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Medical Sciences	100%

Selected Abstracts

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

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

Treatment of Lentigo Maligna with Imiquimod before Staged Excision

DERMATOLOGIC SURGERY, Issue 2 2008
MURRAY A. COTTER MD
BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins. OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM. METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision. RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12,34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence. CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery. [source]

Autologous Cultured Melanocytes in Vitiligo Treatment

DERMATOLOGIC SURGERY, Issue 9 2007
RAFAL CZAJKOWSKI MD
BACKGROUND Surgical treatment of vitiligo is indicated when lesions are localized in poorly responding areas. OBJECTIVES The objectives were: (1) to establish the melanocyte culture obtained from the epidermis of vitiligo patients for future treatment; (2) to estimate the influence of selected factors on the formation of suction blisters and the results of culture; and (3) to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus psoralen and ultraviolet A (PUVA) therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA-therapy (CP), and only PUVA therapy (OP). METHODS Forty patients were qualified for the study. The roofs of the suction blisters were used as a melanocyte source for culture establishment or were directly transplanted. RESULTS The CMP procedure was successfully performed on only 10 of 20 patients because of the difficulties in cell culture establishment. The SBP method was carried out on all 20 patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSIONS The effectiveness of culture depends on time of suction blister forming, phototype, and previous PUVA therapy. This study demonstrated the advantage of the SBP over the CMP method. [source]

Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma

THE JOURNAL OF SEXUAL MEDICINE, Issue 11 2008
Chao Feng PhD
ABSTRACT Introduction., Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma. Aim., To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma. Methods., Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery. Main Outcome Measures., The events of NPT and D-CDDU were recorded. Results., In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05). Conclusions., The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction. Feng C, Xu Y-M, Yu J-J, Fei X-F, and Chen L. Risk factors for erectile dysfunction in patients with urethral strictures secondary to blunt trauma. J Sex Med 2008;5:2656,2661. [source]