Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study.

BACKGROUND: Clinical manifestations of cutaneous lupus erythematosus (CLE) vary widely, and different subtypes of this autoimmune disease exist. Tumidus subtype (LT) has been recently separated from the chronic subtypes and is now considered an independent entity due to its particular clinical and histological features. Different treatments are usually prescribed for CLE. Our group has experience of CLE effectively treated with pulsed dye laser (PDL). It was our impression that better responses were achieved in the LT subtype, but no controlled prospective studies with PDL have been specifically performed. MATERIALS AND METHODS: A prospective study was performed on 10 patients with histologically confirmed LT treated with PDL. All patients were treated with 595 nm PDL using the 10 mm spot size at 0.5 ms pulse width and a fluence of 8 J/cm(2). Biopsies were taken before and 4 weeks after treatment and were stained with haematoxylin-eosin. RESULTS: Evaluation after PDL treatment showed clinical improvement in all of them without side-effects and reduction of the dermal lymphocytic infiltrate in 9/10 of the patients. Epidermal changes were absent in all patients. Mucin deposition persisted only in one patient. However, 50% of the patients developed new lesions nearby or distant to the treated zones. CONCLUSIONS: PDL therapy is an effective and fast treatment option for acute flares of LT; however, it does not prevent recurrences. A histological improvement has been confirmed in this study. Purpura seems to be necessary to achieve a good response.

[Plaque-phase mycosis fungoides treated with photodynamic therapy: results from 12 patients]. / Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes.

BACKGROUND: Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. OBJECTIVES: To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. MATERIALS AND METHODS: We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite). RESULTS: Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. CONCLUSIONS: Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.

[Chylothorax as a late complication of pacemaker endocarditis]. / Quilotórax como una complicación a largo plazo de la endocarditis sobre marcapasos.

The mortality observed in pacemaker endocarditis may be high when all the components of the device are not withdrawn. Few studies have reported the posterior morbidity once the acute disease is resolved. Herein we present a patient who developed superior vena cava thrombosis, obstruction of thoracic duct and chylothorax after the initial episode of endocarditis. The evolution of the patient illustrates the late complications of isolated antibiotic treatment of pacemaker endocarditis, the poor results obtained with temporal oral anticoagulation in the management of superior vena cava thrombosis in the presence of retained intravascular foreign material, the excellent, prolonged initial response of chylothorax to conservative measures with anticoagulation and diet, relapse of chylothorax related to the increase in arterial pulmonary pressure, the absence of response at this time to the dietary measures and the successful treatment with video-assisted thoracic surgery to treat chylothorax without the morbidity of the large surgical procedures.

[The evolution and prediction of the incidence of breast cancer in Zaragoza, 1961-2000]. / Evolución y predicción de la incidencia de cáncer de mama en Zaragoza, 1961-2000.

BACKGROUND: Using the data available from the Cancer Registry of Zaragoza, the incidence of breast cancer in women from 1961 to 1985 was analyzed with future evolution being predicted up to the year 2000. METHODS: The age, period and birth cohort effects, in addition to the place of residence (capital/rest of province) were analyzed using both, graphic analysis techniques and multivariate models of incidence rates by the Poisson regression. Assuming a constant period effect, the age and cohort effects were used to predict incidence rates in a period of 15 years between 1986 and 2000. RESULTS: Age-standardized incidence rates increased from 17.1 cases per 100,000 women per year in 1961-1965 to 36.5 in 1981-1985. This increase was mainly observed in women above the age of 40 residing in an urban environment. In a graphic analysis of rates by birth cohorts, an age and cohort effects were observed, producing an anticipation of age to which the highest values in incidence rates were reached. In the prediction of incidence with multivariate models, and increase is foreseen up to the year 2000. CONCLUSIONS: An increase of breast cancer incidence in Zaragoza has been observed with a further increase foreseen up to the year 2000. This increasing incidence has been related to the age, the year of birth and the place of residence of cases. A relation with some other determinants of disease, and whether the results observed may be extrapolated to the rest of Spain are discussed.

[Survival in cancer of the breast in Zaragoza (1960-1990) in relation to age, clinical stage and period of time of the diagnosis]. / Supervivencia del cáncer de mama en Zaragoza (1960-1990) en relación con la edad, estadio clínico y período de tiempo del diagnóstico.

BACKGROUND: The characteristics of a population based series of 3,066 women diagnosed with breast cancer collected by the Cancer Registry of Zaragoza, Spain from 1960 to 1990 are herein described. Gross short and long term survival, as well as specific survival were estimated according to age at diagnosis, tumor stage and the period in which the patient was diagnosed. METHODS: Every patient was followed up to verification of death or to the latest information available up to January 1, 1991. Diagnosis specified in writing in the clinical history and support by surgical or anatomopathologic reports were required. The data concerning place and site of residence and the vital status of the cases were verified by the municipal and civil registries, death certificates and burial registries. The survival curves were estimated by the Kaplan-Meier method, and short and long term survival, by age and tumor stage at diagnosis and the diagnostic period were also evaluated. RESULTS: Gross survival was estimated as 89.1% in the first year, 50.9% at 5 years, and 34.7%, 28.4% and 20.0% at 10, 15, 20 and 25 years, respectively. Survival at 5 years according to TNM clinical stage classification (UICC-AJC 1978) was 90% for stage I, 69.5% for stage II, 44.6% for stage III and 20.6% for stage IV. The cases diagnosed between 1980 and 1990 presented better survival than those previously diagnosed. The differences were statistically significant in all the cases (p < 0.001, log-rank test). CONCLUSIONS: A slight improvement has been observed in the survival of women diagnosed with breast cancer in Zaragoza, Spain during the study period. Despite of that fact, the survival rates were worse than those observed in other countries with similar socioeconomic development.

[The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs]. / Morbilidad, mortalidad y costes sanitarios evitables mediante una estrategia de tratamiento del tabaquismo en España.

OBJECTIVE: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs. METHODS: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated. RESULTS: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. CONCLUSIONS: The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain.

[Disseminated intravascular coagulation in a patient with polyarteritis nodosa and bilateral hypoacusis]. / Coagulación intravascular diseminada en un paciente con panarteritis nodosa e hipoacusia bilateral.

We describe the case of a 44-years-old female patient with a panarteritis nodosa preceded by a rapid progressive bilateral deafness after an acute otitis media. Once on treatment with steroids and cyclophosphamide, she developed a disseminated intravascular coagulation, with a fatal evolution not justifiable by a different cause apart from her main disease.

[Meningitis and cerebrospinal liquid fistula as a complication from the surgery of endolymphatic sac]. / Meningitis y fístula de LCR como complicación de un caso de cirugía del saco endolinfático.

A 28 years old woman diagnosed of Méniére's disease was surgically treated with a drainage from endolymphatic system and a valve placed. Six years after surgery, the patient presented a bacteria meningitis an a cerebrospinal fluid leak to mastoid was found. New surgery was needed. Complications of endolymphatic system surgery, its treatment and frequency are discussed. This case is a very rare.

[The mastoid surgery in children at the Doce de Octubre Hospital. Review of the years 1988-1991]. / Cirugía de la mastoides en niños en el Hospital Doce de Octubre. Revisión de los años 1988-1991.

A study was made of 21 children with cholesteatoma and chronic otitis media between 1989 and 1991. We reviewed diagnostic tools, presurgical data, surgical procedures and results. Certain aspects of special relevance such as congenital anomalies and presurgical complications, are emphasized. The procedure of choice was mastoid tympanoplasty with the canal wall down, which is preferred in children. Hearing results were poor, partially caused by the process of bone resorption and by the surgical technique used. The incidence of persistent disease and recurrent cholesteatoma was high but we achieved a good control of the disease development because the canal wall down procedure allowed visualization and cleaning of the mastoid cavity.

[Congenital medially invasive cholesteatoma of the temporal bone: supralabyrinthine dissemination and possible origin in the area of the geniculate ganglion]. / Colesteatoma congénito medialmente invasivo de hueso temporal: vía de diseminación supralaberíntica y posible origen en área de ganglio geniculado.

Congenital cholesteatoma appears in about 2% of all cholesteatomas. The possibility of deep extension producing a medially invasive petrous bone cholesteatoma is very uncommon because congenital cholesteatomas are not as aggressive as acquired ones. The onset of facial palsy in a patient with a history of several years of hearing loss must suggest this possibility. We reviewed in this report the main concepts on this subject after bibliographic review and a case report.