Intense Pulsed Light Treatment of 1,000 Consecutive Patients with Facial Vascular Marks

Background: Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. Methods: Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1–9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. Results: Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. Conclusion: The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.     

Surgical complications do not affect longterm survival after esophagectomy for carcinoma of the thoracic esophagus and cardia

BACKGROUND: Surgical resection is the only real chance of cure for carcinoma of the esophagus and esophagogastric junction, although it carries considerable postoperative morbidity and mortality. The longterm prognosis for patients undergoing operation depends largely on the pathologic stage of the disease. The real impact of postoperative complications on survival is still under evaluation. STUDY DESIGN: A retrospective analysis was performed on patients with squamous cell carcinoma and adenocarcinoma of the thoracic esophagus and esophagogastric junction, undergoing surgical resection between January 1992 and December 2002. For the 522 patients considered for esophagogastroplasty, we analyzed comorbidities, preoperative staging, neoadjuvant treatments, surgical data, histopathology, postoperative surgical or medical complications, and survival. RESULTS: Surgical complications occurred in 85 of 522 patients (16.3%); their survival rate was entirely similar to that of the group of patients without surgical complications (p=0.9). The survival rate was worse for patients with concurrent surgical and medical complications. Analysis of the 99 patients (19%) who had only medical complications postoperatively revealed a survival rate comparable (p=0.9) with that of the 338 patients (63.7%) with an uneventful postoperative course. The median postoperative hospital stay was 14 days for all 522 patients, and 18 days for patients with medical or surgical postoperative complications. Multivariate analysis of the predictive factors showed that surgical complications do not affect longterm prognosis. CONCLUSIONS: Surgical complications have no negative impact on survival rates, which seem to depend exclusively on the pathologic stage of the tumor.     

Impact of new lymph node staging on lymphadenectomy and on the prognosis of patients undergoing surgery for gastric cancer

The TNM system has become the principal method for assessing the extent of disease, determining prognosis in gastric cancer patients, and influencing therapeutic strategies. The extent of lymph node metastases is the most important prognostic factor. The aim of the study was to compare the 4th and 6th TNM edition N-classifications and to retrospectively evaluate the prognostic value of the 2002 TNM edition. We evaluated 344 patients who underwent curative total or subtotal gastrectomy. Our data confirm the simplicity and easy application of the new staging and the better prognostic stratification of the N-stage. In multivariate analysis the difference between the old and new TNM staging is minimal. We therefore suggest comparing lymph node location and number in larger series. For the purposes of correct N-staging, 10 lymph nodes in early gastric cancer and at least 16 in the other pT stages seem sufficient to achieve effective pNO staging.     

Prenatal ultrasound diagnosis of cloacal exstrophy associated with myelocystocele complex by the 'elephant trunk-like' image and review of the literature

A case of cloacal exstrophy (CE) was detected by ultrasound as early as 22 weeks of gestation in association with myelocystocele complex, an unusual form of occult spinal dysraphism often associated with such a disease. The ultrasonographic diagnosis was made through the detection of a wavy cord-like segment of soft tissue protruding from the anterior abdominal wall, just below the umbilical cord insertion, strongly resembling the trunk of an elephant. Our article enforces the suggestion that the ultrasound elephant trunk-like image should be added to the existing major criteria for making prenatal diagnosis of CE.     

Rapid identification of Enterobacteriaceae with microbial enzyme activity profiles.

A total of 539 clinical isolates belonging to 10 species of the Enterobacteriaceae family were identified by enzyme activity profiles within 30 min of test inoculation. Each isolate was grown at 37 degrees C for 18 h on Mueller-Hinton agar and suspended to an optical density of 200 Klett units on 0.85% saline. Enzyme activity profiles were obtained by inoculating 18 fluorogenic substrates with the standardized bacterial suspension and monitoring initial rates of hydrolysis over the first 30 min of analysis. Individual enzyme activity profiles were entered into a coded data bank, and identifications were based on the Bayesian theory of probabilities. At a confidence level of 95%, five species were identified with a greater than 90% efficiency, three species were identified between 83 and 88% efficiency, and two species demonstrated a 72 and 75% efficiency of identification. The enzyme activity profile method of bacterial identification is rapid, easily automated, and reproducible.     

Association of Adams-Oliver syndrome with pulmonary arterio-venous malformation in the same family: a further support to the vascular hypothesis

Adams-Oliver syndrome (AOS) is a rare disease characterized by congenital scalp defects, terminal transverse limb defects and cutis marmorata telangiectatica. A significant incidence of cardiac and vascular malformations has been reported, leading to the hypothesis of a vascular defect early involved in the pathogenesis. We report two members of the same family with previously diagnosed AOS based on clinical phenotype and later recognized to have pulmonary arterio-venous malformation (PAVM). None of the subjects fulfilled current diagnostic criteria of hereditary hemorrhagic telangiectasia, which is the most common cause of PAVM. The occurrence of PAVM in AOS lends support to the hypothesis that endothelial specific abnormalities could be a patho-physiological mechanism in its development. Therefore, the role of screening for PAVM in clinical management of subjects with AOS should deserve further studies.