Narrowband UVB therapy for vitiligo: does the repigmentation last?

BACKGROUND: Since 1997, a number of trials have shown promising results in treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults and children. However, there is little knowledge concerning the duration and permanency of the treatment-induced repigmentation. OBJECTIVE: Our main objective was to perform a follow-up trial of successfully treated patients receiving narrowband UVB for generalized vitiligo. METHODS: We have investigated to what degree the treatment-induced repigmentation remains stable for up to 2 years post-treatment. We performed an initial open trial including 31 patients with generalized vitiligo. They received narrowband UVB thrice weekly for up to 12 months. Patients experiencing > 75% repigmentation were defined responders and were included in the follow-up trial. Responders were followed every 6 months for up to 2 years after cessation of treatment. We observed the pigmentation status and registered any changes indicating loss of pigmentation and relapse. RESULTS: Eleven of the 31 treated patients were included in the follow-up trial. Six patients had relapse and five patients had stable response 24 months after cessation of treatment. Four out of six relapses were within 6 months post-treatment. CONCLUSION: In our study population of 31 patients with generalized vitiligo, five patients (16%) experienced > 75% stable repigmentation 2 years after cessation of a treatment programme of up to 1 years narrowband UVB therapy.     

Cryoscopy: a novel enhancing method of in vivo skin imaging

BACKGROUND: It is a common observation that superficial freezing of normal skin and skin tumors may create a transient superficial whitening effect. In this respect, cryoscopy refers to the direct observation by dermoscopy, with or without digital recording, of the visual alterations of the frozen tissues. AIMS: To define the optimal method of cryoscopy and to describe the cryoscopy patterns of normal skin and selected skin lesions. MATERIALS AND METHODS: The influence of (a) different cryogenic sources [solid carbon dioxide (-78.5 degrees C), liquid nitrogen (N(2), -196 degrees C), and a mixture of dimethyl ether and propane (-57 degrees C)], (b) various application methods (spraying, cotton chill tips, copper plate), and (c) freezing time was assessed with regard to clinical feasability, visualization quality, and persistance time of the whitening effect. Cryoscopy patterns of normal skin, callosities and of histologically proven seborrheic keratoses, verrucous hamartomas, molluscum contagiosum, keratoacanthomas, viral warts, condylomas, actinic keratoses, dermatofibromas, skin tags, basal cell carcinomas, angiomas, and melanocytic naevi were assessed. RESULTS: The cryoscopy images of skin highlighted the skin lines. They appeared similar regardless of the freezing source and the application method. The aspects differed according to the nature of the lesions. The cotton chill tip method provided a longer whitening period compared with the other cold sources, both in normal and lesional skin. Hence, it represented the most convenient way for performing digital recording cryoscopy. On normal skin, cryoapplication was limited to about 1.5 s due to pain, resulting in whitening times ranging from 6 to 9 s, which was too short for easy digital recording. On all studied skin tumors, a 10-s N(2) freezing time was not experienced as painful, and blanching time persisted for 20-34 s, allowing easy digital recording. The whitening time was longer with increasing freezing time on both normal and lesional skin. Every single examined normal skin site and all the skin lesions showed a strong whitening effect, except heavily cornified structures, including some keratoses, callosities, and viral warts. Increased contrast of the skin surface texture was observed in almost every studied lesion. CONCLUSION: The N(2) cotton chill tip technique appeared to be the most convenient technique for cryoscopy and provided longer whitening periods compared with the other freezing sources. Pain prevented its use on normal skin, but a series of exophytic skin lesions was conveniently accessible to cryoscopy. The differences in whitening periods of various epidermal components resulted in increased visual contrast, creating typical cryoscopy images for the different exophytic skin tumors. Cryoscopy represents a novel in vivo skin imaging technique that is rapid, non-invasive, cost-effective, and easily performed. It shows both investigative and diagnostic potentials. It is remarkable that cryoscopy pictures closely resemble those yielded by skin capacitance imaging.     

Ongoing pregnancies after intracytoplasmic injection using cryopreserved testicular spermatozoa

We report two clinical pregnancies occurring after intracytoplasmic sperm injection (ICSI) using cryopreserved spermatozoa obtained from testicular biopsy, made in two different infertility situations in our clinic. The first patient showed a secretory azoospermia associated with elevated serum follicular stimulating hormone (FSH) level and spermiogenesis maturation arrest. The second patient was affected by azoospermia resulting from bilateral epididymal obstruction. Spermatozoa present in the wet preparation of testicular biopsy made on the day of scrotal exploration were cryopreserved within the testicular tissue for both men. Intracytoplasmic injections were performed at a later date, using spermatozoa prepared from frozen-thawed tissues. In each case, three embryos were obtained and transferred in utero. The transfers resulted in a twin pregnancy for the first case, and in a singleton pregnancy for the second. Living foetuses were seen in the ultrasound scan at the 7th week and both pregnancies are proceeding to date beyond 30 weeks without complications.      

Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.