Publication date: Available online 12 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): C. Pindado-Ortega, D. Saceda-Corralo, D. Buendía-Castaño, P. Fernández-González, Ó.M. Moreno-Arrones, P. Fonda-Pascual, A. Alegre-Sánchez, A.R. Rodrigues-Barata, S. Vañó-Galván
IntroducciónA pesar de que los únicos fármacos con indicación aprobada en nuestro país para la alopecia androgénica (AGA) son minoxidil tópico y finasterida oral, es común la utilización de numerosas terapias fuera de indicación, provocando una gran variabilidad en el manejo de estos pacientes. El objetivo principal de este trabajo fue describir los hábitos de prescripción de los dermatólogos en España en AGA masculina (MAGA) y AGA femenina (FAGA).Material y métodosEstudio descriptivo transversal mediante cuestionarios digitales autocumplimentados por dermatólogos que ejercen en territorio español.ResultadosSe incluyeron las respuestas de un total de 241 dermatólogos. En MAGA los tratamientos más utilizados fueron en este orden: minoxidil tópico (98%), finasterida oral (96%), nutricosméticos (44%), finasterida tópica (37%), dutasterida oral (33%), plasma rico en plaquetas (14%) y láser de baja potencia (8%). En FAGA premenopáusica: minoxidil tópico (98%), anticonceptivos orales (81%), nutricosméticos (72%), acetato de ciproterona (58%), finasterida oral (39%), finasterida tópica (39%), espironolactona (27%), plasma rico en plaquetas (20%), dutasterida oral (20%), flutamida oral (18%) y láser de baja potencia (7%). En FAGA posmenopáusica: minoxidil tópico (98%), finasterida oral (84%), nutricosméticos (68%), finasterida tópica (50%), dutasterida oral (35%), plasma rico en plaquetas (21%), espironolactona (16%), acetato de ciproterona (16%), flutamida oral (9%) y láser de baja potencia (9%). Como limitaciones de nuestro estudio, no se incluyeron terapias novedosas para AGA como minoxidil oral o microinyecciones de dutasterida.ConclusionesLos agentes terapéuticos más utilizados en MAGA y FAGA posmenopáusica por los dermatólogos en España fueron minoxidil tópico, finasterida oral y nutricosméticos, mientras que en FAGA premenopáusica fueron minoxidil tópico, anticonceptivos orales y nutricosméticos.BackgroundTopical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA).Material and methodsDescriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain.ResultsThe responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%).A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy.ConclusionsThe most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.
Σάββατο 14 Απριλίου 2018
Estudio transversal acerca de los hábitos de prescripción en alopecia androgénica de los dermatólogos en España en 2017
Utilidad de la ecografía en el diagnóstico diferencial de un nódulo doloroso en el tórax
Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Morgado-Carrasco, S. Gómez, L. Alós, P. Giavedoni
Teledermatología urbana: concepto, ventajas y desventajas
Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): G. Romero-Aguilera, L. Ferrandiz, D. Moreno-Ramírez
Disección ganglionar en el paciente con melanoma y metástasis en el ganglio centinela: propuesta de decisión basada en la evidencia actual
Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Moreno-Ramírez, A. Boada, L. Ferrándiz, E. Samaniego, G. Carretero, E. Nagore, P. Redondo, P. Ortiz-Romero, J. Malvehy, R. Botella-Estrada
La reciente publicación de los resultados de ensayos clínicos en los que la disección ganglionar no ha demostrado beneficio de supervivencia en pacientes con metástasis en el ganglio centinela plantea la necesidad de modificar el tratamiento del paciente con melanoma. El presente trabajo aporta una actualización de la evidencia sobre diferentes aspectos necesarios (vías de progresión metastásica, factores predictores, tratamiento adyuvante, etc.) para la toma de decisiones en el paciente con melanoma y metástasis en el ganglio centinela y plantea un algoritmo de toma de decisiones para este escenario clínico. La evidencia actualmente disponible respalda el abandono de la disección ganglionar en aquellos pacientes con metástasis de bajo riesgo en el ganglio centinela (carga tumoral en el ganglio centinela inferior o igual a 1mm).Recent publication of the results of clinical trials in which lymph node dissection was not associated with any survival benefit in patients with sentinel node metastasis makes it necessary to reconsider the treatment of patients with melanoma. This article provides an update on the available evidence on the diverse factors (routes of metastatic spread, predictors, adjuvant therapy, etc.) that must be considered when treating patients with sentinel node-positive melanoma. The authors propose a decision-making algorithm for use in this clinical setting. The current evidence no longer supports lymph node dissection in patients with low-risk sentinel node metastasis (sentinel node tumor load ≤1mm).
Pelillos a la mar
Publication date: Available online 12 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): S. Sánchez-Pérez, C. Torres-Sánchez, V. Alonso-Usero
Erupción dermatomiositis-like en una paciente tratada con hidroxiurea
Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): E. Moreno-Artero, J.J. Paricio, J. Antoñanzas, A. España
FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares
Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): A. Alegre-Sánchez, P. Boixeda
Regresión completa espontánea del tumor primario en el carcinoma de células de Merkel
Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J. Marcoval, F. Valentí-Medina, R.M. Penín, J. Bermejo
Aplicación del colgajo de keystone en dermatología. Experiencia clínica en 18 pacientes
Publication date: Available online 4 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): R. Aragón-Miguel, M. Gutiérrez-Pascual, A. Sánchez-Gilo, J. Sanz-Bueno, F.J. Vicente-Martin
Introducción y objetivosEl colgajo de keystone es un colgajo fasciocutáneo cuya vascularización proviene de las arteriolas perforantes musculares. Su aplicación en dermatología es para cubrir defectos en zonas de piel poco distensible (miembros inferiores, superiores y de la espalda). Presentamos nuestra experiencia clínica y los resultados quirúrgicos del centro.Material y métodosEstudio descriptivo retrospectivo de pacientes con tumores cutáneos malignos en miembros inferiores en los que se realizó el colgajo de keystone.ResultadosSe operaron 18 pacientes con una edad media de 77,83 años. Se realizaron 17 mediante la técnica propuesta por Behan y uno con la técnica modificada de Moncrieff. El 38,8% de los tumores extirpados fueron carcinomas basocelulares, el 33,3% carcinomas epidermoides y el 27,7% tumores malignos pigmentados. El 72,22% presentaba algún factor de riesgo cardiovascular. Se observó un 38,8% de complicaciones menores y ningún caso de necrosis parcial o total del colgajo.ConclusionesConsideramos que el colgajo de keystone es una buena alternativa terapéutica a otros colgajos e injertos para la reconstrucción de defectos en miembros inferiores. Los resultados estéticos y funcionales son buenos, con una tasa de éxito elevada.Introduction and objectivesThe keystone flap is a fasciocutaneous flap supplied by perforating arteries. It is used in dermatology to repair surgical defects in areas with low skin extensibility (the upper and lower limbs and the back). We review the clinical experience gained with keystone flap reconstruction at our hospital and report on the surgical outcomes.Material and methodsDescriptive retrospective study of patients with malignant skin tumors on the lower limbs who underwent keystone flap reconstruction.ResultsEighteen patients (mean age, 77.83 years) underwent keystone flap reconstruction using the Behan technique in 17 cases and the modified Moncrieff technique in one. Basal cell carcinomas accounted for 38.8% of the tumors excised, squamous cell carcinomas 33.3%, and malignant pigmented tumors 27.7%. Cardiovascular risk factors were observed in 72.2% of patients. Minor complications occurred in 38.8% of patients, and there were no cases of partial or total flap necrosis.ConclusionsWe consider the keystone flap to be a good alternative to other flaps and grafts for the surgical reconstruction of lower limb defects. The success rate was high, and the cosmetic and functional outcomes were good.
Graphical abstract
Tratamiento de úlcera venosa refractaria mediante la «interrupción terminal de la fuente de reflujo»
Publication date: Available online 4 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): M. Mendieta-Eckert, J.L. Azpiazu-Macho, N. Landa-Gundin
FR- Riesgo de cáncer cutáneo no melanoma en pacientes hemodializados
Publication date: Available online 3 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): P. Aguayo Carreras, J. Tercedor Sánchez, R. Ruiz Villaverde
Lesión solitaria en el lateral del segundo dedo de la mano
Publication date: Available online 3 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): F.J. García-Martínez, I. López-Martín
Proyección internacional de Actas Dermo-Sifiliográficas
Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): S. Arias-Santiago, Y. Gilaberte
Solitary Filiform Papule in the Left Nasal Vestibule
Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): S. Lopes, T. Baudrier, F. Azevedo
Síndrome de Gorlin
Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): I. Palacios-Álvarez, R. González-Sarmiento, E. Fernández-López
El síndrome de Gorlin es una enfermedad infrecuente de herencia autosómica dominante producida por mutaciones en genes de la vía de señalización Sonic Hedgehog, entre los que destaca PTCH1. Se caracteriza por el desarrollo de múltiples carcinomas basocelulares en edades tempranas, que pueden ir asociados a otras manifestaciones cutáneas como pits palmoplantares, o a manifestaciones extracutáneas, entre las que destacan los queratoquistes odontogénicos y el meduloblastoma. El papel del dermatólogo es importante en la sospecha de este síndrome, pero suele ser necesario un equipo multidisciplinar en el diagnóstico, seguimiento y en el tratamiento de estos pacientes. El tratamiento dermatológico puede ser complicado debido al alto número de carcinomas basocelulares y a su extensión. En los últimos años se han desarrollado nuevos fármacos que inhiben la vía Sonic Hedgehog y parecen prometedores para estos pacientes, aunque su eficacia está limitada por los efectos secundarios y la creación de resistencias.Gorlin syndrome is a rare autosomal dominant disease caused by mutations in the sonic hedgehog signaling pathway. Of particular importance is the PTCH1 gene. The disease is characterized by the development of multiple basal cell carcinomas at young ages. These tumors may present with other skin manifestations such as palmoplantar pits and with extracutaneous manifestations such as odontogenic keratocysts and medulloblastoma. Although the dermatologist may be key for recognizing clinical suspicion of the syndrome, a multidisciplinary team is usually necessary for diagnosis, treatment, and follow-up. Skin treatment may be complicated due to the large number of basal cell carcinomas and the extent of involvement. In recent years, new drugs that inhibit targets in the sonic hedgehog pathway have been developed. Although these agents appear promising options for patients with Gorlin syndrome, their efficacy is limited by adverse effects and the development of resistance.
Graphical abstract
Programme scientifique du 31e Congrès de l’ADF
Source:Annales de Dermatologie et de Vénéréologie
Traitement des toxidermies graves
Publication date: Available online 13 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Ingen-Housz-Oro, T.-A. Duong, N. de Prost, A. Colin, L. Fardet, B. Lebrun-Vignes, A. Barbaud, O. Chosidow, P. Wolkenstein
Localisation cutanée de la maladie de Rosai Dorfmann
Publication date: Available online 11 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Doghri, Y. Houcine, M. Driss, R. Sellami, L. Charfi, K. Mrad
A mechanistic approach to explore the neuroprotective potential of zonisamide in seizures
Abstract
Background
Epilepsy, a disease of the brain, is one of the most common serious neurological conditions. It is associated with a group of processes which alter energy metabolism, interrupt cellular ionic homeostasis, cause receptor dysfunction, activate inflammatory cascade, alter neurotransmitter uptake and result in neuronal damage. The increasing knowledge and understanding about the basis of neuronal changes in epilepsy lead to investigate the mechanistic pathway of neuroprotective agents in epilepsy. With this background, the present study is designed to reveal the molecular and biochemical mechanisms involved in the neuroprotective potential of zonisamide in epilepsy.
Methods
Seizure-induced neuronal damage was produced by maximal electroshock seizures in animals. The oxidative stress and neuroinflammatory and apoptotic markers were assessed in the brain tissue of animals.
Results and discussion
The present findings revealed that zonisamide treatment prevented the development of seizures in animals. Seizures-induced free radicals production and neuroinflammation were markedly ameliorated by zonisamide administration. In conclusion, the present study demonstrated the mechanisms behind the strong neuroprotective potential of zonisamide against seizures by attenuating the oxidative stress, inflammatory cascade and neuronal death associated with progression of seizures. It can be further developed as a neuroprotective agent for epilepsy and other neurodegenerative disorders.
Curcumin ameliorates palmitate-induced inflammation in skeletal muscle cells by regulating JNK/NF-kB pathway and ROS production
Abstract
Curcumin, a natural polyphenol compound, has the beneficial effects on several diseases such as metabolic syndrome, cancer, and diabetes. The anti-inflammatory property of curcumin has been demonstrated in different cells; however, its role in prevention of palmitate-induced inflammation in skeletal muscle C2C12 cells is not known. In this study, we examined the effect of curcumin on the inflammatory responses stimulated by palmitate in C2C2 cells. The results showed that palmitate upregulated the mRNA expression and protein release of IL-6 and TNF-α cytokines in C2C12 cells, while pretreatment with curcumin was able to attenuate the effect of palmitate on inflammatory cytokines. The anti-inflammatory effect of curcumin was associated with the repression of phosphorylation of IKKα-IKKβ, and JNK. Palmitate also caused an increase in reactive oxygen species (ROS) level that curcumin abrogated it. Collectively, these findings suggest that curcumin may represent a promising therapy for prevention of inflammation in skeletal muscle cells.
Probiotic mixture of Lactobacillus and Bifidobacterium alleviates systemic adiposity and inflammation in non-alcoholic fatty liver disease rats through Gpr109a and the commensal metabolite butyrate
Abstract
Aims
The study explored the systemic adiposity and inflammation through Gpr109a and the commensal metabolite butyrate during the treatment of non-alcoholic fatty liver disease rats with the probiotic mixture of Lactobacillus and Bifidobacterium for 16 weeks.
Methods
Fifteen male SD rats were randomly divided into three groups of five rats each: normal control group (basal feed), high-fat diet (HFD) feeding group (83% basal feed + 10% lard oil + 5% sucrose + 1.5% cholesterol + 0.5% cholate), and probiotic mixture intervention group (HFD + 0.6 g kg−1 day−1 probiotic mixture). Body composition, serum lipids, serum inflammatory markers, Gpr109a, and the commensal metabolite butyrate were assessed.
Results
Compared with HFD group, probiotic mixture significantly reduced body weight and the levels of serum FFA, TG, ALT, IL-1β, and IL-18 (P < 0.05). The levels of Gpr109a and the commensal metabolite butyrate also changed significantly (P < 0.05).
Conclusions
Probiotic mixture might inhibit systemic adiposity and inflammation through Gpr109a and the commensal metabolite butyrate in response to the insult of HFD.
Brazilian green propolis hydroalcoholic extract reduces colon damages caused by dextran sulfate sodium-induced colitis in mice
Abstract
This study investigated the effects of Brazilian green propolis hydroalcoholic extract (BPE) in 3% w/v dextran sodium sulfate (DSS)-induced colitis in mice. The effects of BPE (3, 30 and 300 mg/kg, p.o, by 7 days) on the morphological (colon length and colon weight), clinical (disease activity index and weight loss), microscopic (histological score and mucin levels) and biochemical parameters were determined. The effects of BPE (300 mg/kg, p.o) in the gastrointestinal transit of mice were also evaluated. As expected, the DSS ingestion damaged the colonic tissue, lowered the body weight, decreased the mucin levels, increased MPO activity, reduced SOD activity and GSH amount. In contrast, the treatment with BPE (300 mg/kg) significantly reduced macroscopic colonic injury and the mucosal damage in colon on histopathological examination and reversed the decrease in mucin levels induced by DSS. It also significantly normalized the SOD activity and the levels of GSH, but did not elicit any effect on MPO activity in the colon. In addition, BPE did not change the gastric emptying or the intestinal transit rate of mice. Together, these results suggested that BPE reduced the signs of DSS-induced colitis in mice through maintenance of intestinal mucin barrier and favoring intestinal antioxidant defenses.
Curcumin–galactomannoside complex inhibits pathogenesis in Ox-LDL-challenged human peripheral blood mononuclear cells
Abstract
Oxidised low-density lipoprotein (ox-LDL) is a pro-atherogenic molecule, which induces inflammatory response and contributes to the pathogenesis of vascular dysfunction to atherosclerosis. The aim of the present study was to explore the anti-inflammatory effect of a novel bioavailable formulation of curcumin as 'curcumagalactomannosides' (CGM) against ox-LDL-induced inflammatory responses in human peripheral blood mononuclear cells (hPBMCs). Curcumagalactomannosides was made from natural curcumin using the soluble dietary fibre (galactomannans) derived from fenugreek seeds (Trigonella foenumgracum) and the hPBMCs were isolated from healthy human volunteers. The cells were cultured in collagen-coated plates at 37 °C and grouped as Group I (Control), Group II (ox-LDL treated) and Group III (ox-LDL + CGM treated). Further analysis of inflammatory markers, reactive oxygen species and mRNA expression levels indicated significantly increased expressions of iNOS, TNF-α, IL-6 and VCAM-1 in ox-LDL-treated group along with the nuclear translocation of NF-κB. Other inflammatory markers such as LOX, PGE2, total COX and lipid peroxidation level were also found to be significantly (p < 0.05) increased upon ox-LDL treatment. The treatment with CGM on the other hand was found to down-regulate and reverse the ox-LDL-induced alterations indicating its potential anti-inflammatory effect on hPBMCs via. NF-κB signalling pathway.
Inosine improves cognitive function and decreases aging-induced oxidative stress and neuroinflammation in aged female rats
Abstract
In the present study, the effect of inosine was evaluated on learning and memory of 18 months old aged female rats. Inosine (50, 100 and 200 mg/kg; i.p.) was administered to separate groups of rats for 15 successive days. Donepezil (1 mg/kg; i.p.), an acetylcholinesterase inhibitor, was used as a standard drug. Behavioral models such as Morris water maze and elevated plus maze were used to evaluate the effect of drugs on learning and memory of rats. After behavioral studies, animals were killed and their brain was isolated and further processed for estimation of various biochemical parameters such as acetylcholinesterase activity, oxidative stress markers, proinflammatory marker and histological examinations. Inosine (100 and 200 mg/kg) significantly improved learning and memory of aged rats. Further, inosine significantly reduced lipid peroxidation and nitrite, and increased the levels of reduced glutathione and superoxide dismutase. However, no significant difference in AChEs activity was observed in inosine-treated rats as compared to aged control rats. TNF-α level was found to be ameliorated in aged rats by inosine. Histopathological evaluation showed that inosine-treated aged rats have less number of pyknotic neurons in hippocampal CA1 region as compared to aged control rats. In conclusion, inosine significantly improved learning and memory of aged female rats possibly through its antioxidant as well as anti-inflammatory effect and improvement of neuronal survival in the hippocampal CA1 region. However, additional studies are required to further explore the downstream signaling pathways involved in the neuroprotective effect of inosine in aged animals.
Gastrodin microinjection suppresses 6-OHDA-induced motor impairments in parkinsonian rats: insights into oxidative balance and microglial activation in SNc
Abstract
Purpose of the research
In this study, we appraised the effect of pre-treatment with intra-cerebro ventricular (i.c.v) microinjection of gastrodin (Gst) on catalepsy, motor imbalance, substantia nigra pars compacta (SNc) myeloperoxidase (MPO) activity, lipid peroxidation levels, nitric oxide (NO) production and total antioxidant capacity (TAC) in 6-hydroxydopamine (6-OHDA) rats model of PD.
Materials and methods
Male Wistar rats were pre-treated with i.c.v microinjections of Gst (20, 40 and 80 μg/3 μl/rat) for five consecutive days. Then, catalepsy and motor balance were induced by unilateral infusion of 6-OHDA (8 μg/2 μl/rat) into the SNc. The anti-cataleptic and motor balance improving effect of Gst was assessed by the Bar test and Rotarod 3 weeks after neurotoxin injection, respectively. SNc MPO activity and lipid peroxidation levels, NO production and TAC were assessed at the end of behavioral experiments.
Results
Our data demonstrated that Gst pre-treatment significantly (p < 0.001) was prevented motor in-coordination and catalepsy in neurotoxin lesioned rats. The most motor improving effect was seen at 80 μg Gst (p < 0.001). Pre-treatment of parkinsonian rats with Gst meaningfully (p < 0.001) was suppressed MPO activity, lipid peroxidation and NO production. Furthermore, the TAC level in the SNc was increased (p < 0.001) in Gst-microinjected rats about to the normal non-parkinsonian animals.
Major conclusions
In summary, pre-treatment with Gst abolished 6-OHDA-induced catalepsy and improved motor incoordination by decreasing: SNc MPO activity, lipid peroxidation levels and NO production, and restoring SNc levels of TAC to the levels of healthy rats.
Graphical abstract
Flavonoid quercetin–methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of synovial tissues in joints, leading to progressive destruction of cartilage and joints. The disease-modifying anti-rheumatic drugs currently in use have side-effects. Thus, there is an urgent need for safe anti-inflammatory therapies for RA. This study aimed to evaluate the therapeutic effect of the flavonoid quercetin on arthritis in mice immunized with type II collagen (CII). An arthritis model was established in C57/BL6 mice by intradermal administration of chicken CII mixed with Freund's complete adjuvant. Quercetin (30 mg/kg orally) and methotrexate (0.75 mg intraperitoneally twice a week) were administered to investigate their protective effects against collagen-induced arthritis (CIA). Levels of tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, and the matrix metalloproteinases (MMP), 3, and 9 were detected to assess the anti-inflammatory effect of quercetin. The mRNA expression of MMP3, MMP9, CCL2, and TNF-α was also measured by quantitative real-time PCR. Quercetin significantly alleviated joint inflammation by reducing the levels of circulating cytokines and MMPs. There was a significant decrease in the expression of TNFα and MMP genes in the ankle joints of arthritic mice. A significant reduction in the levels of knee-joint inflammatory mediators were observed with combined quercetin and methotrexate treatment. Thus, quercetin has the potential to prevent joint inflammation and could be used as an adjunct therapy for RA patients who have an inadequate response to anti-rheumatic monotherapy.
Läsionale Therapieoptionen beim maligen Melanom
Zusammenfassung
Hintergrund
In den letzten Jahren kam es bezüglich der systemischen Therapie des metastasierten malignen Melanoms durch die Einführung der Immuncheckpointinhibitoren und die Möglichkeit der zielgerichteten Therapie mit BRAF- und MEK-Inhibitoren zu einer revolutionären Entwicklung. Problematisch können allerdings die Nebenwirkungen der Therapien sein, und zudem ist man noch weit davon entfernt, allen Patienten ein Benefit mit diesen Therapien zu bescheren. Viele Melanompatienten entwickeln im metastasierten Stadium kutane, subkutane oder Lymphknotenmetastasen, die einer lokalen oder intraläsionalen Therapie zugänglich sind.
Material und Methode
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Läsionale Therapie beim malignen Melanom".
Ergebnisse und Schlussfolgerung
Auch im Bereich der läsionalen Therapie des metatasierten malignen Melanoms konnten Fortschritte mit neuen Therapiestrategien erreicht werden. Von besonderem Interesse sind hier die oftmals aktuell in klinischen Studien getesteten Kombinationstherapien, die unter Umständen die Möglichkeit der Resistenzüberwindung gegenüber einer Checkpointinhibitor-Monotherapie ermöglichen.
Zervixkarzinom in der Schwangerschaft
Zusammenfassung
Hintergrund
Das Zervixkarzinom stellt in der Schwangerschaft das am häufigsten diagnostizierte gynäkologische Malignom dar. Da eine leitliniengerechte Therapie analog der Behandlung nichtschwangerer Patientinnen in den meisten Fällen nicht mit dem Erhalt einer Schwangerschaft vereinbar wäre, ist nach interdisziplinärer Diskussion des Falls die Erstellung eines individuellen Therapiekonzepts unter Berücksichtigung des Patientenwunsches von zentraler Bedeutung.
Ergebnisse
Prinzipiell wird die Therapie neben dem FIGO-Stadium (FIGO International Federation of Gynecology and Obstetrics) der Erkrankung und dem Nodalstatus maßgeblich von zwei weiteren Faktoren bestimmt: dem Schwangerschaftsalter bei Erstdiagnose sowie dem Wunsch eines Schwangerschafts- bzw. Fertilitätserhalts seitens der Patientin. Während bei klinischem Verdacht auf eine zervikale Neoplasie diagnostische Maßnahmen wie die Kolposkopie und Biopsie auch in der Schwangerschaft jederzeit möglich sind, sollten operative Maßnahmen erst nach Abschluss des 1. Trimenons erfolgen. Zur möglichst präzisen Risikoeinschätzung ist ab Stadium FIGO IB1 eine laparoskopische pelvine Lymphonodektomie empfohlen. Bei höhergradigen FIGO-Stadien kann die Durchführung einer neoadjuvanten Chemotherapie mit einem Cisplatin-haltigen Regime das Fortführen der Schwangerschaft bis zum Erreichen der fetalen Reife ermöglichen.
Schlussfolgerung
Trotz der insgesamt spärlichen Datenlage scheint ein Schwangerschaftserhalt in den meisten Fällen möglich zu sein, ohne signifikant die Prognose der Patientin zu verschlechtern.
Positive und negative Veränderungen im Leben nach der Krebsdiagnose
Zusammenfassung
Fragestellung
Diese Studie ging der Frage nach, welche positiven und negativen Veränderungen von erwachsenen Krebspatienten während der ersten 2 Jahre nach der Diagnose erlebt werden.
Methoden
Patienten wurden zu Beginn des Krankenhausaufenthalts eingeschlossen und kurz vor Entlassung sowie 2 Jahre später nachbefragt. Sie wurden gebeten anzugeben, in welchen Lebensbereichen es bei ihnen negative oder positive Ereignisse gegeben habe und welcher Art diese gewesen seien. Die Antworten wurden wörtlich erfasst und anschließend in Kategorien zusammengefasst. Als mögliche Prädiktoren von Verschlechterungen wurden Alter, Geschlecht und Tumorentität mittels multipler logistischer Regression untersucht.
Ergebnisse
Es nahmen 447 Patienten an der Befragung teil. Sie berichteten positive Ereignisse v. a. in den Bereichen Freunde/Verwandte (66 %), Hobbys, Urlaube, sportliche Aktivitäten (64 %) und Partnerschaft (61 %). Negative Ereignisse bezogen sich besonders häufig auf Sexualität (54 %), Gesundheit (35 %) und die finanzielle Situation (32 %). Über Verschlechterungen der Sexualität klagten v. a. Männer (Odds Ratio [OR] 4,1; 95 %-Konfidenzintervall [95 %-KI] 2,0–8,5; p < 0,01), Patientinnen mit gynäkologischen Tumoren (OR 2,6; 95 %-KI 1,1–6,2; p = 0,04), Patienten mit Prostatakarzinom (OR 8,3; 95 %-KI 3,9–17,7; p < 0,01) und mit anderen urologischen Tumoren (OR 2,3; 95 %-KI 1,1–5,0; p = 0,04). Ältere Patienten gaben seltener Verschlechterungen in der Sexualität (OR 0,5; 95 %-KI 0,3–0,9; p = 0,01) und bei finanziellen Problemen (OR 0,6; 95 %-KI 0,4–0,9; p = 0,01) an. Im Bereich der Gesundheit gab es keine Hinweise auf einen Zusammenhang von Alter, Geschlecht oder Tumorentität mit negativen Ereignissen. Am häufigsten genannt wurden hier Schmerzen, Probleme mit dem Stütz- und Bewegungsapparat, psychische Probleme, eingeschränkte Beweglichkeit, komorbide internistische Erkrankungen und Fatigue.
Schlussfolgerung
In der Nachsorge sollte nicht nur auf gesundheitliche Themen eingegangen werden, sondern auch auf mögliche finanzielle und sexuelle Probleme der Betroffenen.
Strahlenbelastung in der Schwangerschaft
Zusammenfassung
Hintergrund
Eine Strahlenexposition in einer Schwangerschaft ist häufig mit einer starken Verunsicherung der betroffenen Patientin verbunden. Die für das Kind mit der Strahlenexposition verbundenen Risiken sind stark abhängig von der Art der Exposition und der untersuchten Region.
Ziel
Die Risiken der Strahlenexposition einer schwangeren Patientin werden dargestellt und Möglichkeiten des Umgangs mit strahlenexponierten Schwangeren aufgezeigt.
Material und Methoden
Diese Arbeit basiert auf einer selektiven Literaturrecherche und einer Analyse der Berichte und Empfehlungen der International Commission on Radiological Protection, der UN Scientific Committee reports, der deutschen Strahlenschutzkommission und der Deutschen Gesellschaft für Medizinische Physik und Deutschen Röntgengesellschaft.
Ergebnisse und Diskussion
Bei Projektionsaufnahmen sind die bei korrekter Anwendung auftretenden Expositionen und das Risiko für das ungeborene Kind gering. Bei Anwendungen der Computertomographie, der interventionellen Radiographie, der nuklearmedizinischen Diagnostik und Therapie sowie der Strahlentherapie können die Dosiswerte in einigen Fällen mit gewissen Risiken verbunden sein und müssen daher genauer betrachtet werden. Die Risiken werden dargestellt und eine Vorgehensweise zur Bewertung der Strahlenexposition gegeben. Die notwendigen Überlegungen zu einem möglichen Schwangerschaftsabbruch werden diskutiert.
Cicer arietinum extract ameliorate γ-irradiation disorders via modulation of oxidative/antioxidative pathway
Publication date: Available online 14 April 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Amany A. Sayed, Osama A. Abbas, Mona A. Saad, Mohamed-Assem S. Marie
Ionized radiations trigger thoughtful adverse hazards through multiple organ dysfunctions. Recently, antioxidant-based biodrugs are used to prevent and treat ionizing radiation hazards. The present study aimed to investigate the prospective ameliorative effect of Cicer arietinum extract (CAE) against γ-irradiation and the pathway of this amelioration in male albino rats. Twenty four rats were allocated into four groups; (i) control group, (ii) CAE group in which rats treated with a dosage of 500 mg CAE/kg b.wt, (iii) γ-irradiated group in which rats exposed to 6Gy γ-irradiation, (iv) γ-irradiated+CAE group; rats of this group treated with CAE 1 h post exposure. All rats treated for 21 days. Liver, kidney and femoral bone were rapidly excised and homogenized for the biochemical analysis. Energy dispersive X-ray (EDX) and inductively coupled plasma emission spectrometer (ICP) analyses exhibit that γ-irradiation elicits significant change in the essential trace elements content in liver, kidney, and bone. Further, significant increases in TBARS and H2O2 contents accompanied by significant decreases in GSH, SOD, CAT, and GPx activities in liver, kidney and bone tissues were recorded in the γ-irradiated rats compared to control group. Additionally, marked reduction in the thickness of cortical bone was recorded in rats exposed to γ-irradiation. Conversely, CAE (500 mg/kg b.wt, p.o) administration for 21 days to γ-irradiated rats effectively reverses most of the altered parameters of the γ-irradiated rats. In conclusion, the present findings suggested that CAE is a potential agent that can be used against radiation hazards. This effect may be owing to its antioxidant mechanism, as CAE has an inhibitory effect against hydrogen peroxide (H2O2) and superoxide radical (O2·−) beside its ferric reducing antioxidant power (FRAP). This finding recommended that CAE can be utilized clinically to mitigate ionized radiation-induced hazard effects.
Epidemiology of pediatric nickel sensitivity: Retrospective review of North American Contact Dermatitis Group (NACDG) data 1994-2014
Nickel is a common allergen responsible for allergic contact dermatitis.
A comparative study on defluoridation capabilities of biosorbents: isotherm, kinetics, thermodynamics, cost estimation, and eco-toxicological study
Abstract
The present study aims towards fluoride remediation from synthetic water using steam-activated carbon of Aegle marmelos (bael shell/wood apple) (BAC) and Parthenium hysterophorus (PHAC) according to batch sorption techniques. The impact of different parametric conditions viz. initial fluoride concentration (4–12 mg/L), time (0–5 h), temperature (293.15–333.15 K), adsorbent dosage (4–14 g/L), pH (4–9), and RPM (150–350) were considered for both the adsorbents. Maximum defluoridation of 89% was achieved by BAC at a concentration of 10 mg/L, adsorbent dose 6 g/L, pH 5, temperature 313.15 K, agitation speed 250 rpm, and contact time 9 h, whereas PHAC attained maximum removal of 78% at an initial concentration of 8 mg/L, adsorbent dose 10 g/L, pH 4, temperature 313.15 K, and contact time 12 h. Instrumental analysis by SEM, EDX, and FTIR confirmed about the fluoride binding ability of the adsorbents. The Langmuir isotherm model provided the best fit (R2 = 0.9962 and 0.9945) to the removal process with maximum adsorptive uptake of 16.85 and 6.22 mg/g by BAC and PHAC respectively. The adsorption phenomenon was found to obey pseudo-second-order kinetics. The endothermic, spontaneous, and feasible nature of the sorption process was confirmed by the thermodynamic study. The total costs of 1 kg adsorbent preparation were calculated as 1.122 USD and 1.0615 USD which helped us in determining the economic feasibility of the adsorbents in large-scale applications. The growth of Chlorella sorokiniana BTA 9031 was also observed to be affected by the fluoride solution. Comparing the removal efficiencies of both the adsorbents, it can be concluded that BAC shell proved to be an efficient adsorbent over PHAC for fluoride elimination from aqueous solution.
Graphical abstract
Monitoring OH-PCBs in PCB transport worker’s urine as a non-invasive exposure assessment tool
Abstract
In this study, we analyzed hydroxylated polychlorinated biphenyls (OH-PCBs) in urine of both PCB transport workers and PCB researchers. A method to monitor OH-PCB in urine was developed. Urine was solid-phase extracted with 0.1% ammonia/ methanol (v/v) and glucuronic acid/sulfate conjugates and then decomposed using β-glucuronidase/arylsulfatase. After alkaline digestion/derivatization, the concentration of OH-PCBs was determined by HRGC/HRMS-SIM. In the first sampling campaign, the worker's OH-PCB levels increased several fold after the PCB waste transportation work, indicating exposure to PCBs. The concentration of OH-PCBs in PCB transport workers' urine (0.55~11 μg/g creatinine (Cre)) was higher than in PCB researchers' urine (< 0.20 μg/g Cre). However, also a slight increase of OH-PCBs was observed in the researchers doing the air sampling at PCB storage area. In the second sampling, after recommended PCB exposure reduction measures had been enacted, the worker's PCB levels did not increase during handling of PCB equipment. This suggests that applied safety measures improved the situation. Hydroxylated trichlorobiphenyls (OH-TrCBs) were identified as a major homolog of OH-PCBs in urine. Also, hydroxylated tetrachlorobiphenyls (OH-TeCBs) to hydroxylated hexachlorobiphenyls (OH-HxCBs) were detected. For the sum of ten selected major indicators, a strong correlation to total OH-PCBs were found and these can possibly be used as non-invasive biomarkers of PCB exposure in workers managing PCB capacitors and transformer oils. We suggest that monitoring of OH-PCBs in PCB management projects could be considered a non-invasive way to detect exposure. It could also be used as a tool to assess and improve PCB management. This is highly relevant considering the fact that in the next 10 years, approx. 14 million tons of PCB waste need to be managed. Also, the selected populations could be screened to assess whether exposure at work, school, or home has taken place.
NaCl impact on Kosteletzkya pentacarpos seedlings simultaneously exposed to cadmium and zinc toxicities
Abstract
Data regarding NaCl impact on halophyte plant species exposed to a polymetallic contamination remain scarce. Seedlings of the salt marsh species Kosteletzkya pentacarpos were simultaneously exposed to cadmium (10 μM) and zinc (100 μM) in the absence or presence of 50 mM NaCl. Heavy metal exposure reduced plant growth and increased Cd and Zn concentrations in all organs. Cd and Zn accumulation reduced net photosynthesis in relation to stomatal closure, decreased in chlorophyll concentration and alteration in chlorophyll fluorescence-related parameters. Salinity reduced Cd and Zn bioaccumulation and translocation, with a higher impact on Cd than Zn. It mitigated the deleterious impact of heavy metals on photosynthetic parameters. NaCl reduced the heavy metal-induced oxidative stress assessed by malondialdehyde, carbonyl, and H2O2 concentration. Subcellular distribution revealed that Cd mainly accumulated in the cell walls, but NaCl increased it in the cytosol fraction in the leaf and in the metal-rich granule fraction in the roots. It had no impact on Zn subcellular distribution. The additional NaCl contributed to a higher sequestration of Cd on phytochelatins and stimulated glutathione synthesis. The positive impact of NaCl on K. pentacarpos response to polymetallic pollution made this species a promising candidate for revegetation of heavy metal-contaminated salt areas.
Performance of synthesized cast and electrospun PVA/chitosan/ZnO-NH 2 nano-adsorbents in single and simultaneous adsorption of cadmium and nickel ions from wastewater
Abstract
The performance of synthesized cast and electrospun polyvinyl alcohol/chitosan/zinc oxide/aminopropyltriethoxylsilane (PVA/chitosan/ZnO-APTES) nano-adsorbents were compared in removal of Cd(II) and Ni(II) ions from wastewater. The adsorbents were characterized by SEM, BET, FTIR and TGA analyses. Furthermore, the swelling investigations were carried out to study the adsorbent stability in aqueous solution. The effect of several parameters such as contents of ZnO-NH2, contact time, initial Cd(II) and Ni(II) concentration and temperature on the adsorption capacity was investigated in a batch mode. In comparison with cast adsorbent, nanofiber adsorbent indicated the better adsorption performance. The experimental data well fitted the double-exponential kinetic model. In single metal ion system, the maximum adsorption capacity of nanofiber for Cd(II) and Ni(II) ions is estimated to be 1.239 and 0.851 mmol/g, respectively, much higher than qm of cast adsorbent for Cd(II) (0.625 mmol/g) and Ni(II) (0.474 mmol/g) ions. Thermodynamic parameters were investigated to identify the nature of adsorption process. In binary system of Cd(II)-Ni(II) ions, the inhibitory effect of competitive Cd(II) ion on the Ni(II) adsorption was greater than the inhibitory effect of competitive on the Cd(II) adsorption. The selectivity adsorption of both nanofiber and cast adsorbents was in order of Cd(II) > Ni(II).
Distribution, relationship, and risk assessment of toxic heavy metals in walnuts and growth soil
Abstract
Walnut is one of the most popular nuts worldwide and contains various mineral nutrients. Little is known, however, about the relationship between toxic heavy metals in walnuts and growth soil. In this study, we investigated the distribution, relationship, and risk assessment of five toxic heavy metals—lead (Pb), arsenic (As), chromium (Cr), cadmium (Cd), and mercury (Hg)—in walnuts and growth soil in the main production areas of China. The results showed that the main heavy metal pollution in walnut and soil was Pb and Cd. Regionally, positive relationships existed between heavy metals and the pH and organic matter of soil. In addition, we observed a notable uptake effect between walnut and growth soil. In this study, we found a significant correlation (r = 0.786, P < 0.05) between the bioconcentration factors and the longitude of the sampling areas. The risks (total hazard quotients) of five heavy metals toward children and adults by dietary walnut consumption were 46.8 and 56.2%, respectively. The ability to identify toxic heavy metal pollution in walnuts and growth soil could be helpful to screen suitable planting sites to prevent and control heavy metal pollution and improve the quality and safety of walnut.
Le lambeau de grand épiploon : traitement des plaies et lymphorrhees chroniques : à propos d’un cas
Source:Annales de Chirurgie Plastique Esthétique
Author(s): D. Boccara, K. Serror, M. Mimoun, M. Chaouat
IntroductionLes complications cicatricielles post-chirurgie abdominale ou pelvienne sont plus fréquentes chez les patientes obèses. L'infection, les séromes et les retards de cicatrisation occasionnés peuvent dans ce cas être extrêmement difficiles à traiter. L'objectif de cette note technique est de vous présenter un cas original d'une patiente de 48 ans obèse, opérée neuf ans auparavant d'une hystérectomie par laparotomie et présentant de manière chronique une fistule chronique associée à une lymphorrée septique non résolutive malgré de multiples interventions chirurgicales, dont la guérison a pu être obtenue par un lambeau de grand épiploon.Technique chirurgicaleL'idéal est de réaliser cette intervention en double équipe avec un chirurgien digestif en cas de survenue de plaie viscérale ou vasculaire intra-abdominale durant la dissection. Le lambeau de grand épiploon était levé de manière classique sur l'artère gastro-épiploïque droite. Un orifice suffisamment large doit être laissé au niveau de l'aponévrose abdominale afin d'éviter toute compression du pédicule. Enfin, le lambeau doit être étalé sur toute la surface du décollement et fixé à l'aponévrose antérieure.ConclusionLa fiabilité et la richesse à la fois vasculaire et lymphatique font du lambeau de grand épiploon une méthode très efficace dans les cas de plaies chroniques associées à une lymphorrhée majeure. La cicatrisation obtenue dans le cas clinique présenté met ainsi en valeur les qualités spécifiques de ce lambeau.IntroductionCicatricial complications after abdominal or pelvic surgery are more frequent in obese patients. In this case, infection, seroma and delays in scarring can be extremely difficult to treat. The objective of this technical note is to present an original case of an obese patient operated nine years ago of a hysterectomy by laparotomy and chronically presenting a non-resolving septic seroma despite multiple surgical procedures whose healing could be obtained by a flap of greater omentum.Surgical techniqueThe ideal is to carry out this intervention in a double team with a digestive surgeon in case of intra-abdominal visceral or vascular wound during dissection. The greater omentum flap was raised in a conventional manner over the gastroepiploic artery. A sufficiently wide orifice should be left at the level of the abdominal aponeurosis in order to avoid any compression of the pedicle. Finally, the flap must be spread over the whole surface of the detachment and fixed to the anterior aponeurosis.ConclusionReliability and vascular and lymphatic richness make the greater omentum flap a very effective method in chronic wound cases associated with important seroma. The scarring obtained in the clinical case presented thus highlights the specific qualities of this flap.
Editorial Board
Source:Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 1
Les brûlures profondes par agents basiques : évaluation d’une stratégie chirurgicale en deux temps
Publication date: Available online 10 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): F. Devinck, C. Deveaux, Y. Bennis, V. Deken-Delannoy, M. Jeanne, V. Martinot-Duquennoy, P. Guerreschi, L. Pasquesoone
IntroductionLes brûlures chimiques sont rares mais entraînent des lésions cutanées souvent profondes. Les agents basiques possèdent un pouvoir pénétrant fort et prolongé, provoquant des brûlures évolutives sur plusieurs jours. Le traitement local de ces patients est chirurgical associant excision et couverture par greffe de peau mince. Réalisées précocement dans un contexte d'agent chimique, ces greffes sont de prise difficile, retardant la cicatrisation. Nous proposons donc pour ces patients de différer la greffe de peau mince, 10jours après l'excision de la brûlure. Nous présentons une étude comparative originale et nouvelle pour évaluer notre stratégie chirurgicale en deux temps.Matériel et méthodesNous avons réalisé une étude rétrospective des patients victimes de brûlures profondes par agents basiques pris en charge dans le centre des brûlés de Lille. Les caractéristiques épidémiologiques et les modalités de prise en charge chirurgicales ont été étudiées sur dossier. Nous avons comparé la durée de cicatrisation et le taux de lyse de greffes de peau chez les patients ayant bénéficié d'une couverture initiale (témoins) ou secondaire (cas) après excision. Cette comparaison a été possible après appariement sur l'âge et le sexe.RésultatsNotre population a inclus 25 témoins et 16 cas. Les hommes étaient majoritairement atteints avec un âge moyen de 41,9 ans. Les brûlures étaient localisées dans 78 % des cas aux membres inférieurs. Le délai entre la brûlure et l'excision était en moyenne de 16,5jours. Chez les cas, la greffe de peau mince était réalisée en moyenne 11,3jours après l'excision initiale. Nous n'avons pas mis en évidence de différence significative entre les deux groupes pour la surface corporelle totale atteinte, la topographie des brûlures et l'agent causal. La durée de cicatrisation était significativement plus courte chez les cas par rapport aux témoins (37,5jours vs 50,3jours ; p<0,025). On observait de plus une diminution du nombre de lyse de greffes chez les cas par rapport aux témoins (13,3 % vs 46,7 % ; p=0,059).ConclusionNotre étude montre l'intérêt d'une stratégie chirurgicale en deux temps chez les patients victimes de brûlures par agents basiques. L'excision dite précoce associée à la réalisation d'une greffe de peau mince dans un second temps permet une cicatrisation plus rapide et diminue les risques de lyse de greffe.IntroductionChemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision.ResultsOur population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059).ConclusionOur study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure.
Faut-il encore drainer les réductions mammaires ?
Publication date: Available online 9 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): N. Vidali, A. Chevet-Noel, P. Ringenbach, J.B. Andreoletti
ObjectifLe drainage du site opératoire est courante en chirurgie mammaire pour diminuer les complications à court et moyen termes. Il n'existe pas à l'heure actuelle d'« evidence-based medicine » justifiant son utilisation qui relève plus des habitudes de chaque chirurgien. L'objectif de cette étude était de démontrer que le taux de complications n'était pas plus élevé en l'absence de drainage après réduction mammaire.Patientes et méthodeNous avons réalisé une étude rétrospective et comparative de deux cohortes de patientes ayant bénéficié d'une réduction mammaire avec et sans drainage postopératoire. Les complications suivantes ont été colligées : épanchements (sérome, hématome), infections, désunions cicatricielles, nécroses cutanées ou aréolaires, cytostéatonécroses et reprises chirurgicales.RésultatsCent trente-huit seins ont été opérés (37 patientes avec drain et 32 sans drain). Le recul moyen pour le recueil des complications était de 10 mois (1–15 mois). Nous n'avons pas retrouvé de différences significatives entre les deux groupes concernant les taux de complications, ce qui correspond aux données de la littérature.ConclusionHormis pour certains cas (comme la gigantomastie), le drainage de routine après réduction mammaire ne nous paraît pas indiqué. Il ne diminue pas les complications postopératoires et induit un allongement de la durée d'hospitalisation impliquant des frais médicaux évitables. Il est source d'inconfort, de douleurs et d'anxiété supplémentaire pour les patientes.ObjectiveDespite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged.MethodsWe conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation.ResultsA total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1–15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature.ConclusionExcept for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.
Le microlift biplan. Principes, technique, résultats
Source:Annales de Chirurgie Plastique Esthétique
Author(s): V. Mitz
La demande pour des liftings plus légers que le grand lifting cervico-facial biplan avec grands décollements a significativement augmenté ces dernières années. Cela explique la popularité des méthodes de lifting « médical » basées sur les fils tenseurs. Une alternative chirurgicale est néanmoins possible en développant une technique dérivée des minilifts, mais comportant une dissection monobloc (peau+SMAS), et respectant au maximum les ligaments suspenseurs de la face, tout en y associant une résection cutanée pré dessinée. Trente-deux patients ont été opérés selon cette technique depuis 2014 ; 3 ont dû subir une retouche pour détérioration du résultat après 1 an. Peu de complications ont été observées, essentiellement sous forme d'hématomes modérés, ou des conflits cutanés de cicatrisation sur fils résorbables. Les meilleures indications semblent être les patients jeunes présentant un début de bajoues ou de distension cervicale, ou les reprises légères après un premier grand lifting classique.There has been a growing number of patients asking for a lighter face lift than the classical biplane procedure with wide undermining; This explains the popularity of medical threads lifts. A surgical approach is nevertheless possible by performing a new technique, derived from minilfts, but with a dissection elevating skin and SMAS layers together, preserving as much retaining ligaments as possible, and allowing a predesigned skin excision. Thirty-two patients have been operated this way since 2014; 3 asked and sustained for a redo because of skin relapse at one year postoperatively. Few complications have occurred, mostly limited hematomas, or skin problems because of suture threads rejection. The best indications seemed to be young patients presenting a jowl ptosis or cervical skin laxity, and patients who require a secondary facelift as a lighter procedure.
Triple flap technique for vulvar reconstruction
Publication date: Available online 9 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): R. Mercut, R. Sinna, R. Vaucher, P.A. Giroux, N. Assaf, A. Lari, S. Dast
ObjectivePerineal defects are encountered ever more frequently, in the treatment of vulvar cancers or abdominoperineal resection. The surgical treatment of vulvar cancer leads to significant skin defect. The aim of the reconstruction is not to provide volume but rather to resurface perineum. We propose a new solution to cover the extensive skin defect remaining after excision.MethodsWe report 3 patients who underwent large excision for vulvar cancer, with lymph node dissection. For reconstruction, we performed 3 advancement flaps. Two V-Y flaps cantered on the infra-gluteal folds and based on pudendal perforator arteries were used to cover the postero-lateral parts of the defect. The third advancement flap from the superior aspect of the defect was a Y-V Mons pubis flap.ResultsThe defects were successfully covered by the 3 flap technique. The first patient suffered a non-union that slowly healed by secondary intention. For the other cases, we used the same technique, but applied negative pressure wound therapy on the sutures, with excellent results.ConclusionThe 3 flap technique is a simple and reliable method and the donor site morbidity is minimal. It can be realised without changing the position of the patient after tumour excision, and does not require delicate perforator dissection. This surgical option can be easily applied, allowing better management of these cases.
Partial medial second toe pulp free flap and dermal substitute with skin graft for salvage reconstruction of a complete skin envelope degloving of the small finger
Publication date: Available online 5 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): V. Calafat, C. Strugarek, D. Montoya-Faivre, F. Dap, G. Dautel
Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum.
Sans complexe et à côté de la plaque !
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Glicenstein
Apport du lambeau scrotal pour la couverture des escarres ischiatiques et périnéales
Publication date: Available online 11 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M. Vantomme, R. Viard, R. Aimard, P.-L. Vincent, J.-P. Comparin, D. Voulliaume
IntroductionL'escarre ischiatique est une pathologie fréquente chez les blessés médullaires rééduqués, malgré une prévention attentive. Le traitement médical par décharge et cicatrisation dirigée n'est pas toujours suffisant et une chirurgie utilisant des lambeaux musculocutanés locaux est souvent indispensable. Malheureusement, la récidive est fréquente et la disponibilité des lambeaux locaux est limitée. Le lambeau scrotal est un excellent complément aux lambeaux classiques, lambeaux glutéaux ou lambeaux d'ischiojambiers. Il peut être utilisé seul ou en complément d'un autre lambeau musculocutané, en première ou deuxième intention.Matériel et méthodesLe lambeau scrotal est un lambeau musculocutané, utilisant le Dartos, muscle peaucier du scrotum. Il est richement vascularisé, extensible et résistant. Sa grande plasticité permet de l'adapter à toute forme de perte de substance, avec un arc de rotation pouvant atteindre la marge anale. Il peut également être désépidermisé et enfoui pour combler un défect profond. Dix cas de lambeaux scrotaux et leurs différentes indications sont revus : certains sont utilisés en première intention, d'autres en complément de lambeaux musculocutanés.RésultatsLe prélèvement d'un lambeau scrotal est rapide et extrêmement facile. La fermeture aisée du site donneur autorise, grâce à la grande laxité locale, des prélèvements de la moitié du scrotum. Les lambeaux scrotaux réalisés ont rapidement cicatrisé, ainsi que les sites donneurs. Une seule récidive a été observée, secondaire à un traitement inadapté de l'ostéite sous-jacente. Aucune complication n'est survenue.ConclusionLe lambeau musculocutané scrotal, fiable, résistant, et de prélèvement aisé et rapide est un excellent moyen de couverture de la région périnéale. Il peut être utilisé pour le traitement de toute perte de substance périnéale chez l'homme, mais reste particulièrement utile pour le traitement des escarres ischiatiques ou périnéales.IntroductionThe ischiatric pressure sore is a common pathology in rehabilitated spinal cord injured people, despite careful prevention. Medical treatment by discharge and directed healing is not always sufficient and surgery using local musculocutaneous flaps is often essential. Unfortunately, recidivism is frequent and the availability of local flaps is limited. The scrotal flap is an excellent complement to classic flaps, gluteal flaps or hamstrings. It can be used alone or in addition to another musculocutaneous flap, in first or second intention.Material and methodsThe scrotal flap is a musculocutaneous flap, using the Dartos, the platys muscle of the scrotum. It is richly vascularized, extensible and resistant. Its great plasticity makes it adaptable to any form of loss of substance, with an arc of rotation that can reach the anal margin. It can also be desepidermized and buried to fill a deep defect. Ten cases of scrotal flaps and their different indications are reviewed: some are used in first intention, others in addition to musculocutaneous flaps.ResultsThe removal of a scrotal flap is fast and extremely easy. The simple closure of the donor site allows the sampling of half of the scrotum due to the great local laxity. The scrotal flaps achieved quickly healed, as well as the donor sites. Only one recurrence was observed after an inappropriate treatment of underlying osteitis. No complications have occurred.ConclusionThe scrotal musculocutaneous flap, reliable, resistant, quick and easy to remove is an excellent means of coverage of the perineal region. It can be used for the treatment of any loss of perineal substance in humans, but remains particularly useful for the treatment of ischial or perineal pressure sores.
Une forme pagétoïde de pseudomélanome d’Ackerman secondaire à un naevus congénital dans l’enfance : à propos d’un cas
Publication date: Available online 4 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Bompy, J. Levasseur, A. Hallier, S. Fraitag, M.-H. Aubriot-Lorton, B. Bonniaud, N. Zwetyenga
IntroductionLe pseudomélanome d'Ackerman est une tumeur bénigne présentant des similitudes avec des lésions malignes. Il survient classiquement chez l'adulte à la suite de l'exérèse incomplète d'un naevus commun acquis. Son incidence varie de 0,3 à 27 % selon les études. Nous présentons ici un cas clinique pédiatrique de forme pagétoïde de pseudomélanome d'Ackerman apparu dans les suites de l'exérèse d'un naevus congénital.Cas cliniqueL'exérèse d'un naevus congénital localisé au niveau du thorax a été réalisée sur une patiente de 9 mois. L'analyse histologique a conclu à un naevus commun acquis d'exérèse complète. À sept mois post-opératoires, deux autres lésions cutanées sont apparues. Nous avons réalisé l'exérèse de ces deux lésions avec 2mm de marges. L'analyse a conclu à un pseudomélanome d'Ackerman avec des atypies histologiques. Il n'a pas été constaté de récidive à trois ans post-opératoires.DiscussionIl s'agit d'un cas clinique original devant l'apparition d'un pseudomélanome d'Ackerman après exérèse d'un naevus congénital chez un enfant. De plus, cette tumeur présentait plusieurs atypies histologiques. Les médecins, qu'il s'agisse de chirurgiens, dermatologues ou anatomopathologistes, se doivent d'être informés du risque d'erreur diagnostic dont est source cette lésion qui présente des similitudes avec le mélanome SSM en régression. Il serait intéressant de déterminer des marqueurs qui permettrait de statuer sur son caractère bénin. Il n'existe pas de recommandation quant à la conduite à tenir face à cette tumeur mais il semble nécessaire de la retirer afin d'éliminer une tumeur maligne.IntroductionRecurrent nevus (RN) is a cutaneous benign tumour with similarities with malignant lesions. Typically, it occurs after a partial resection of commun-acquired nevus. Its incidence varies from 0.3 to 27% according to the studies. We present here a pediatric case of a pagetoid form of a recurrent nevus occurring from a congenital nevus.Case reportA congenital nevus was removed from a 9-month-old girl. Pathologists concluded to a commun-acquired nevus of complete exeresis. Two other cutaneous lesions appeared and we decided to realise a total removal. Analysis showed a recurrent nevus with some atypical histological features. No recurrence has occurred during the three post-operative of follow-up.DiscussionIt is an interesting case because of the occurrence of a RN after the removal of a congenital nevus in a child. Furthermore, it displayed some atypical histological features. Practicians, such as surgeons, dermatologists or pathologists, have to be aware of the risk of misdiagnosis with this lesion, which presents some similarities with SSM melanoma. It would be interesting to determinate some markers to statuate about its benign feature. There is no management recommendation about this lesion but it seems to be necessary to remove it to eliminate a malignant tumour.
Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis
Source:Annales de Chirurgie Plastique Esthétique
Author(s): R. Nail-Barthelemy, N. Stroumza, Q. Qassemyar, M. Delage, A. Nassif, M. Atlan
BackgroundHidradenitis suppurativa is a very debilitating disease, treated by antibiotics and excision. The reconstruction is usually done by secondary wound healing and/or split-thichness skin graft. The aim of this study was to evaluate the reconstruction of the axilla with local perforator flaps as a single stage surgical treatment.MethodsThis was a monocentric retrospective study conducted between November 2013 and June 2015. We included the patients with a severe axillary localization of the disease. Between 6 months and 1 year postoperatively, we noted length of complete healing, complications, patients satisfaction score about the surgery, DASH functional score, maximum abduction angle of the arm, and recurrence of the disease.ResultsThirteen patients were included, for a total of seventeen affected axillae. We performed seven thoracodorsal artery perforator flaps, seven lateral intercostal artery perforator flaps and three serratus anterior artery perforator flaps. The mean duration of follow-up was 279.1±84.1 days (180–365). The average complete healing time was 20.5±13.5 days (10–60). Six axillae were compounded (35%). The average recurrence rate of HS was 0%. The average score in the DASH questionnaire was 68.6±35.3 points (39–152) and the average maximum abduction angle of the arm was 160.6±18.5 degrees. The average score on the satisfaction questionnaire was 36.5±5.6 points (25–43).ConclusionThis is a single stage, reliable and effective surgical procedure. The results are very encouraging, with a good quality of life, a low functional disability and a shorter healing time.
Our 35 years’ experience on postburn heterotopic ossification: A three-step treatment
Publication date: Available online 2 April 2018
Source:Annales de Chirurgie Plastique Esthétique
Author(s): N. Malca, K. Serror, M. Mimoun, S. Chatelain, J. Kaplan, M. Chaouat, O. Marco, D. Boccara
Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment – excision surgery, early rehabilitation, and antalgia – seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.
Editorial Board
Source:Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 2
The ongoing emergence of robotics in plastic and reconstructive surgery
Source:Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 2
Author(s): S. Struk, Q. Qassemyar, N. Leymarie, J.-F. Honart, H. Alkhashnam, K. De Fremicourt, A. Conversano, J.-B. Schaff, F. Rimareix, F. Kolb, B. Sarfati
Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities.
Sinus pericranii occipital : à propos d’une situation inhabituelle et revue de la littérature
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M.A. Ennouhi, F. Choumi, A. Boudhas, M. Moumine, A. Moussaoui
Le sinus pericranii désigne un ensemble de présentations cliniques qui ont en commun une connexion pathologique entre les veines du scalp et le sinus veineux intracrânien sous-jacent. La nature de cette communication va de la simple dilatation des veines émissaires du crâne, à des connexions larges à travers un os calvarial défectueux laissant quasiment le sinus veineux intracrânien en contact direct avec les structures sous-cutanées. Les auteurs présentent le cas d'un sinus pericranii occipital de découverte peropératoire. Congénitale, post-traumatique ou spontanée, l'anomalie concerne le plus souvent le scalp frontal, et siège sur ou près de la ligne médiane. La présentation clinique habituelle est celle d'une masse souple qui se vide à la pression en position debout, tandis qu'elle se remplit dans toutes les situations qui augmentent la pression intracrânienne (manœuvre de Valsalva …). Le diagnostic de certitude n'est pas toujours facile à établir, et repose sur un faisceau d'arguments cliniques et radiologiques. À travers une revue de la littérature nous proposons de mettre le point sur les particularités cliniques, moyens diagnostiques et options thérapeutiques de cette entité rare.The sinus pericranii refers to a set of clinical presentations that share a pathological communication between the scalp veins and the underlying cranial venous sinus. The nature of this connection ranges from the simple dilatation of the emissary veins, to wide connections through a calvarial bone loss leaving almost the cranial venous sinus in direct contact with the subcutaneous tissue. The authors present the case of an occipital pericranii sinus of intraoperative discovery. Congenital, post-traumatic or spontaneous, this anomaly is most often frontal and located on or close to the midline. The usual clinical presentation is that of a soft mass that empties to the pressure while standing, while it fills in all situations that increase the intracranial pressure (Valsalva maneuver …). The diagnosis is not always easy to establish, and relies on a bundle of clinical and radiological arguments. Through a review of the literature we propose to focus on the clinical features, diagnostic means and therapeutic options of this rare entity.
Injections d’acides hyaluroniques au niveau de visages atteints de malformations faciales. Étude préliminaire de l’assouplissement des zones cicatricielles et de l’amélioration esthétique
Source:Annales de Chirurgie Plastique Esthétique
Author(s): G. Franchi, C. Neiva-Vaz, A. Picard, M.-P. Vazquez
Objectif de l'étudeLes « volumateurs » à base d'acide hyaluronique réticulé sont la référence pour traiter les rides superficielles, les plis profonds et les creux liés au vieillissement du visage. Cette étude a pour objectif d'évaluer, en plus des effets d'augmentation de volume, les effets sur la souplesse et l'élasticité des tissus cicatriciels, de 3 acides hyaluroniques réticulés commercialisés (dosés à 15mg/mL, 17,5mg/mL et 20mg/mL), après chirurgie réparatrice chez des patients atteints d'anomalies faciales congénitales ou acquises.Patients et méthodeNous avons débuté l'usage des acides hyaluroniques réticulés en gel injectable dans ces indications en 2013 et avons réalisé à ce jour 46 séances d'injections, chez 32 patients âgés de 13–32 ans. Les résultats ont été évalués par le patient lui-même et par un chirurgien, environ 15jours après les injections et 6–18 mois plus tard.RésultatsLes acides hyaluroniques réticulés ont apporté des résultats morphologiques et esthétiques très subtils, en complément des interventions chirurgicales, avec un niveau de satisfaction élevé des patients. Dans les zones cicatricielles fibreuses, la première session d'injections améliorait la souplesse et l'élasticité ; la seconde session améliorait les volumes. Les acides hyaluroniques sont capables de restaurer simultanément les volumes manquants et l'élasticité des tissus cicatriciels.ConclusionAu-delà de leur fonction de volumateur, un second effet des acides hyaluroniques réticulés est démontré cliniquement : l'augmentation de la souplesse et de l'élasticité des tissus cicatriciel fibreux. Plusieurs études expérimentales corroborent nos résultats en démontrant qu'ils modifient la composition des matrices extra cellulaires notamment en stimulant la production d'élastine et de collagène.BackgroundCross-linked hyaluronic acid-based fillers have gained rapid acceptance for treating facial wrinkles, deep tissue folds and sunken areas due to aging. This study evaluates, in addition to space-filling properties, their effects on softness and elasticity as a secondary effect, following injection of 3 commercially available cross-linked hyaluronic acid-based fillers (15mg/mL, 17,5mg/mL and 20mg/mL) in patients presenting with congenital or acquired facial malformations.Patients et methodsWe started injecting gels of cross-linked hyaluronic acid-based fillers in those cases in 2013; we performed 46 sessions of injections in 32 patients, aged from 13–32. Clinical assessment was performed by the patient himself and by a plastic surgeon, 15 days after injections and 6–18 months later.ResultsCross-linked hyaluronic acid-based fillers offered very subtle cosmetic results and supplemented surgery with a very high level of satisfaction of the patients. When injected in fibrosis, the first session enhanced softness and elasticity; the second session enhanced the volume. Cross-linked hyaluronic acid-based fillers fill sunken areas and better softness and elasticity of scar tissues.ConclusionIn addition to their well-understood space-filling function, as a secondary effect, the authors demonstrate that cross-linked hyaluronic acid-based fillers improve softness and elasticity of scarring tissues. Many experimental studies support our observations, showing that cross-linked hyaluronic acid stimulates the production of several extra-cellular matrix components, including dermal collagen and elastin.
Reconstruction of an anterior chest wall radionecrosis defect by a contralateral latissimus dorsi flap: A case report
Source:Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 2
Author(s): A. Vairinho, A. Al Hindi, M. Revol, A. Legras, K. Rem, Y. Guenane, S. Cristofari, T. Sorin
IntroductionSoft tissue and bone radionecrosis are rare but serious complications may occur late after radiotherapy.Case reportWe report the case of an 86-year-old woman with a history an infiltrating ductal carcinoma of the left breast, treated by total mastectomy, left axillary dissection and adjuvant radiotherapy. Eighteen years later, the first radionecrosis lesions appeared and grew progressively in a 6-month period. These lesions are deep, involving the anterior aspect of the 4th to the 6th ribs and infiltrating the chest wall to the left cardio-thoracic space communicating largely with the pericardium. During axillary dissection, the neurovascular pedicle of the left latissimus dorsi muscle had been severed. The first part of the operation consisted of performing a left side parietectomy of the thoracic wall with a large resection of pericardial tissue and a small myocardial patch. The second step consisted of repairing the thoracic wall defect with a contralateral musculocutaneous latissimus dorsi flap.ConclusionDue to its significant axis of rotation, the latissimus dorsi muscle flap must be considered in the therapeutic algorithm for covering of contralateral anterior chest wall defects.
Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery
Source:Annales de Chirurgie Plastique Esthétique
Author(s): S. La Padula, R. Billon, F. Schonauer, F. D'Andrea, W. Noel, Y. Belkacémi, R. Bosc, B. Hersant, J.P. Meningaud
Background and objectivesBreast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery.MethodsA systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016.ResultsAmong the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated.ConclusionsBreast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used.
Three-stage post-oncological reconstruction of the scalp using a dermal-assisted skin graft, adipose tissue graft and follicular graft: A clinical case
Source:Annales de Chirurgie Plastique Esthétique
Author(s): N. Ouar, Q. Qassemyar, D. Boccara, M. Atlan
Fente labiale inférieure para-commissurale : stratégie thérapeutique
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Chauvel-Picard, A. Gleizal
Nous rapportons le premier cas décrit dans la littérature de fente labiale inférieure para-commissurale droite retrouvée chez un enfant de 2 ans. Cette anomalie causait une incompétence labiale nécessitant une correction chirurgicale. Différentes techniques chirurgicales ont été décrites pour le traitement des fentes labiales supérieures. Nous avons étudié chacune d'elles, analysé les avantages et inconvénients de ces techniques en les inversant et en les adaptant pour la lèvre inférieure. Nous avons opté pour la plastie en double « Z » de Malek car la différence de hauteur entre le côté fendu et le côté sain était importante. De plus, cette technique dissimule une partie de la cicatrice dans le sillon labio-mentonnier. Le résultat fonctionnel et esthétique à 6 mois postopératoire est satisfaisant.We report the first case described in the literature of lateral, paracommissural cleft of the lower lip in a 2-year-old child. This anomaly caused labial incompetence requiring surgical correction. Different surgical techniques have been described for the treatment of the cleft of the upper lip. We studied each of them, analyzed the advantages and disadvantages of these techniques by inverting them and adapting them for the lower lip. We opted for the double "Z" plasty of Malek because the difference in height between the cleft side and the healthy side was important. In addition, this plasty hides part of the scar in the labiomental groove. The functional and aesthetic result at 6 months after surgery is satisfactory.
Wrist to forearm ratio as a median nerve shear wave elastography test in carpal tunnel syndrome diagnosis.
Publication date: Available online 13 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): L. Paluch, P. Pietruski, J. Walecki, B.H. Noszczyk
Keeping the fat on the right spot prevents contour deformity in temporalis muscle transposition.
Publication date: Available online 13 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Martinus M. van Veen, Steven F.S. Korteweg, Pieter U. Dijkstra, Paul M.N. Werker
The temporalis muscle transposition is a reliable, one-stage reanimation technique for longstanding facial paralysis. In the variation described by Rubin the muscle is released from the temporal bone and folded over the zygomatic arch towards the modiolus. This results in unsightly temporal hollowing and zygomatic bulging. We present a modification of this technique which preserves the temporal fat pad in its anatomical location, and conceals temporal hollowing and prevents zygomatic bulging.The data of 23 patients treated with this modification were analysed. May classification was used for evaluation of mouth reanimation. Experts and patients scored visibility of the contour deformity on a 100 millimetre VAS score (0 = poor / 100 = best). 3D images of the face were used to measure temporal hollowing and zygomatic bulging. 3D images were compared to those of controls with a similar gender- and age distribution.After a median follow-up of 5.7 years, all patients achieved symmetry at rest. Eleven patients achieved symmetry while smiling with closed lips (May classification "Good"). A median (IQR) VAS score of 19 (6; 41) was given by experts and 25 (5; 59) by patients themselves. 3D volumes of zygomatic bulging differed from control subjects, although all volume differences were small (median < 3.3 ml), temporal hollowing did not differ significantly.Based on our results we conclude that our modified Rubin temporalis transposition technique provides an elegant way to conceal bulging over the zygomatic arch and prevents temporal hollowing, without the need for fascial extensions to reach the modiolus.
Shoulder-related donor site morbidity and patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back: A comparative analysis
Publication date: Available online 13 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mikkel Børsen Rindom, Gudjon L. Gunnarsson, Marianne D. Lautrup, René D. Christensen, Professor Jens A. Sørensen, Jørn B. Thomsen
BackgroundWe report a study evaluating and comparing shoulder-related morbidity associated with delayed breast reconstruction using either the conventional latissimus dorsi (LD) flap or the thoracodorsal artery perforator (TAP) flap.Material & MethodsWe conducted a retrospective cohort study of women over 18 years who had a unilateral, delayed breast reconstruction by either a LD or TAP flap at one centre over a 56 months period. Shoulder function was assessed using the Constant Shoulder Score (CSS), evaluating pain, activity in daily life (ADL), range of motion (ROM) and strength. A number of secondary outcomes were also examined.Results49 women were included. Demographics and breast treatment data were comparable between the groups. For the TAP flap there was a statistically significant better score for the reconstructed side of 10.9 points, 95%CI(2.6-19.2), p-value 0.01. The CSS-score did not differ statistically significant between groups for the non-reconstructed side with a difference of 0.1, 95%CI (-6.1-6.2), p-value 0.98. The sub score-analysis revealed an advantage to the TAP flap of 3.2 points for pain (p-value 0.003) and 5.5 points for ROM (p-value 0.011). The factors ADL and strength were of equal magnitude in both groups.ConclusionsPatients who undergo delayed breast reconstruction by the TAP flap seem less prone to suffer from postoperative pain and restricted ROM, why this flap should be considered an advantageous alternative to the conventional LD flap. A randomized clinical trial is warranted to lend sufficient evidence to this statement.
Adsorption of Cu (II) and Ni (II) from aqueous solutions by taro stalks chemically modified with diethylenetriamine
Abstract
Taro stalks (TS) were modified by diethylenetriamine (DETA) to obtain the modified taro stalks adsorbents (recorded as MTSA). This kind of raw material is unprecedented and the method of modification is relatively simple. The physicochemical properties of MTSA were characterized by scanning electron microscope (SEM), FTIR, and zeta potential analyzer. The capacity of MTSA for adsorbing heavy metals under different influencing factors was tested by UV-visible spectrophotometer. The results indicated that the gaps between the microspheres of MTSA are more, which are conducive to adsorption. The MTSA might have increased the amino-functional groups which are beneficial for adsorption, resulting in an increase in the adsorption capacity of copper and nickel ions (35.71 and 31.06 mg/g) of about 5–7 times compared to bare taro stalks (5.27 mg/g and 6.08 mg/g). High Cu2+ uptake on MTSA was observed over the pH range of 5.5–7.0, while for Ni2+ the range was 7.0–8.5, and the optimum dosage of adsorbent were both about 0.80 g for Cu2+ and Ni2+. The adsorption kinetics of Cu2+ and Ni2+ on MTSA could be interpreted with a pseudo-second order and the equilibrium data were best described by the Langmuir isotherm model.
Graphical abstract
CME Part 1: Hair disorders in cancer patients
Publication date: Available online 14 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Azael Freites-Martinez, Jerry Shapiro, Shari Goldfarb, Julie Nangia, Joaquin J. Jimenez, Ralf Paus, Mario E. Lacouture
Cytotoxic chemotherapies, molecularly targeted therapies, immunotherapies, radiotherapy, stem cell transplants, and endocrine therapies may lead to hair disorders (including alopecia, hirsutism, hypertrichosis, pigmentary and textural hair changes). The mechanisms underlying these changes are varied and remain incompletely understood, hampering the development of preventive or therapeutic guidelines. The psychosocial impact of chemotherapy -induced alopecia has been well-documented mainly in the oncology literature, however the effect of other alterations such as radiation-induced alopecia, hirsutism, changes in hair color or texture on quality of life have not been described. This article reviews clinically significant therapy-related hair disorders in cancer patients, underlying pathophysiological mechanisms, severity grading scales, patient reported quality of life instruments, management strategies, and future translational research opportunities.
Dermoscopic features of onychotillomania: A study of 36 cases
Publication date: Available online 14 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Austin John Maddy, Antonella Tosti
BackgroundOnychotillomania is a nail-picking disorder characterized by nail dystrophy and abnormal morphology of the nail plate, nail bed, and periungual skin.ObjectiveThe purpose of this study was to describe the dermoscopic features of onychotillomania.MethodsA retrospective study of the dermoscopy images of 36 patients affected by onychotillomania. The images were reviewed independently by both authors and a list of dermatoscopic findings was established.ResultsScales were observed in 34 cases (94.4%); absence of nail plate was seen in 30 (83.3%); wavy lines were observed in 25 (69.4%); hemorrhages were observed in 23 (63.9%); crusts were seen in 22 (61.1%); nail bed pigmentation was observed in 17 (47.2%); speckled dots were observed in 14 (38.9%); nail plate melanonychia was observed in 4 (11.1%).LimitationsLimitations included small sample size and retrospective study.ConclusionAbsence of the nail plate with multiple obliquely oriented nail bed hemorrhages, nail bed gray pigmentation, and presence of wavy lines are characteristic findings of onychotillomania and not seen in other nail diseases.
Teaser
Onychotillomania is a nail-picking disorder that is likely underreported and often misdiagnosed, The dermoscopic features of onychotillomania include scales, absence of the nail plate, wavy lines, hemorrhages, speckled dots, melanonychia, and nail bed pigmentation, Recognizing the common dermoscopic features of onychotillomania will assist the clinician in the diagnosis and management of this disorder.CME Part 2: Hair disorders in cancer survivors Persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, and hair growth disorders related to endocrine therapy or cancer surgery
Publication date: Available online 14 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Azael Freites-Martinez, Jerry Shapiro, Corina van den Hurk, Shari Goldfarb, Joaquin Jimenez, Anthony M. Rossi, Ralf Paus, Mario E. Lacouture
With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, post-surgery alopecia and localized hypertrichosis, alopecia attributed to therapeutic transplants, and to novel anticancer therapies. The information contained in this continuing medical education article should facilitate a better understanding on hair disorders in cancer survivors, so that adequate support and therapies may be provided to cancer survivors.
Tracking tumor kinetics in patients with germline CYLD mutations
Publication date: Available online 13 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Sarah Brown, Sylvia A. Worthy, James AA. Langtry, Neil Rajan
Certolizumab Pegol for the Treatment of Chronic Plaque Psoriasis: Results through 48 Weeks from Two Phase 3, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Studies (CIMPASI-1 and CIMPASI-2)
Publication date: Available online 13 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Alice B. Gottlieb, Andrew Blauvelt, Diamant Thaçi, Craig L. Leonardi, Yves Poulin, Janice Drew, Luke Peterson, Catherine Arendt, Daniel Burge, Kristian Reich
BackgroundCertolizumab pegol, the only Fc-Free, PEGylated anti-tumor necrosis factor biologic, demonstrated clinically meaningful improvements and suggested a positive risk-benefit balance in phase 2 studies in adults with moderate-to-severe chronic plaque psoriasis.ObjectiveAssess certolizumab efficacy and safety versus placebo in phase 3 studies.MethodsPatients with moderate-to-severe chronic plaque psoriasis were randomized 2:2:1 to certolizumab 400 mg, 200 mg, or placebo every 2 weeks. At Week 16, certolizumab-treated patients achieving 50% reduction in psoriasis area and severity index continued treatment through Week 48. Coprimary endpoints were Week 16 responder rates, defined as 75% reduction in psoriasis area and severity index and physician's global assessment 0/1 ('clear'/'almost clear' and ≥2-point improvement). Safety was assessed by treatment-emergent adverse events.ResultsWeek 16 endpoints were significantly greater for both doses of certolizumab versus placebo, and responses maintained through Week 48. For most measures, improvement was numerically greater for certolizumab 400 mg. No unexpected safety signals were identified.LimitationsNo active comparator.ConclusionsTreatment with either certolizumab 400 mg or 200 mg every 2 weeks was associated with significant, clinically meaningful improvements in moderate-to-severe psoriasis. The 400 mg dose may provide additional clinical benefit. The safety profile was consistent with the therapeutic class.
Teaser
Certolizumab pegol is an Fc-Free, PEGylated anti-tumor necrosis factor biologic. In these phase 3 psoriasis studies, certolizumab pegol 200 mg and 400 mg every 2 weeks demonstrated statistically significant and clinically meaningful improvements versus placebo; no new safety signals were observed. Certolizumab pegol affords additional psoriasis treatment options.Certolizumab Pegol for the Treatment of Chronic Plaque Psoriasis: Results Through 48 Weeks of a Phase 3, Multicenter, Randomized, Double-Blinded, Etanercept- and Placebo-Controlled Study (CIMPACT)
Publication date: Available online 14 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Mark Lebwohl, Andrew Blauvelt, Carle Paul, Howard Sofen, Jolanta Węgłowska, Vincent Piguet, Daniel Burge, Robert Rolleri, Janice Drew, Luke Peterson, Matthias Augustin
BackgroundPhase 2 psoriasis studies with the Fc-free, PEGylated, anti-tumor necrosis factor biologic certolizumab pegol demonstrated meaningful clinical activity.ObjectiveAssess safety and efficacy of certolizumab in adults with moderate-to-severe chronic plaque psoriasis.MethodsPatients were randomized 3:3:1:3 to certolizumab 400 mg, 200 mg, or placebo every 2 weeks for 16 weeks or etanercept 50 mg twice-weekly for 12 weeks. Certolizumab-treated patients achieving ≥75% reduction in psoriasis area and severity index at Week 16 were re-randomized to certolizumab or placebo for 32 weeks. The primary endpoint was responder rate (≥75% reduction in psoriasis area and severity index) versus placebo (primary analysis) and etanercept (secondary analysis) at Week 12; secondary endpoints included responder rates on various measures versus placebo at Weeks 12, 16, and 48. Safety was assessed by treatment-emergent adverse events.ResultsAll endpoints were significantly greater for certolizumab versus placebo with the greatest response seen with 400 mg. Certolizumab 400 mg was superior to and 200 mg was noninferior to etanercept. Adverse events were consistent with the anti-tumor necrosis factor class.LimitationsSingle-blind etanercept.ConclusionBoth certolizumab regimens improved psoriasis symptoms with greater response at the higher dose. No new safety signals were observed.
Teaser
Certolizumab pegol is an Fc-free, PEGylated anti-tumor necrosis factor biologic.; In this phase 3 study, both certolizumab doses improved psoriasis symptoms at Week 12 that was maintained, following re-randomization, through Week 48 with a safety profile consistent with its class.; The higher dose of certolizumab may provide superior efficacy.Alectinib versus chemotherapy in crizotinib-pretreated anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer: results from the phase III ALUR study
Παρασκευή 13 Απριλίου 2018
Buffered local anesthetics reduce injection pain and provide anesthesia for up to 5 hours
Local anesthetics are manufactured as acidic solutions to increase their stability and shelf life [1]. The pH of lidocaine in preparations used for local anesthesia varies between 3.5 and 7.0 [2]. However, physiological pH lies between 7.35 and 7.45. The difference in pH in the tissue and the more acidic local anesthesia increases the number of hydrogen ions upon infiltration. Hydrogen ions activate nociceptors, which is thought be the reason why these agents cause pain on infiltration. The time taken for the tissue to transform the solution from the ionized to the unionized form could also delay the onset of anesthesia [1-3].
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
