Search

Various materials have been used for tissue augmentation and for the treatment of rhytids. Autologous fat transfer (AFT) is considered ideal regarding biocompatibility and patient concerns. This study was performed on a series of 215 female patients for face rejuvenation with tumescent technique fat harvesting and saline washing. The study was based on two AFT procedures for each patient. Second treatment was performed at least 1 month after the first operation. Their mean age was 55.5±2.1 years. High-definition photographs in five standard views, front (n=1), side (n=2) and oblique of 3/4 (n=2), were taken for the preoperative morphological study. Aesthetic outcomes were evaluated by the operating surgeon, the patient and an independent dermatologist. Outcomes were evaluated by comparing the preoperative photographs with those taken 1 month after the first procedure and at the end of the 1-year follow-up period. At 12 months all the patients except one noted an improvement. Of these 85.6% (184 patients) were satisfied with the treatment. The operating surgeon and the independent observer noted respectively a sufficient correction in 88.8 and 95.3%. AFT was considered painless by 94.9% and slightly painful by 5.1% of subjects. Fat tissue harvesting by tumescent anesthesia and purification with saline washing enable adipocyte viability to be preserved throughout the procedure and to perform the treatment under local anesthesia., (Copyright © 2012 S. Karger AG, Basel.)

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor of the skin with high rates of local recurrence. It is debated whether Mohs micrographic surgery (MMS) involves lower recurrence rates than wide local excision (WLE). Recent preliminary reports indicate more consistently favorable cure rates with MMS. We report comparative observational data on 41 patients who underwent MMS and 38 who underwent WLE. Their data were then pooled with those available in the medical literature to obtain more precise estimates of recurrence rates with MMS and WLE., Methods: The records of 79 patients with DFSP who underwent WLE (n=38) or MMS (n=41) in 1990-2005 were reviewed retrospectively. The primary endpoint was tumor recurrence rate. The PubMed database was searched for DFSP case series treated with WLE or MMS, and the recurrence proportions reported for the two separate procedures were pooled., Results: Five of the 38 WLE patients (follow-up=4.8 years) had recurrences (13.2%, 95% CI 4.4-28.1%) as opposed to none (95% CI 0-8.6%) of the 41 MMS patients (follow-up=5.4 years). Pooling of these data with those from the literature yielded 6/463 recurrences for MMS (1.3%, 95% CI 0.5-2.8%) and 288/1394 recurrences for WLE (20.7%, 95% CI 18.6-22.9%). The relative risk of recurrence for WLE vs. MMS patients was 15.9 (95% CI 7.2-35.5)., Conclusions: Significantly lower recurrence rates were recorded in our patients subjected to MMS compared with those treated with WLE. The pooled data also indicated a clear advantage of MMS. There is inconclusive evidence for any advantage of MMS in non-primary cases, while MMS was most effective in treating head and neck tumors. These data may be useful to guide clinicians in the choice of the more appropriate surgical treatment for DFSP patients.

Early surgical intervention remains the most successful therapy for melanoma. Despite better outcomes observed in soft tissue and lymph node metastases, the results of pharmacological therapies are still disappointing. Currently, there is no standard adjuvant therapy for melanoma. Low concentrations of coenzyme Q10 have been demonstrated in melanoma cell lines and in sera of melanoma patients. These data and the results of clinical trials of patients with other advanced cancers prompted this study of the long-term administration of an optimized dose of recombinant interferon alpha-2b and coenzyme Q10 to patients with stage I and II melanoma. A 3-year trial envisaging uninterrupted treatment with low-dose recombinant interferon alpha-2b (9 000 000 000 IU weekly) administered twice daily and coenzyme Q10 (400 mg/day) was conducted in patients with stage I and II melanoma (American Joint Committee on Cancer criteria 2002) and surgically removed lesions. Treatment efficacy was evaluated as incidence of recurrences at 5 years. All patients completed the treatment and the follow-up. Significantly different rates of disease progression were observed in the interferon+coenzyme Q10 and the interferon group for both stages. No patient withdrew from the study owing to side effects. Long-term administration of an optimized dose of recombinant interferon alpha-2b in combination with coenzyme Q10 seemed to induce significantly decreased rates of recurrence and had negligible adverse effects. A survival study could not be undertaken owing to the small patient sample and the short duration of follow-up.

Background: Improvement in skin laxity can be difficult to achieve without invasive surgical procedures. Monopolar radiofrequency (RF) treatment is used by physicians to heat skin and promote tissue tightening and contouring. RF technology produces an electric current that generates heat through resistance in the dermis and subcutaneous tissue. The thermal effect depends on the conductivity features of the treated tissue. When heated, collagen fibrils will denature and contract, which is believed to lead to the observed tissue tightening., Methods: Ninety-three consecutive patients with mild to moderate laxity were included in the study. The Surgitron Dual Frequency RF (Radiowave technology, Ellman International) was used to treat skin laxity. The application of RF energy took place in an ambulatory setting with no need for skin sterilization or anesthesia., Results: Patients immediately noticed a microlifting retraction in the treated tissues according to the vectors mapped in the area. There were no significant complications and the majority of patients were satisfied with the procedure and able to return to their daily routine after leaving the office, thereby substantiating the popularity of noninvasive rejuvenating procedures.

Background: Despite their benign nature, keloids may constitute a severe aesthetic and, in some cases, functional problem with important repercussions on patients' quality of life. There is no consensus on keloid treatment and no wholly satisfactory therapy has yet emerged., Objective: To assess the efficacy of cryotherapy in the treatment of keloids., Methods: 135 patients with 166 keloids received cryosurgical treatment between 1990 and 2004. Freeze times and number of sessions varied. Scar volume was measured before and after treatment. Median follow-up was 48.6 months (range 12.4-72.6 months)., Results: Of the 166 lesions treated, 79.5% responded very well with a volume reduction of the initial mass of greater than 80% after a median of 3 treatments (range: 1-9). A good result was obtained in 14.5% of lesions, while results were unsatisfactory in 6% of cases. The main adverse effects reported were atrophic depressed scars and residual hypopigmentation (75% of cases). No recurrences arose during the follow-up period (12-72 months)., Conclusions: To date, cryotherapy appears to be the most effective, safe, economic, and easy-to-perform monotherapy to treat keloid lesions and hypertrophic scars.

Background: Abnormally low plasma levels of coenzyme Q10 (CoQ10) have been found in patients with cancer of the breast, lung, or pancreas., Objective: A prospective study of patients with melanoma was conducted to assess the usefulness of CoQ10 plasma levels in predicting the risk of metastasis and the duration of the metastasis-free interval., Methods: Between January 1997 and August 2004, plasma CoQ10 levels were measured with high-performance liquid chromatography in 117 consecutive melanoma patients without clinical or instrumental evidence of metastasis according to American Joint Committee on Cancer criteria and in 125 matched volunteers without clinically suspect pigmented lesions. Patients taking CoQ10 or cholesterol-lowering medications and those with a diagnosis of diabetes mellitus were excluded from the study. Multiple statistical methods were used to evaluate differences between patients and control subjects and between patients who did (32.5%) and did not (67.5%) develop metastases during follow-up., Results: CoQ10 levels were significantly lower in patients than in control subjects (t test: P < .0001) and in patients who developed metastases than in the metastasis-free subgroup (t test: P < .0001). Logistic regression analysis indicated that plasma CoQ10 levels were a significant predictor of metastasis (P = .0013). The odds ratio for metastatic disease in patients with CoQ10 levels that were less than 0.6 mg/L (the low-end value of the range measured in a normal population) was 7.9, and the metastasis-free interval was almost double in patients with CoQ10 levels 0.6 mg/L or higher (Kaplan-Meier analysis: P < .001)., Limitations: A study with a larger sample, which is currently being recruited, and a longer follow-up will doubtlessly increase the statistical power and enable survival statistics to be obtained., Conclusions: Analysis of our findings suggests that baseline plasma CoQ10 levels are a powerful and independent prognostic factor that can be used to estimate the risk for melanoma progression.

Melasma is a common disorder of hyperpigmentation involving sun exposed face and neck areas. Three clinical patterns of melasma are recognized: the centrofacial, the malar, and the mandibular ones. Several factors have been implicated in the pathogenesis of this disorder including pregnancy, oral contraceptive therapy, sun exposure, genetic factors, cosmetics, and race. This condition is most frequently observed in women and affects all racial groups; however, it is commonly found in darker-complexioned individuals (skin types IV through VI) and in Asian women who live and work under strong sunlight exposure for long periods. Melasma is very difficult to treat and often resistant to therapy. Treatment of melasma includes various hypopigmenting agents, chemical peeling, and laser surgery with unsatisfactory results. We report 3 cases of facial melasma successfully treated with a Q-switched Alexandrite laser.

Hyperhidrosis is an invalidating condition, and one that is difficult to treat. It is characterized by an excessive and uncontrolled production of sweat by the sweat glands, often causing psychological, social, and occupational problems for the patient. Hyperhidrosis can be distinguished in two forms: idiopathic (of unknown etiology), or secondary, due to an alteration of the endocrine system (ex: hyperthyroidism, neuropathy, neoplasia etc.) It is found in about 0.3-0.5% of the population and can be localized (axillary, palmar, plantar, facial) or diffused. The subcutaneous injection of type A botulinum toxin, until now used only for the treatment of blepharospasm or hemifacial spasm, has shown to be a useful treatment for localized hyperhidrosis. The objective of the authors is to evaluate the therapeutic efficacy, safety, and management of botulinum toxin treatment in patients affected with axillary or palmar hyperhidrosis resistant to conventional therapies.

Background: Early surgical intervention is still the most successful therapy for patients with melanoma. The results obtained with medical therapies are still quite disappointing, with better results observed in soft tissue and lymph node metastasis. There currently is no standardized adjuvant therapy for primary melanoma. On the basis of the activity demonstrated in vitro against melanoma cell lines and the results obtained in many clinical trials in patients with advanced melanoma, the authors chose to study the use of recombinant interferon-alpha (IFN-alpha) as adjuvant therapy for patients with Stage I and Stage II melanoma., Methods: A randomized multicenter trial based on the use of recombinant IFN-alpha-2b for 3 years at the dose of 3 MU given intramuscularly 3 times a week for a period of 6 months with a 1-month interval between cycles was conducted in Stage I and Stage II melanoma patients (using the American Joint Committee on Cancer classification). The efficacy of this treatment was evaluated calculating the incidence of recurrence after 3 and 5 years., Results: Results were collected at the end of the treatment period and after 5 years of follow-up for a smaller number of patients. Statistical evaluation showed a significant difference between treated patients and untreated controls with regard to progression of the disease. In particular, IFN-alpha appears to be more effective in patients with worse prognosis lesions., Conclusions: IFN-alpha appears to be effective as adjuvant therapy for high risk melanoma patients and the risk/benefit ratio appears to be very favorable. The authors' next goal is to separate those patients who might benefit from adjuvant therapy from those who are cured after the surgical intervention only.

Background: Numerous approaches are used to treat keloids, but none is ideal for all scars and recurrence after treatment is frequent., Objective: The purpose of this study was to evaluate the efficacy of cryotherapy for treatment of these scars., Methods: Sixty-five lesions of various sizes and ages were treated with a hand-held liquid nitrogen spray unit; freeze times and number of sessions varied. Scar volume was measured before and after treatment., Results: Complete flattening was achieved in 48 scars (73%), most of which were less than 2 years old. Unacceptable responses were seen in six scars. No recurrence was seen during follow-ups ranging from 17 to 42 months. Side effects were limited to hypopigmentation and slight to moderate atrophy in three cases., Conclusion: Cryotherapy is an effective, low-risk approach to keloid treatment associated with a low rate of recurrence.

Peripheral blood mononuclear cells (PBMC), as defined by monoclonal antibodies (OKT3, OKT4, OKT8, OK 1, Leu 7, Leu 11b) were determined in 10 psoriatic patients and in 10 healthy subjects before and after administration of short-term PUVA therapy. A comparison of the mean baseline percentages of the two groups showed a statistically significant increase in Leu 7+ cells (p less than 0.001) as well as a slight increase in OKM1 and OKT8 positive cells in the psoriatic subjects. After 21 exposures, these subsets showed a reduction towards control values, while a significant increase in OKT3 and OKT4 positive cells (p less than 0.01) could be observed only in the control group. These results indicate that short-term PUVA therapy is associated with changes in PBMC subpopulations. This modification, however, does not necessarily imply a disturbance of immune system function, including natural killer activity.

Pre-treatment Serum Beta 2-microglobulin (S B2-m) and OKT4/OKT8 Ratio (T4/T8 R) were studied in 15 patients with Mycosis Fungoides (MF) and in 10 subjects with Chronic Superficial Benign Dermatitis (CSBD) in order to verify whether these parameters may lend support to an earlier differential diagnosis. S B2-m levels and T4/T8 R showed no significant difference in CSBD as compared to normal controls. MF patients displayed elevated S B2-m and T4/T8 R values in comparison to healthy controls and subjects suffering from CSBD (P less than 0.001). After photochemotherapy (PUVA), markedly decreased S B2-m and T4/T8 R values were observed in all patients but two who proved to be unresponsive to PUVA treatment. On the basis of reported data, S B2-m and T4/T8 R can be regarded as an additional tool to discriminate CSBD and MF when clinical and histological features are not significantly diagnostic. Finally, these parameters seem to provide reliable information in monitoring response to treatment.