他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

Ascites after liver transplantation--a mystery.

Ascites after liver transplantation, although uncommon, presents a serious clinical dilemma. The hemodynamic changes that support the development of ascites before liver transplantation are resolved after transplant; therefore, persistent ascites (PA) after liver transplantation is unexpected and poorly characterized. The aim of this study was to define the clinical factors associated with PA after liver transplantation. This was a retrospective case-control analysis of patients who underwent liver transplantation at the University of Pennsylvania. PA occurring for more than 3 months after liver transplantation was confirmed by imaging studies. PA was correlated with multiple recipient and donor variables, including etiology of liver disease, preoperative ascites, prior portosystemic shunt (PS), donor age, and cold ischemic (CI) time. There were 2 groups: group 1, cases with PA transplanted from November 1990 to July 2001, and group 2, consecutive, control subjects who underwent liver transplantation between September 1999 and December 2001. Both groups were followed to censoring, May 2002, or death. Twenty-five from group 1 had ascites after liver transplantation after a median follow-up of 2.6 years. In group 1 vs group 2 (n = 106), there was a male predominance 80% vs 61% (P =.10) with similar age 52 years; chronic hepatitis C virus (HCV) was diagnosed in 88% vs 44% (P <.0001); preoperative ascites and ascites refractory to treatment were more prevalent in group 1 (P =.0004 and P =.02, respectively), and CI was higher in group 1, (8.5 hours vs 6.3 hours, P =.002). Eight of the 25 (group 1) had portal hypertension with median portosystemic gradient 16.5 mm Hg (range, 16-24). PS was performed in 7 of 25 cases, which resulted in partial resolution of ascites. The development of PA after liver transplantation is multifactorial; HCV, refractory ascites before liver transplantation, and prolonged CI contribute to PA after liver transplantation.     

Clinical Comparison of Topical 2.5% Benzoyl Peroxide plus 5% Niacinamide to 2.5% Benzoyl Peroxide Alone in the Treatment of Mild to Moderate Facial Acne Vulgaris

BackgroundThe combination of benzoyl peroxide and a new topical therapy, such as topical niacinamide, reduces facial sebum production and also has a skin-lightening effect. This combined treatment might lead to improved efficacy in the treatment of facial acne vulgaris while also promoting the resolution of postacne erythema and postinflammatory hyperpigmentation.ObjectiveThe primary objective was to evaluate and compare the clinical efficacy of topical 2.5% benzoyl peroxide plus 5% niacinamide and 2.5% benzoyl peroxide with cream base for mild to moderate facial acne vulgaris. Secondary objectives were to evaluate and compare clinical efficacy regarding postinflammatory hyperpigmentation, postacne erythema, reduction of facial sebum production, and side effects. METHODS: Patients with mild to moderate facial acne vulgaris and aged 18 to 40 years were enrolled. Treatment was randomly assigned to the left or right side of the face for 12 weeks. Both inflammatory and noninflammatory acne lesions were counted by a physician, and the postinflammatory hyperpigmentation score and postacne erythema score were calculated using an Antera 3D^® camera (Miravex, Dublin, Ireland). Sebum casual level was measured using a Sebumeter^® (Courage+Khazaka Electronic, Köln, Germany) every two weeks. Physician improvement score, patient satisfaction index, and side effects were assessed by evaluation forms every two weeks.ResultsAt Week 12, the niacinamide group (5% niacinamide+2.5% benzoyl peroxide) showed significant reduction in both the acne lesion count and sebum casual levels from baseline (p=0.000 and p=0.001, respectively). The reduction in noninflammatory lesion count in the niacinamide group was better than that in the cream base group (2.5% benzoyl peroxide+cream base), with a statistically significant difference (p=0.004). However, the reduction in inflammatory lesions was not significantly different between the two groups. The sebum casual level in the niacinamide group was reduced faster than that in the cream base group. The postacne erythema score was reduced from baseline in both groups, with no statistically significant difference within or between the two groups. The postinflammatory hyperpigmentation score showed increases in both groups above the baseline, with a statistically significant difference in the cream base group (p=0.000) but no such difference in the niacinamide group (p=0.58). There was no statistically significant difference between the two groups. Furthermore, no statistically significant differences were found between the two groups at every follow-up visit in terms of physician improvement scale, patient satisfaction index, or side effects.Conclusion The combination of 2.5% benzoyl peroxide and 5% niacinamide is more effective than 2.5% benzoyl peroxide alone for mild to moderate facial acne vulgaris.     

Clinical Efficacy of Short Contact Topical 5-Fluorouracil in the Treatment of Keratoacanthomas: A Retrospective Analysis

Objective: To determine the efficacy of treating patients with a recent onset, biopsy-proven keratoacanthoma with short-contact topical 5% 5-fluorouracil cream twice daily until resolution. Design: Chart review of 10 patients who applied 5% 5-fluorouracil for the treatment of biopsy-proven keratoacanthoma. Setting: Outpatient clinic of a board-certified dermatologist. Participants: The study population was 90-percent women (9/10), 10-percent men (1/10) and ranged in ages from 52 to 92 years old with a mean age of 74.4. Measurements: Patients were followed for weekly visits for the duration of their treatment and at varying, less-frequent intervals after resolution of the lesion clinically. Photographs were taken at each visit. Results: The authors performed a retrospective analysis of 10 patients with biopsy-confirmed keratoacanthomas treated with topical 5-fluorouracil. One patient elected to have Mohs surgery after one week of topical 5-fluorouracil due to personal concern and cosmetic appearance and did not complain of any side effects due to the drug. Of the nine patients that remained on topical 5-fluorouracil, all patients had complete resolution of the lesion within six weeks. The range in the number of weeks to resolution was four to six weeks. Two patients required a one- to two-week drug holiday secondary to erythema, which resolved without any further complication or patient discomfort. All nine patients who continued therapy reported satisfaction with the results and showed excellent compliance with treatment. Conclusion: Short-contact topical 5% 5-fluorouracil appears to provide excellent cosmetic results and is well-tolerated by patients. This should be an initial consideration for the treatment of keratoacanthomas and does not preclude future surgical intervention if deemed necessary.Keratoacanthomas (KAs) are generally regarded as self-healing, squamous cell tumors without the ability to metastasize. These unsightly lesions typically spontaneously regress over time, usually within a few months. However, because of the disfiguring and troublesome cosmetic appearance of these lesions, the potential pain associated with the lesions, and the potential for rapid enlargement, as well as local destruction from expansion, patients will often undergo surgery to have the lesions removed.1,2The major nonsurgical therapies for the treatment of KAs can be divided into local and systemic therapies. Local therapies are composed primarily of intralesional injections and topical therapies. However, other methods, such as electrodessication and curettage and laser therapy have been reported.1,2 The ideal agent would speed resolution and provide a superior cosmetic result. 5-fluorouracil (5-FU) has shown promise in the treatment of KAs in various routes— intralesional injection, topically, and combined with laser.1,3 In order to further investigate topical treatment of KAs, the authors performed a chart review of patients with biopsy-confirmed KAs that were managed with topical 5-FU.     

308nm准分子激光联合0.1%他克莫司乳膏治疗白癜风的临床体会

目的:比较应用0.1%他克莫司软膏联合308nm准分子激光与单用308nm准分子激光治疗白癜风的效果。方法:64例白癜风患者,每个部位选择1～2处皮损将自身皮损分为A、B两组,分别108处皮损,A组予308nm准分子激光治疗,2次/周,共30次;B组在激光治疗的基础上外用0.1%他克莫司乳膏,2次/天。治疗过程中记录疗效及不良反应。结果:两组分别108处皮损,所有患者完成了治疗。总有效率:A组65.74%(71/108),B组89.81%(97/108),(χ2=18.10,P<0.05);其中面颈部有效率:A组88.10%(38/42),B组92.86%(39/42)(χ2=0.26,P>0.05);躯干部有效率:A组53.84%(28/52),B组94.23%(49/52)(χ2=22.06,P<0.05);四肢有效率A组50.00%(5/10),B组80.00%(8/10);手足有效率:A组0(0/4),B组25.00%(1/4);平均治疗次数:A组21.8次、B组19.4次,平均出现色素次数:A组7次、B组5.5次。结论:308nm准分子激光联合他克莫司乳膏治疗白癜风起效快、疗效好,副作用少;面颈部单用308nm准分子激光亦可获良效。     

Clinical profile of breast cancer in Arab and Jewish women in the Jerusalem area

BACKGROUND: The clinical profile of breast cancer may vary among different ethnic groups living in the same country and therefore affect the yield of a breast cancer screening program. The present study attempts to better characterize the breast cancer clinical profile of Arab women compared with Jewish women in the greater Jerusalem area with a future aim of establishing a comprehensive and effective screening program for this population. METHODS: Retrospective chart review was conducted and the following covariates were correlated with survival: ethnicity, age at diagnosis, and American Joint Committee on Cancer (TNM) stage at diagnosis. RESULTS: A total of 312 women were operated on for breast cancer between 1994 and 1999; 51% were Ashkenazi Jews (AJ), 26% were Sephardic Jews (SJ), 21% were Palestinian Arabs (PA), and 2% patients did not fit into those ethnic groups. The mean age at diagnosis was 51.5 years for the PA group, 53.4 +/- 1.5 for the SJ group, and 55.9 years for the AJ group (P <0.03 PA versus AJ). The tumor size (mean +/- SEM) was 38.8 +/- 3.7 mm, 31.1 +/- 2.4 mm, and 24.5 +/- 1.6 mm for the PA, SJ, and AJ groups, respectively (P = 0.03 for PA versus SJ and P <0.001 for PA versus AJ). Five-year overall survival was 77 %, 72%, and 58% for the AJ, SJ, and PA groups, respectively (P = 0.02); and 5-year disease-free survival was 72%, 51%, and 50% for the AJ, SJ, and PA groups, respectively (P = 0.03, AJ versus SJ). CONCLUSIONS: Our data demonstrate younger age and larger primary tumor size for the Arab patients compared with the Jewish patients. These findings were associated with lower 5-year survival and disease-free survival of the Arab patients.     

Desmoid Tumors (Fibromatoses) of the Breast: A 25-Year Experience

Background Breast desmoid tumors are rare and often clinically mistaken for carcinoma. We reviewed our 25-year institutional experience with breast desmoid tumors. Methods A search of pathology and sarcoma databases (1982–2006) identified 32 patients with pathologically confirmed breast desmoids. Records were retrospectively reviewed. Results Median presentation age was 45 years (range, 22–76). Eight patients (25%) had prior history of breast cancer and 14 (44%) of breast surgery, with desmoids diagnosed a median of 24 months postoperatively. All presented with physical findings. Mammography visualized the mass in 6/16, ultrasound in 9/9, and magnetic resonance imaging (MRI) in 8/8 patients in whom it was performed. In 15 patients with attempted needle biopsy, fine needle aspiration was inconclusive (9/9 patients), and core biopsy demonstrated a spindle cell lesion (6/7 patients). Treatment was surgical, with median tumor size of 2.5 cm (range, 0.3–15). Eight patients (29%) had recurring tumors at a median 15 months. Patients with recurring tumors were younger (median age: 28 vs. 46 years, p = 0.03). A trend toward more frequent recurrences in patients with positive (5/9 patients) versus negative (3/19 patients) margins (p = 0.07) and larger tumors (p = 0.12) was observed. Conclusions In our series, breast desmoids presented as palpable masses suspicious for carcinoma clinically and radiographically. Therapy remains primarily surgical, and core biopsy aided in operative planning. Recurrences are common, with younger age and possibly positive margin status and larger tumor size associated with increased risk of recurrence. As 5/9 patients with positive and 3/19 patients with negative margins experienced recurrences, clinical judgment should be used prior to extensive and potentially deforming resections.     

Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial

BACKGROUND: Venous leg ulcers are a major cause of morbidity, economic loss, and decreased quality of life in affected patients. Recently, biomaterials derived from natural tissue sources have been used to stimulate wound closure. One such biomaterial obtained from porcine small-intestine submucosa (SIS) has shown promise as an effective treatment to manage full-thickness wounds. Our objective was to compare the effectiveness of SIS wound matrix with compression vs compression alone in healing chronic leg ulcers within 12 weeks. METHODS: This was a prospective, randomized, controlled multicenter trial. Patients were 120 patients with at least 1 chronic leg ulcer. Patients were randomly assigned to receive either weekly topical treatment of SIS plus compression therapy (n = 62) or compression therapy alone (n = 58). Ulcer size was determined at enrollment and weekly throughout the treatment. Healing was assessed weekly for up to 12 weeks. Recurrence after 6 months was recorded. The primary outcome measure was the proportion of ulcers healed in each group at 12 weeks. RESULTS: After 12 weeks of treatment, 55% of the wounds in the SIS group were healed, as compared with 34% in the standard-care group (P = .0196). None of the healed patients treated with SIS wound matrix and seen for the 6-month follow-up experienced ulcer recurrence. CONCLUSIONS: The SIS wound matrix, as an adjunct therapy, significantly improves healing of chronic leg ulcers over compression therapy alone.     

可见光固化材料对后牙牙体病损修复的临床疗效

探究可见光固化材料对后牙牙体病损修复的临床疗效。方法 选取2022年11月-2023年8月 我院收治的80例后牙牙体病损患者为研究对象,采用随机数字表法分为对照组和观察组,各40例。对照 组采用普通树脂材料进行后牙牙体病损修复,观察组采用可见光固化材料进行后牙牙体病损修复,比 较两组临床疗效、治疗满意度及不良反应发生率。结果 观察组临床总有效率为90.00%,高于对照组的 70.00%（P＜0.05）;观察组治疗总满意度为92.50%,高于对照组的70.00%（P＜0.05）;观察组不良反应发 生率为7.50%,低于对照组的25.00%（P＜0.05）。结论 在后牙牙体病损修复中,可见光固化材料具有临床 疗效好、患者满意度高、不良反应少的优势,值得临床应用。     

Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study

Thirty-seven patients with previously untreated perianal condylomata acuminata were randomly treated by application of 25 per cent podophyllin or scissor excision. The result of treatment was assessed by an independent observer. At 6 weeks, scissor excision completely cleared the warts from 16 of 18 patients (89 per cent) compared with 15 of 19 patients (79 per cent) treated with podophyllin. Following complete clearance by surgery, two patients had recurrent warts at 18 weeks and a further single patient at 42 weeks, giving a cumulative recurrence rate of 19 per cent. In contrast, five of 15 patients whose warts were cleared by podophyllin had recurrent warts at 18 weeks and a further four at 42 weeks representing a cumulative recurrence rate of 60 per cent (X2 = 3.95, d.f. = 1, P = 0.05). At 42 weeks six patients (32 per cent) were free of disease in the podophyllin group compared with 13 (72 per cent) in the scissor excision group (X2 = 4.6, d.f. = 1, P = 0.03). Scissor excision is therefore preferable to podophyllin application in the treatment of perianal condylomata acuminata.     

点阵激光联合外用曲安奈德治疗神经性皮炎的临床效果

目的 探究点阵激光联合外用曲安奈德治疗神经性皮炎的临床效果。方法 选择我院2022年2月- 10月收治的50例神经性皮炎患者为研究对象,按照随机数字表法分为对照组和治疗组,每组25例。对照组 给予曲安奈德注射治疗,治疗组给予点阵激光照射后联合曲安奈德涂抹治疗,比较两组症状评分和临床疗 效。结果 治疗组皮损红斑、水肿/浸润/丘疹、鳞屑、苔藓样变、瘙痒程度评分低于对照组（P ＜0.05）; 治疗组治疗总有效率为96.00%,高于对照组的72.00%（P ＜0.05）。结论 对神经性皮炎患者采用点阵激光 联合外用曲安奈德治疗法能够有效提升治疗效果,缓解症状,值得临床应用。     

5-氨基酮戊酸光动力疗法治疗中重度痤疮的临床观察

目的：探讨5-氨基酮戊酸光动力疗法（ALA-PDT）治疗中重度痤疮的安全性及有效性。方法：将42例中重度痤疮患者随机单盲分为两组：治疗组21例,给予ALA-PDT治疗,每周治疗1次,共治疗1～4次;对照组21例,单用红光照射,每周治疗1次,共治疗1～4次。在治疗后第2、4、6周对两组患者进行疗效判断和比较,同时,记录治疗过程中出现的不良反应。结果：21例接受ALA-PDT治疗的患者经过1～4次治疗后,总有效率95.2%;对照组第6周总有效率为42.9%,治疗组疗效明显优于对照组（P〈0.05）。另外,ALA-PDT组复发程度明显轻于对照组,且病情控制时间明显延长。治疗组的所有皮损,包括粉刺、丘疹、脓疱、囊肿、结节等,均比对照组明显减少。结论：5%ALA-PDT和单用红光照射治疗中重度痤疮都能使痤疮皮损有不同程度的减少,但是5%ALA-PDT疗效明显优于单用红光治疗,因此,我们认为ALA-PDT是一种简单、高效、不良反应轻微的治疗中重度痤疮的新方法。     

308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效观察

目的:探讨308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风的疗效及安全性。方法:选取门诊面部白癜风患者180例,随机平均分为三组,共有167例完成了试验观察,A组为治疗组57例,308nm准分子激光(2次/周)联合0.1%糠酸莫米松乳膏(1次/天)治疗;B组为对照1组56例,单用308nm准分子激光治疗(2次/周);C组为对照2组54例,单用0.1%糠酸莫米松乳膏外用治疗(1次/天),疗程均为12周或至皮损完全复色,观察三组治疗方法治疗面部白癜风的疗效及不良反应。结果:A组显效率为75.43%,B组为48.21%,C组为14.81%,A组和B组及C组比较,显效率差异有统计学意义(P<0.05)。三组患者均未出现严重不良反应。结论:308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效好、副作用少,显效率明显高于单独治疗。     

Comparison of topical, intravenous, and intracuff lidocaine for reducing coughing after extubation during emergence from general anesthesia]

OBJECTIVE: To compare the effect of topical, intravenous, and intracuff lidocaine on reducing coughing during emergence from general anesthesia. PATIENTS AND METHODS: Patients with an ASA physical status of I or II were enrolled if they were over 18 years of age and scheduled for elective surgery lasting between 60 and 120 minutes under balanced anesthesia with orotracheal intubation. Enrolled patients were randomly assigned to one of 3 treatment groups (intravenous lidocaine, topical lidocaine, or intracuff lidocaine) or to the control group. Numerical variables were described as mean (SD) or median and interquartile range, depending on distribution. Categorical variables were described using frequencies (number) and percentages. Multiple-group comparisons were performed using analysis of variance, the Kruskal-Wallis test, or the chi2 test, as appropriate. A level of P < .05 was considered to be statistically significant. RESULTS: We enrolled 80 patients; data for 78 were entered into analysis. Thirteen patients (65%) presented coughing in the control group, 5 (263%) in the topical lidocaine group, 3 (15.8%) in the intracuff group, and 3 (16%) in the intravenous group (P < .05). CONCLUSIONS: Intravenous lidocaine and intracuff lidocaine significantly reduce the incidence of coughing during emergence from anesthesia.     

百特5%及25%人血白蛋白在肝脏、胰腺手术围手术期应用的疗效和安全性

目的 观察百特5%及25%人血白蛋白在肝脏/胰腺围手术期合理分配应用的疗效和安全性.方法 收集上海瑞金医院移植科2007年1至10月收治的40例胰腺及60例肝脏手术病人的临床资料,根据人血白蛋白使用情况分为白蛋白组(A组),即从手术之日起每日予5%500 ml或25%100 m1人血白蛋白一支,连续使用9 d;生理盐水组(B组),即每日给予生理盐水.蛋白组又分为5%白蛋白使用组(A1组),即连续9 d使用5%白蛋白,和5%、25%合并用药组(A2组),即术后1～5 d使用5%白蛋白,术后6～9 d使用25%白蛋白.其余治疗各组皆相同.比较各组病人术后肝肾功能、凝血功能、电解质以及胆瘘、胰漏、胸腹水量、伤口愈合时间及住院时间.结果 白蛋白组术后病人血清白蛋白水平明显高于对照组,肝脏切除术后(术前Child-Pugh A级及B级)白蛋白组PT、APTT均明显低于对照组,胰腺术后胆瘘、胰瘘的发生率明显低于对照组.对于术后胸腹水的产生,白蛋白组与对照组相比显著降低,而5%、25%合并用药组与5%白蛋白使用组相比则显著降低.术后白蛋白组伤口愈合不良发生率明显低于对照组,术后住院时间明显缩短.结论 在肝脏/胰腺手术术后使用白蛋白能显著改善病人的肝肾、凝血功能,促进伤口愈合,减少相关并发症,缩短住院时间.术中及术后前期使用等渗性白蛋白溶液能纠正低白蛋白血症,术后后期使用高渗性白蛋白,在纠正低白蛋白血症的同时能显著减少水肿及胸腹水的发生.提示在肝脏/胰腺手术围手术期合理分配等渗性和高渗性白蛋白在纠正低蛋白血症的同时能更有效地改善体液分布,使之平衡,达到更佳的临床治疗效果.     

A therapeutic metastasectomy of pulmonary metastases by VATS

The use of VATS to perform diagnostic metastasectomy is uniformly accepted, but the role of therapeutic VATS metastasectomy remains controversial. We retrospectively compared the value of therapeutic metastasectomy by VATS with that by open thoracotomy in the management of pulmonary metastatic tumors. The forty-six patients who underwent a complete metastasectomy of pulmonary metastatic tumors were divided into groups: one group in which metastasectomy was performed by VATS (VATS group; 23 cases, 25 operations) and another group in which metastasectomy was performed by open thoracotomy (Thoracotomy group 23 cases, 26 operations). Here, complete metastasectomy means compete resection of all tumors, which were detected by preoperative high resolution computed tomography in both groups and also by intraoperative manipulation in the thoracotomy group, without positive lesions of the surgical margin. The groups were matched with respect to preoperative clinical characteristics (age, sex, primary lesion, disease-free interval) and histological findings (maximum tumor size, number of metastatic tumors, minimum distance between surgical margin and tumor edge). The cumulative survival one-year and three-year rates were 83.5 and 83.5% in the VATS group, and 89.5 and 77.5% in the thoracotomy group, respectively. The cumulative one-year and three-year non-recurrence rates were 72.3 and 68.0% in the VATS group and 83.9 and 63.8% in the thoracotomy group, respectively. There were no significant differences between the two groups. We conclude that pulmonary metastasectomy by VATS can be used safely not only as a diagnostic but also therapeutic tool if complete resection is done following diagnosis by preoperative high resolution computed tomography.     

Topical Photodynamic Therapy Using Intense Pulsed Light for Treatment of Actinic Keratosis: Clinical and Histopathologic Evaluation

BACKGROUND: Photodynamic therapy (PDT) is suitable for the treatment of actinic keratosis, and, recently, topical PDT using intense pulsed light as a light source has been reported. However, evaluations of its therapeutic effects have been clinically based. OBJECTIVE: The objective of this study was to confirm the histopathologic resolution of actinic keratosis treated by topical PDT using intense pulsed light as a light source. METHODS: Twelve actinic keratosis lesions in seven patients were treated with 5-aminolevulinic acid-PDT using intense pulsed light as a light source. After a single treatment, the clinical response was assessed and histopathologic examinations were performed on clinically resolved lesions. RESULTS: Six of 12 (50%) lesions showed clinical clearance after a single treatment, but histologic examinations showed that only 5 of the 12 (42%) lesions had been removed. No complications, such as pigmentary changes or scarring, were observed. CONCLUSION: Intense pulsed light is potentially an effective light source for PDT. However, the determination of complete remission in actinic keratosis requires caution, and long-term follow-up or histologic confirmation may be required.     

Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children

Background/Purpose

Phimosis, owing to the presence of a preputial fibrotic ring, is surgically treated in 1% of children. During the last decade, however, topical steroid treatment has been proposed for phimosis.

Methods

We present a double-blind study comparing 0.1% mometasone furoate topical cream vs moisturizing cream (placebo) for the treatment of phimosis. Children aged from 2 to 13 years (n = 110) presenting with phimosis (Kikiro's classification grade 5) and scheduled for circumcision were included in this trial. The patients were evaluated after 8 weeks of topical treatment with moisturizing cream (n = 54) or steroid cream (n = 56). Nonresponders from both groups received an additional 8 weeks of steroid cream treatment.

Results

In the steroid group, the ring disappeared and glans exposure was obtained in 49 (88%) of 56 patients vs 28 (52%) of 54 patients in the placebo group (P < .05). After a second treatment, in the steroid group, 5 of the 7 patients were finally cured vs 22 of the 26 in the placebo group (P < .05). Two children with persisting phimosis (Kikiro's retractability grade 5 and appearance grade 3) in the steroid group (4%) vs 4 children in the placebo group (7%) ended up receiving postectomy.

Conclusions

The present investigation adds up and supports the effectiveness of phimosis topical corticoid treatment. Nevertheless, hygiene and preputial traction, when appropriately performed, seem to play an important role in the disappearance of the phimotic ring as well. New studies are necessary to confirm if this is true or not.     

Effectiveness of antioxidants (propolis, blueberry, vitamin E) associated with verapamil in the medical management of Peyronie's disease: a study of 151 cases

A total of 151 patients (age: 24-74 years, mean: 55 ± 10.3) diagnosed with Peyronie's disease were enrolled in a non-surgical treatment. In addition to medical histories and physical examinations, all patients underwent the following tests: penile ultrasound, IIEF questionnaire and photographic documentation. The penile curvature was measured by taking a photograph during maximum erection. All 151 patients were treated at different times and with different combinations of drugs, and afterwards, they were clinically studied and divided into five different treatment groups: 1st = verapamil (injection + iontophoresis) + vitamin E + topical diclofenac + blueberries; 2nd = verapamil (injection + iontophoresis) + vitamin E + topical diclofenac + propolis; 3rd = verapamil (injection) + vitamin E + topical Diclofenac; 4th = verapamil (iontophoresis) + vitamin E + topical diclofenac; 5th = verapamil (injection + iontophoresis) + topical diclofenac + blueberries + propolis. All patients were treated for 6 months after which they underwent the same follow-up tests as performed prior to the treatment. The following was achieved: group 1 had the most reduction in plaque size (-66.4%; p = 0.000), group 2 obtained the highest rate where penile curvature disappeared (24.5%; p = 0.019); the best results with reference to decrease in curvature angle were reached by the 2nd group (-14°) and group 1 obtained -9.6° (p = 0.000).     

Oral Hairy Leukoplakia in Immunocompetent Patients Revisited with Literature Review

Oral hairy leukoplakia (OHL) is an Epstein-Barr virus (EBV) related lesion seen in severely immunocompromised patients especially, those with concomitant human immunodeficiency virus (HIV) infection. It has been rarely reported in immunocompetent patients. OHL most often presents on the lateral border of the tongue as an asymptomatic, white, and corrugated plaque that does not rub off. With Institutional Review Board (IRB) approval, the University of Florida Oral & Maxillofacial Pathology Biopsy Service archives spanning 1994–2020 were queried. All cases of OHL affecting immunocompetent patients were identified. Data related to age, gender, clinical presentation, results of Epstein-Barr virus in situ hybridization (EBER-ISH), and periodic acid–Schiff (PAS)-fungus stains were recorded. Medical history and histology of all cases were reviewed for confirmation of diagnosis. A total of 11 cases were identified, the majority of which were males (63.6%) with a mean age of 62 years. All patients were Caucasian. Lesions entirely were located on the lateral borders of the tongue. OHL should not be considered pathognomonic for HIV infection and should be included in the differential diagnoses of keratotic lesions affecting the lateral border of tongue even in immunocompetent elderly patients. The etiology of OHL in this group of patients is not clearly understood.