Thoracoscopic management of iatrogenic cardiac perforations.

AIMS: Iatrogenic cardiac perforation is an uncommon but potentially fatal complication of invasive cardiac procedures. When nonsurgical management fails, urgent cardiac surgery is required. The standard surgical approach is usually through full sternotomy. However, we propose a less invasive and equally effective technique with video-assisted thoracoscopic surgery (VATS). METHODS: This single-center retrospective study in a tertiary hospital identified all patients requiring surgical intervention due to iatrogenic cardiac perforation over a period of 5 years. Patients were grouped by surgical approach, being either sternotomy or VATS. Primary endpoints were operating time, length of ICU stay, hospital stay, 30-day mortality, and all-round mortality. RESULTS: Twenty-five patients were identified: 11 in the sternotomy group and 14 in the VATS-group. Preoperative baseline characteristics were equal. Significant difference was found for 30-day mortality (p < .05). There was no difference for the other endpoints. CONCLUSIONS: VATS is a promising alternative to standard sternotomy for iatrogenic cardiac perforations after invasive cardiac procedures.

Observational Study of Clindamycin Phosphate and Tretinoin Gel for the Treatment of Acne

INTRODUCTION: Acne vulgaris can cause pain/discomfort and have a negative impact on quality of life (QOL). Clin-RA is an acne treatment consisting of clindamycin phosphate 1.2% and tretinoin 0.025%, which has been proven effective and well tolerated in clinical studies. This prospective, non-interventional study aimed to capture data on previous treatment, acne severity, and QOL in patients with acne treated with Clin-RA and assess the efficacy and tolerability of Clin-RA in routine clinical practice. METHODS: The study was performed at 18 centers in Sweden and enrolled patients aged ≥15 years with acne, who were prescribed Clin-RA for the first time. The observation period was ~12 weeks. The primary objective was to assess the patient's perception of their facial acne severity before and during Clin-RA treatment using a visual analog scale (VAS; 100 mm scale). Secondary objectives included QOL evaluation before and after treatment, using the Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: 84 patients were enrolled and eligible for analyses (79.8% female; mean age 22.6 years). Patient-assessed VAS scores for acne severity decreased continuously during the study, indicating improvement: the median percentage reduction from baseline for VAS score was 17.6% at week 4 and 63.8% at week 12, with changes from baseline being statistically significant (P=0.0004 at week 4; P<0.0001 at weeks 8 and 12). Overall, QOL improved after Clin-RA treatment, reflected by a decrease in the mean (standard deviation) DLQI sum score from 8.8 (5.8) on day 0 to 4.9 (4.2) at week 12. Seventy percent of patients were satisfied/very satisfied with treatment. Clin-RA was well tolerated, with no serious adverse drug reactions reported. CONCLUSIONS: Treatment with Clin-RA resulted in continuous improvement of facial acne over the course of 12 weeks, along with improved QOL and a tolerable safety profile, supporting the use of Clin-RA in clinical practice. J Drugs Dermatol. 2019;18(4):328-334.

Development and Evaluation of a Rosacea Screening Instrument (Rosascreen).

BACKGROUND: There are no current instruments to facilitate population screening for rosacea. OBJECTIVE: To develop and evaluate a screening instrument for rosacea applicable for population surveys. METHODS: A rosacea-specific screening instrument (Rosascreen), consisting of a subject-completed questionnaire and screening algorithm, was developed based on current diagnostic criteria for rosacea. Three iterations were pilot tested and refined for clarity and sensitivity in adult outpatients with and without rosacea. RESULTS: Three subject groups were consecutively evaluated with iterations of the questionnaire at each centre (overall N = 121). The final version had a sensitivity of 93% to 100% for key diagnostic criteria, and use of the algorithm had a sensitivity of 100% for detection of rosacea and specificity of 63% to 71%. Most subjects found the questionnaire easy to understand and complete. CONCLUSION: Rosascreen, a subject-completed questionnaire and diagnostic algorithm, is a highly sensitive screening instrument that may facilitate estimation of rosacea prevalence in general populations.

Comparison of Moisturizing Creams for the Prevention of Atopic Dermatitis Relapse: A Randomized Double-blind Controlled Multicentre Clinical Trial.

Atopic dermatitis (AD) affects adults and children and has a negative impact on quality of life. The present multicentre randomized double-blind controlled trial showed a barrier-improving cream (5% urea) to be superior to a reference cream in preventing eczema relapse in patients with AD (hazard ratio 0.634, p = 0.011). The risk of eczema relapse was reduced by 37% (95% confidence interval (95% CI) 10-55%). Median time to relapse in the test cream group and in the reference cream group was 22 days and 15 days, respectively (p = 0.013). At 6 months 26% of the patients in the test cream group were still eczema free, compared with 10% in the reference cream group. Thus, the barrier-improving cream significantly prolonged the eczema-free time compared with the reference cream and decreased the risk of eczema relapse. The test cream was well tolerated in patients with AD.

Rosacea: current state of epidemiology.

Case definitions are critical in epidemiologic research. However, modern disease indicators must now consider complex data from gene-based research along with traditional clinical parameters. Rosacea is a skin disorder with multiple signs and symptoms. In individuals, these features may be multiple or one may predominate. While studies on the epidemiology of rosacea have previously been sparse, there has been a recent increase in research activity. A broader body of epidemiological information that includes a greater variety of countries beyond Northern Europe and general population-based demographics is needed. As there are operational issues in current case definitions of rosacea subtypes--rationalization and standardization--universal consistent applications in future research is also imperative. Further improvement in disease definition combining new research information along with clinical pragmatism should increase the accuracy of rosacea case ascertainment and facilitate further epidemiological research.

Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the Hand Eczema Extent Score (HEES).

BACKGROUND: Health-related quality of life (HRQoL) is associated with the extent and severity of hand eczema. We still lack a consensus about which HRQoL instrument to use as the standard, and how to measure the extent and severity of hand eczema. OBJECTIVES: To compare the Dermatology Life Quality Index (DLQI) with EQ-5D (a standardized instrument for use as a measure of health outcome), and to evaluate how the Hand Eczema Extent Score (HEES) relates to these instruments. METHODS: Ninety-three patients (61 females) were included. The HEES was recorded by a dermatologist, and the DLQI and EQ-5D by the patients. The results were analysed with factor analysis and non-parametric statistics. RESULTS: The DLQI and EQ-5D showed decreased HRQoL. Using factor analysis, we could not establish an association between the DLQI and EQ-5D. There were, however, correlations between the DLQI and the HEES (0.31), the EQindex and the HEES (-0.32), the DLQI and the EQVAS (-0.62), and the DLQI and the EQindex (-0.67) (the EQVAS and the EQindex are calculated from EQ-5D). CONCLUSIONS: We could not link factors in the DLQI to EQ-5D, which has previously been done for SF-36 (Short Form 36). On the basis of this, we cannot recommend EQ-5D over SF-36 for hand eczema studies. The DLQI correlates with the EQVAS and the EQindex, and can probably be used as an approximation for EQ-5D. Our findings with the HEES are interesting, as it can be used by patients.

No skin reactions to mineral powders in nickel-sensitive subjects.

BACKGROUND: Cosmetic products are known to be able to induce contact dermatitis. Contact dermatitis may also be induced by nickel, and it is estimated that up to 17% of women are allergic to nickel. OBJECTIVES: The aim of the present study was to investigate whether nickel sensitized individuals react to make-up products containing pigments with nickel as an impurity. PATIENTS/MATERIALS/METHODS: Twenty-three individuals with a clinical history of nickel allergy and/or with positive patch test reactions to nickel were exposed to mineral make-up products and individual pigments dispersed in alkylbenzoate (50%) in small Finn Chambers® for 48 hr. The skin reactions were evaluated visually and with a non-invasive instrument that quantifies skin erythema. RESULTS: The results showed that 74% of the included individuals showed a visible reaction to the positive control nickel sulfate, and a significant correlation was found between the visual and instrumental readings. However, none of the nickel sensitive individuals reacted to the test products. A subgroup analysis of the 50% most sensitive individuals also confirmed the absence of skin reactions to the powders. CONCLUSIONS: The bioavailability of the trace amounts of nickel in the particles was below the level needed to elicit an eczematous reaction in any of the nickel-sensitized individuals.

The effects of 884 MHz GSM wireless communication signals on headache and other symptoms: an experimental provocation study.

Findings from prior studies of possible health and physiological effects from mobile phone use have been inconsistent. Exposure periods in provocation studies have been rather short and personal characteristics of the participants poorly defined. We studied the effect of radiofrequency field (RF) on self-reported symptoms and detection of fields after a prolonged exposure time and with a well defined study group including subjects reporting symptoms attributed to mobile phone use. The design was a double blind, cross-over provocation study testing a 3-h long GSM handset exposure versus sham. The study group was 71 subjects age 18-45, including 38 subjects reporting headache or vertigo in relation to mobile phone use (symptom group) and 33 non-symptomatic subjects. Symptoms were scored on a 7-point Likert scale before, after 1(1/2) and 2(3/4) h of exposure. Subjects reported their belief of actual exposure status. The results showed that headache was more commonly reported after RF exposure than sham, mainly due to an increase in the non-symptom group. Neither group could detect RF exposure better than by chance. A belief that the RF exposure had been active was associated with skin symptoms. The higher prevalence of headache in the non-symptom group towards the end of RF exposure justifies further investigation of possible physiological correlates. The current study indicates a need to better characterize study participants in mobile phone exposure studies and differences between symptom and non-symptom groups.

[Time to limit the use of antibiotics in rosacea!] / Dags att minska användningen av antibiotika vid rosacea - Isotretinoin bör övervägas vid frekventa recidiv ­ lokalbehandling fortfarande förstahandsterapi.

Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.

Laser treatment of rosacea: a pathoetiological study.

OBJECTIVE: To study the effect of laser treatment on rosacea, a common facial skin disease with symptoms of blushing, redness, telangiectasis, papules, pustules, and diffuse swelling of the skin, we focused on the stinging sensation and performed immunohistochemical evaluation of nerve density and neuropeptide expression. DESIGN: Clinical investigation as well as the lactic acid (stinger) test was performed before and 3 months after the treatment with flashlamp pulsed dye laser, when skin biopsy specimens were also taken. SETTING: University hospital. PATIENTS: Thirty-two patients with rosacea, all with positive results from the lactic acid "stinger" test, were treated by flashlamp pulsed dye laser. MAIN OUTCOME MEASURES: The biopsy specimens were taken from the stinger-positive areas in the nasolabial folds, fixed in Lanas fixative (10% formalin and 0.4% picric acid), and analyzed for the expression of protein gene product 9.5 (general nerve marker), substance P, calcitonin gene-related peptide, and vasoactive intestinal polypeptide, using a biotinylated streptavidin technique. RESULTS: Thirty-one patients who were stinger positive before treatment showed decreased scores after treatment, and 1 patient had the same stinger test score before and after treatment. The number of protein gene product 9.5-positive fibers in the epidermis (P< .05) as well as the papillary dermis (P< .01) was decreased. This was also the case for substance P in the papillary dermis (P< .001), whereas no evident difference was noted for vasoactive intestinal polypeptide and calcitonin gene-related peptide. No difference was found for contact between nerves and vessels (factor VIII positive). CONCLUSIONS: Laser treatment of rosacea that destroys small vessels has a good medical relevance because it reduces the unpleasant symptoms of the sensitive skin. A neurogenic etiology of stinging may be possible.

Atopic dermatitis, stinging, and effects of chronic stress: a pathocausal study.

BACKGROUND: Patients with atopic dermatitis (AD) often have increased skin sensitivity and this symptom often worsens during stress. OBJECTIVE: We sought to find out whether patients with AD had stinging, and to identify the pathocausal neuroimmune mechanisms, including the role of stress. METHODS: In all, 25 patients with AD with histories of stress worsening were tested using a stinger test. Skin biopsy specimens were processed for immunohistochemistry. Stress inquiries and salivary cortisol tests were performed. RESULTS: In all, 16 patients were stinger-positive and 9 were negative. The stinger-positive papillary dermis had an increased number of mast cells, vasoactive intestinal polypeptide-positive fibers, and a tendency to a higher number of substance P-positive nerve fibers, but a decrease of calcitonin gene-related peptide fibers. Patients who were stinger-positive had a tendency to lower salivary cortisol. CONCLUSIONS: The majority of patients with AD experience stinging. Substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, and mast cells may have a pathocausal role, as might chronic stress.

A novel formulation of mometasone furoate in psoriasis patients: a multicenter, randomized, double-blind clinical study.

INTRODUCTION: Further formulations of mometasone furoate are needed for treatment of patients with plaque psoriasis to meet individual patient preferences. This has motivated the development of Ovixan(®) (Galencia, Malmoe, Sweden), a formulation of mometasone furoate with different cosmetic properties than the commonly used formulation, Elocon(®) (Merck [Schering Plough], Whitehouse Station, New Jersey, USA). This novel formulation of mometasone furoate was examined in a vasoconstrictor assay comparing its efficacy with that of Elocon. Subsequently, the new formulation was tested in a multicenter, randomized, double-blind clinical study in patients with plaque psoriasis. METHODS: Healthy volunteers were included in the vasoconstrictor study. The treatments were randomly assigned to test fields on the forearms. The test fields were gently cleaned after treatment for 6 h. Skin color was measured during the following 24 h and area under the time curve was calculated. The clinical efficacy and tolerance of Ovixan was as compared to that of Elocon and their vehicles in a double-blind study in patients with plaque psoriasis. Patients with four symmetrically placed lesions on the arms or the legs were treated for 6 weeks. Primary endpoint was the change from baseline of the Total Severity Sign score for each treated lesion. The cosmetic characteristics of the two test preparations were assessed by an independent cosmetological institute. RESULTS: Ovixan was shown to have skin blanching potency almost identical to the vasoconstrictor potency of Elocon. Clinical equivalence of Ovixan to Elocon was demonstrated in the clinical study of the efficacy in patients with plaque psoriasis. A professional testing team clearly documented the cosmetic superiority of Ovixan as compared to Elocon. CONCLUSION: The results of the investigations show that Ovixan is equipotent to the commonly used formulation Elocon. However, the cosmetic properties are in favor of Ovixan. The effect of the cosmetic differences on patient preferences and patient adherence to prescribed treatment has to be investigated in further studies.

Influence of mono-axis random vibration on reading activity.

Recent studies on train passengers' activities found that many passengers were engaged in some form of work, e.g., reading and writing, while traveling by train. A majority of the passengers reported that their activities were disturbed by vibrations or motions during traveling. A laboratory study was therefore set up to study how low-frequency random vibrations influence the difficulty to read. The study involved 18 healthy male subjects of 23 to 32 yr of age group. Random vibrations were applied in the frequency range (1-10 Hz) at 0.5, 1.0 and 1.5 m/s(2) rms amplitude along three directions (longitudinal, lateral and vertical). The effect of vibration on reading activity was investigated by giving a word chain in two different font types (Times New Roman and Arial) and three different sizes (10, 12 and 14 points) of font for each type. Subjects performed reading tasks under two sitting positions (with backrest support and leaning over a table). The judgments of perceived difficulty to read were rated using 7-point discomfort judging scale. The result shows that reading difficulty increases with increasing vibration magnitudes and found to be maximum in longitudinal direction, but with leaning over a table position. In comparison with Times New Roman type and sizes of font, subjects perceived less difficulty with Arial type for all font sizes under all vibration magnitude.

Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea.

BACKGROUND AND OBJECTIVES: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions. STUDY DESIGN/MATERIALS AND METHODS: Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment. RESULTS: Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions. CONCLUSION: Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.