[Pulsed dye laser treatment for Jessner's lymphocytic infiltration of the skin]. / Infiltrat lymphocytaire de Jessner et Kanof traité par laser à colorant pulsé

BACKGROUND: Jessner's lymphocytic infiltration of the skin (LIS) is a chronic, benign T-cell infiltrative disorder, usually manifesting as erythematous papules or plaques on the face, neck and back. PATIENTS AND METHODS: five patients presented LIS with numerous skin lesions on the face and back characteristic of this disease. Histological examination showed a lymphocytic infiltrate in the dermis without any modification of the epidermis. Direct immunofluorescent study was negative in all cases. Response to dermocorticoids proved inconsistent or negative in all patients. An excellent outcome was achieved in all five patients with pulsed dye laser. In one case, further skin lesions appeared at 1 year and responded to the same treatment. Following a single treatment session with 6-8 J/cm(2), three of five patients showed normal skin. Regression occurred in the other two cases after two to three sessions. Pulsed dye laser appeared to be the best treatment for Jessner-Kanof disease for three patients at 4-8 years of follow-up. DISCUSSION: only one case of Jessner-Kanof disease treated by pulsed dye laser has been reported. Pulsed dye laser has been used in cutaneous lupus and annular granuloma. Selective photothermolysis allows photocoagulation of dilated vessels. CONCLUSION: pulsed dye laser at 595nm could offer a valuable therapeutic alternative, and even a first-line treatment with no side effects.

Treatment by splenic irradiation in 22 chronic lymphocytic leukemia patients.

Twenty-two patients with chronic lymphocytic leukemia, score 2 according to Rai et al. (10), who received only a course of splenic irradiation are reviewed. Splenic doses ranged from 420 to 1080 rad. Response to splenic irradiation was rated by evaluating peripheral lymphocytosis, hepatosplenomegaly, adenomegaly and disease-related symptoms. Following splenic irradiation, 8 patients showed a significant reduction in splenomegaly; 7 patients showed a significant reduction in peripheral lymphocytosis (less than 10,000/mm3), which has lasted from 15-42 months without any other treatment. In 14 patients, response to splenic irradiation was partial, and it has successively been necessary to treat 12 patients with chemotherapy. Methods of splenic irradiation, survival, clinical and hematologic behavior are discussed in detail.

Role of radiation therapy in management of adult leukemia.

There are both defined and evolving roles for radiation therapy in the management of adult leukemias. For the acute leukemias, emphasis presently is on adjuvant irradiation of local manifestations including CNS "prophylaxis" for subclinical meningeal involvement. In chronic myelocytic leukemia, local palliative radiotherapy is complemented by the use of splenic irradiation for its systemic effect. Recently, total body irradiation has been shown to influence the natural history of chronic lymphocytic leukemia. For the first time, it has been possible to achieve remissions that prolong survival as well as improve the quality of life. Future exploitation or radiotherapy in adults with leukemia will be dependent upon improved communication and cooperation between the various medical specialists concerned with patient care in these diseases.

The role of splenic irradiation in chronic lymphocytic leukemia.

Fourteen patients with chronic lymphocytic leukemia (CCL) who received a total of 23 courses of splenic irradiation (SI)for various combinations of painful splenomegaly, progressive leukocytosis, lymphocytosis, thrombocytopenia, and anemia are reviewed. Splenic midplane doses ranged from 200-1750 rads (3-14 days), while the most typicalregimen was 300-450 rads in two to three fractions of 150 rads given over 3-8 days. Response to SI was rated according to a scoring system which evaluated the splenic and hematologic response, as well as the response of disease-related symptons. According to this scoring system, most patients demonstrated a significant relief of painful splenomegaly, along with improvement of hemogram and bone marrow parameters. While those patients judged as failures to prior chemotherapy or total body irradiation showed improvement following SI, those who had received minimal therapy prior to SI showed a superior response. SI, in those showing a satisfactory response, was repeated successfully in several patients (up to six times in one instance). The onset and duration of response to SI, dose-reponse data, survival, clinical and hemotologic responses, and the possible mechanism of action of SI are discussed with reference to the available literature.

[Roentgen therapy of dermatoses: indications and hazards]. / Röntgenbehandlung von Dermatosen: Indikationen und Gefahren.

Indications for radiotherapy of benign dermatoses have decreased markedly during the past decades. The remaining indications are reviewed. Side effects of ionizing radiation therapy are discussed in detail, with special emphasis on radiodermatitis and radiation cancer of the skin, mutagenic and genetic effects of x rays, and induction of carcinogenesis of interanl organs. Thyroid cancer is used as an example to discuss modern theories of radiocarcinogenesis and risk coefficients of various organ systems. Guide lines for radiotherapy of benign dermatoses are proposed.