Analysis of Individualized Silicone Rubber Bolus Using Fan Beam Computed Tomography in Postmastectomy Radiotherapy: A Dosimetric Evaluation and Skin Acute Radiation Dermatitis Survey

Objective: To investigate the dosimetric effects of using individualized silicone rubber (SR) bolus on the target area and organs at risk (OARs) during postmastectomy radiotherapy (PMRT), as well as evaluate skin acute radiation dermatitis (ARD). Methods: A retrospective study was performed on 30 patients with breast cancer. Each patient was prepared with an individualized SR bolus of 3 mm thickness. Fan-beam computed tomography (FBCT) was performed at the first and second fractions, and then once a week for a total of 5 times. Dosimetric metrics such as homogeneity index (HI), conformity index (CI), skin dose (SD), and OARs including the heart, lungs, and spinal cord were compared between the original plan and the FBCTs. The acute side effects were recorded. Results: In targets' dosimetric metrics, there were no significant differences in Dmean and V105% between planning computed tomography (CT) and actual treatments (P > .05), while the differences in D95%, V95%, HI, and CI were statistically significant (P < .05). In OARs, there were no significant differences between the Dmean, V5, and V20 of the affected lung, V5 of the heart and Dmax of the spinal cord (P > .05) except the V30 of affected lung, which was slightly lower than the planning CT (P < .05). In SD, both Dmax and Dmean in actual treatments were increased than plan A, and the difference was statistically significant (P < .05), while the skin-V20 and skin-V30 has no difference. Among the 30 patients, only one patient had no skin ARD, and 5 patients developed ARD of grade 2, while the remaining 24 patients were grade 1. Conclusion: The OR bolus showed good anastomoses and high interfraction reproducibility with the chest wall, and did not cause deformation during irradiation. It ensured accurate dose delivery of the target and OARs during the treatment, which may increase SD by over 101%. In this study, no cases of grade 3 skin ARD were observed. However, the potential of using OR bolus to reduce grade 1 and 2 skin ARD warrants further investigation with a larger sample size.

Chondrodermatitis nodularis helicis in a teenager caused by frequent headphone use

Chondrodermatitis nodularis helicis is a benign condition that presents as a painful ear nodule and is commonly seen in older adults. Herein, we highlight a pediatric case of chondrodermatitis nodularis helicis caused by an increasingly common age-related behavior of frequent headphone use.

Surgical Treatment of Tattoo Complications

With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented.

[Surgical problems of homeless people]

Estimated quantity of homeless people in Poland is about 30.000. Health conditions of homeless depends on poor living conditions, alcohol abuse and lack of medical care. The aim of the study was to present surgical problems of homeless people at St. Brother Albert's Aid Society Shelter in Szczodre.

MATERIAL AND METHODS

In years 2009-2011 in St. Brother Albert's Aid Society Shelter in Szczodre 1053 homeless were provided outpatient surgical care. The frequency of occurrence of diseases rated on the basis of the medical examination, medical history and medical records.

RESULTS

The patients were aged 20-82 years (median: 46 years). The most common surgical problem of homeless people was skin infectious such as scabies, lice, tinea and lower limb ulceration due to underlying chronic vanous insufficiency or due to sustained injury. Other problems requiering surgical care were: frostbite, abscesses, phlegmon, unhealed wounds, back pain and pain due to sustained injuries. Most frequent causes of homelessness were family problems, alcohol abuse, conflict with the law, loss of ocupation or loss of home.

CONCLUSIONS

Surgical diseases of homeless people have multifactorial etiology. The most frequent diseases in our patients were skin infectious and lower limb ulcerations. Medical care oriented on specific needs of homeless people is particulary important because poor health condition is not only consequence but could also be the cause of homelessness.

[Pilot study on the use of diode laser therapy for treatment of dermatitis in koi carp (Cyprinus carpio)]

OBJECTIVE

Therapy of dermatitis in koi using a diode laser technique.

MATERIAL AND METHODS

A diode laser with a wavelength of 980 nm and an energy density of 9 J/cm(2) was used to treat defined skin alterations in ten koi carp. The clinical situation after repeated laser application was recorded. In addition, the diode laser was used for surgical removal of proliferative skin alterations caused by Dermocystidium sp. in two koi ponds.

RESULTS

An improvement of the clinical situation following laser therapy was seen in nine of the ten koi carp. Complete healing of the wound area occurred in four carp. A pronounced healing process was observed in four patients and a low healing tendency in one fish. Healing of the skin lesions following removal of the alterations caused by Dermocystidium sp. was unproblematic in one pond, whereas in the other collection a repeated treatment was necessary due to relapse of the alterations.

CONCLUSIONS AND CLINICAL RELEVANCE

Diode laser therapy for treatment of dermatitis in koi is a promising technique. An expedited wound healing process was seen in wound areas that were present for long periods and resistant to previous therapy attempts, including antibiotics. Wound healing was undisturbed following surgical use of the laser technique for the removal of skin proliferations. Therefore, the diode laser technique can be recommended for the treatment of dermatitis in koi, especially in cases of unsuccessful treatment using anti-infective drugs, and for the treatment of Dermocystidium infections.

Evaluation of the 1,540-nm Erbium:Glass Laser in the Treatment of Inflammatory Facial Acne

BACKGROUND

The erbium:glass laser is approved to treat inflammatory acne on the back.

OBJECTIVE

This aim of this study was to evaluate the use of the 1,540-nm erbium:glass laser in the treatment of moderate to severe inflammatory acne on the face.

METHODS AND MATERIALS

An erbium:glass laser (Aramis, Quantel Medical, Clermont-Ferrand, France) was used to treat 15 patients with moderate to severe acne four times at 2-week intervals. Active lesions were first treated with six pulses at 10 J/cm(2). The entire face was then treated with a single pass using bursts of four pulses at 10 J/cm(2). Sebum measurements were performed. Six patients continued in a double-arm study to determine whether an additional treatment at 6 months would prolong the lesion-free period. Final evaluation was at 9 months. RESULTS At 6-month follow-up, patients rated improvement as 68%, and the mean investigator improvement assessment was 78%. Sebum measurements did not change. No patients required anesthesia, and no side effects were observed. A single retreatment session 6 months after the initial course held clearance at 80% at 9-month follow-up, whereas patients without retreatment had 72% clearance.

CONCLUSION

Treatment of inflammatory facial acne with the 1,540-nm erbium:glass laser is effective and relatively painless. Papules, pustules, and nodules all respond well to therapy. Additional treatment sessions may prolong the lesion-free period, and maintenance therapy should be included as a part of the treatment course.

Pediatric chondrodermatitis nodularis helicis

Chondrodermatitis nodularis helicis (CNH) is a rare condition of the pinna affecting mainly adults. A pediatric case of this condition is presented in the current report, and the literature of pediatric CNH is reviewed.

[Ten cases of Verneuil's disease]

INTRODUCTION

Verneuil's disease is a chronic inflammatory, suppurating and fistulizing disease. It is often misdiagnosed and taken for another pathology. The aim of this study was to describe the epidemiological, clinical, and therapeutic features of 10 patients presenting with this disease, in our dermatology unit.

PATIENTS AND METHODS

We retrospectively analyzed 10 observations of Verneuil's disease from 1994 to 2005. We studied the clinical, epidemiological, and therapeutic characteristics.

RESULTS

Nine male and one female patients were included. The mean age was 35 years. The mean delay between onset of symptoms and diagnosis was 6 years. All patients presented with a severe form of the disease. The localizations were the buttocks in 4 cases, the pubis in one case, and the axilla in another case. Four patients also presented with buttock and anoperineal lesions. The medical treatment was antiseptics, antibiotic therapy, or isotretinoin. All patients were treated surgically.

CONCLUSION

A suppurated and fistulized nodule on an anoperineal or axillary location must suggest this disease. Our series is characterized by the prevalence of men and the frequency of severe forms.

Narrow elliptical skin excision and cartilage shaving for treatment of chondrodermatitis nodularis

BACKGROUND

Surgical excision remains the hallmark of therapy for chondrodermatitis nodularis chronica (CNC). Although excision is generally successful, recurrence at the edge of the excised nodule is well recognized.

OBJECTIVE

To analyze the clinical features and the recurrence rate of patients with CNC treated with elliptical excision of the papule and removal of the underlying cartilage.

DESIGN

Seventy-four outpatients with CNC, 52 men and 22 women, were retrospectively analyzed. A narrow elliptical excision of the papule followed by a slice of the underlying cartilage were carried out with local anesthetic. Cartilage spikes were trimmed carefully shaping a smooth contour from the normal helical rim to the defect.

RESULTS

Good cosmetic results were obtained in all patients. The median follow-up for helical and antihelical lesions were 54 and 50 months, respectively. The global recurrence rate was 13.5% and ranged from 10.6 to 37.5% for helical and antihelical lesions, respectively.

CONCLUSIONS

We recommend this surgical procedure because it has been shown to be as efficient as other methods and probably faster to perform.

Endoscopy-aided laser therapy for intractable granular myringitis

Objective: We report our technique and results for endoscopy-aided CO2 laser therapy for the treatment of intractable granular myringitis, as an out-patient office procedure.

Materials and methods: A total of 21 patients (14 women and seven men; mean age 32.6 years) were retrospectively reviewed, all of whom suffered from intractable granular myringitis and had undergone endoscopy-aided laser treatment. Granulation tissue was vaporized for one to two seconds with a CO2 laser (spot size 0.5–1 mm with a power setting of 5–10 W in continuous mode). The mean follow-up period was 11 months.

Results: Eighteen of the 21 patients (85 per cent) were cured after a single treatment. Three patients with the diffuse form of the disease required repeat laser treatments coupled with self-irrigation with a diluted vinegar solution. We noted no perforations of patients' tympanic membranes after laser vaporization. We also observed no recurrences over follow-up periods ranging from three months to 2.6 years. Our laser procedure produced no adverse effect on hearing thresholds, nor were any other complications observed.

Conclusion: Our results suggest that endoscopy-aided CO2 laser ablation is a reliable and minimally invasive method associated with low rates of recurrence and a low incidence of complications. It can be conducted as an office procedure.

Perivulvar dermatitis in a cat treated by episioplasty

Perivulvar dermatitis is common in obese, older female dogs that have infantile vulvae. Removing the excessive perivulvar skin folds by episioplasty has been recommended as the treatment of choice for perivulvar dermatitis in bitches. This report describes a case of perivulvar dermatitis in a cat that was treated by episioplasty. Ten days after surgery a substantial improvement was noticed, and 67 days later the skin in the perineal/perivulvar area appeared to be normal. The cat had not been given any medication. As in bitches, episioplasty in cats can be successful in reducing perivulvar dermatitis.

[Dermatofibroma accompanied by perforating dermatosis in the auricle: a case report]

Although dermatofibroma is one of the most common soft tissue tumors, it is rarely seen in the face. Perforating dermatosis is characterized by papulonodules measuring 1-10 cm, with a central cup-shaped epidermal depression filled with a keratotic plug. An 82-year-old woman presented with a hyperkeratotic erythematous papular lesion, 0.8 cm in diameter, on the posterior side of the left auricle, showing no infiltration to the peripheral tissues. Total excisional biopsy was performed, which showed dermatofibroma accompanied by perforating dermatosis. No recurrence was detected during her follow-up. Our literature search did not yield any reported case of dermatofibroma accompanied by perforating dermatosis.

Comparative study of three surgical treatments for two forms of the clinical presentation of bovine pododermatitis

In this study, 1013 animals showing signs of clinical pododermatitis were examined and divided into five unevenly numbered groups. Affected animals in Groups I and II showed only signs of vegetative interdigital pododermatitis. The lesions were surgically removed and either protected with bandages (in Group I) or cauterized with incandescent iron (Group II). The animals in Groups III, IV, and V, showed signs of necrotic pododermatitis. These were treated with different protocols after the necrotic tissue was surgically removed: in Group III, the lesion was cauterized; in Group IV, the wound was protected with bandages; and in Group V, both the second and the third phalanges were amputated. There was a statistically significant relapse difference between Group III and Group V, as well as a difference among Group IV and Group V animals, and there were fewer relapses among the latter. The treatment used in Groups II and III proved to be efficient and inexpensive. Amputation of the phalanges was the treatment that resulted in fewer relapses among all protocols, despite its mutilating effect. The association of a local and parenteral treatment with an antibiotic agent, as well as the use of foot baths, contributed greatly to a fast recovery.

Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear. In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease. Reports on this technique claim excellent cosmetic results with only a small chance of recurrence. In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports. Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery. The authors recommend this safe and simple technique to other physicians who treat patients with CDN.

Episioplasty for the treatment of perivulvar dermatitis or recurrent urinary tract infections in dogs with excessive perivulvar skin folds: 31 cases (1983-2000)

OBJECTIVE

To evaluate the effectiveness of episioplasty for the treatment of perivulvar dermatitis or chronic or recurrent urinary tract infections (UTI) believed to be secondary to excessive perivulvar skin folds in dogs and to document whether a causal relationship exists between the presence of chronic or recurrent UTI and excessive perivulvar skin folds in female dogs.

DESIGN

Retrospective study.

ANIMALS

31 female dogs.

PROCEDURE

Medical records of dogs with vulvar dermatitis (group 1; n = 15) or UTI (group 2; 16) were reviewed for history, signalment, physical examination findings, hematologic findings, results of urine or vaginal bacteriologic culture, and results of additional diagnostic procedures.

RESULTS

14 of 15 dogs in group 1 had complete resolution of perivulvar dermatitis and associated clinical signs following episioplasty. One dog had a relapse of clinical signs and vulvar dermatitis 2 years after surgery in association with a 9-kg (1 9.8-1b) weight gain. Sixteen of 16 dogs in group 2 had complete resolution of clinical signs of UTI following episioplasty. Urine samples were obtained via cystocentesis no earlier than 1 month after surgery to confirm resolution of UTI in 13 of 16 of dogs in group 2. Mild-to-moderate incisional swelling was the only surgical complication reported for either group, with the exception of 1 dog in group 2 that had wound dehiscence. All owners were satisfied with surgical outcomes.

CONCLUSIONS AND CLINICAL RELEVANCE

All owners reported complete resolution of clinical signs for both groups of dogs. Episioplasty is an effective low morbidity treatment for perivulvar dermatitis and chronic UTI associated with excessive perivulvar skin folds.

Autoimmune progesterone dermatitis: onset in a women without previous exogenous progesterone exposure

Autoimmune progesterone dermatitis is a rare clinical entity that may be seen by the family practitioner, gynecologist, or dermatologist. Recognition of the entity is paramount in the therapy of this easily treated condition. We report a case of a 36-year-old woman with a recurrent facial dermatitis of many months' duration. We found the cutaneous eruption to be temporally related to her menstrual cycle. The patient denied any changes in her diet, cosmetics, medications, or soaps that could account for the dermatitis. Despite no previous exposure to exogenous progesterone, the diagnosis of autoimmune progesterone dermatitis was made. The patient was cured by oophorectomy.

Chondrodermatitis nodularis chronica helicis et antihelicis

A retrospective study of 50 patients (25 male, 25 female) suffering from chondrodermatitis nodularis chronica is presented. There was equal distribution between male and female, with the nodule being situated on the helix in 36 cases (23 male, 13 female), and on the antihelix in 18 cases (4 male, 14 female). Four patients had bilateral lesions. All the patients complained of severe pain in the affected ear when they slept on it at night. Of the 54 ears in this study, 23 had undergone previous surgery for the complaint. These recurrences occurred when either skin alone, or a disproportionately large piece of skin relative to cartilage, was excised. A treatment technique is described involving minimal skin excision combined with extensive cartilage resection. There has been no recurrence following our technique and postoperative deformity has been minimal.

[Argon laser therapy of chondrodermatitis nodularis chronica helicis]

In 5 years 9 patients with a total of 16 painful ear nodules (chondrodermatitis helicis) have been treated as follows. A small excision is carried out with local anaesthesia for histological examination. The rest of the nodule or any other nodules are carbonized by means of the argon laser, also with local anaesthesia, including the surface of the cartilage under the nodules. There have been no cases of postoperative inflammation or infection. New nodules occurring several months after treatment have been successfully treated in the same way. There have been no real recurrences. The cosmetic result is very good in all cases. The patients are free of pain immediately after the laser therapy. Laser therapy for painful nodules of the ear has good and lasting results, with a lower rate of recurrences than any other form of treatment.

The treatment of chondrodermatitis nodularis with cartilage removal alone

Fifty-eight patients with chondrodermatitis nodularis on the antihelix in 24 ears (16 women and eight men) and the helix in 40 ears (six women and 34 men) were studied. Twelve ears responded to intralesional steroid therapy. Under local anesthetic, 46 operations were performed to remove cartilage without skin excision. On the helix, a longitudinal incision was made; on the antihelix, a flap was raised and the underlying cartilage was excised, taking care to leave no rough cartilage edges. Follow-up (mean, 16 months; range, 4.5 to 34 months) showed that 10 of 17 antihelix lesions and 24 of 29 helix lesions healed completely with excellent cosmetic results. Recurrences, requiring further treatment, occurred at cartilage-excision margins in seven ears, and further cartilage excision alone was successful in four ears. This study demonstrates that only cartilage needs to be removed in the surgical treatment of chondrodermatitis nodularis.

Bilateral chondrodermatitis helicis: case presentation and literature review

Chondrodermatitis helicis is a benign, painful lesion of the auricle affecting the elderly population, particularly men. These lesions usually affect the helix of the ear, although the antihelix and, less commonly, the antitragus may be involved. The lesions are most frequently unilateral, although bilateral involvement has been reported. An unusual case of bilateral involvement of the antitragus is presented. The etiologic and pathologic manifestations are reviewed and current treatment modalities outlined.

Reconstruction of the pinna using pre-auricular flaps

The pre-auricular skin reservoir provides an excellent source of full thickness skin for reconstruction of defects of the pinna. Pre-auricular flaps may be based superiorly or inferiorly. The skin texture and color match is ideal for pinna reconstruction.

Management of a case of chronic radiodermatitis on the forehead

An area of radiodermatitis was excised from the forehead area, repaired with an advancement-rotation flap, and followed by elevation of the ipsilateral brow to restore symmetry.

The posterior stocking seam approach to radical subfascial clipping of perforating veins

The posterior stocking seam approach to radical subfascial ligation of perforating veins has been advocated for the patient with postphlebitic syndrome presenting with severe stasis dermatitis, leg edema, and recurrent ulceration. Our indications for this procedure have been extended to include signs and symptoms of advanced venous insufficiency which persist after multiple operative procedures for recurrent varicose veins in the absence of deep venous thrombosis. In this series of twenty-five operations there was one instance of recurrent stasis ulceration after the procedure, and reversal of the pigmentation of stasis dermatitis was dramatic in the majority of cases. All limbs have completely healed, and there has been no significant swelling. The long-term results of this surgical procedure have been excellent, and short-term complications have been minimal.

Microsurgical composite tissue transplantation: a method of immediate reconstruction of the head and neck

A new approach utilizing microsurgical composite tissue transplantation is advocated for the management of difficult reconstructive problems in the region of the head and neck. This method is especially useful when local flap coverage may be inadequate. Morbidity and hospitalization is reduced and reconstruction is complete upon discharge from the hospital. Extirpative surgery for a malignancy can now have the defect reconstructed immediately with less disfigurement and psychological insult to the patient and family.

Little tips with big rewards

We all would like to reduce the pain of injecting a local anesthetic, to simplify the treatment of xanthelasma palpebrarum and chondrodermatitis nodularis; and to improve methods of shave excision of nevi and cosmetic extirpation of large seborrheic keratoses. Here are some tips that might help.