishing cultures from 3 mm punch biopsies from the upper buttock. Local lidocaine anesthesia is used. Samples are collected following informed consent and under an approved human research protocol. Other species are sampled by dart gun8 or while sedated. Skin samples can be collected from various body sites without compromising the 2D electrophoresis metric, which does not rely on quantitative differences in protein expression. To comply with the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), tissues collected from wild and captive exotic animals must be obtained under specific permits issued by the U.S. Fish and Wildlife Service. 

A 17-year-old boy took amfebutamone (dose unstated) for attention deficit disorder and 1 week later developed a generalized pruritic rash, but continued to take amfebutamone (27). After a further week he presented as an emergency with large joint tenderness and joint swelling. A punch biopsy of a skin lesion showed urticaria with vasculitis. Amfebutamone was withdrawn and a single dose of methylprednisolone sodium succinate was given. His symptoms resolved completely within 36 hours. 

A 70-year-old white man, with no significant preceding medical history, developed an acute painful rash, a fever (38.4° C), and severe arthralgia 5 days after starting to take diazepam 10 mg bd for lumbar muscular contracture due to hard physical exercise. He had taken no other medications. There were well-defined purple-red skin plaques, surmounted by vesicular and hemorrhagic blisters. He had a leukocytosis. Sweet s syndrome was confirmed by punch biopsy of a lesion. Diazepam was withdrawn, and prednisolone 30 mg/day was given for 2 weeks and then tapered. The patient improved quickly and the eruption cleared in 10 days. 

Punch biopsies can confirm cutaneous anthrax if Gram stain and culture results are negative, due to antibiotic treatment (Godyn et al., 2005), and a suspicion of cutaneous anthrax remains (Celia, 2002). The center of the eschar, the erythematous region, and the skin margin should all be included in the biopsy when an eschar is present (Godyn et al., 2005). 

Punch biopsy should be submitted in formalin to CDC. Polymerase chain reaction can also be done on formalin-fixed specimen. Gram stain and culture are frequently negative for B. anthrads after initiation of antimicrobials. 

The absorption of ZnO from intact skin after topical application is non-detectable. The data on TiOg are controversial. Earlier studies suggested that a very small amount of titanium dioxide may penetrate the skin, but it is unlikely that this would have any biological significance (237). However, a recent in viuo human study, in which skin punch biopsies were collected after application of titanium dioxide, (256) showed that this sunscreen is solely deposited on the outermost surface of the stratum corneum and does not penetrate into the deeper stratum corneum layers, the epidermis or the dermis regardless of the surface properties of the particles (256). 

Patients that present with a suspicious pigmented lesion should undergo a full thickness excisional biopsy, if possible. Sites in which excisional biopsy are inappropriate include the face, pahn of the hand, sole of the foot, distal digit, and subungual lesions. A full thickness incisional or punch biopsy is preferred in these cases to provide microstaging and ultimately to determine therapy. 

A coal tar solution (crude coal tar diluted to 20% with ethanol and polysorbate 80) was applied to clinically unaffected skin of three patients with severe atopic dermatitis and six patients with generalized psoriasis (Bickers and Kappas 1978). Another skin area at least 10 cm away was not treated or was treated with 100 mL of the vehicle alone. Twenty-four hours later, a 6-mm punch biopsy was obtained from coal tar treated and control areas and the effect on AHH activity was determined. Application of coal tar to the skin caused induction of cutaneous AHH activity that varied from 2.4- to 5. 4-fold over the enzyme activity in untreated skin areas, suggesting absorption after topical application. 

The traditional mainstays of topical treatment for AD have been the topical corticosteroids. It is interesting to note, however, that steroids are not believed to have any effects on histamine release from human mast cells [116, 117]. A direct comparative study of the mechanism of steroids versus tacrolimus has not been performed. However, in preliminary work done by Fujisawa Laboratories in the United States utilizing sequential punch biopsies from patients with atopic dermatitis treated with either steroids or tacrolimus topically, some differences were noted in the patterns of cytokine expression between the two treatments (M. Kobayashi, personal communication, 2000). Additional studies will need to be performed before clear conclusions can be drawn. 

Also suggested is a human model to assess the potential of the barrier to encourage the growth of microorganisms. A punch biopsy or skin-stripped induced wound is treated with the product and the wound monitored for growth promotion of microorganisms. 

Armstrong, R.B., Nichols, J., and Pachance, J. 1986. Punch biopsy wounds treated with Monsel s solution or a coUagen matrix.Arch. Dermatol. 122 546-549. 

A 41-year-old man developed suspected occupational hand dermatitis, but had clinical features that were not typical of contact dermatitis, with discrete excoriated papules and some hchenilied plaques on the dorsum of the hands and wrists the palms were unaffected [50 ]. Punch biopsies from the backs of the hands suggested Uchen simplex. However, patch testing was positive with various salts of cobalt. At work he had been exposed to cobalt in a viscous polyester resin, which he had sanded without gloves. 

Urate crystals in synovial punch biopsy Subcutaneous tophi... 

The patients had a much greater frequence of nephrolithiasis, crystalline urate deposits in synovial punch biopsies and were somewhat more tophaceous than expected.The severity of their gout was confirmed by the high incidence of radiographic finding of bone erosions and by the high number of joints involved for each patient. 

The analysis of tissue lipids has always been important for elucidation of lipid storage diseases. TLC has greatly simplified the necessary investigations and permits the range of application to be extended also to punch biopsy material and the smallest organs of experimental animals. 

Figure 22.5 Hematoxylin and eosin-stained punch biopsies of the wound with CCS applied at Day 7 and Day 10. The integrated BTM can be seen toward the lower pole of the core biopsy. At Day 7, the CCS has visibly deposited its cellular component to create a stratified squamous epithelium. By Day 10, the CCS polymer is extruded, leaving a healed wound deep to it.

Histological analysis of a punch biopsy prior to delamination revealed seal/matrix adherence with no significant development of a scar layer between the seal and the polymer matrix. Wound size at Day 28 was 82% of original size, the least wound contraction observed thus far in trials of BTM in pig wounds. 

Photographic records were taken at every intervention. Punch biopsy specimens of representative areas were taken at intervals for histological analysis. Formal scar assessment was performed at 1 year by a physiotherapist. 

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