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Gaca PJ, Rejdak R, Toro MD, Lewandowicz M, Kopecky A, Somfai GM, Nowak R, Heindl LM. [Therapeutic management of a kissing nevus of the eyelid]. DIE OPHTHALMOLOGIE 2024; 121:116-122. [PMID: 38165419 DOI: 10.1007/s00347-023-01963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
Congenital divided melanocytic nevi of the upper and lower eyelid are rare pigmented changes of the eyelids. These processes are also known as "kissing nevi," "panda nevi," and "split ocular nevi," and were first described by Fuchs in 1919. About 120 cases have been described in the literature so far. Congenital melanocytic nevi are either present at birth (small nevi are already found in about 1% of neonates) or manifest predominantly during the first decade of life. These rare melanocytic changes of the eyelids should be controlled regularly, as malignant transformation can occur. The actual incidence of malignant transformation is highly variable in the literature, ranging from 2 to 40% depending on the duration of follow-up, with an average of 14% for the whole lifetime. Moreover, nevi of the eyelids may be considered cosmetically disturbing and cause functional problems. Therapeutic removal (dermabrasion, cryotherapy, laser therapy, and surgical excision with ophthalmoplastic reconstruction) is rarely medically indicated due to the low risk of malignant transformation. Removal can be performed in cases of secondary amblyopia in ptosis, compression of the lacrimal point, epiphora, or cosmetic desire. Treatment becomes necessary not only in case of suspicious manifestation or impairment of eyelid function, but it also helps to avoid possible bullying at school among children and is recommended at age 4 to 6 (before school age).
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Affiliation(s)
- P J Gaca
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen.
| | - R Rejdak
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
| | - M D Toro
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
- Klinik für Augenheilkunde, Abteilung für öffentliche Gesundheit, Universität Neapel Federico II, Neapel, Italien
| | - M Lewandowicz
- Abteilung für onkologische Chirurgie, Multidisziplinäres M. Copernicus Woiwodschaftszentrum für Onkologie und Traumatologie, Lodz, Polen
| | - A Kopecky
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechien
- Medizinische Fakultät, Universität Ostrava, Ostrava, Tschechien
| | - G M Somfai
- Augenklinik, Stadtspital Zürich, Zürich, Schweiz
| | - R Nowak
- Wojskowy Instytut Medyczny, Klinika Okulistyki, Warszawa, Polen
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Bonn-Düsseldorf-Köln, Köln, Deutschland
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Rembielak A, Yau T, Akagunduz B, Aspeslagh S, Colloca G, Conway A, Danwata F, Del Marmol V, O'Shea C, Verhaert M, Zic R, Livesey D. Recommendations of the International Society of Geriatric Oncology on skin cancer management in older patients. J Geriatr Oncol 2023; 14:101502. [PMID: 37080793 DOI: 10.1016/j.jgo.2023.101502] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) is becoming ever more prevalent among older adults. However, older adults with NMSC are often underrepresented in clinical trials and guidelines on effective management is still unclear. The International Society of Geriatric Oncology (SIOG) created a multi-disciplinary task force to explore the potential in developing practical guidelines for the treatment of older patients with basal cell carcinoma (BCC) and skin (cutaneous) squamous cell carcinoma (cSCC). MATERIALS AND METHODS A systematic literature search to identify relevant and up-to-date literature on treatment of NMSC in older adults was conducted on various databases including MEDLINE, Embase, CINAHL, Cochrane, and PubMed. The resulting papers were discussed by an expert panel, leading to a consensus recommendation. RESULTS A total of 154 articles were identified for the expert panel to utilise in generating consensus recommendations. A major focus on geriatric assessment and management options including surgery, radiotherapy, systemic therapy, clinical monitoring, and medical/medicophysical therapy were reviewed for recommendations. DISCUSSION Patient age should not be the sole deciding factor in the management of patients with NMSC. Assessment from a multidisciplinary team (MDT) is crucial, and the decision-making process should consider the patient's lifestyle, needs, and expectations. A comprehensive geriatric assessment should also be considered. Patients should feel empowered to advocate for themselves and have their views considered a part of the MDT discussion.
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Affiliation(s)
- Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Thomas Yau
- Barts and the London School of Medicine and Dentistry, Young SIOG Member, Queen Mary University of London, London, UK.
| | - Baran Akagunduz
- Young SIOG Member, Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, Erzincan, Turkey
| | - Sandrine Aspeslagh
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Giuseppe Colloca
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Aoife Conway
- Department of Radiation Oncology, The Mater Hospital, Crows Nest, NSW, Australia.
| | - Falalu Danwata
- Rosemere Cancer Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.
| | - Veronique Del Marmol
- Department of Dermatology and Venereology, Hopital Erasme-Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Marthe Verhaert
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Rado Zic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Dan Livesey
- The Christie Library, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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Dell'Antonia M, Anedda J, Tatti A, Falco A, Sanna S, Ferreli C, Atzori L. Non-surgical treatment of hidradenitis suppurativa: the role of cryotherapy. Front Med (Lausanne) 2023; 10:1141691. [PMID: 37144039 PMCID: PMC10151524 DOI: 10.3389/fmed.2023.1141691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic and recurrent inflammatory disease with a great impact on a patient's quality of life, due to the painful involvement of very sensitive areas, such as the groin, mammary area, and genitals, with malodourous discharge. Multiple treatment options are available; however, no single treatment is effective for all patients, and usually, a combination of medical therapy with various surgical and physical procedures is provided. Cryotherapy is not a routine technique to treat HS, although usually available in the majority of medical clinics, and is cheaper than laser and surgical treatments. The aim of this study was to evaluate the effectiveness of cryotherapy on persistent HS nodules, to reduce the burden of local disease. Materials and methods Retrospective observational study in all patients treated with liquid nitrogen cryotherapy for persistent nodules of hidradenitis suppurativa in the last 2 years, with at least 6 months of follow-up after the procedure. Disease severity was assessed with Hurley staging and sonographic staging according to SOS-HS (18 MHz probe, Esaote-MyLab™). The results were scored with a 0-3 points scale, as complete remission (3), partial response (2 to 1), or no response (0), after one session of treatment. Local cleansing and antiseptic treatment after the procedure was the same as previously performed in each patient, not to influence recovery. Results In total, 23 patients were included, with a total of 71 persistent nodules treated with a single cryotherapy session. The treatment has been effective in 63 out of 71 nodules treated (88.7%), and the patients attested that they recommend the treatment, the discomfort during recovery was minimal, and the management was not different from daily routine. Persistence was considered as having a failure rate (11.3% overall) and occurred in 7.5% of the nodules of the axillary region, 18.2% on the groin, and 11.2% for nodules of the gluteal region. Conclusion Cryotherapy is a simple and effective procedure for the treatment of persistent nodules of HS not responding to medical therapy, and it is a valid alternative to local surgery or laser ablation.
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Dash G, Patil A, Kassir M, Goldman MP, Gold MH, Adatto M, Große-Büning S, Grabbe S, Goldust M. Non-laser treatment for tattoo removal. J Cosmet Dermatol 2023; 22:74-78. [PMID: 35122391 DOI: 10.1111/jocd.14819] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 01/24/2023]
Abstract
Tattoos are increasingly gathering attention in the young population, especially in second to fourth decade of life. With such trends, rate of its removal also has been on the rise. Treatment options for tattoo removal besides lasers are surgery, radiofrequency, infrared light, cryotherapy, dermabrasion and salabrasion. Unfortunately, none of these procedures are associated with satisfactory cosmetic results due to adverse effects such as scarring and dyspigmentation. Although laser treatment has become the gold standard for tattoo removal, it is also associated with some limitations. Some tattoo inks are resistant to laser, and multiple sessions and multiple wavelengths may be required for its complete removal. Considering these limitations, other treatment modalities for tattoo removal must be explored. This article highlights the non-laser treatment options for tattoo removal. We reviewed all published literature identified from electronic databases (MEDLINE and PubMed) till August 2021 to highlight the non-laser treatment options for tattoo removal.
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Affiliation(s)
- Gaurav Dash
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | | | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, California, USA.,Department of Dermatology, University of California, San Diego, California, USA
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, Tennessee, USA
| | - Maurice Adatto
- Skinpulse Dermatology and Laser Centre, Geneva, Switzerland
| | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Assorted Skin Procedures. Prim Care 2022; 49:47-62. [DOI: 10.1016/j.pop.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Srivastava P, Kumar A. Nano-cryospray: An adjuvant assisted approach to increase the efficacy of cryospray. Cryobiology 2022; 106:148-156. [DOI: 10.1016/j.cryobiol.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
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Han MG, Kim JY. Application of local anaesthesia and cryosurgery for eyelid masses in dogs. Vet Med Sci 2021; 8:476-482. [PMID: 34919349 PMCID: PMC8959322 DOI: 10.1002/vms3.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Eyelid mass removal and cryotherapy application using only local anaesthesia and restraint may benefit patients with high anaesthesia risks. Objective To evaluate and validate cryosurgery application using the CryoPen XL® on palpebral masses under local anaesthesia for patients not suitable for general anaesthesia. Methods Thirty patients underwent the procedure between November 2015 and April 2020. The procedure steps were as follows: skin preparation and local anaesthesia of the affected eyelid; debulking by resection and/or squeezing out the inspissated material; cryosurgery and post‐operative care using topical medication, antibiotics and anti‐inflammatory ointment. The medical records of the patients who underwent the operation were evaluated. Moreover, a telephonic survey with the pet owners was performed to determine recurrence, time to recurrence, survivability and side effects. Results Among the 30 owners, 29 responded to the survey. Ten (10/38, 26.3%) masses recurred with an average time to recurrence of 6.0 months. The estimated average depths for all, non‐recurred, and recurred masses were 1.89, 1.88 and 1.90 mm, respectively. The average recurrence rate and time to recurrence were higher and earlier, respectively, than previously reported values. However, no patient presented intra‐ or post‐operative complications. Conclusion These findings suggest that local anaesthesia and cryosurgery using the CryoPen XL® can be used in patients with eyelid masses who are not suitable for general anaesthesia. Compared with the surgical eyelid mass removal and blepharoplasty procedure, the reported procedure is time‐ and cost‐effective, with the additional benefit of not requiring general anaesthesia.
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Affiliation(s)
- Myung-Gyun Han
- Department of Veterinary Ophthalmology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Joon-Young Kim
- Department of Veterinary Ophthalmology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
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Efficacy Evaluation of the Pixie ® Skin Tag Cryogenic Device on Skin Tags in a Prospective, Single-Blinded, Randomized, Comparative Clinical Trial. Dermatol Ther (Heidelb) 2021; 11:995-1007. [PMID: 34019230 PMCID: PMC8163951 DOI: 10.1007/s13555-021-00532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/09/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Cryotherapy is an efficient method to treat various cutaneous lesions. In the current clinical evaluation, the efficacy of the Pixie® Skin Tag cryogenic pen as a home treatment for benign skin tags was evaluated against a marketed comparator device. In addition, the safety, tolerability, and expected visual effects of the treatment were assessed. METHODS Fifty-six healthy volunteers presenting with skin tags were included and randomized in a prospective, single-blinded, parallel, single-center, comparative trial and subjected to treatment with either Pixie® Skin Tag or a comparator device, Wortie® skin tag remover. Selected skin tags located on the neck, breast, and under the armpits were topically treated according to device prescriptions for maximally three times with a 15-day interval between treatments. RESULTS Of the skin tags treated with Pixie® Skin Tag, 64.3% completely disappeared during the study, of which half of the skin tags were cleared after one treatment, compared with 7.1% of the study population treated with Wortie® skin tag remover (p < 0.001). Both medical devices were safe to use, painless, and very well tolerated by 64.3% in the Pixie® Skin Tag and 96.4% in the Wortie® skin tag remover group. In addition, 72% of the subjects using Pixie® Skin Tag were satisfied with the results, and two-thirds of this study group would buy and use the device for the treatment of other skin tags. For the comparator device, only 11.0% were satisfied and 7.0% would buy the device. CONCLUSION Treatment of skin tags with Pixie® Skin Tag showed superior clinical performance when compared to Wortie® skin tag remover. Both treatments were safe and well tolerated, with the majority of skin response serving as a predictor for clinical performance in the Pixie® Skin Tag treated group. TRIAL REGISTRATION NUMBER ANSL Registration: 2018-A01804-51.
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Srivastava P, Kumar A. Optimizing the spray parameters of a cryospray process. Cryobiology 2020; 98:201-209. [PMID: 33171196 DOI: 10.1016/j.cryobiol.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Smaller spray zone of single-hole nozzle (SHN) constrains cryospray as a treatment method suitable for lesions having diameter larger than 15 mm on the skin surface. The present study is an attempt to resolve this issue, through the improvement in conventional technique of spraying liquid nitrogen on cancerous lesion. A multi-hole nozzle (MHN) with 5 holes is fabricated to demarcate the variation in outcome when cryogen is sprayed through customised MHN instead of conventional SHN. Special emphasis is placed on reducing the number of sitting required for completion of treatment and increasing the feasibility of cryospray process for larger lesions. Commercial SHN having a hole diameter of 0.8 mm is selected to compare results with the customised MHN having 5 holes of 0.8 mm diameter (4 holes are arranged in a circle of radius 2 mm around the central hole). Single freeze-thaw cycle is carried out to spray liquid nitrogen on tissue mimicking gel. Temperature profile accessed through infrared images advocates that lethal area formed through application of MHN is twice larger than the lethal area formed through the application of SHN on the surface of gel for same spraying distance (z). Thermocouples placed at various locations strengthen the fact that higher cooling rate (CR) corresponding to MHN ensures 15 mm spread of necrotic zone from the centre of spray (CS) and up to a depth of 2 mm from the gel surface while in case of SHN, it is limited to the vicinity of CS. On the basis of observations made through thermal images and digital images, it can be said that the ratio of lateral spread to penetration depth of ice ball remains almost same for SHN and MHN. However, the lateral spread of ice ball formed through the application of MHN is twice larger than SHN while the axial depth of ice ball does not record such increment. This reflects that MHN provides more destruction to superficial skin than SHN. Among the three spraying distances selected (i.e. z = 13 mm, 18 mm and 23 mm), the most optimised spraying distance (z) for MHN is also explored in this study. It has been found that cryoablation is not inversely proportional to the spraying distance. Spraying distance of z = 18 mm provided the most optimised result in terms of cryoablation.
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Affiliation(s)
- Prashant Srivastava
- Department of Mechanical Engineering, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Amitesh Kumar
- Department of Mechanical Engineering, Indian Institute of Technology (BHU), Varanasi, 221005, India.
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Characterization of performance of multihole nozzle in cryospray. Cryobiology 2020; 96:197-206. [DOI: 10.1016/j.cryobiol.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
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Singh S, Neema S. Comparison of electrosurgery by electrodessication versus cryotherapy by liquid nitrogen spray technique in the treatment of plantar warts. Med J Armed Forces India 2019; 76:156-160. [PMID: 32476712 DOI: 10.1016/j.mjafi.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background Warts or verrucae are benign proliferations of the skin and mucosa resulting from infection with papilloma viruses. Warts form a small subset of patients attending skin out-patient department (OPD), out of which the plantar warts are one of the common presentation. The present study is an attempt to compare two modalities of treatment that is electrosurgery and cryotherapy in patients with plantar warts. There are no studies available where comparison of complications between two modalities has been done in plantar warts thus making it one of unique studies of its kind. Methods A prospective, comparative study was conducted over a period of 6 years. After exclusion criteria, one hundred forty-seven male patients having plantar warts were included in the study. Selection of patients suffering from warts subjected to treatment was done by simple random selection. After treatment, 39 patients were lost to follow-up, and finally 48 patients treated by electrosurgery and 60 by cryotherapy were compared and analysed statistically for response to treatment and incidence of complications. Results The overall clearance rate was 75% in electrosurgery versus 73.3% in cryotherapy patients. The pain, delayed wound healing and scarring were observed significantly in more patients treated with electrosurgery than cryotherapy. In our study, recurrence at 24 weeks was observed in 21.9% of the electrosurgery patients which was slightly higher than cryotherapy, where it was 16.6%. Conclusion This study highlighted that cryotherapy is quick, safe and comparatively painless procedure with less complications with success almost similar to electrosurgery making it more suitable for plantar warts.
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Affiliation(s)
- Sehdev Singh
- Senior Adviser (Dermatology), Command Hospital (Eastern Command), Kolkata, India
| | - Shekhar Neema
- Classified Specialist (Dermatology), Command Hospital (Eastern Command), Kolkata, India
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Kumari C, Kumar A, Sarangi SK, Thirugnanam A. Effects of spray parameters on skin tumour ablation volume during cryotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:453-464. [DOI: 10.1007/s13246-019-00740-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/20/2019] [Indexed: 12/21/2022]
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Fichman V, do Valle ACF, de Macedo PM, Freitas DFS, de Oliveira MME, Almeida-Paes R, Gutierrez-Galhardo MC. Cryosurgery for the treatment of cutaneous sporotrichosis in four pregnant women. PLoS Negl Trop Dis 2018; 12:e0006434. [PMID: 29684015 PMCID: PMC5933803 DOI: 10.1371/journal.pntd.0006434] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/03/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Pregnant women with sporotrichosis should not receive systemic antifungal therapy except in severe cases when amphotericin B is recommended. Thermotherapy is the most reported treatment described in this group of patients. It entails weeks of daily self-application of heat to the lesions, requires that the patient faithfully apply it, and it could cause skin burns. Cryosurgery is a useful therapeutic tool for many cutaneous infectious diseases, safe for pregnant women, but not well evaluated for sporotrichosis treatment in this group. Methodology The authors conducted a retrospective study describing epidemiological, clinical, and therapeutic data related to four pregnant patients with sporotrichosis treated with cryosurgery. The authors reviewed the clinical records of four pregnant patients diagnosed with cutaneous sporotrichosis and treated with cryosurgery. The sessions were carried out monthly up to clinical cure. Molecular identification of the Sporothrix species was performed in two cases using T3B PCR fingerprinting assays. Principal findings All patients were in the second trimester of pregnancy and their age ranged from 18 to 34 years. With regard to clinical presentation, two patients had lymphocutaneous and two had the fixed form. S. brasiliensis was identified in two cases as the causative agent. Cryosurgery was well tolerated and the number of sessions ranged from 1 to 3. All the patients reached a complete clinical cure. Conclusions Cryosurgery was a safe, easy to perform and well tolerated method, and therefore it is suggested to be a suitable option for the treatment of cutaneous sporotrichosis in pregnant women. Sporotrichosis is a cosmopolitan disease, considered the most important subcutaneous mycosis in Latin America. Since 1998, there is an ongoing cat-transmitted zoonotic epidemic of sporotrichosis occurring in Rio de Janeiro, Brazil. Pregnant women are a vulnerable population occasionally affected that require special attention regarding sporotrichosis treatment. Antifungal drugs should be avoided because of their potential risks to the fetus, unless in severe cases when amphotericin B (an intravenous antifungal drug) can be indicated. In this context, local measures are the treatment of choice. Cryosurgery consists in local application of intense cold using liquid nitrogen to destroy some infectious, tumoral and inflammatory cutaneous diseases. It is scarcely reported in the literature for the treatment of sporotrichosis, especially in pregnant women for whom local heat is most used. This works aims to describe the clinical response and outcome of cryosurgery for the treatment of sporotrichosis in four pregnant women. All patients reached clinical cure after one to three sessions. These results suggest that cryosurgery can be a well-tolerated, safe, and efficient method for the treatment of sporotrichosis in pregnancy.
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Affiliation(s)
- Vivian Fichman
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- * E-mail:
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Prado L, Rossetto V, Carvalho L, Ferreira A, Matsubara L, Rodrigues J, Brandão C. Evaluation of the cryosurgery for treatment of squamous cell carcinoma in cats. ARQ BRAS MED VET ZOO 2017. [DOI: 10.1590/1678-4162-9060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The cryosurgery is a very useful therapy for the treatment of a variety of neoplastic and non-neoplastic processes. Nevertheless, it is still poorly described as an option for the treatment of specific cutaneous neoplasms, such as squamous cell carcinoma. The purpose of the present study was to analyze the clinical response of cryosurgery for the treatment of squamous cell carcinoma in cats. For this 13 squamous cell carcinoma lesions were selected in 11 cats, diagnosed through citopathological and/or histopathological examinations. The lesions were frozen using liquid nitrogen spray, and the evaluations were performed in the moment of freeze and approximately every 15 days until the wound was completely healed. The response of cryosurgery was considered complete with tumoral remission on 38.5% of the cats, and partial on 46.1%. The main complications included crusting and nostril stenosis. The presented results suggested that cryosurgery is effective and may be a viable option for the treatment of squamous cell carcinoma in cats. The effectiveness of the therapy; however, depends on the correct selection of the candidates for cryosurgery based on the lesion size, and the attendance to some criteria, such as the freezing time and post-operative care.
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Cervantes J, Magno RJ, Perper M, Rajabi-Estarabadi A, Eber AE, Verne SH, Nouri K. Cells to Surgery Quiz: August 2017. J Invest Dermatol 2017; 137:e161. [PMID: 28735618 DOI: 10.1016/j.jid.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ali Rajabi-Estarabadi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sebastian H Verne
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol 2016; 177:350-358. [PMID: 27500794 DOI: 10.1111/bjd.14852] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 02/05/2023]
Abstract
Actinic keratoses (AKs) are common, with prevalence in the U.S.A. estimated at almost 40 million in 2004 and annual costs of > $1 billion (U.S.D.). However, there is no universally accepted definition of AK and thus it is difficult to identify reliably. AKs are lesions of epidermal keratinocytic dysplasia that result from chronic sun exposure and have the ability to progress to invasive squamous cell carcinoma (SCC), but clinicians disagree about whether AKs are premalignant lesions, superficial SCCin situ or epiphenomena of chronically sun-damaged skin. Yearly AK to SCC progression rates of 0·6% were reported in an elderly population with multiple prior keratinocyte carcinomas (KCs); and rates of spontaneous AK regression have been reported to be > 50%, but regressed lesions often reappear. As AKs have both cosmetic consequences and potential for malignant transformation, there are multiple reasons for treatment. There is no current agreement on the most efficacious treatment, but 5-fluorouracil has been shown to both prevent and treat AKs, and imiquimod and photodynamic therapy may have the best cosmetic outcomes. AKs may be treated to improve appearance and relieve symptoms, but the keratinocytic dysplasia that gives rise to malignancy, and sometimes appears as an AK, may be what actually threatens patient health. Thus, treatments should aim to decrease the risk of KC or facilitate KC diagnosis by reducing the potential for misidentification created when a KC appears in a field of AKs. Improved agreement among clinicians on AK definition may improve management.
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Affiliation(s)
- J A Siegel
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - K Korgavkar
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - M A Weinstock
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
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Abstract
A mucocele is a common salivary gland disorder that most commonly affects young adults. A 35-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, with the chief complaint of swelling on the left side of floor of mouth. The aim of this case report is to present the management of mucocele present in floor of the mouth in a young female patient using liquid nitrogen cryosurgery. The present case report has also discussed mechanism of action, current protocol of cryosurgery with emphasis on clinical pros and cons along with the clinical outcomes.
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Affiliation(s)
- Kamaldeep K Aulakh
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot, India
| | - Ramandeep S Brar
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot, India
| | - Anurag Azad
- Department of Oral Surgery, Bhabha Rao Ambedkar University, Agra, India
| | - Swati Sharma
- Department of Pedodontics and Preventive Dentistry, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Abhishek Anand
- Department of Pedodontics and Preventive Dentistry, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Bhuvan Jyoti
- Department of Oral Medicine and Radiology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, India
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Abstract
Dermatologists perform a wide variety of procedures on a daily basis. The skin biopsy is a fundamental technique that can be performed by all physicians who manage cutaneous conditions. Specimens should always be sent for pathologic evaluation, regardless of whether the sampled lesion appears benign. Postoperative care and education are critical for minimizing complications.
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Affiliation(s)
- Shelley Yang
- Division of Dermatology, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Jeremy Kampp
- Division of Dermatology, University of Washington School of Medicine, Seattle, WA 98105, USA.
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Abstract
This article provides information on the clinical development of skin reactions after cryosurgery/cryotherapy and the indications, complications and contraindications of skin cryosurgery. Successful skin cryosurgery requires rapid freezing and slow thawing, minimum tissue temperature of -25 to -60℃ and, in malignant lesions, repetition of the freeze-thaw cycle. Frozen tissue reacts with peripheral erythema immediately after thawing, followed by edema, bulla formation, exudation and mumification. Lesions usually heal with a fine atrophic scar after approximately 4 weeks. Nowadays, cryosurgery is considered the treatment of choice in hypertrophic scars and keloids, granuloma annulare, small capillary infantile hemangioma and isolated actinic keratoses. It is also a valuable alternative therapy for various other skin diseases, including common warts, solar lentigo, superficial basal cell carcinoma and Kaposi's sarcoma. Cryosurgery is a safe regimen with relatively few adverse effects and contraindications. Pain during and/or shortly after treatment, bulla formation and local edema are the major temporary adverse effects; lesional hypopigmentation and/or peripheral hyperpigmentation is the most common long-term complication.
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Divine J, Stefaniwksy L, Reddy R, Padilla P, Hagele T, Patel NS, Cherpelis BS. A comprehensive guide to the surgical management of nonmelanoma skin cancer. Curr Probl Cancer 2015; 39:216-25. [DOI: 10.1016/j.currproblcancer.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Clinical practice trends in cryosurgery: a retrospective study of cutaneous lesions. Postepy Dermatol Alergol 2015; 32:88-93. [PMID: 26015777 PMCID: PMC4436237 DOI: 10.5114/pdia.2015.48048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/20/2014] [Accepted: 09/10/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Cryosurgery is an alternative treatment for many benign, premalignant, and malignant lesions of the skin. Aim To review the indications of cryosurgery for cutaneous lesions. Material and methods The retrospective study was based on the assessment of medical records of 1031 dermatology patients who had cryosurgery. Results One thousand two hundred and forty-four sessions of cryosurgery were applied to the total of 1031 patients. Of the 1031 patients, the most frequent indication for cryosurgery was common warts which were present in 535 (61.59%) patients, followed by anogenital warts in 119 (11.54%) patients, callosity in 81 (7.85%) patients, actinic keratosis in 77 (7.46%) patients, molluscum contagiosum in 35 (3.39%) patients, and other benign or malignant skin lesions. Conclusions Cryosurgery is still a valuable treatment of choice in various benign, premalignant, and malignant skin diseases but seems to be underused for indications other than viral warts.
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Gavigan G, McEvoy A, Beecker J. Contact Cryoprobe Sterilization Practices: A Patient Quality and Safety Issue for Dermatologists. J Cutan Med Surg 2015; 19:388-90. [PMID: 25775616 DOI: 10.1177/1203475415575011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cryotherapy is a commonly employed treatment modality in dermatology. There is literature to suggest that sterilization of the contact cryotherapy probe is needed for proper decontamination. OBJECTIVE To determine the status on the usage and sterilization methods employed by dermatology staff and residents affiliated with an academic training centre in Ontario, Canada, with the overall goal of improving patient safety. METHODS An anonymous qualitative survey was conducted and analyzed. RESULTS The survey had a response rate of 71% (n=34 of 48); 11 of 34 physicians reported using contact cryoprobes in their practice to treat viral infections, benign tumours, and malignant tumours. Out of the 11 using contact cryoprobes, 3 (27%) employed any type of cleaning method between patients. CONCLUSIONS Current use of contact cryotherapy probes could be improved for safety considerations. Patient safety may be enhanced by the incorporation of routine autoclaving or other recommended decontamination methods of contact cryotherapy probes between patients.
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Affiliation(s)
- Geneviève Gavigan
- Ottawa Hospital Research Institute, Ottawa, Canada University of Ottawa, Ottawa, Canada
| | | | - Jennifer Beecker
- Ottawa Hospital Research Institute, Ottawa, Canada University of Ottawa, Ottawa, Canada
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Benninger MS, Derakhshan A, Milstein CF. The Use of Cryotherapy for Papilloma and Early Laryngeal Cancers: Long-term Results. Ann Otol Rhinol Laryngol 2015; 124:509-14. [PMID: 25573394 DOI: 10.1177/0003489414566266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis. SUMMARY OF BACKGROUND DATA The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis. METHODS Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations. RESULTS The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23). CONCLUSION The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important.
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Walker K, Lindeque B. The application of cryoprobe therapy in orthopedic oncology. Orthopedics 2014; 37:536-40. [PMID: 25102496 DOI: 10.3928/01477447-20140728-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
The cryoprobe is a relatively new surgical tool offering a more selective destruction of unwanted cells. Using expanded versions of basic thermodynamic formulas of conduction and convection, mathematical models are becoming more effective at mapping out the zone of destruction that can be expected when using cryoprobes. The development of this technology will allow for better surgical planning and postoperative care to decrease patient morbidity and mortality. It is thought that this invaluable tool will become increasingly prevalent in orthopedics.
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Zane C, Facchinetti E, Rossi M, Specchia C, Ortel B, Calzavara-Pinton P. Cryotherapy is preferable to ablative CO2laser for the treatment of isolated actinic keratoses of the face and scalp: a randomized clinical trial. Br J Dermatol 2014; 170:1114-21. [DOI: 10.1111/bjd.12847] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 12/01/2022]
Affiliation(s)
- C. Zane
- Department of Dermatology; Spedali Civili di Brescia; University of Brescia; P.le Spedali Civili 1, 25123 Brescia Italy
| | - E. Facchinetti
- Department of Dermatology; Spedali Civili di Brescia; University of Brescia; P.le Spedali Civili 1, 25123 Brescia Italy
| | - M.T. Rossi
- Department of Dermatology; Spedali Civili di Brescia; University of Brescia; P.le Spedali Civili 1, 25123 Brescia Italy
| | - C. Specchia
- Department of Molecular and Translational Medicine; Spedali Civili di Brescia; University of Brescia; P.le Spedali Civili 1, 25123 Brescia Italy
| | - B. Ortel
- Department of Pathology; NorthShore University HealthSystem; Evanston IL U.S.A
| | - P. Calzavara-Pinton
- Department of Dermatology; Spedali Civili di Brescia; University of Brescia; P.le Spedali Civili 1, 25123 Brescia Italy
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Abstract
The purpose of this article is to review the common neoplasms, infections, and inflammatory dermatoses that may present around or near the mouth. Dental professionals are well positioned to evaluate perioral skin conditions, further contributing to patients' general health. This article includes a review of seborrheic keratosis, warts, actinic keratoses, actinic cheilitis, and squamous cell carcinoma, among several other perioral cutaneous lesions.
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Affiliation(s)
- Geoffrey F S Lim
- Department of Dermatology, Drexel University College of Medicine, The Arnold T. Berman, M.D. Building, 219 North Broad Street, Philadelphia, PA 19107, USA.
| | - Carrie Ann R Cusack
- Department of Dermatology, Drexel University College of Medicine, The Arnold T. Berman, M.D. Building, 219 North Broad Street, Philadelphia, PA 19107, USA
| | - Joseph M Kist
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, South Pavilion, 1st Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Kumar S, Bhat GS, Bhat KM. Effectiveness of cryogen tetrfluoroethane on elimination of gingival epithelium and its clinical application in gingival depigmentation-histological findings and case series. J Clin Diagn Res 2014; 7:3070-2. [PMID: 24551730 DOI: 10.7860/jcdr/2013/5353.3855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 09/27/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To histologically assess and clinically co-relate the effectiveness of cryogen Tetrafluoroethane (TFE) for gingival depigmentation procedure. MATERIAL AND METHODS Twelve patients having unaesthetic gingival melanin pigmentation were included in the study. Gingival tissues of eight patients having gingival melanin pigmentation undergoing gingivoplasty or gingivectomy for crownlengthening were exposed to the cryogen and this was used for the histological examination. Gingivectomies were done after 8, 24, 96 hours and after a week of application of tetrafluoroethane. Four fair skinned patients complaining of unaesthetic gingival hyperpigmentation underwent gingival depigmentation using Tetrafluoroethane cryogen. RESULTS Histologically after 96 hours of application of cryogen there was complete loss of retepegs and epithelial detachment from the corium was evident. Complete re - epithelialisation was noted after a week and was clinically correlated. CONCLUSION We therefore, concluded that histologically tetrafluoroethane can effectively destroy gingival epithelium without causing damage to the connective tissue and clinically the color of the gingiva had more pleasing appearance 6 months postoperatively. Hence the cryogen can be used safely for depigmentation procedure.
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Affiliation(s)
- Santhosh Kumar
- Assistant Professor, Department of Periodontics, Manipal College of Dental Sciences , Manipal, Udupi, Karnataka, India
| | - G Subraya Bhat
- Professor and Head, Department of Periodontics, Manipal College of Dental Sciences , Manipal, Udupi, Karnataka, India
| | - K Mahalinga Bhat
- Professor, Department of Periodontics, Manipal College of Dental Sciences , Manipal, Udupi, Karnataka, India
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Rezende KM, Moraes PDC, Oliveira LB, Thomaz LA, Junqueira JLC, Bönecker M. Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children. Braz Dent J 2014; 25:352-6. [PMID: 25250502 DOI: 10.1590/0103-6440201302254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 07/14/2014] [Indexed: 11/21/2022] Open
Abstract
Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.
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Al-Qubati Y, Janniger EJ, Schwartz RA. Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource-poor country. Int J Dermatol 2013; 51:1217-20. [PMID: 22994668 DOI: 10.1111/j.1365-4632.2011.04958.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Leishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost-effective, simple, successful, and affordable option.
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Affiliation(s)
- Yasin Al-Qubati
- Dermatology, Taiz University School of Medicine, Taiz, Yemen.
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Na CH, Park HP, Song IG, Choi H, Kim MS, Shin BS. A comparison of therapeutic efficacy of a melamine foam sponge and conventional cotton wool bud in the cryotherapy of viral warts: a paired comparison study. Pediatr Dermatol 2012; 29:555-9. [PMID: 22353042 DOI: 10.1111/j.1525-1470.2011.01707.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many therapies have been studied for the treatment of viral warts, but none are uniformly effective. The aim of this study was to compare the efficacy of conventional cotton wool bud with that of melamine foam sponge as applicators in the treatment of warts with liquid nitrogen. A paired comparison study was conducted in 27 patients with at least two similar clinical types of warts. Similar clinical lesions were allocated to have liquid nitrogen applied with cotton wool bud or melamine foam sponge. Mean size reduction rate after the first treatment was 30.5% in the cotton wool bud group and 59.1% in the melamine foam sponge group. Mean number of total treatments was 3.05 in the cotton wool bud group and 2.29 in the melamine foam sponge group. Melamine foam sponge was found to be more effective in comparison to conventional cryotherapy with cotton wool bud.
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Affiliation(s)
- Chan Ho Na
- Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea
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The effect of cryotherapy on oral mucosa: a study in healthy volunteers. Med Oncol 2012; 29:3587-91. [PMID: 22476810 DOI: 10.1007/s12032-012-0230-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
Oral cryotherapy causes local vasoconstriction, which reduces blood flow and reduces the cytotoxic damage to the oral mucosa, has been shown to reduce oral mucositis after intense cytostatic treatment. The main object of this study was to investigate the effect of oral cryotherapy on the temperature in the oral mucosa, the level of proinflammatory cytokine interleukin-6 (IL-6) in saliva and the effect on blood pressure in healthy volunteers, before and after 1 h of cooling the oral cavity with crushed ice. Twelve healthy volunteers [mean age 32.4 (SD 13.2) (20-56) years] were treated with oral cryotherapy in the form of crushed ice. Temperature measurements were performed in the oral mucosa using infrared thermograph following a flowchart protocol. Blood pressure (BP) was measured with a sphygmomanometer. Saliva was analysed for inflammatory cytokine IL-6, using an enzyme-linked immunosorbent assay (ELISA). All participants fulfilled the cooling session. The temperature in the oral cavity decreased significantly (mean 12.9 °C, p < .002). The systolic BP was marginally but significantly higher after cooling (~5 mmHg, p = .019). We could not detect any differences in cytokine IL-6 levels before and after oral cooling. We conclude that cryotherapy during 1 h lowers the mucosal temperature as much as ~12.9 °C, which explains the significant protective effect against mucosal damage by cytostatic drugs. The cooling caused no increase in IL-6 levels. Systemic blood pressure was marginally increased.
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Konda VJ, Dalal K. Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions. Ther Clin Risk Manag 2011; 7:447-58. [PMID: 22162921 PMCID: PMC3233528 DOI: 10.2147/tcrm.s23425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Esophageal adenocarcinoma and its precursor, Barrett’s esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett’s esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett’s segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett’s esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett’s epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett’s esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett’s esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.
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Affiliation(s)
- Vani Ja Konda
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
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35
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Ribeiro AS, de Aguiar MCF, do Carmo MAV, de Abreu MHNG, Silva TA, Mesquita RA. 660 AsGaAl Laser to Alleviate Pain Caused by Cryosurgical Treatment of Oral Leukoplakia: A Preliminary Study. Photomed Laser Surg 2011; 29:345-50. [DOI: 10.1089/pho.2010.2824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adriana Spinola Ribeiro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Vienne A, Prat F. [Endoscopic treatments for Barrett oesophagus]. Presse Med 2011; 40:516-28. [PMID: 21474270 DOI: 10.1016/j.lpm.2011.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 11/25/2022] Open
Abstract
High grade dysplasia and superficial carcinomas (with no extension under muscularis mucosae) can be indications for endoscopic treatments of Barrett oesophagus. When an endoscopic treatment is considered, a gastroscopy with use of acetic acid and planimetry and the confirmation of high-grade dysplasia by a new examination after PPI treatment and a pathologic second confirmation is needed. For high-grade dysplasia in focalised and visible lesions, an endoscopic resection by EMR or ESD should be proposed: it allows a more accurate pathologic examination and can be an effective curative treatment. After endoscopic resection of visible high grade dysplasia lesions, a complete eradication of Barrett oesophagus may be proposed to prevent dysplasia recurrence. In case of extensive high-grade dysplasia or to eradicate Barrett oesophagus residual lesions, radiofrequency ablation is the preferred endoscopic technique. Photodynamic therapy may also be proposed for more invasive lesions or after other endoscopic techniques with mucosal scars. Surgical oesophagus resection is still recommended for diffuse high-grade dysplasia in young patients or in case of pathologic pejorative criteria in endoscopic resection specimen. In case of Low-grade dysplasia, either endoscopic surveillance should be performed every six or 12 months or radiofrequency ablation could be proposed in the yield of prospective studies.
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Affiliation(s)
- Ariane Vienne
- Assistance publique-Hôpitaux de Paris, hôpital Cochin, service de gastro-entérologie, 75014 Paris, France.
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Chennat J, Konda VJA, Waxman I. Endotherapy for Barrett's esophagus: Which, how, when, and who? Gastrointest Endosc Clin N Am 2011; 21:119-33. [PMID: 21112502 DOI: 10.1016/j.giec.2010.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent developments in endoscopic therapeutic options for Barrett's esophagus (BE) early neoplasia have resulted in a dramatic paradigm shift in its clinical management. With multiple endoscopic choices available, it is important to discern subtle differences between these approaches based on the available current data and known limitations of each modality. The goals of endoscopic therapy of Barrett's neoplasia are to preserve the esophagus while ablating or removing the entire BE segment. This article reviews the currently available BE endoscopic treatments with emphasis on appropriate selection of patients, indications and timing of use, and clinical management considerations.
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Affiliation(s)
- Jennifer Chennat
- Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9028, Chicago, IL 60637-1463, USA
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Basal cell carcinoma of the head and neck. J Skin Cancer 2010; 2011:496910. [PMID: 21209728 PMCID: PMC3010650 DOI: 10.1155/2011/496910] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/17/2010] [Accepted: 10/19/2010] [Indexed: 11/18/2022] Open
Abstract
Basal cell carcinoma (BCC) is a malignant neoplasm derived from nonkeratinizing cells that originate from the basal layer of the epidermis and is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor. BCC occurs most frequently at sun-exposed sites, with the head and neck being common areas. Tumors can be classified as nodular, superficial, morpheaform, infiltrating, metatypic, and fibroepithelioma of Pinkus. Several treatment options such as surgical excision and nonsurgical procedures are available. The choice of treatment should be determined based on the histological subtype of a lesion, cost, its size and location, patient age, medical condition of the patient, treatment availability, and the patient's wishes. The aim of any therapy selected for BCC treatment involving the head and neck is to ensure complete removal, the preservation of function, and a good cosmetic outcome.
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Abstract
Barrett's esophagus (BE) is defined as abnormal specialized columnar metaplasia with intestinalization in place of the normal squamous esophageal epithelium. Gastroesophageal reflux disease is a known risk factor for BE; nonetheless BE is also detected in asymptomatic individuals. Other risk factors for BE include smoking, male gender, age over 50 and obesity. Patients diagnosed with BE (without dysplasia) are recommended to undergo endoscopic surveillance every 3-5 years. Advances in imaging techniques (such as narrow band imaging, autofluorescence imaging and confocal laser endomicroscopy) have the potential to improve the detection of dysplasia and early cancer, thus making surveillance a more cost-effective endeavor. Patients with high grade dysplasia (HGD) and early cancer have a high rate of progression to invasive adenocarcinoma and traditionally these patients were treated with esophagectomy. The rapid advancement of endoscopic therapeutic techniques along with a low risk of complications have made endoscopic therapy an acceptable alternative to an esophagectomy in patients with HGD and early cancer. Several endoscopic treatment techniques such as endoscopic mucosal resection, multipolar electrocoagulation, photodynamic therapy, argon plasma coagulation, cryotherapy, and radiofrequency ablation have been studied for endoscopic treatment.
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Affiliation(s)
- Srinivas Gaddam
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA
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AlGhamdi K, Kumar A. Depigmentation therapies for normal skin in vitiligo universalis. J Eur Acad Dermatol Venereol 2010; 25:749-57. [DOI: 10.1111/j.1468-3083.2010.03876.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Poligone B, Heald P. Innovative therapy of cutaneous T-cell lymphoma: beyond psoralen and ultraviolet light and nitrogen mustard. Dermatol Clin 2010; 28:501-10. [PMID: 20510760 DOI: 10.1016/j.det.2010.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cutaneous T-cell lymphoma is a malignancy of skin-homing T cells. This unique population of lymphocytes requires alternative therapies to those used in nodal lymphomas. Although phototherapy and nitrogen mustard have been standard treatments for decades, newer therapies have been arriving with increased frequency. Moreover, some therapies, currently used to treat other diseases, have been used with good effect. These innovative therapies are discussed, with review of current data and examples of how these therapies may be used today.
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Affiliation(s)
- Brian Poligone
- Department of Dermatology, University of Rochester School of Medicine, Rochester, NY, USA.
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Chennat J, Waxman I. Endoscopic treatment of Barrett’s esophagus: From metaplasia to intramucosal carcinoma. World J Gastroenterol 2010; 16:3780-5. [PMID: 20698040 PMCID: PMC2921089 DOI: 10.3748/wjg.v16.i30.3780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The annual incidence of adenocarcinoma arising from Barrett’s esophagus (BE) is approximately 0.5%. Through a process of gradual transformation from low-grade dysplasia to high-grade dysplasia (HGD), adenocarcinoma can develop in the setting of BE. The clinical importance of appropriate identification and treatment of BE in its various stages, from intestinal metaplasia to intramucosal carcinoma (IMC) hinges on the dramatically different prognostic status between early neoplasia and more advanced stages. Once a patient has symptoms of adenocarcinoma, there is usually locally advanced disease with an approximate 5-year survival rate of about 20%. Esophagectomy has been the gold standard treatment for BE with HGD, due to the suspected risk of harboring occult invasive carcinoma, which was traditionally estimated to be as high as 40%. In recent years, the paradigm of BE early neoplasia management has recently evolved, and endoscopic therapies (endoscopic mucosal resection, radiofrequency ablation, and cryotherapy) have entered the clinical forefront as acceptable non-surgical alternatives for HGD and IMC. The goal of endoscopic therapy for HGD or IMC is to ablate all BE epithelium (both dysplastic and non-dysplastic) due to risk of synchronous/metachronous lesion development in the remaining BE segment.
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Dumot JA, Vargo JJ, Falk GW, Frey L, Lopez R, Rice TW. An open-label, prospective trial of cryospray ablation for Barrett's esophagus high-grade dysplasia and early esophageal cancer in high-risk patients. Gastrointest Endosc 2009; 70:635-44. [PMID: 19559428 DOI: 10.1016/j.gie.2009.02.006] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 02/01/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ablation of Barrett's esophagus (BE) is a treatment option for patients with high-grade dysplasia (HGD) and intramucosal carcinoma (IMCA). OBJECTIVE To assess the safety and efficacy of a unique noncontact method of liquid nitrogen cryoablation as measured by histologic response rate and cancer-free survival. DESIGN Single-center, nonrandomized cohort study. SETTING Referral center, conducted between September 2005 and September 2008. PATIENTS Patients with BE and HGD or IMCA who were deemed inoperable or who refused esophagectomy. Age, length of BE, and previous ablation were not exclusion criteria. INTERVENTION Cryoablation every 6 weeks until endoscopic resolution. EMR was used for pathologic staging of nodular areas before cryoablation and focal residual areas during the follow-up period. MAIN OUTCOME MEASUREMENTS Histologic response was defined by the worst pathology obtained at any level of the esophagus or gastric cardia in 1 of 3 categories: (1) incremental = absence of HGD and IMCA in all biopsy specimens, (2) partial = residual IMCA with absence of any dysplasia, and (3) complete = absence of any intestinal metaplasia or dysplasia. RESULTS Thirty patients underwent ablation; 9 had undergone previous ablation or mucosectomy. Twenty-seven of 30 patients (90%) had downgrading of pathology stage after treatment. Elimination of cancer or downgrading of HGD at last follow-up was 68% for HGD and 80.0% for IMCA, with a median follow-up period of 12 months (25th percentile, 6; 75th percentile, 24). Minor adverse events included mild pain (n = 7), a low incidence of mild strictures (n = 3), and lip ulcer (n = 1). One major adverse event (perforation) in a patient with Marfan syndrome occurred with the prototype system. During follow-up, 3 of 6 patients with complete response had recurrence of dysplasia or cancer in the gastric cardia. LIMITATIONS A nonrandomized, single-center study with a heterogeneous cohort of patients. CONCLUSIONS Patients with BE and HGD or IMCA have a positive response to endoscopic cryotherapy at 1-year follow-up.
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Affiliation(s)
- John A Dumot
- Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
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Management of benign skin lesions commonly affecting the face: actinic keratosis, seborrheic keratosis, and rosacea. Curr Opin Otolaryngol Head Neck Surg 2009; 17:315-20. [DOI: 10.1097/moo.0b013e32832d75e3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ho T, Byrne PJ. Evaluation and Initial Management of the Patient with Facial Skin Cancer. Facial Plast Surg Clin North Am 2009; 17:301-7. [DOI: 10.1016/j.fsc.2009.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Treatment of benign skin lesions commands a high demand for cosmetic outcome. Among the alternatives for the treatment of benign lesions, cryosurgery has many advantages: it is a safe office-based method, the predictable outcome is cosmetically good and the cost of treatment is relatively low compared with operative surgery or laser techniques for example. The controllability and the tissue selectivity of cryosurgery allow its use in and around the eyelids.
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Affiliation(s)
- R E Suhonen
- Department of Dermatology, Mikkeli Central Hospital, Finland.
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Moraes AMD, Velho PENF, Magalhães RF. Criocirurgia com nitrogênio líquido e as dermatoses infecciosas. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000400002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A criocirurgia com nitrogênio líquido é recurso cirúrgico utilizado para o tratamento de várias lesões cutâneas, benignas, pré-malignas e malignas. Promove destruição dos tecidos acometidos por congelamento e alterações da resposta imunológica. Os autores enfocam a utilização da criocirurgia no tratamento das dermatoses infecciosas, principalmente as verrugas virais, leishmaniose e ccromoblastomicose. Discutem os resultados como tratamento primário ou coadjuvante. O artigo também apresenta os cuidados com os instrumentos no tratamento das doenças infecciosas.
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Affiliation(s)
- Riccardo Rossi
- University Unit of Dermatology and Physiotherapy, School of Medicine, University of Florence, Florence, Italy.
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50
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Sharma S, Bhanot A, Kaur A, Dewan SP. Role of liquid nitrogen alone compared with combination of liquid nitrogen and intralesional triamcinolone acetonide in treatment of small keloids. J Cosmet Dermatol 2007; 6:258-61. [DOI: 10.1111/j.1473-2165.2007.00344.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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