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One Lesion (one + lesion)
Selected AbstractsCold Air Analgesia in Photodynamic Therapy of Basal Cell Carcinomas and Bowen's Disease: An Effective Addition to Treatment: A Pilot StudyDERMATOLOGIC SURGERY, Issue 1 2004FACD, John Pagliaro MB Background. There is considerable interpatient variability in pain tolerance during and after treatment of skin cancer with photodynamic therapy (PDT). Additionally, erythema and edema are common, with mild crusting and healing over 1 to 2 weeks. Objective. To determine whether concurrent cold air analgesia improves the tolerability of PDT. Method. Twenty-six patients with two similar superficial skin cancers were treated with PDT. One lesion was treated with cold air analgesia and the other without. Patients rated their pain during treatment using the Wong Baker Faces Pain Scale and detailed duration of posttreatment pain. At week 2, the inflammatory response was assessed. Result. A statistically significant difference in the analgesia group was shown with respect to the mean duration of pain and the level of erythema after the first treatment as well as pain scores during the second treatment. Conclusion. Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field. [source] Histological evolution of lentiginous melanoma: a report of five new casesJOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2007Tracy Davis Background:, The term lentiginous melanoma was recently used for atypical melanocytic proliferations sharing some histological features with lentigo maligna and associated with a protracted in situ stage before invasion. Lentiginous melanoma was characterized by predominantly single-cell lentiginous growth pattern with focal junctional nests and pagetoid spread, preservation of the dermoepidermal junction, limited cytological atypia, and lack of significant solar elastosis. We report five similar cases. Methods:, Histological review of routine sections with clinicopathological correlation. Results:, Three patients were male and two were female. The age at presentation ranged from 24 to 66 years. All lesions arose on the truck or proximal extremities. All five cases fulfilled histological criteria proposed for lentiginous melanoma. None of the lesions showed significant solar elastosis. One lesion was followed clinically and histologically for 16 years without intervening treatment. It had three local recurrences before culminating in invasive melanoma. Conclusions:, Our observations support recent efforts to distinguish lentiginous melanoma as a distinct clinicopathological entity. Lentiginous melanoma can remain in situ for a long time before invasion and may be considered an analogue of lentigo maligna occurring on non-severely sun-damaged skin. Familiarity with the histological features of this variant is important for its early recognition and treatment. [source] Comparison of potassium titanyl phosphate vascular laser and hyfrecator in the treatment of vascular spiders and cherry angiomasCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2003G. Dawn Summary Patients with vascular spiders and angiomas, especially on exposed sites, demonstrate considerable psychological morbidity and therefore request treatment. Traditionally, electrosurgical modalities have been used to treat such lesions, but more recently lasers have been introduced. This open study assesses the efficacy of these two treatment modalities, scoring patients' preference and psychological morbidity before and after treatment. All patients had two vascular spiders or angiomas. One lesion was randomized for treatment with the hyfrecator, whilst the other lesion was treated with the potassium titanyl phosphate (KTP) vascular laser. The end-point of the study was either clearance of lesions or a maximum of three treatments at 2-month intervals. In this first comparative study, we demonstrate that both therapeutic modalities were effective in treating these lesions and in significantly reducing the post-treatment psychological morbidity score. However, on average, only one treatment with the KTP laser was required to achieve clearance compared with two treatments with the hyfrecator. This would result in less clinic visits. In addition, patients favoured the KTP laser because of the lack of side-effects. Both the KTP vascular laser and the hyfrecator were able to clear vascular spiders and angiomas, but the KTP laser was superior as fewer treatment episodes were required and patients preferred this treatment modality because of the lack of side-effects. [source] Driving in the melanoma landscapeEXPERIMENTAL DERMATOLOGY, Issue 6 2009Meenhard Herlyn Abstract:, The melanoma landscape is rapidly evolving. The melanoma oncologists have now the first successful targets for therapy that have a genetic base , albeit in rare forms of the malignancy. Once melanoma becomes part of the Cancer Genome Atlas consortium, a comprehensive map of genetic changes will be established to point the field to true drivers of the disease that will become new targets for therapy. The same abnormalities will also serve as biomarkers for diagnosis, prognosis and therapy follow-up. Melanomas as a group are heterogenous as are tumor cells within one lesion. New strategies will move towards individualized therapies and combination therapies to target all cells within a tumor. [source] Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis,,HEPATOLOGY, Issue 3 2008Francis Y. Yao We previously reported encouraging results of down-staging of hepatocellular carcinoma (HCC) to meet conventional T2 criteria (one lesion 2,5 cm or two to three lesions <3 cm) for orthotopic liver transplantation (OLT) in 30 patients as a test of concept. In this ongoing prospective study, we analyzed longer-term outcome data on HCC down-staging in a larger cohort of 61 patients with tumor stage exceeding T2 criteria who were enrolled between June 2002 and January 2007. Eligibility criteria for down-staging included: (1) one lesion >5 cm and up to 8 cm; (2) two to three lesions with at least one lesion >3 cm and not exceeding 5 cm, with total tumor diameter up to 8 cm; or (3) four to five lesions with none >3 cm, with total tumor diameter up to 8 cm. A minimum observation period of 3 months after down-staging was required before OLT. Tumor down-staging was successful in 43 patients (70.5%). Thirty-five patients (57.4%) had received OLT, including two who had undergone live-donor liver transplantation. Treatment failure was observed in 18 patients (29.5%), primarily due to tumor progression. In the explant of 35 patients who underwent OLT, 13 had complete tumor necrosis, 17 met T2 criteria, and five exceeded T2 criteria. The Kaplan-Meier intention-to-treat survival at 1 and 4 years after down-staging were 87.5% and 69.3%, respectively. The 1-year and 4-year posttransplantation survival rates were 96.2% and 92.1%, respectively. No patient had HCC recurrence after a median posttransplantation follow-up of 25 months. The only factor predicting treatment failure was pretreatment alpha-fetoprotein >1,000 ng/mL. Conclusion: Successful down-staging of HCC can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome. (HEPATOLOGY 2008.) [source] A possible case of coccidioidomycosis from the Los Muertos site, Tempe, ArizonaINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 4 2006D. H. Temple Abstract Coccidioidomycosis is a fungal disease endemic to southwestern North America and parts of Central and South America. Coccidioidomycosis frequently disseminates to the human skeleton and produces mostly lytic skeletal lesions. However, this disease is infrequently described within archaeological populations. As a result, it is important to report potential cases in order to improve current understanding of the appearance and distribution of lesions resulting from coccidioidomycosis in archaeological specimens. This study describes skeletal lesions in an adult male recovered from the Los Muertos site, Tempe, Arizona (AD 500,1450). These lesions are present on the inferior border of the left scapular spine, the medial portion of the left first metacarpal head, and the medial portion of the right first metatarsal. The lesions are predominantly lytic with sclerotic and, in some cases, healed cortical bone distributed around their margins. Evidence of skeletal healing is recorded within the destructive focus of one lesion. Geographical information on pathogen endemism, overall lesion distribution, and agricultural-era Hohokom behaviour suggest that coccidioidomycosis is the most likely diagnostic option for these lesions. Mounting evidence for possible infections in the palaeopathological literature, combined with high frequencies of nutritional stress levels in endemic regions, suggests that coccidioidomycosis contributed at least moderately to morbidity in the American Southwest. Copyright © 2006 John Wiley & Sons, Ltd. [source] Spontaneous regression of hepatocellular carcinoma and review of literatureJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2000Yoshio Takeda Abstract A 68-year-old man presented with multiple hepatocellular carcinoma, which was considered to be unresectable at the first admission in January 1994. Pathological diagnosis was made by biopsy of the one lesion among them. From January 1994 to December 1997, 10 transarterial chemoembolizations and six percutaneous ethanol injection therapies were performed on the tumours in the cirrhotic liver. In February 1998 the tumour situated in the right lobe began to increase in size. The maximum tumour diameter was 6.3 cm measured by computed tomography (CT). In the beginning of May 1998 moderate ascites was present and mild hepatic encephalopathy was noticed. The patient was in the terminal stage of hepatocellular carcinoma and no further treatment was possible at that time. However, serum ,-fetoprotein and protein induced by vitamin K absence or antagonist II dramatically decreased in June 1998. The CT scan also showed that the tumour had completely regressed without specific treatment. In February 1999 a new biopsy-proven hepatocellular carcinoma, 2 cm in diameter, developed in the lateral segment of the liver. It was well treated by percutaneous ethanol injection therapy. The patient was alive in good condition without any symptoms or tumour recurrence in June 1999. It was concluded that a rare case of spontaneous regression of hepatocellular carcinoma had occurred. [source] Button osteoma: Its etiology and pathophysiologyAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 3 2002Vered Eshed Abstract The present study investigates a circumscribed bony overgrowth on the cranial vault, known as button osteoma (BtO) and referred to here as button lesion (BtL). We discuss its anthropological implications. Data on its histology, location, and population distribution (by age, race, and gender) are provided. Microscopically, BtL is composed of well-organized dense lamellated bone which is poorly vascularized and with very few osteocytes. It forms a dome-shaped roof over an underlying diploeized area which includes the ectocranial table. The frequency of BtL is similar in modern (37.6%) and archaeological (41.1%) populations, in blacks, whites, males, and females, and correlates with age. It is rare in nonhuman primates. Fifty-five percent of the human skulls studied by us had BtL only on the parietal, 23.6% on the frontal, and 3.6% on the occipital bones. Fifteen percent had BtL on both the frontal and parietal bones. No lateral preference was found. Most skulls with BtL (64.1%) had only one lesion, 20.4% had two BtL, and 15.4% demonstrated multiple BtL. The average number of button osteomas on an affected skull was 1.97. The frequency of large osteomas (0.5,1.0 cm) was similar in young and old age groups. The demographic characteristics of BtL, mainly its high frequency among ancient and modern populations, its independence of sex and race, its scarcity in other primates, and the fact that its macro- and microstruture are indicative of an hamartoma (and not an osteoma or exostosis) suggest an evolutionary background to the phenomenon. Am J Phys Anthropol 118:217,230, 2002. © 2002 Wiley-Liss, Inc. [source] An Early Regional Experience with Expansion of Milan Criteria for Liver Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010J. J. Guiteau The Milan Criteria (MC) showed that orthotopic liver transplantation (OLT) was an effective treatment for patients with nonresectable, nonmetastatic HCC. There is growing evidence that expanding the MC does not adversely affect patient or allograft survival following OLT. The adult OLT programs in UNOS Region 4 reached an agreement allowing lesions outside MC (one lesion <6 cm, ,3 lesions, none >5 cm and total diameter <9 cm,[R4 T3]) to receive the same exception points as MC lesions. Kaplan,Meier curves and log-rank tests were used to compare survival data. Chi-squared and Mann,Whitney U tests were used to compare patient data. A p - value of <0.05 was considered significant. All statistical analyses were performed on SPSS 15 (SPSS, Chicago, IL). Four hundred and forty-five patients were transplanted for HCC (363-MC and 82-R4 T3). Patient demographics were found to be similar between the two groups. Three year patient, allograft and recurrence free survival between MC and R4 T3 were found to be 72.9% and 77.1%, 71% and 70.2% and 90.5% and 86.9%, respectively (all p > 0.05). We report the first regionalized multicenter, prospective study showing benefit of OLT in patients exceeding MC based on preoperative imaging. [source] HP10 LAPAROSCOPIC RESECTION OF SUBMUCOSAL GASTRIC LESIONS , THE WHANGAREI EXPERIENCEANZ JOURNAL OF SURGERY, Issue 2007J. Y. Yang Purpose To evaluate safety of laparoscopic resection of submucosal gastric lesions performed in Whangarei Based Hospital. Methodology From November 2002 to December 2006, 8 consecutive patients underwent the above mention surgery. (M : F = 5 : 3; Average age 63 [range, 43,83]). All patients underwent pre-operative gastroscopy. Wedge resections were performed for anterior wall lesions. (n = 3). Posterior wall lesions were resected via transgastric approach. (n = 4). Retroperitoneal resection was performed for the foregut duplication cyst. (n = 1). All except one lesion were resected using endoscopic GIA stapler. The medical records of the patients were reviewed retrospectively. Results All patients were successfully treated laparoscopically. No conversion to open surgery. Pathology included: Gastrointestinal-stromal tumor (GIST) (n = 5), Malignant leiomyosarcoma (n = 1), Ectopic pancreas (n = 1), and Foregut duplication cysts (n = 1). All achieved adequate negative surgical margin. Average operation time was 106.14 minutes. [Range, 75,150]. Average length of hospital stay was 3.42 days [range, 1,5]. Complication included one wound infection, and one pyloric stenosis. Average length of follow up was 10.96 months [range, 0.46,31.73]. No recurrence detected and all are still alive till date. Conclusion Laparoscopic resection of submucosal gastric lesions is a safe and appropriate alternative to open surgery. Its main advantage over open technique includes shorter length of hospital stay, lower recurrence rate and lower mortality rates. Surgical technique depends very much on tumor size and location. Outcome of the patients described from our centre is comparable to the others published till date. [source] Dermoscopic pattern of intermediate stage in seborrhoeic keratosis regressing to lichenoid keratosis: report of 24 casesBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2007P. Zaballos Summary Background, Lichenoid keratosis (LK) is a well-described entity which has been proposed to represent an immunological or regressive response to pre-existing epidermal lesions such as solar lentigines or seborrhoeic keratoses. Objectives, To evaluate the dermoscopic criteria of a series of cases of LK with remaining areas of seborrhoeic keratosis which were both dermoscopically and histologically diagnosed. Methods, Pigmented lesions with dermoscopic areas of seborrhoeic keratosis and LK in the same tumour were consecutively diagnosed and prospectively included in the study. All pigmented lesions were examined and registered using DermLite Foto equipment (3Gen, LLC, Dana Point, CA, U.S.A.), at 10-fold magnification, at the Dermatology Department of Hospital de Sant Pau i Santa Tecla (Tarragona, Spain), between 1 January 2003 and 31 December 2005. Results, In total, 24 cases of lesions with dermoscopic areas of seborrhoeic keratosis and LK were collected. In four lesions (17%), the clinical differential diagnosis without dermoscopy included malignant melanoma and in seven lesions (29%), basal cell carcinoma. The diagnosis of LK was clinically considered without dermoscopy in only six cases (25%). A granular pattern was observed to be distributed throughout the LK areas of the lesions. This pattern consisted of the presence of brownish-grey, bluish-grey or whitish-grey coarse granules that formed, in 11 cases (46%), globules and/or short lines. In one lesion, located on the face, these short lines produced annular or rhomboid structures as seen in lentigo maligna melanoma. Conclusions, Dermoscopy is a useful tool which assists in the correct clinical recognition of LK, which may also potentially illuminate the pathogenesis of these tumours, showing the intermediate stage of regressing epidermal lesions in an LK. [source] Detection of epidermodysplasia verruciformis-associated human papillomavirus DNA in nongenital seborrhoeic keratosisBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2004Y-H. Li Summary Background, DNA of epidermodysplasia verruciformis (EV)-associated human papillomaviruses (HPVs) has been widely detected in lesions of malignant skin tumours, benign tumours and other proliferative diseases of epithelial origin. Objectives, To investigate the presence of EV-associated HPV DNA in nongenital seborrhoeic keratosis (SK) and to elucidate the prevalence of distinct HPV genotypes. Methods, We investigated HPV DNA in 55 nongenital SK biopsies, which were compared with 48 normal skin biopsies (healthy controls) using a nested polymerase chain reaction (PCR) using consensus primers CP65/CP70 and CP66/CP69. The positive PCR products were retracted and used to prepare recombination clones with T-vector. Distinct clones were analysed with endonucleases, and HPV genotypes were identified by direct sequencing. Results, EV-associated HPV DNA was detected in 42 of 55 (76%) nongenital SK biopsies vs. only 13 of 48 (27%) healthy controls (,2 = 22·087; P < 0·005). The prevalence was higher in patients with more than five lesions than in those with only one lesion (P < 0·05). Ten distinct HPV genotypes were detected in the nongenital SK biopsies: HPV 20, 23, 5, renal transplant recipient (RTR) X7, HPV 17, 37, 17b, RTRX4, RTRX4b and strain SK3. HPV 20 was found in 26 of 42 (62%) positive specimens, followed by HPV 23 (11 of 42, 26%) and HPV 5 (six of 42, 14%). Existence of multiple HPV genotypes was observed in 12 of 42 (29%) positive specimens. In healthy controls, five genotypes of EV-associated HPV (HPV 20, 23, 5, 17 and RTRX4) were detected, with the same predominant genotype of HPV 20 (five of 13, 38%). Several distinct HPV genotypes were found to coexist in four of 13 (31%) positive specimens. Conclusions, This study provides some evidence that EV-associated HPVs might play a part in the pathogenesis of nongenital SK. [source] Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma of the forefootBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2000K. Pelzer Mycetoma is a localized primary subcutaneous infection due to fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who acquired an implantation infection on the forefoot following a motorcycle accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were isolated simultaneously from the lesion. Under combined therapy with itraconazole and trimethoprim,sulphamethoxazole for 7 months the lesion healed completely. A combination of causative organisms in mycetomas is rare, and the combination of S. schenckii and N. asteroides together has not been reported from one lesion. [source] Brain magnetic resonance imaging abnormalities in neuromyelitis opticaACTA NEUROLOGICA SCANDINAVICA, Issue 4 2008Y. Li Objective,,, Brain abnormalities in neuromyelitis optica (NMO) attracted much attention. Our study was to identify the brain magnetic resonance imaging (MRI) abnormalities in Chinese NMO patients. Methods,,, Patients who fulfilled the latest diagnostic criteria of NMO proposed by Wingerchuk et al. [Neurology 66 (2006) 1485] and whose brain MRI did not meet the multiple sclerosis (MS) criteria of McDonald et al. [Ann Neurol 50 (2001) 121] were selected to perform MRI scanning of the brain, spinal cord and optic nerves. Results,,, Twenty-eight of 33 patients (84.8%) had abnormal MRI findings. Twenty-two patients (66.7%) presented with well-defined brain parenchymal lesions and the other six patients (18.2%) with macroscopic symmetrical diffuse hyperintensities in deep white matter. Fifteen of 22 patients had more than one lesion (,2 lesions) and the other seven patients had single lesion. In the supratentorium, most lesions were punctate or small round dot and non-specific in juxtacortical, subcortical and deep white matter regions, a few were patchy atypical confluent lesions. Brainstem was easily involved (14/33, 42.4%) especially in medulla (7/33, 21.2%). Conclusions,,, This study demonstrates the characteristics of brain MRI abnormalities in Chinese NMO patients, which are helpful to the revision of diagnostic criteria for NMO. [source] Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010Neeraj Badhey MD Abstract Background: We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions. Methods: We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions). Results: An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two in-stent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis. Conclusion: In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of ,25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use. © 2010 Wiley-Liss, Inc. [source] Langerhans cell histiocytosis in an adult: good response of cutaneous lesions to acitretinCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2010J. C. Cardoso Summary A 57-year-old man presented with a 2-year history of bilateral erosive lesions on the inguinal region, and erythematous, brown and crusted papules over the trunk. Histological examination of one lesion in conjunction with immunohistochemical study and electron microscopy led to the diagnosis of Langerhans' cell histiocytosis. After a thorough examination, the only associated findings were retroperitoneal fibrosis and hypergonadotrophic hypogonadism with a granulomatous testicular infiltrate. The patient was treated with oral acitretin for 1 year (with a topical corticosteroid for the inguinal lesions), resulting in clearing of the cutaneous lesions. He underwent placement of bilateral double-J ureteral catheters and was started on hormone replacement therapy. At follow-up 1 year after treatment with acitretin ceased, the patient remained free of cutaneous lesions and his overall condition, including the retroperitoneal fibrosis, had improved. This case had an uncommon combination of features, with a good response to acitretin. [source] An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and managementCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2005R. Mahendran Summary There is currently much interest in the potential role of telemedicine in improving the delivery of dermatological care in the UK. The two teledermatology systems available at present are divided into live video and store-and-forward technology. We investigated the value of a store-and-forward teledermatology system in the diagnosis and management of lesions suspicious of skin cancer. A total of 163 store-and-forward referrals of patients with one lesion each were assessed independently by a Consultant and a third-year trainee dermatologist. The accuracy of diagnosis and appropriateness of management from these assessments was compared to a subsequent face-to-face consultation with the Consultant. Analysis of the Consultants' diagnoses showed that 48% were identical for teledermatology and conventional face-to-face consultations. A further 17% of teledermatology diagnoses included the actual clinical diagnosis as a possibility but 20% were either incorrect or a diagnosis could not be made. In the remaining 15% of cases the digital image was of insufficient quality for assessment. Of the trainee's reports, 44% were identical to the clinical diagnoses and another 20% included the clinical diagnosis as a possibility. The management plan was appropriate in 55% of the total teledermatology referrals assessed by the Consultants and in 52% assessed by the trainee when compared with the conventional consultation. This study illustrates that the store-and forward type telemedicine system has limited diagnostic accuracy for skin lesions. However, our results suggest that store-and-forward teledermatology may be suitable and safe for screening out clearly benign lesions but the study casts doubt on its efficiency. [source] | ||||||||||