HAEMOPHILIA, Issue 3 2007
T. LAMBERT
Summary. BeneFix®, the only recombinant factor IX (FIX), has been reformulated. The reformulation involves a change in diluent and allows for more concentrated infusions of recombinant FIX. A double-blind, randomized, pharmacokinetic (PK) crossover study demonstrated that reformulated BeneFix was bioequivalent to original BeneFix and follow-up PK evaluation after 6 months of treatment demonstrated the PK stability of reformulated BeneFix after multiple exposures. Favourable efficacy and safety profiles, consistent with those already well-established for original BeneFix, were observed: 81.1% of haemorrhages resolved with only a single infusion; 85.3% of initial treatment response ratings were Excellent or Good; more than half of the subjects using reformulated BeneFix for routine prophylaxis (11 of 17, 64.7%) had no spontaneous haemorrhages during their 6,12 month course of prophylactic treatment, with an overall spontaneous bleeding rate of 0.72 year,1; and for the single surgical procedure (knee washing), treatment was rated Useful. In addition, there was no FIX inhibitor development, allergic-type manifestations, or thrombogenic complications with more than 1100 infusions (nearly 5.2 million IUs) administered in this trial. All efficacy and safety outcomes from this study were achieved with more concentrated recombinant protein infusions than that possible with original BeneFix, and utilization of the 2000 IU per vial dosage strength, newly introduced with the reformulated product, was high (>62%). The reformulation of BeneFix allows smaller delivery volumes and an increased choice of dosage strengths without altering the PK properties (including incremental recovery and half-life) or the established efficacy and safety profile of recombinant FIX. [source]

Radiation synovectomy by 188Re-Sulfide in haemophilic synovitis

HAEMOPHILIA, Issue 5 2004
P. Li
Summary., Radiation synovectomy is a safe and effective treatment for chronic haemophilic synovitis causing recurrent haemarthroses. This study reports results of 29 188Re-sulfide radiation synovectomies in knee joint with a follow-up 18 months. Using the absorbed dose factor, three groups of radioactivity dose (555 MBq, 687 MBq and 917 MBq) were used according to the synovium thickness that measured by MRI. Excellent and good results (haemarthrosis reduction from 75 to 100%) were obtained in 71% of cases at 18 months. Comparison of the results, no significant difference was found among the radioactivity dose groups. Radiation was well contained within the knee. There were no observed or identified complications including the detectable harm to the articular cartilage, as shown by MRI. [source]

Safety and Efficacy of Arterial Switch Operation in Previously Inoperable Patients

JOURNAL OF CARDIAC SURGERY, Issue 4 2010
Liu Ying-long M.D.
This study aimed to evaluate the safety and efficacy of ASO in these selected subset patients. Methods: The records of 86 patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH who underwent ASO at our institution from May 2000 to October 2008 were reviewed retrospectively. Eighty survivors were followed-up. Results: There were six hospital deaths (7.0%, 95% confidence limit 1.6 to 12.4%). From January 2006 to October 2008, 46 consecutive ASOs were performed with no death. Operative mortality and mobility decreased significantly (p = 0.008 and p = 0.046, respectively). The median duration of follow-up was 42.1 ± 28.8 months (range, 2.0 to 99.5). Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association (NYHA) class II and 97.2% were in NYHA class I. Conclusions: Excellent early and mid-term results of ASO are obtained from patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH in current era, and ASO is safe and effective in these selected subset patients. (J Card Surg 2010;25:400-405) [source]

A Review of 21 Curricula for Abstinence-Only-Until-Marriage Programs

JOURNAL OF SCHOOL HEALTH, Issue 3 2005
Kelly L. Wilson
ABSTRACT: The authors reviewed the content, methods, and overall quality of 21 curricula used in abstinence-only-until-marriage programs. Only materials designed for use in middle school grades (fifth to eighth) or with middle school-aged audiences (9,13 years of age), which presented the abstinence message in at least 40% of their content, were included. A rating instrument adapted from 2 sets of education guidelines structured the assessment of each curriculum. Four experienced teachers rated each curriculum. Curricula exhibited considerable variability in overall quality ratings. While on average, materials scored a 3.33 on a 1-to-5 scale (1 = Unacceptable; 5 = Excellent), 12 curricula received summative scores above the average, with 4 scoring 4.0 or higher. Eight curricula, however, received a below-average rating. While abstinence materials vary considerably in terms of overall quality, the values and world views underlying this sample of curricula were clear and consistent: those who develop abstinence education curricula value nonsexual antecedents of sexual behavior such as skills (goal setting, decision making, and assertiveness), ideals (fidelity, friendships), and psychological factors such as self-esteem. [source]

Management of cancer gallbladder found as a surprise on a resected gallbladder specimen

JOURNAL OF SURGICAL ONCOLOGY, Issue 8 2006
FRCS (Glasg), Mahesh Chandra Misra MS
Abstract Carcinoma gallbladder is associated with an overall 5-year survival rate reported less than 5% due to late diagnosis. Advent of ultrasound scanning may help in detecting gallbladder polyps and an early gallbladder cancer. Excellent 5-year survival (up to 100%) has been reported for Stage Ia disease and the survival has significantly improved for Stage Ib, II, and III if appropriate re-operation is carried out soon after the incidental detection of gallbladder cancer. Laparoscopic cholecystectomy (LC) is contraindicated in the presence of gallbladder cancer. It is recommended to excise all laparoscopic port sites, at the time of re-operation. Re-operation for Stage II gallbladder cancer is associated with a 90,100% 3-year survival rate. Patients with Stage III and IV tumors also benefit from an extended cholecystectomy. Patients with bulky primary tumors without lymph node metastases (T4N0) seem to have a better prognosis than those with distant lymph node metastases, and should be treated aggressively. It is advantageous to perform the appropriate extent of surgery for gallbladder cancer at the initial operation. Heightened awareness of the presence of cancer and the knowledge of appropriate management are important. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated for all disease except Stage Ia. Radiotherapy and chemotherapy have not been found effective as an adjuvant or palliative therapy in gallbladder cancer. J. Surg. Oncol. 2006;93:690,698. © 2006 Wiley-Liss, Inc. [source]

Phase Transformation and Tunable Piezoelectric Properties of Lead-Free (Na0.52K0.48,xLix)(Nb1,x,ySbyTax)O3 System

JOURNAL OF THE AMERICAN CERAMIC SOCIETY, Issue 1 2009
Ruzhong Zuo
Lead-free (Na0.52K0.48,x)(Nb1,x,ySby)O3 - xLiTaO3 (NKNS,LT) piezoelectric ceramics have been fabricated by ordinary sintering. A special attention was paid to the composition design through which the dielectric and piezoelectric properties of the (Li, Ta, Sb) modified NKN systems were significantly promoted. A property spectrum was generated with a particular discussion on the relationship between the Sb content, the LT content, the polymorphic phase transition, and the electrical properties and their temperature stability. Excellent and tunable electrical properties of d33=242,400 pC/N, kp=36%,54%, , and Tc=230°,430°C demonstrate a tremendous potential of the compositions studied for device applications. [source]

Clinical trial: 2-L polyethylene glycol-based lavage solutions for colonoscopy preparation , a randomized, single-blind study of two formulations

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010
L. B. Cohen
Aliment Pharmacol Ther 2010; 32: 637,644 Summary Background, The 2-L polyethylene glycol (PEG) lavage solutions provide efficacy similar to that of standard 4-L PEG formulations in spite of the reduced volume. The comparative efficacy and tolerability of two formulations of 2-L PEG solution remain unknown. Aims, To assess the efficacy, safety and tolerability of PEG + Bis compared with PEG + Asc, and to study the effect of bowel cleansing quality on adenoma detection rates. Methods, Patients were randomized to receive either 2-L PEG with ascorbic acid (PEG + Asc) or 2-L PEG plus bisacodyl 10 mg (PEG + Bis). The primary endpoint was overall colon cleansing score, assessed by blinded investigators using a validated four-point scale. Secondary endpoints included adenoma detection rate, patient tolerability and compliance and adverse events. Results, Fifty-two patients received PEG + Asc and 55 patients received PEG + Bis. Overall colon cleansing scores (±s.d.) were 1.40 ± 0.69 and 1.75 ± 0.70 (P < 0.003) in the PEG + Asc and PEG + Bis groups, respectively. Excellent and good ratings were recorded in 69% and 23% receiving PEG + Asc compared to 38% and 51% (P = 0.01) of patients receiving PEG + Bis. More adenomas were detected in colonoscopies performed with PEG + Asc (39%) than in those performed with PEG + Bis (20%) (P = 0.04). Patient tolerability and safety were similar with both preparations. Conclusion, The use of PEG + Asc resulted in better colon cleansing and higher adenoma detection rates compared with PEG + Bis. [source]

Effect of fluence on efficacy using the 1440 nm laser with CAP technology for the treatment of rhytids,

LASERS IN SURGERY AND MEDICINE, Issue 6 2008
Jenifer R. Lloyd D.O.
Abstract Background and Objective The objective of this study was to evaluate the effect of fluence on the treatment of rhytids using a 1440 nm laser with CAPSM technology and the T350 tip. Study Design/Materials and Methods Twelve subjects with rhytids were enrolled in an IRB approved study. The AffirmÔ laser with CAP technology (Cynosure, Inc., Westford, MA) 1440 nm, 10 mm T350, 2 milliseconds, 1.5 Hz was used at fluences ranging from 3.0 to 5.5 J/cm2 in a split face study. At each treatment visit, fluences on the right side of the face were held constant at 3.0 J/cm2, while the left side of the face started at 3.0 J/cm2 and increased 0.5 J/cm2 with each treatment to a maximum of 5.5 J/cm2. Five treatments were given at 2-week intervals using the SmartCoolÔ (Cynosure, Inc.). Photographic comparisons at baseline and 3 months were used to compare fluence results as well as to evaluate for efficacy in the treatment of rhytids. The following standard scale was employed: Poor (0,25%), Fair (26,50%), Good (51,75%), and Excellent (76,100%). In addition, following the study, a few subjects received a series of laser pulses at increasing fluences on their buttocks to further evaluate the effect of fluence on tissue reaction. Results Comparing the right and left photographic results, no clinically observable differences were noted. Both sides received the same grade in all cases. Five subjects (42%) were noted to have Good results, three (25%) were given a rating of Fair, and four (33%) were given a Poor result with little or no improvement observed. The follow-up buttock fluence study demonstrated an effect threshold at 3.0 J/cm2. Conclusion The 1440 nm laser with CAP technology can provide overall improvement in patients with rhytids at moderate fluences. Increasing the fluence does not appear to increase efficacy. Lesers Surg. Med. 40:387,389, 2008. © 2008 Wiley-Liss, Inc. [source]

Effect of Social Class Disparities on Disease Stage, Quality of Treatment and Survival Outcomes in Breast Cancer Patients from Developing Countries

THE BREAST JOURNAL, Issue 4 2008
Zeba Aziz MD
Abstract:, To assess the relationship between social class disparities on disease stage on presentation, quality of treatment, and survival outcome of breast cancer patients in Pakistan and compare our data with SEER (Surveillance, Epidemiology, and End Results) data from US on white and African-American women to evaluate differences in disease stage and survival outcomes. Patients were evaluated for age, tumor size, grade, receptor status, stage, and 5-year survival and were compared with SEER data. Socio-economic status was evaluated with financial income. Patients were divided in poor and middle/high groups. Excellent and comparable 5-year survival with SEER data was observed with localized disease in all groups from different strata. Advanced disease was more common in the disadvantaged group with negligible 5-year survivals. Development and implementation of early detection programs, public awareness, and clinical and breast self examination that are more pragmatic in the settings of countries with limited resources are essential. [source]

Light and Transmission Electron Microscopy of Immature Camelus Dromedarius Oocyte

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2004
H. Nili
Summary In order to provide a consistent system for laboratory production of embryos, the characteristics of immature camel oocyte must first be described. The objective of this study was to define ultrastructural features of immature camel oocyte. Ovaries were obtained from camels at a local abattoir, and then transported to the laboratory within 2 h. Camelus cumulus oocyte complexes (COCs) were aspirated from 2,6 mm follicles using a 22-gauge needle. Excellent and good quality COCs were selected and prepared for transmission electron microscopy study using a cavity slide. The fine structure of camel oocyte is morphologically similar to that of other mammalian oocytes. However, some minor differences exist between COC of camel and other mammalian species. Different size and shape of membrane-bound vesicles, lipid droplet, mitochondria and cortical granules were distributed throughout the ooplasm. Discrete or in association with endoplasmic reticulum, Golgi complexes were observed in the periphery of the oocytes. The majority of the oocytes were in the germinal vesicle stage. [source]

Propargyl Bromide as an Excellent ,-Bromoacetone Equivalent: Convenient and New Route to ,-Aroylacetones.

CHEMINFORM, Issue 21 2006
Sakkarapalayam M. Mahalingam
Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract, please click on HTML or PDF. [source]

Safety and efficacy of a sucrose-formulated recombinant factor VIII product for the treatment of previously treated patients with haemophilia A in China

HAEMOPHILIA, Issue 4 2007
J. SHI
Summary., The use of plasma-derived products has contributed to a high rate of blood-borne infections among haemophilia patients in China. Recombinant factor VIII (rFVIII) products that are manufactured without human or bovine albumin and include dedicated viral inactivation steps, hold a significant safety advantage over plasma products. However, there is little information published on the use of rFVIII products in non-caucasian populations. This is the first reported evaluation of the efficacy and safety of a rFVIII product in Chinese haemophiliacs. An open-label, non-randomized, prospective, multicentre trial enroled previously treated Chinese patients with haemophilia A. All treatments were administered using a sucrose-formulated rFVIII-FS (Kogenate®). Forty-nine patients received totals of 291 infusions (mean, 5.94/patient) and 742 140 IU rFVIII-FS (mean, 2550.3 IU/infusion). Of the 60 acute bleeding episodes that were treated, 90% were successfully managed with only one (81.7%) infusion or two (8.3%) infusions. Physicians reported haemostasis control for acute bleeds to be ,Excellent' or ,Improved' with rFVIII-FS therapy. No FVIII inhibitors were detected in any patient. Only one treatment-related adverse event was reported, which was mild dizziness that resolved spontaneously. rFVIII-FS was efficacious, safe and well tolerated in the treatment of previously treated patients with haemophilia A in China. [source]

The Long Road to Better ACHD Care

CONGENITAL HEART DISEASE, Issue 3 2010
Gary Webb MD
ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source]

Continuous and Discontinuous Innovation: Overcoming the Innovator Dilemma

CREATIVITY AND INNOVATION MANAGEMENT, Issue 4 2007
Mariano Corso
Challenged by competition pressures and unprecedented pace of change, firms can no longer choose whether to concentrate on the needs of today's customers or on the anticipation of those of tomorrow: they must be excellent in both. This requires managing two related balancing acts: on the one side, being excellent in both exploitation and exploration of their capabilities and, on the other side, being excellent in managing both incremental and radical innovation. These balances are critical since exploitation and exploration, on the one side, and incremental and radical innovation, on the other, require different approaches that have traditionally been considered difficult to combine within the same organization. Working on evidence and discussion from the 7th CINet Conference held in Lucca (Italy) in 2006, this Special Section is aimed at contributing to theory and practice on these two complex balancing acts that today represent a hot issue in innovation management. [source]

Modulation of calcium signalling by intracellular organelles seen with targeted aequorins

ACTA PHYSIOLOGICA, Issue 1 2009
M. T. Alonso
Abstract The cytosolic Ca2+ signals that trigger cell responses occur either as localized domains of high Ca2+ concentration or as propagating Ca2+ waves. Cytoplasmic organelles, taking up or releasing Ca2+ to the cytosol, shape the cytosolic signals. On the other hand, Ca2+ concentration inside organelles is also important in physiology and pathophysiology. Comprehensive study of these matters requires to measure [Ca2+] inside organelles and at the relevant cytosolic domains. Aequorins, the best-known chemiluminescent Ca2+ probes, are excellent for this end as they do not require stressing illumination, have a large dynamic range and a sharp Ca2+ -dependence, can be targeted to the appropriate location and engineered to have the proper Ca2+ affinity. Using this methodology, we have evidenced the existence in chromaffin cells of functional units composed by three closely interrelated elements: (1) plasma membrane Ca2+ channels, (2) subplasmalemmal endoplasmic reticulum and (3) mitochondria. These Ca2+ -signalling triads optimize Ca2+ microdomains for secretion and prevent propagation of the Ca2+ wave towards the cell core. Oscillatory cytosolic Ca2+ signals originate also oscillations of mitochondrial Ca2+ in several cell types. The nuclear envelope slows down the propagation of the Ca2+ wave to the nucleus and filters high frequencies. On the other hand, inositol-trisphosphate may produce direct release of Ca2+ to the nucleoplasm in GH3 pituitary cells, thus providing mechanisms for selective nuclear signalling. Aequorins emitting at different wavelengths, prepared by fusion either with green or red fluorescent protein, permit simultaneous and independent monitorization of the Ca2+ signals in different subcellular domains within the same cell. [source]

Optical and dielectric studies on pure and Ni2+, Co2+ doped single crystals of bis thiourea cadmium chloride

CRYSTAL RESEARCH AND TECHNOLOGY, Issue 4 2008
R. Uthrakumar
Abstract Good quality single crystals of Ni2+, Co2+ ions doped Bisthiourea Cadmium Chloride (BTCC) are some of the excellent and efficient non-linear optical materials grown from aqueous solution by slow evaporation method. The lattice parameters of the grown crystals are determined by single crystal X-ray analysis. UV spectral analyses on these samples reveal the improved transparency of the doped crystals ascertaining the inclusion of metal ion in the lattice. FTIR spectral analysis carried out on the materials confirm the presence of functional groups. Dielectric measurements reveal that the dielectric constant of pure and doped crystals decreases with increase of frequency. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Single-tooth implant treatment in the anterior region of the maxilla for treatment of tooth loss after trauma: a retrospective clinical and interview study

DENTAL TRAUMATOLOGY, Issue 3 2003
Lars Andersson
Abstract,,, The aim of this study was to evaluate the results of single-tooth implant treatment in patients where teeth have been lost as a result of trauma. Also, the patients' and professionals' opinions regarding the final outcome of treatment were assessed. Thirty-four patients with 42 lost teeth were evaluated by clinical and radiographic examinations and interviews 2,5 years after treatment. A professional who had not taken part in the treatment evaluated the implant crowns. Central maxillary incisors were the most frequently lost and replaced teeth after trauma (75%) followed by lateral incisors (21%). In patients with incomplete growth, implant treatment was generally postponed until completion of growth. Lack of space was treated by presurgical orthodontics (7%) or by selecting an implant with a reduced diameter (5%). Deficiency of bone was seen in 17% and was treated by bone grafting or local augmentation prior to implant surgery. Patients who had lost two or more teeth after trauma were all subjected to bone grafting. Preservation of roots in the alveolar process seemed to maintain the bone volume enabling better conditions for later implant placement. Forty-one implants (97.6%) were integrated successfully. Complications were few and of minor importance (9.5% before and 12% after cementation of crowns) and could all be managed. No or minimal bone loss was seen. In general, the patients felt that they received good care and that they were well informed about their treatment. Some patients reported that the local anesthesia procedure was not pain-free, but 71% of the patients experienced the treatment as pain-free. For each of the variables (color, shape, height, and size of the crowns), the highest degree of satisfaction was noted in 93,98% of the patients and 91,95% of the single evaluating professional. Given that the patients have finished growth and a careful treatment planning and timing are performed, the functional and esthetical outcome of single-tooth implant treatment today is excellent and can be recommended for replacing tooth losses after trauma in the anterior region of the maxilla. [source]

Cross-cultural evaluation of the Panic Disorder Severity Scale in Japan

DEPRESSION AND ANXIETY, Issue 1 2004
Ikuyo Yamamoto M.D.
Abstract The Panic Disorder Severity Scale (PDSS) [Shear et al., 1997] is rapidly gaining world-wide acceptance as a standard global severity measure of panic disorder, however, its cross-cultural validity and reliability have not been reported yet. We developed the Japanese version of the PDSS and examined its factor structure, internal consistency and inter-rater reliability and concurrent validity among Japanese patients with panic disorder with or without agoraphobia. We also established rules of thumb for interpreting PDSS total scores, taking the Clinical Global Impression severity scale as the anchoring criterion. The identical one-factor structure of the PDSS was confirmed among the Japanese patients as among the United States patients. Both internal and inter-rater reliability was excellent (Cronbach's alpha was 0.86, and ANOVA ICCs were all above 0.90). Concurrent validity of the PDSS items with self-report questionnaires tapping similar or overlapping domains was satisfactory (Pearson correlation coefficients were mostly above 0.5). Using the anchor-based approach, the following interpretative guides are suggested: among those with established panic disorder diagnosis, PDSS total scores up to 10 correspond with "mild," those between 11 and 15 with "moderate," and those at or above 16 correspond with "severe" panic disorder. The present findings support the cross-cultural generalizability of panic disorder symptomatology and of the PDSS, in particular. Depression and Anxiety 20:17,22, 2004. © 2004 Wiley-Liss, Inc. [source]

Treatment of Superficial Infantile Hemangiomas of the Eyelid Using the 595-nm Pulsed Dye Laser

DERMATOLOGIC SURGERY, Issue 5 2010
CHRISTOPHER M. HUNZEKER MD
BACKGROUND Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76,100%), good (51,75%), moderate (26,50%), or poor (0,25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid. Roy G. Geronemus, MD, is on the Medical Advisory Board for Candela Laser Corp. [source]

Cosmetic Use of Poly- l -Lactic Acid: A Retrospective Study of 130 Patients

DERMATOLOGIC SURGERY, Issue 2 2010
MELANIE D. PALM MD
BACKGROUND Poly- l -lactic acid (PLLA) is an effective treatment for patients seeking to correct volume loss due to aging. Although the Food and Drug Administration has approved PLLA for use in people with the human immunodeficiency virus (HIV), it is well-suited for patients seeking cosmetic treatment. OBJECTIVE To evaluate the efficacy and incidence of adverse events of HIV-negative patients treated with PLLA for volume restoration. MATERIALS AND METHODS This is a retrospective, single-center study of 130 HIV-negative patients treated with PLLA from 2003 to 2008. Patient satisfaction and incidence of adverse reactions were evaluated. RESULTS The most common reaction to PLLA treatment was the formation of nodules (8.5%). Almost all of the nodules were palpable; only one was visible. Treatment areas with the highest incidence of post-treatment nodules were the hands (12.5%) and cheeks (7.2%). Overall, patients were satisfied, with 55% having good to excellent correction; 75% of patients with five or more treatments rated their correction as good to excellent. Sixty-eight percent of all patients would repeat the procedure again. CONCLUSION PLLA is a safe, biodegradable volumizer used to reverse the signs of aging by gradually correcting volume loss. Patients should be aware of possible adverse reactions during the course of treatment. Nodule formation is low, with most patients having good to excellent correction. Drs. Butterwick and Goldman are consultants for Sanofi-Aventis. [source]

Treatment of Vitiligo on Difficult-to-Treat Sites Using Autologous Noncultured Cellular Grafting

DERMATOLOGIC SURGERY, Issue 1 2009
SANJEEV V. MULEKAR MD
BACKGROUND Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. OBJECTIVE To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte,keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. METHODS AND MATERIALS Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. RESULTS For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. CONCLUSIONS The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site." [source]

Application of a New Intense Pulsed Light Device in the Treatment of Photoaging Skin in Asian Patients

DERMATOLOGIC SURGERY, Issue 11 2008
YUAN-HONG LI MD
BACKGROUND Intense pulsed light (IPL) technology has long been used in the treatment of photoaging skin. OBJECTIVE To evaluate the efficacy and safety of a new IPL device in the treatment of photoaging skin in Asian patients. METHODS One hundred fifty-two Chinese women with photoaging skin were enrolled in this open-labeled study. Subjects received four IPL treatments at 3- to 4-week intervals. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter, and a Corneometer. RESULTS One hundred thirty-nine of 152 patients (91.44%) experienced a score decrease of 3 or 2 grades, according to the dermatologist. One hundred thirty-six of 152 patients (89.47%) rated their overall improvement as excellent or good. The mean skin melanin index (MI) and erythema index values deceased with each session. MI on forehead and EI on cheilion decreased most significantly. Adverse effects were limited to mild pain and transient erythema. CONCLUSION IPL treatment is a safe and effective method for photoaging skin in Asian patients. Adverse effects were minimal and acceptable. [source]

Surgical Treatment of Ingrown Toenail without Matricectomy

DERMATOLOGIC SURGERY, Issue 1 2008
BERNARD NOËL MD
BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed. OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix. METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed. RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable. CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results. [source]

Condition Known as "Dark Rings Under the Eyes" in the Japanese Population is a Kind of Dermal Melanocytosis Which can be Successfully Treatedby Q-Switched Ruby Laser

DERMATOLOGIC SURGERY, Issue 6 2006
SHINICHI WATANABE MD
BACKGROUND In general, dark rings under the eyes are believed to be a phenomenon caused mainly by physiological change because of their daily fluctuation. Medically speaking, the precise cause or pathogenesis of dark rings is unknown, and this condition has not been clearly defined. In our experience, the dark rings associated with conventional nevus of Ota can be successfully treated with Q-switched ruby laser (QSRL). OBJECTIVE This study was conducted to clarify the nature of dark rings under the eyes and to determine the efficacy of QSRL. PATIENTS AND METHODS Fifty-four patients who received a biopsy for pigment macules of the face were retrieved, and of that number 12 patients with bilateral homogeneous pigment macule on suborbital regions were selected for study of the dark rings. Of those patients, the histology and the efficacy of QSRL were evaluated retrospectively. RESULTS Histologically, all 12 patients indicated dermal melanocytosis, which was confirmed by the Masson-Fontana silver stain and staining against S100. In five patients who received QSRL therapy two times or more, the clinical improvement of two patients was scored as good (40,69%), and two other patients as excellent (>70% clearance). CONCLUSIONS We speculate that so-called dark rings under the eyes in the Japanese population is a kind of dermal melanocytosis which can be successfully treated by QSRL. [source]

Novel Face-Lift Suspension Suture and Inserting Instrument: Use of Large Anchors Knotted into a Suture with Attached Needle and Inserting Device Allowing for Single Entry Point Placement of Suspension Suture.

DERMATOLOGIC SURGERY, Issue 3 2006
Preliminary Report of 20 Cases with 6- to 12-Month Follow-Up
BACKGROUND Various suspension suture techniques exist to elevate the mid-face, jowls, and neck. OBJECTIVE To assess safety and efficacy of a new suspension suture and inserting instrument with both standard and minimal incision (no-skin-excision) face-lifts. METHODS A new type of multianchor suspension suture assembled from commercially available 2-0 absorbable monofilament material, with 5 to 9 equally spaced knots through which are secured 7 to 9 mm bits of 0 thickness similar suture material, and an attached straightened needle, was used to elevate and suspend facial tissues to temporal or mastoid fascia. The suspension sutures are placed in the deep subcutaneous tissues, just above the superficial musculo aponeurotic system (SMAS), by use of a novel, blunt instrument, which does not require a second, distal exit point. The suspension suture distal end floats free. The proximal needle end is sutured to fascia. The suture was used on 20 patients. Fourteen of them underwent pure, "no-skin-excision," suspension lifts. Six had suspension suture elevation of the mid-face in conjunction with relatively conservative open lifts. Nine- to 12-month results were evaluated. RESULTS With open face-lifts, 9- to 12-month results are excellent with significant persistence of the correction initially achieved. Resulting scars remained fine line. There were no complications. With pure suspension lifts, initial results were impressive. By 6 months, correction started to fade. By 12 months 100% of initial correction for jowls, and 80 to 100% for mid-face, appeared lost. Recovery time was 2 to 4 days. There were no significant complications. CONCLUSION Large multianchor, absorbable monofilament sutures can safely and effectively enhance results of conservative lifts, with remarkable elevation of the mid-face not achievable with simple SMAS flaps. These suspension sutures can easily and safely achieve impressive, though relatively short-term results, with a minimal incision, "no-skin-excision" technique. [source]

Intraoral Extraction of Cheek Skin Cyst

DERMATOLOGIC SURGERY, Issue 12 2005
Richard Bennett MD
Background. When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. Objective. To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. Method. An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. Result. The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. Conclusion. A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin. RICHARD BENNETT, MD, MUBA TAHER, MD, AND JUSTINE YUN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Forehead Donor Site Full-Thickness Skin Graft

DERMATOLOGIC SURGERY, Issue 3 2005
Vassilios Dimitropoulos MD
Background Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar. Objective The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery. Methods A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon. Results FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids. Conclusion FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid. VASSILIOS DIMITROPOULOS, MD, CHRISTOPHER K. BICHAKJIAN, MD, AND TIMOTHY M. JOHNSON, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Plantar Hyperhidrosis and Pitted Keratolysis Treated with Botulinum Toxin Injection

DERMATOLOGIC SURGERY, Issue 12p2 2004
Bhertha M. Tamura
Background. Sulcate plantare keratolysis or pitted keratolysis (plantar keratolysis sulcatum) is a disease that is commonly found in tropical countries. Patients have also reported plantar hyperhidrosis. Objective. Two patients with pitted keratolysis resistant to topical and systemic treatments are described. Methods. Both patients were injected with botulinum toxin distributed evenly through the plantar extension. Results. The response to the treatment was excellent despite using a low dose of botulinum toxin with the plantar keratolysis healing completely. Conclusion. Hyperhidrosis may be considered the major etiologic factor for pitted keratolysis that does not respond to treatment. [source]

Photorejuvenation for Asian Skin by Intense Pulsed Light

DERMATOLOGIC SURGERY, Issue 7 2001
Kei Negishi MD
Background. Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought. Objective. To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed. Methods. Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks. Results. Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of "good" or "excellent" was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks. Conclusion. Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future. [source]

Resurfacing of Pitted Facial Acne Scars with a Long-Pulsed Er:YAG Laser

DERMATOLOGIC SURGERY, Issue 2 2001
Jeung-Tae Jeong MD
Background. Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. Objective. To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. Methods. Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III,V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0,7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. Results. The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. Conclusion. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars. [source]