A double-blind, comparative study of nonanimal-stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands

BACKGROUND AND OBJECTIVE

Cosmetic surgery to counteract the aging process is an evolving field. Most procedures have concentrated on the face; however, the hands are an often-neglected area. Current methods of hand rejuvenation include autologous fat injection, sclerotherapy, intense pulsed light, chemical peel, and microdermabrasion. Only autologous fat injection restores dermal thinning. We compare the use of hyaluronic acid (Restylane, Medicis Aesthetics Inc.) versus collagen (Cosmoplast, INAMED Aesthetics) for soft tissue augmentation of the dorsal hands.

MATERIALS AND METHODS

Ten female patients who demonstrated dermal thinning of the dorsal hands were randomized to receive 1.4 mL of hyaluronic acid or 2.0 cm(3) collagen to alternate interphalangeal spaces of dorsal hands. Patients returned at 1 week, 1 month, 3 months, and 6 months for digital photography and completion of a patient/physician questionnaire.

RESULTS

Hands were scored by two separate blinded physicians on scales of 1 to 5 for clearance of veins. Patients scored both tolerability and satisfaction on a scale of 1 to 5. Analysis showed a mean difference of 0.95 (0.004), median difference of 0.9 (0.008) for clearance, and a mean difference of 0.90 (0.010) with a median difference of 1.0 (0.031). The satisfaction difference was not significant with a mean difference of 0.80 (0.070) and median difference of 1.0 (0.117).

CONCLUSION

Aging of the hands is a common problem that is often overlooked. The use of soft tissue fillers is a viable tool in hand rejuvenation. In this study hyaluronic acid proved to be superior in efficacy to collagen.

Violaceous papules on the palms and soles

BACKGROUND

Lichen planus (LP) is a condition with many clinical variants that can be quite varied in their presentation.

OBJECTIVE

We report a case of a 60-year-old woman who presented with a very unusual palmoplantar eruption characterized by violaceous pustule-like papules that was subsequently diagnosed as LP.

METHODS

The above case is reported, along with biopsy results. The patient was subsequently treated with a combination of topical corticosteroids and oral acitretin, and her clinical course was followed.

RESULTS

The eruption responded dramatically to our combination treatment and resolved by the 2-month follow-up.

CONCLUSION

Palmoplantar LP is a rare variant of LP that bears little resemblance to its classic LP. This condition responds well to a combination of potent topical corticosteroids and oral acitretin.

Multistep loading of titania nanoparticles in the mesopores of SBA-15 for enhanced photocatalytic activity

A multistep deposition of anatase nanoparticles was employed to incorporate high amounts of titania into the mesopores of SBA-15. Anatase nanoparticles were synthesized and deposited following the Acid Catalyzed Sol Gel method. With this method, the size of the anatase nanoparticles can be controlled and therefore, the titania loading into the mesopores of SBA-15 can be controlled. Through multistep deposition of anatase nanoparticles, a further increase of titania loading into the mesoporous channels can be obtained. For the degradation of Rhodamine-6G, the samples synthesized by multistep deposition showed an enhanced photocatalytic activity.

Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature

OBJECTIVES

The aim of the present study was to investigate the possible association between periodontal health and acute myocardial infarction (AMI) in a case-control design.

MATERIALS AND METHODS

A total of 500 patients, 250 with AMI and 250 with coronary heart disease (CHD) were included in this study. The patients in the AMI group were admitted in the department of Medicine, Goa Medical College and Hospital, Bambolim-Goa because of AMI. The patients in the CHD group had no documented history of recent acute coronary events. Medical history was taken and data on serum lipid values, decayed teeth, missing teeth, filled teeth, probing depth (PD), simplified oral hygiene index (OHI-S) and bleeding on probing (BOP) were recorded. Sample proportions were compared by Pearson's chi-square test and quantitative variables with Student's t-test. The relation of clinical parameters and conventional risk factors with AMI was assessed with multivariate logistic regression analysis.

RESULTS

All the serum lipids and dental parameters were statistically different between AMI and CHD groups (p <0.05). Logistic regression analysis showed that serum lipids, number of decayed teeth, mean PD, percentage of sites with BOP, and oral hygiene were significantly associated with AMI (p <0.05).

CONCLUSION

The results of this study indicate that periodontal disease may be associated with AMI. We propose that prospective randomised studies are needed to determine whether periodontal disease is a risk factor in the occurrence of AMI.

Induction of VEGF secretion in ovarian cancer by PDGF BB

5557

Background: We identified the PDGFR as a potential target in epithelial ovarian carcinoma (EOC). This led us to test whether inhibition of the receptor affects ovarian cancer cell proliferation and survival and regulates other processes critical to tumor growth and metastasis. We postulated that the PDGF-PDGFR axis regulates VEGF secretion in EOC. Methods: VEGF secretion in ovarian tumors, cancer cells, serum and ascites was measured by IHC, Western Blot and ELISA. The HOG Gyn03–62 protocol was a phase II protocol for patients with recurrent platinum resistant EOC. Patients were treated with imatinib and docetaxel. Serum and tumor samples from patients enrolled on this protocol were analyzed for VEGF. Results: VEGF expression was quantified by IHC in ovarian tumors. Of 21 PDGFR expressing ovarian tumors, seven specimens immunostained strongly for VEGF and six tumors demonstrated 2+ VEGF reactive extracellular (secreted) material. PDGF and VEGF secretion was measured in 17 specimens of malignant EOC ascites. The levels of PDGF BB and VEGF were strongly correlated (Pearson coefficient =0.728, p-value=0.001), suggesting that the two pathways interconnect. There was no correlation between PDGF AA and VEGF levels. VEGF levels were measured in 13 paired serum samples from patients enrolled in the clinical protocol HOG: Gyn03–62, before and after treatment. VEGF serum levels were stabilized or decreased in 9 of 13 EOC patients treated with imatinib. In conditioned media from primary cells, VEGF secretion was four fold higher for tumor derived cells than for cells derived from the normal ovarian epithelium. PDGF increased ten-fold VEGF secretion in PDGFR expressing immortalized ovarian cells (C272/hTert/E7 and C889/hTert), while imatinib reduced VEGF production to basal state. The effects of imatinib were mediated via inhibition of Akt and MAPK pathways, by stabilization of HIF1 alpha. In ovarian cancer cells overexpressing consitutively active Akt, imatinib inhibited only partially the secretion of VEGF compared to control cells, suggesting that the PI3K/Akt pathway is significantly implicated in PDGF-stimulated VEGF secretion. Conclusions: These results suggest that by blocking the PDGFR, imatinib inhibits VEGF production. This affects the tumor microenvironment favoring ovarian tumor growth and metastasis.

No significant financial relationships to disclose.

Lack of horizontal gene transfer of methicillin-resistance genetic determinants from PBP2a-positive, coagulase-negative staphylococci to methicillin-sensitive Staphylococcus aureus using transcutaneous electrical nerve stimulation (TENS)

Previous research shows that approximately half of the coagulase-negative staphylococci (CNS) isolated from patients in the intensive care unit (ICU) at Belfast City Hospital were resistant to methicillin. The presence of this relatively high proportion of methicillin-resistance genetic material gives rise to speculation that these organisms may act as potential reservoirs of methicillin-resistance genetic material to methicillin-sensitive Staphylococcus aureus (MSSA). Mechanisms of horizontal gene transfer from PBP2a-positive CNS to MSSA, potentially transforming MSSA to MRSA, aided by electroporation-type activities such as transcutaneous electrical nerve stimulation (TENS), should be considered. Methicillin-resistant CNS (MR-CNS) isolates are collected over a two-month period from a variety of clinical specimen types, particularly wound swabs. The species of all isolates are confirmed, as well as their resistance to oxacillin by standard disc diffusion assays. In addition, MSSA isolates are collected over the same period and confirmed as PBP2a-negative. Electroporation experiments are designed to mimic the time/voltage combinations used commonly in the clinical application of TENS. No transformed MRSA were isolated and all viable S. aureus cells remained susceptible to oxacillin and PBP2a-negative. Experiments using MSSA pre-exposed to sublethal concentrations of oxacillin (0.25 microg/mL) showed no evidence of methicillin gene transfer and the generation of an MRSA. The study showed no evidence of horizontal transfer of methicillin resistance genetic material from MR-CNS to MSSA. These data support the belief that TENS and the associated time/voltage combinations used do not increase conjugational transposons or facilitate horizontal gene transfer from MR-CNS to MSSA.

Treatment of Wrinkles and Elastosis Using Vacuum-Assisted Bipolar Radiofrequency Heating of the Dermis

BACKGROUND

Reduction of wrinkles is increasingly becoming one of the most sought after aesthetic procedures. A variety of treatment modalities are available for this application, including radiofrequency energy in various modes of action.

OBJECTIVE

The goal of the reported study was to evaluate the safety and efficacy of a new device, which implements an innovative combination of bipolar radiofrequency and vacuum.

METHODS

Forty-six healthy adults at two clinics underwent eight facial treatments every 1 to 2 weeks. For 6 months after treatment, patients were assessed directly by two evaluators at each clinic (the treating physician and an additional reviewer) using standard evaluation tools-the Fitzpatrick-Goldman Classification of Wrinkling and Degree of Elastosis and a visual analog scale.

RESULTS

Significant improvement in the skin's appearance and texture was observed during the treatment course and continued to increase during the follow-up period. The mean elastosis score on the wrinkling and elastosis scale before treatment was 4.5 and was reduced to less than 2.5 by 6 months after treatment, representing a drop of an entire wrinkle class (from II to I) on this scale. The reported pain levels were low, and the subjects expressed their satisfaction with the treatment and its outcome. The adverse responses consisted mainly of transient erythema and burn/blistering; there were also a few occurrences of edema, purpura, and crusting and one transient hyperpigmentation. No permanent complications had occurred.

CONCLUSIONS

Our results demonstrate the safety and efficacy associated with use of this radiofrequency and vacuum device, employing Functional Aspiration Controlled Electrothermal Stimulation (FACES) technology, for reduction of facial wrinkles and elastosis.

Randomized, blind, controlled trial of transdermal rotigotine in early Parkinson disease

OBJECTIVE

This multicenter, randomized, double-blind study was performed to compare the safety and efficacy of the once-daily dopamine agonist rotigotine, in a continuous-dosing transdermal-patch formulation, vs placebo in patients with early-stage Parkinson disease (PD).

METHODS

Patients were randomized to receive placebo (n = 96) or rotigotine (n = 181), starting at 2 mg/24 h (10-cm(2) patch size; 4.5-mg total drug content), titrated weekly up to 6 mg/24 h (30-cm(2) patch size; 13.5-mg total drug content), and then maintained for 6 months. The primary efficacy measures were 1) the change in the Unified Parkinson's Disease Rating Scale (UPDRS) scores (parts II and III) from baseline to end of treatment and 2) responder rates (patients with > or =20% improvement).

RESULTS

Patients receiving rotigotine had a mean absolute difference of 5.28 (+/-1.18) points lower in UPDRS subtotal scores compared with those receiving placebo (p < 0.0001). The mean change in part III motor scores was -3.50 (+/-7.26) (n = 177) and was the greatest contributor to UPDRS improvement. The rotigotine group had more responders (48 vs 19%; p < 0.0001). The most commonly reported adverse events were application site reactions (44% rotigotine vs 12% placebo), nausea (41 vs17%), somnolence (33 vs 20%), and dizziness (19 vs 13%), and most were mild or moderate in intensity.

CONCLUSIONS

Transdermal rotigotine, when titrated to a dosage of 6 mg/24 h, was effective for the treatment of early-stage Parkinson disease in this trial. Adverse events were similar to those found with other transdermal systems and dopamine agonists.

Photodynamic Therapy for Actinic Keratoses

Actinic keratoses (AKs) are one of the most common conditions that are treated by dermatologists and they have the potential to progress to squamous cell carcinoma if left untreated. Photodynamic therapy (PDT) has emerged as a novel and versatile method of treating those lesions. Topical preparations of aminolevulinic acid and methyl aminolevulinate are commercially available photosensitizers, and numerous light sources may be used for photoactivation. This article focuses on practical aspects of PDT in the treatment of AKs, outcomes of relevant clinical trials, and special applications of PDT in transplant recipients and other who are predisposed to AK formation. Step-by-step descriptions of PDT sessions are presented.

Improvement in the appearance of wrinkles with topical transforming growth factor beta(1) and l-ascorbic acid

BACKGROUND AND OBJECTIVE

Facial rhytides are a common cosmetic concern. Surgical treatment effects dramatic improvement; however, the associated risk and cost may be prohibitive. Recent focus is on developing topical products containing biologically active ingredients for at-home therapy. Our study examines the effects of a topical cream containing transforming growth factor-beta(1) (TGF-beta(1)), l-ascorbic acid, and Cimicifuga racemosa extract (CRS) (Topix Pharmaceuticals, North Amityville, NY, USA).

MATERIALS AND METHODS

In the first arm of the study, 12 subjects were randomized to apply CRS to the left or right side of their face and a cream containing l-ascorbic acid and C. racemosa in silicone base (vitamin C [Vit C]) to the contralateral side twice daily for 3 months. In the second arm of the study, 20 subjects were randomized to apply CRS to the left or right side of their face and Tissue Nutrient Solution Recovery Complex (TNS) (SkinMedica, Carlsbad, CA, USA), a product containing a variety of growth factors including VEGF, PDGF-A, G-CSF, HGF, IL-6, IL-8, and TGF-beta(1) (Nouricel-MD) without l-ascorbic acid, C. racemosa extract, or silicone base, to the contralateral side of their face twice daily for 3 months. Digital photographs were scored by study-blinded physicians, and self-assessments were completed by all subjects at baseline and at the conclusion of the protocol.

RESULTS

CRS and TNS were well tolerated, and all subjects completed the 3-month protocol for the CRS versus Vit C arm of the study. Physicians rated success in facial wrinkling scores on the CRS-treated side of the face for 27 of 31 subjects. Responders showed, on average, 21.7% improvement in physician-rated wrinkle scores. The mean improvement in the group of 31 patients as a whole was 12%. Eighteen of 31 subjects reported a noticeable improvement on their CRS-treated side. Both CRS and TNS demonstrate significant success between baseline and 3-month scores, and both growth factor products are superior to Vit C. Patients preferred CRS over TNS.

CONCLUSION

CRS is effective in minimizing the appearance of facial rhytides. The success of the CRS product is largely attributable to the incorporation of TGF-beta(1).

Autocrine activation of PDGFRalpha promotes the progression of ovarian cancer

Platelet-derived growth factor receptor (PDGFR)alpha expression was found in ovarian cancer cells and tumors by microarray hybridization. This led us to test whether ovarian cancers also produce ligands for this receptor, as this would demonstrate that such malignancies support their own growth and spread through autocrine activation. We assayed the expression of ligands for the PDGFR in ovarian tumors, cell lines and peritoneal fluid using RT-PCR, immunohistochemistry (IHC) and ELISA. We detected strong mRNA expression for the PDGFRalpha ligands in most ovarian tumors. Receptor and ligand expressions (PDGFRalpha and PDGF AB) were also detected by IHC in, respectively, 34 and 32 of 47 ovarian tumors. The stainings for PDGFRalpha and PDGF AB were strongly correlated (P-value=0.014), suggesting that an autocrine loop is functional in ovarian cancer. PDGF AA and BB were quantified in peritoneal fluid by ELISA. Both ligands are secreted at higher levels in ovarian cancer ascites specimens (n=54) than in fluid from nonmalignant disorders (n=8). PDGF was detected in media conditioned by ovarian cancer cells. Such conditioned media induced activation of the PDGFR, Akt and MAPK and stimulated cell proliferation. A neutralizing PDGF antibody blocked these effects. Specific PDGFR inhibition by siRNA or a neutralizing antibody to the receptor inhibited PDGF-stimulated receptor activation and cell proliferation, suggesting that receptor targeting has a role in ovarian cancer treatment.

Regulation of cerebral glucose metabolism

The brain uses glucose as a primary fuel for energy generation. Glucose gains entry into the brain by facilitated diffusion across the blood-brain barrier. Glucose transport may adapt during changes in cerebral glucose metabolism, neural activation and changes in plasma glucose levels. Within the brain, glucose is either oxidized to produce ATP or used to synthesize glycogen. To ensure the delivery of a continuous supply of glucose to maintain normal cellular function, the brain has developed a complex regulatory system to preserve its supply. Gluco-sensing neurons have been demonstrated in various regions of the brain and they appear to play an important role in not only detecting changes in brain glucose levels but also in initiating responses to maintain constant brain glucose levels. In this review, we will discuss the regulation of brain glucose metabolism (CMR(gluc)) and how it adapts to chronic changes in glycemia, like that seen in hyperglycemic patients with diabetes mellitus or patients with type 1 diabetes, recurrent hypoglycemia, and hypoglycemia unawareness. We will also consider the role of brain glycogen in providing fuel for energy under conditions of stress.

Biomechanical and Histomorphometric Analyses of Monocortical Screws at Placement and 6 Weeks Postinsertion

Maxillofacial screws are increasingly being used in orthodontics to provide anchorage for tooth movement. The objective of this study was to determine the biomechanical stability as well as the bone tissue response of screws at 6 weeks postinsertion in a canine model. Seven skeletally mature male dogs received 102 screws (2 × 6 mm or 2 × 8 mm) at predetermined sites. Twenty screws became loose or were lost during the 6-week undisturbed healing period. Forty-eight screws were randomized for mechanical testing and 34 for histology. Peak pullout strength was recorded and ∼80-μm sections were examined for histomorphometric parameters. Statistical analyses were conducted by analysis of variance and Tukey-Kramer method. Mean ± SE peak pullout strengths for the various sites ranged from 153.5 ± 37.6 N to 389.3 ± 32.5 N with no significant (P &lt; .05) differences at immediate placement and 6 weeks postinsertion. Bone contact ranged from 79% to 95%. Histomorphometric analyses indicated higher bone formation rate in the mandible than in the maxilla and a gradient of decreasing turnover with increasing distance from the screw interface. These results provide the clinical orthodontist with an estimate of the holding power of these screws and an understanding of early biological healing response associated with self-drilling screws.

Prospective, Comparative Evaluation of Three Laser Systems Used Individually and in Combination for Axillary Hair Removal

BACKGROUND

Using the concept of selective photothermolysis, a variety of laser systems have been developed to remove unwanted hair.

OBJECTIVE

To evaluate the relative efficacy, tolerability, and subject satisfaction of three different laser systems used individually and in rotation for axillary hair removal.

METHODS

Twenty female patients (17 with dark-colored hair, 3 with red or light-colored hair) with Fitzpatrick phototype II skin received three treatments performed at 6- to 8-week intervals. Each axilla was divided in half to yield four distinct areas that were treated by the following lasers: (1) three sessions with a long-pulse 755 nm alexandrite laser, (2) three sessions with a long-pulse 810 nm diode laser, (3) three sessions with a long-pulse 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and (4) rotational treatment consisting of a single session by each of the three laser systems. Percent hair reduction and acute and long-term side effects were evaluated after treatment. Subjects completed questionnaires assessing tolerability and satisfaction.

RESULTS

All subjects tolerated the treatments well, with only local, transient side effects seen. At the 3-month follow-up, the greatest average hair reduction was comparably similarly seen after the alexandrite laser at 59.3 +/- 9.7% and the 810 nm diode laser at 58.7 +/- 7.7%. The Nd:YAG laser and rotational regimens were less efficacious, with 31.9 +/- 11.1% and 39.8 +/- 10.1% hair reduction, respectively. Subjects with red or light-colored hair experienced 5 to 15% reduced efficacy with any laser system used. Subjects found the alexandrite and diode lasers to be equally tolerable, with only slight discomfort, and the Nd:YAG laser to be the least comfortable of the three systems. Overall, subject satisfaction of each treated site, in decreasing order, was (1) the 810 nm diode laser, (2) the alexandrite laser, (3) rotational therapy, and (4) the Nd:YAG laser.

CONCLUSION

At the 3-month follow-up, the long-pulse alexandrite and 810 nm diode lasers demonstrated no statistically significant differences in efficacy, comparable efficacy and tolerability, and highest subject satisfaction. Rotational therapy with the three laser systems is not as effective as treatment with the alexandrite laser or diode laser alone but is statistically more effective than use of the long-pulse Nd:YAG system alone. Individuals with red or light-colored hair and Fitzpatrick phototype II skin have decreased efficacy of laser treatment than those with dark-colored hair and the same phototype.

Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration

BACKGROUND

Injections of corticosteroids are commonly used for a variety a dermatologic conditions but may cause local, persistent cutaneous atrophy, with few therapeutic options.

OBJECTIVE

To determine the effectiveness of bacteriostatic normal saline infiltration on the improvement of corticosteroid-induced cutaneous atrophy.

MATERIALS AND METHODS

Four patients with corticosteroid-induced atrophy of the skin, two caused by acneiform cysts and one from intramuscular steroid injection, were treated with weekly injections of normal saline directly into the atrophic site. The patients were seen on weekly follow-up visits, and improvement was documented.

RESULTS

All four patients demonstrated complete resolution of skin atrophy and restoration of surface contour within 4 to 8 weeks of initial presentation. Injected volumes of normal saline ranged from 5 to 20 cm(3) per treatment session and three to six weekly treatments. The patients were completely satisfied with these results.

CONCLUSION

Normal saline infiltration offers a safe, tolerable, relatively rapid, and effective treatment for local, persistent corticosteroid-induced atrophy.

Clinical comparison between two hyaluronic acid-derived fillers in the treatment of nasolabial folds: hylaform versus restylane

BACKGROUND

Hyaluronic acid-derived injectible fillers are ideal to reduce the appearance of nasolabial folding because their effect is relatively long-lasting, the material is malleable and easy to use, and there is a very low incidence of allergic reaction.

OBJECTIVE

To compare the tolerability and efficacy of two commercially available hyaluronic acid-based fillers, Hylaform (INAMED Aesthetics, Inc., Santa Barbara, CA, USA) and Restylane (Medicis Pharmaceutical Corporation, Scottsdale, AZ, USA), in the treatment of nasolabial folds.

METHODS

Eight healthy adult female subjects underwent filler injection therapy for tissue augmentation of their nasolabial folds. Each subject was randomized to receive Restylane 0.7 mL to either the right or the left nasolabial fold and Hylaform 1.0 mL to the contralateral side. High-quality digital photography was performed both at baseline and at 12 weeks post-treatment. These photographs were assessed by four blinded, independent dermatologist reviewers for improvement. Subjects completed questionnaires to document tolerability and satisfaction.

RESULTS

All subjects found the procedure to be tolerable and completely pain free after the use of oral infraorbital regional anesthesia blocks. The average subject satisfaction score was 3.00 of 5 for Hylaform and 3.78 of 5 for Restylane. The blinded, independent reviewer panel attributed an average improvement score of 2.86 of 5 for Hylaform and 3.78 of 5 for Restylane.

CONCLUSION

Both Hylaform and Restylane are effective fillers for tissue augmentation of the nasolabial folds. Restylane demonstrated higher efficacy and subject satisfaction than Hylaform. With regional nerve blocks prior to injection, both agents are completely painless.

Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins

BACKGROUND

Twenty subjects were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent.

OBJECTIVE

To determine the safety and efficacy of two widely used sclerosing agents.

METHODS

After the exclusion of saphenofemoral junction incompetency, each subject's leg veins were categorized by size (< 1, 1-3, and 3-6 mm in diameter). Each leg was then randomized to be treated with 0.5%, 1%, or 1% foam of POL or 0.25%, 0.5%, or 0.5% foam of STS according to vein size. An independent panel of four physicians, blinded to treatment, performed randomized photographic evaluations obtained pretreatment and 12 weeks post-treatment. Subject satisfaction index and overall clinical improvement assessment were also obtained.

RESULTS

An average 83% improvement was noted for all vein sizes in all subjects with both POL and STS after a single treatment. Subjects were satisfied with treatment, regardless of the sclerosing agent used or the vein size treated. There was no statistically significant difference in adverse effects between each group.

CONCLUSION

Both POL and STS are safe and effective sclerosing agents in the treatment of varicose and telangiectatic leg veins. Both are very tolerable and demonstrate similar post-treatment sequelae.

Stability of foam in sclerotherapy: differences between sodium tetradecyl sulfate and polidocanol and the type of connector used in the double-syringe system technique

BACKGROUND

Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Worldwide, the most popular agents used are sodium tetradecyl sulfate (STS) and polidocanol (POL). The double-syringe system technique to make foam out of a sclerosing solution and air has received wide attention for its ease and reproducibility. This study examined the possibility that the relative silicone content of various disposable connectors may affect overall foam stability. We also evaluated the differences in the stability of foam between STS and POL.

MATERIALS AND METHODS

In the first part of the study, one nondisposable stainless steel connector and five disposable plastic connectors were used to create foam from STS 0.50% and air. The procedure was then repeated to produce foam from POL 0.50% and air from each of the six different connector types. As a measure of foam stability, once foam was created with each type of connector, the time required for half of the original volume of sclerosing solution to settle was recorded. In the second part of the study, foam was created with a nondisposable stainless steel connector only and various concentrations of STS and POL. Foam stability was then measured for these different concentrations of sclerosants.

RESULTS

The time for sclerosing solution to settle to half of its initial volume was found to vary according to the specific sclerosant and concentration used, with no statistically significant variation based on connector type.

CONCLUSIONS

The type of connector used in the double-syringe system technique to produce foam for sclerotherapy is not a factor in foam stability. Sclerosing solutions differ in their foaming stability.

A multicenter clinical evaluation of the treatment of mild to moderate inflammatory acne vulgaris of the face with visible blue light in comparison to topical 1% clindamycin antibiotic solution

BACKGROUND

Blue light sources have been shown to be effective in the treatment of mild to moderate inflammatory acne vulgaris lesions.

OBJECTIVE

We evaluated the safety and efficacy of a new blue light source in the treatment of mild to moderate inflammatory acne vulgaris in comparison to topical 1% clindamycin solution.

RESULTS

Blue light therapy reduced inflammatory acne vulgaris lesions by an average of 34%, as compared to 14% for topical 1% clindamycin solution.

CONCLUSIONS

The blue light source presented in this report is a safe and effective treatment option available to our patients with mild to moderate inflammatory acne lesions.

Multiple Keratoacanthomas Arising Post-UVB Therapy

BACKGROUND

Ultraviolet (UV) radiation is known to be an important etiologic agent in the development of skin cancer. Keratoacanthoma is an unusual, well-described cutaneous neoplasm that resembles squamous cell carcinoma but spontaneously resolves. Rarely, multiple keratoacanthomas may develop.

OBJECTIVE

We present a case of multiple keratoacanthomas in a patient with psoriasis who had received UVB phototherapy. These lesions were hyperkeratotic papules, many of which spontaneously resolved and demonstrated the histologic characteristics of keratoacanthoma.

CONCLUSION

We believe that UV radiation is the most likely etiologic factor in this patient's development of multiple keratoacanthomas. We wish to bring to the attention of clinicians this unusual adverse effect of UV treatment.