Botulinum Toxin Type A for the Treatment of Axillary Hailey–Hailey Disease

BACKGROUND: Hailey-Hailey disease is an inherited acantholytic disorder affecting the intertriginous areas of the body which is exacerbated by sweat, moisture, and friction. The disease is frequently resistant to conventional nonsurgical treatment. OBJECTIVE: To evaluate whether chemodenervation of sweat glands would improve the course of the disease in a patient with Hailey-Hailey. METHODS: We used low-dose treatment of the left axilla with botulinum toxin type A, the right axilla being used as a control, followed by treatment of both axillae with the optimal dose routinely used for the treatment of axillary hyperhidrosis. RESULTS: After one treatment with a low dose of botulinum toxin type A, we observed partial improvement of the treated axilla. With subsequent treatment of both axillae with the recommended dose for axillary hyperhidrosis, we observed a sustained complete remission of the disease in the treated axillae. CONCLUSION: Botulinum toxin type A may be an effective and safe nonsurgical alternative for the treatment of benign familial pemphigus in intertriginous areas such as the axillae.     

Treatment of Upper Lip Wrinkles: A Comparison of the 950 μsec Dwell Time Carbon Dioxide Laser to Manual Tumescent Dermabrasion

Background. High-energy pulsed or computer-scanned continuous-wave carbon dioxide (CO₂) laser resurfacing has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Manual tumescent dermabrasion has also been effective for treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO₂ laser to manual tumescent dermabrasion for the treatment of wrinkles on the upper lip.
Objective. To compare prospectively the clinical efficacy of the 950 μsec dwell time CO₂ laser to that of manual tumescent dermabrasion in the treatment of upper lip wrinkles.
Methods. Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with the 950 μsec dwell time CO₂ laser on one side of the upper lip and manual tumescent dermabrasion on the other.
Results . The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.3 ± 0.2 before treatment to 1.8 ± 0.3 at 6 months after treatment. The average upper lip dermabrasion-treated wrinkle score decreased from 4.4 ± 0.2 to 1.5 ± 0.3. The degree to which the wrinkle score improved after laser treatment compared with that after dermabrasion was not statistically significant ( P = .216).
Conclusion. Manual tumescent dermabrasion and 950 μsec dwell time CO₂ laser resurfacing are equally effective for the treatment of upper lip wrinkles.     

Treatment of Upper Lip Wrinkles: A Comparison of 950 μsec Dwell Time Carbon Dioxide Laser with Unoccluded Baker's Phenol Chemical Peel

BACKGROUND: The high energy, pulsed, or computer-scanned continuous wave carbon dioxide laser (CO2 laser) has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Chemical peels such as phenol have also been effective in treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to phenol for treatment of wrinkles on the upper lip. OBJECTIVE: To compare the effectiveness and side effect profile of the 950 microsec dwell time CO2 laser to that of unoccluded Baker's phenol chemical peel in the treatment of upper lip wrinkles. METHODS: Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with Baker's phenol on one side of the upper lip and the 950 microsec dwell time CO2 laser on the other side. RESULTS: The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.30+/-0.20 before treatment to 1.11+/-0.28 at 6 months after treatment. The average upper lip phenol-treated wrinkle score decreased from 4.20+/-0.20 to 0.47+/-0.12. The degree in which the wrinkle score improved after phenol treatment compared with that after laser treatment was statistically significant (p<0.03). CONCLUSION: Treatment of upper lip wrinkles with Baker's phenol resulted in greater improvement than treatment with the 950 microsec dwell time CO2 laser.     

Treatment of Hypertrophic Scars and Keloids Using Intense Pulsed Light (IPL)

Background

Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne.

Methods

Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL^® Quantum? device. Treatment was administered at 2–4-week intervals, and patients received an average of 8 treatments (range = 6–24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness.

Results

An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high.

Conclusion

This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.     

Long-Pulsed (6-ms) Pulsed Dye Laser Treatment of Rosacea-Associated Telangiectasia Using Subpurpuric Clinical Threshold

BACKGROUND: The pulsed dye laser (PDL), especially the 585-nm short-pulse width (450 micros) laser, has been extensively used in the treatment of facial telangiectasias. However, the resultant posttreatment purpura lasts for days and may not be cosmetically acceptable. OBJECTIVE: To examine the effect of long-pulsed (6 ms) PDL at subpurpuric clinical threshold in the treatment of rosacea-associated telangiectasia. METHODS: Twelve patients with rosacea-associated telangiectasia were recruited into the study. We used the 595-nm PDL at a pulse duration of 6 ms and titrated the fluence between 7 and 9 J/cm2 to produce immediate purpura lasting only a few seconds. Pretreatment cooling was achieved by cryogen spray. Assessment was made by comparing pretreatment and posttreatment photographs. Patients were evaluated 6 to 8 weeks after one PDL treatment. Results were reported as the percentage of reduction in the number of telangiectasias. Patients were asked for their own evaluation of improvement after treatment in terms of excellent, moderate, or poor outcome. Side effects such as pigmentary disturbance and scarring were also documented. RESULTS: Two of 12 patients had more than 75% improvement. Another two had 50% to 75% improvement, and five had 25% to 50% improvement. Overall, 9 (75%) of 12 patients had more than 25% improvement after a single treatment of PDL. None of the patients reported any lasting posttreatment purpura or complications. CONCLUSION: The long-pulsed 595-nm PDL using subpurpuric clinical threshold was effective for treatment of rosacea associated telangiectasia.     

A Pilot Study on the Treatment of Facial Rhytids Using Nonablative 585-nm Pulsed Dye and 532-nm Nd:YAG Lasers

BACKGROUND: There have been reports of successfully using the pulsed dye laser and long-pulse Nd:YAG laser to improve skin wrinkles. OBJECTIVE: To evaluate the efficacy of these lasers in the treatment of moderate to severe wrinkles. METHODS: Seven subjects had one side of their periorbital wrinkles treated with pulsed dye laser (585 nm, 0.45 ms, 2.5 J/cm2, single-pass 10% overlap, three treatments at 6 weeks apart). The second part of the study involved using the long-pulse Nd:YAG laser (532 nm, 2 ms, 7.0 J/cm2 with cooling, three laser passes, three treatments at 6 weeks apart) to treat the contralateral wrinkles in five subjects. Pretreatment and posttreatment photographs were taken, and blinded assessors were asked to choose the better of the two unlabeled photographs. RESULTS: Assessors found that two of the seven subjects had a better posttreatment photograph in the pulsed dye laser-treated group. Three of five subjects had a better posttreatment photograph in the long-pulse Nd:YAG laser-treated group. None of the subjects reported any subjective improvements. CONCLUSION: Neither the pulsed dye laser nor the long-pulse Nd:YAG laser at the previously mentioned parameters produced any improvement in moderate to severe facial wrinkles.     

Effect of N-Acetyl-Cysteine (NAC) Added to Fenoldopam or Dopamine on End-Tidal Carbon Dioxide and Mean Arterial Pressure at Time of Renal Artery Declamping During Cadaveric Kidney Transplantation

N-Acetyl-cysteine (NAC) is known to be a powerful antioxidant used to prevent renal damage. Our deceased-donor kidney transplantation protocol administered an NAC bolus at the time of declamping of the renal artery to reduce the potential oxidative damage with ischemia-reperfusion. The aim of injury this study was to compare the effects of NAC added to a continuous infusion of either fenoldopam or dopamine during kidney recipient anesthesia on mean arterial pressure (MAP) and end-tidal carbon dioxide (ECO₂), which were assumed to be expressions of oxidative and acid-base status. One hundred forty patients undergoing deceased donor kidney transplantation were enrolled in the study. Using a standardized perioperative anesthesia protocol, the patients were divided into 4 groups: group N, receiving an NAC (50 mg/kg) bolus just before renal artery declamping (n = 40); group C, not receiving any NAC or other infusion (n = 20); group NF, same treatment as group N plus fenoldopam (0.1 μg/kg/min) continuous infusion (n = 40); and group ND, same treatment as group N plus dopamine (3 μg/kg/min) continuous infusion (n = 40). We recorded the duration of kidney cold and warm ischemia and EtCO₂ and MAP values before and after arterial declamping, as well as subjective evaluations of graft perfusion and the incidence of early or delayed graft function and adverse events. EtCO₂ was higher and MAP lower in group C compared with group N; comparing groups N, ND, and NF, the NF regimen resulted in lower EtCO₂ and higher MAP values and a greater incidence of early graft function. Subjective evaluation of graft perfusion was more favorable for groups N, ND, and NC, particularly for NF. No significant periprocedural adverse events were recorded in the groups. In our experience, the association of an NAC bolus at the time of renal artery declamping and continuous infusion of fenoldopam resulted in a minor, though non-significant, increase in EtCO₂ values, higher MAP, and greater incidence of early graft function during deceased-donor kidney transplantation compared with no NAC or NAC plus renal-dose dopamine. Further studies are necessary to better define the potential role of oxidative damage in renal ischemia- reperfusion injury, including implications for outcome, as well as the potential role of the combination of NAC plus fenoldopam as a nephroprotective and outcome-modulating regimen.     

Treatment of Small Congenital Nevocellular Naevi Using a Combination of Ultrapulse Carbon Dioxide Laser and Q-Switched Frequency-Doubled Nd-YAG Laser

This report describes treatment combining Ultrapulse CO₂ laser and Q-switched frequency-doubled neodymium:yttrium-aluminum-garnet (Nd-YAG) laser for a number of congenital nevocellular naevi (CNN). The Ultrapulse CO₂ laser removes the superficial component, which contains most of the color, preserving the integrity of the reticular dermis. At a later stage, any residual color is targeted using the Nd-YAG laser. To date, a total of 10 histologically proven CNNs have been treated at the Laser Suite. The median age of the patients was 18 years (range, 13–24 years). All the patients were white females. The patients accepted for treatment had relatively small lesions (mean surface area, 352 mm²; range, 50–1,092 mm²), but the lesions were either cosmetically sensitive or located in an anatomically critical area in which excision could result in a scar that would be unpredictable. The median follow-up period was 24 months. The overall results have been satisfactory, with reduction of color and no significant scarring. The minor textural and pigmentary changes were acceptable to the patients.     

Treatment of Multiple Facial Syringomas with the Carbon Dioxide (CO2) Laser

BACKGROUND: Syringomas are benign tumors of eccrine origin most commonly found in the periorbital area. Previously reported treatments for syringomas include excision, electrodesiccation and curettage, dermabrasion, and carbon dioxide (CO2) laser resurfacing. The ideal treatment of syringomas should be destruction of the tumor with minimal scarring and no recurrence. OBJECTIVE: The objective is to present a treatment method for multiple syringomas without scarring or recurrence. METHOD: Ten patients with multiple periorbital syringomas were treated with a high energy, scanned carbon dioxide laser. Settings of 5 watts, 0.2 second scan time, and 3mm spot size were used. Two passes were performed, but some lesions required four passes. In some cases the entire lower periorbital area was treated. Results were evaluated clinically by both physicians and patients over a span of 1 to 24 months. RESULTS: Elimination of the syringomas was successful in all patients. Each patient remains free of recurrence 1 to 24 months after therapy. Prolonged erythema was the most common side effect, but no scarring was seen. Four out of the ten patients required repeat spot treatments. CONCLUSION: The CO2 laser is a dependable, safe, and nonscarring method for the treatment of periorbital syringomas.     

Tibia Vara (Osteochondrosis Deformans Tibiae or Blount's Disease): Treatment and Follow-up Examination

The collagen metabolism of callus tissue from closed, non-immobilized rat femoral fractures was studied in vitro after in vivo treatment with indomethacin 2 mg/kg/day for 6, 9 and 12 days after fracture. Total hydroxyproline synthesis and incorporation of hydroxyproline into collagen were found to be significantly increased after indomethacin treatment, whereas no significant difference was found regarding collagen resorption. The results Surggest that the recently demonstrated inhibition of fracture healing by indomethacin is not brought about by an inhibition of collagen synthesis.     

Treatment of Facial Skin Using Combinations of CO2, Q-Switched Alexandrite, Flashlamp-Pumped Pulsed Dye, and Er:YAG Lasers in the Same Treatment Session

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.     

精准脉冲光(DPL)治疗玫瑰痤疮的疗效及安全性分析

目的:探讨玫瑰痤疮采取500nm精准脉冲光(DPL)治疗的疗效及安全性。方法:选择笔者医院2018年12月-2019年6月收治的98例玫瑰痤疮门诊患者为研究对象,随机分为对照组和研究组,每组49例。对照组采取药物治疗,研究组采取500nm DPL治疗。比较两组患者的皮损积分、临床疗效及不良反应。结果:治疗后,对照组的皮损总分显著高于研究组的皮损总分,差异有统计学意义(t=5.004,P<0.05);对照组总有效率83.67%,显著低于研究组的95.92%,差异有统计学意义(χ^2=6.642,P<0.05);对照组不良反应率12.24%,与研究组不良反应率8.16%比较,差异无统计学意义(χ^2=0.909,P>0.05)。结论:500nm DPL治疗玫瑰痤疮,可显著改善患者的皮肤症状,提高临床疗效,且安全性高。     

Long-term Followup of Treatment of Peyronie's Disease with Plaque Incision, Carbon Dioxide Laser Plaque Ablation and Placement of a Deep Dorsal Vein Patch Graft

Numerous surgical therapies have been used for Peyronie's disease in patients who maintain potency. We report on incision and carbon dioxide laser ablation of Peyronie's plaque combined with a deep dorsal vein patch graft in the treatment of 6 men (mean age 57 years). The chief indication for surgery was curvature interfering with intromission, with voiding difficulty being a secondary indication as well. Long-term followup (mean 31 months) was available in 6 men, each of whom was potent preoperatively. Potency was preserved in all men, and 5 described significant improvement in penetration and curvature. In 1 patient the curvature returned to preoperative levels. Each patient reported a subjective shortening of the penis from one-quarter to 1 inch but no case was functionally debilitating. We describe this technique, which to our knowledge has been reported previously by only 1 group with 18 patients, and conclude that it may be used with successful preservation of potency and restoration of intercourse in the treatment of Peyronie's plaques.     

Comparison of the 595 nm Long-Pulse (1.5 msec) and Ultralong-Pulse (4 msec) Lasers in the Treatment of Leg Veins

BACKGROUND: Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates. OBJECTIVE: This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins. METHODS: For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals. RESULTS: Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted. CONCLUSION: Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.     

Cultural adaptation and validation of the Filipino version of Kidney Disease Quality of Life – Short Form (KDQOL-SF version 1.3)

Aim: Chronic kidney disease is the 10th leading cause of death among Filipinos. Those with chronic kidney disease are exposed to stressors which effect their daily lives. Therefore, assessment of health‐related quality of life is important in these patients. The objective of the present study was to translate the Kidney Disease Quality of Life – Short Form version 1.3 (KDQOL‐SF ver. 1.3) into Filipino and measure its validity and reliability. Methods: Translation and cultural adaptation began with two translations into Filipino, with reconciliation of the forward translators. Pretesting with 10 renal patients, review by experts (nephrologist, translator and dialysis nurse) and back‐translation was also done. The final questionnaire was administered to 80 patients with chronic renal disease undergoing haemodialysis for at least 3 months, who could understand Filipino, and were without life‐threatening or terminal conditions at the time of the test. A convenience sample of 30 patients from the group had a repeat test 10–14 days after to determine test–retest reliability. Test–retest reliability was assessed by intraclass correlation coefficient and internal consistency reliability was measured by determining the Cronbach's α value. Validity was measured using Pearson's correlation between the overall health rating scale and the items from the questionnaire. Results: All of the items showed good test–retest reliability (intraclass correlation coefficient >0.40), ranging from 0.58 (social interaction) to 0.98 (role – emotional). Internal consistency reliability values were acceptable, with Cronbach's α ranging from 0.60 (cognitive function) to 0.80 (physical functioning and role – physical). Regarding construct validity, overall health rating in kidney disease‐targeted scales was significantly correlated with symptoms/problems, effects of kidney disease and burden of kidney disease. All items in the SF 36 scales had significant correlation with overall health rating (P < 0.05) except for role – emotional. Conclusion: The Filipino version of the Kidney Disease Quality of Life – Short Form can be used to evaluate the health‐related quality of life of Filipinos with chronic renal disease on haemodialysis.     

Control of Carbon Dioxide in Modified Mapleson A and D (Hafnia) Anaesthetic Systems. An Experimental Model

The effects of varying ventilations (V_e) and fresh gas flows (FGF) on end-expiratory CO₂ (F eco ₂) levels were investigated in an experimental model lung, employing the Hafnia modification of the Mapleson A and D anaesthetic systems during CO₂-absorption and CO₂-wash-out (rebreathing). Identical results were found in both systems: F eco ₂ was constant and independent of FGF with CO₂-absorption and constant V_e, whereas rebreathing resulted in increasing F eco ₂ levels as FGF was decreased. As control of F eco ₂ in the rebreathing systems by regulating FGF could only take place within F eco ₂ levels higher than that determined by V_e at complete CO₂-absorption, e. g. for the Hafnia A and D rebreathing systems, control of FGF necessitates relative hyperventilation. F eco ₂ with constant FGF decreased with increasing V_e during CO₂-absorption, as well as during rebreathing, although this decrease was less in the rebreathing systems. Thus a decrease in F eco ₂ with rising V_e can be avoided and hypocapnia prevented. The results agree with those obtained in clinical studies.     

腹膜后血管滤泡增生症的诊断治疗(附3例报道)

目的 探讨腹膜后血管滤泡增生症的临床特点及诊治方法。方法 对我院收治的3例病例并结合相关文献做一回顾性分析。结果 该疾病主要临床表现为腹部包块、贫血等症状，均经手术治疗。术中见包块直径为7～18cm。2例手术完整切除全块，其中1例病理检查为透明血管型，随访至今(7个月)健在，无复发；另1例为浆细胞型，随访2年后失访。余1例仅行剖腹探查术，取部分组织作病理检查，病理报告为浆细胞型，术后8个月死亡。结论 本病缺乏特异性的临床表现和影像特点，术前难以诊断，确诊须依靠病理检查。手术完整切除肿瘤是治疗本病的最佳方法。