Genetic and functional analyses of FH mutations in multiple cutaneous and uterine leiomyomatosis, hereditary leiomyomatosis and renal cancer, and fumarate hydratase deficiency

Germline mutations of the fumarate hydratase (FH, fumarase) gene are found in the recessive FH deficiency syndrome and in dominantly inherited susceptibility to multiple cutaneous and uterine leiomyomatosis (MCUL). We have previously reported a number of germline FH mutations from MCUL patients. In this study, we report additional FH mutations in MCUL and FH deficiency patients. Mutations can readily be found in about 75% of MCUL cases and most cases of FH deficiency. Some of the more common FH mutations are probably derived from founding individuals. Protein-truncating FH mutations are functionally null alleles. Disease-associated missense FH changes map to highly conserved residues, mostly in or around the enzyme's active site or activation site; we predict that these mutations severely compromise enzyme function. The mutation spectra in FH deficiency and MCUL are similar, although in the latter mutations tend to occur earlier in the gene and, perhaps, are more likely to result in a truncated or absent protein. We have found that not all mutation-carrier parents of FH deficiency children have a strong predisposition to leiomyomata. We have confirmed that renal carcinoma is sometimes part of MCUL, as part of the variant hereditary leiomyomatosis and renal cancer (HLRCC) syndrome, and have shown that these cancers may have either type II papillary or collecting duct morphology. We have found no association between the type or site of FH mutation and any aspect of the MCUL phenotype. Biochemical assay for reduced FH functional activity in the germline of MCUL patients can indicate carriers of FH mutations with high sensitivity and specificity, and can detect reduced FH activity in some patients without detectable FH mutations. We conclude that MCUL is probably a genetically homogeneous tumour predisposition syndrome, primarily resulting from absent or severely reduced fumarase activity, with currently unknown functional consequences for the smooth muscle or kidney cell.

Management of androgenetic alopecia

BACKGROUND

Androgenetic alopecia (AGA) is the most frequent cause of hair loss affecting up to 50% of men and 40% of women by the age of 50.

METHODS

This paper outlines the current status of diagnosis and offers guidelines for optimal management of AGA in both men and women.

RESULTS

The diagnosis of AGA can usually be confirmed by medical history and physical examination alone. A trichogram can be useful to assess the progression of the hair loss. A scalp biospy is diagnostic but usually not required. In women with signs of hyperandrogenism, investigation for ovarian (polycystic ovarian disease) or adrenal (late-onset congenital adrenal hyperplasia) disorders is required. Mild to moderate AGA in men can be treated with oral finasteride or topical minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex hair thinning. Medical treatment with finasteride or minoxidil should be continued indefinitely since interruption of therapy leads to hair loss with return to pretreatment status. Mild to moderate AGA in women can be treated with oral antiandrogens (cyproterone acetate, spironolactone) and/or topical minoxidil with good results in many cases. Hair systems and surgery may be considered for selected cases of severe AGA both in men and in women.

CONCLUSIONS

Patients with AGA should be informed about the pathogenesis of the condition. If used correctly, available medical treatments arrest progression of the disease and reverse miniaturization in most patients with mild to moderate AGA.

Follow-up of vermilionectomies: evaluation of the technique

Vermilionectomy is a straightforward technique that provides excellent results, not only in the treatment of solar cheilitis, but also as a prophylactic measure for squamous cell carcinoma (SCC) of the lower lip. Well-planned and well-executed, this operation is considered to have no postoperative complications. However, our 12-month follow-up of 52 postvermilionectomy patients revealed interesting features with regard to the contraction of the lip scar, sensitive, functional, and cosmetic disorders, and the prophylactic role of vermilionectomy on SCC of the lip.

The bilobed flap in sole surgery

The bilobed flap is a simple reconstructive technique principally used to correct substantial defects in the facial region. We present our experience with this local flap in the difficult plantar area, with excellent short-term functional results. We describe the special characteristics of the bilobed flap in this zone, and comment on its indications and possible complications.

International dermatosurgery: genitoperineal cyst of the median raphe

Canals and cysts are not rare embryonic malformations of the male genitoperineal median raphe. These patients usually consult dermatovenereologists . They normally remain asymptomatic for a long period, but secondary infections, caused by Neisseria gonorrheae , may occur. Surgical excision is the treatment of choice.

Congenital fistulas of the lower lip. Radiographic evaluation

Congenital fistula of the lower lip was observed in 3 members of a family. There was no evidence of associated congenital malformations. In the father, we performed fistulography with radiopaque substance, showing that the fistular tract extended beyond the orbicularis oris muscle, a feature with no previous report in the literature.

International dermatosurgery: advancement local flaps in the reconstructive treatment of vulvar carcinoma

The only possible treatment of carcinoma of the vulva, the most frequent and malignant tumor of the external female genital area, is surgical excision. It is necessary to perform wide vulvectomy and bilateral node dissection which usually creates a problem in the reconstruction of the zone. Two local advancement flaps achieve excellent functional and aesthetic results.