Quality of Life During Treatment for Cervicofacial Non-melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1 week, 1 month and 6 months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up.

Factors related to the evolution of quality of life in patients with cervicofacial non-melanoma skin cancer.

PURPOSE: Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution. METHODS: This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received. RESULTS: A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up. CONCLUSIONS: The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic).

Assessment of Quality of Life Following Diagnosis in Patients with Cervicofacial Non-melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC) is the most common neoplasm. The characteristics of this disease (location in aesthetically sensitive areas, the appearance of successive tumors during follow-up, and high rates of survival) are such that the concept of health-related quality of life (HRQoL) is of particular importance. The aim of the present study was to describe and analyses patient quality of life following diagnosis with cervicofacial NMSC. A descriptive cross-sectional study was conducted on patients with cervicofacial NMSC, confirmed by skin biopsy. In each case, when the definitive diagnosis of NMSC was established, the patient completed the Skin Cancer Index questionnaire and demographic data, health status, and sun exposure habits were recorded. The study population was composed of 220 patients with histologically confirmed cervicofacial NMSC. The mean score obtained for the Skin Cancer Index questionnaire was 54.1 (SD 21.9), in which the social-aesthetic component had a mean score of 76.7 (SD 26.2), while the emotional component had a mean score of 23 (SD 25.1). Male patients, those with secondary or higher education, and those who had no history of anxiety or depression had significantly higher mean scores for HRQoL. This study demonstrated that the diagnosis of cervicofacial NMSC significantly impacts HRQoL and that certain population groups (women, persons with only primary or no education qualifications, and those a history of anxiety or depression) are more susceptible. The questionnaire scores obtained were lower than those reported in previous studies on this topic and reflect a particularly strong impact on emotional aspects of patient quality of life.

Impact of a Community Intervention for Early Skin Cancer Diagnosis Implementing Teledermatology.

The principal cause of skin cancer is sun exposure. In areas with high sun exposure levels, early diagnosis and sun protection education strategies must be developed. Aim of the study was to evaluate the impact of an early skin cancer diagnosis intervention implementing teledermatology. Transversal descriptive study on a population in the Western Costa del Sol. Primary care physicians were instructed on skin cancer diagnosis. They recruited consecutive at-risk patients and held four workshops for early skin cancer diagnosis and education on sun protection. The resulting variables on participants' satisfaction and intention to change were collected. 393 patients were recruited. The mean age was 52.9 years, and 65.4% were women. Suspicious lesions were detected in 24.1% of participants, and 11.7% were attended to via teledermatology. Of these, 65.2% were evaluated in person at the Dermatology Department. Fourteen basal cell carcinomas, 5 squamous cell carcinomas, and 2 melanomas were diagnosed. Regarding patient satisfaction, 67.7% found all aspects of the workshops of interest, 41.7% found the skin check-up of interest, and 26.4% found sun and skin cancer prevention information of interest. Of the patients attended to via teledermatology, 100% stated it was good or very good and 100% would consult again via this method. The intervention was successful in terms of participation, skin cancer diagnosis, and satisfaction, especially compared with other international campaigns. Therefore, although the data cannot be extrapolated to all environments, this initiative may be used as the basis for the development of future interventions.

Preventing Skin Cancer Among Staff and Guests at Seaside Hotels.

Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.

Use of topical rapamycin in the treatment of superficial lymphatic malformations.

BACKGROUND: The superficial lymphatic component of vascular malformations poses a significant treatment challenge. It is responsible for the majority of symptoms presented, and to date, there is no consensus regarding treatment. OBJECTIVE: To evaluate the effectiveness of topical rapamycin in treating superficial lymphatic malformations (LM). METHODS: A case series study was performed of patients with superficial LM, treated with topical rapamycin. The clinical characteristics of patients and the concentration and application mode of the drug were recorded. The changes in the signs and symptoms observed and associated adverse effects were noted and analyzed. RESULTS: The study population consisted of 11 patients of an average age of 10.5 years. All were treated with topical rapamycin: 6 patients with a 1% concentration, 1 with a 0.8% concentration, and 4 with a 0.4% concentration. Changes in the clinical appearance of the lesions were observed in all patients. The associated symptoms, present in 9 of 11 patients, improved in every case. The mean follow-up time was 16.1 months. LIMITATIONS: This study is retrospective, with a small sample size and considerable heterogeneity of lesions and treatment approaches. CONCLUSION: Treatment with topical rapamycin modifies the clinical appearance and alleviates symptoms of superficial LM.

Adjusting oral oxybutynin medication for hyperhidrosis to reflect seasonal temperature variations.

Most studies of oral oxybutynin (OOx) for the treatment of hyperhidrosis (HH) have assumed a stable treatment protocol, without taking into account adverse effects (AE) or seasonal variations in temperature. The objective is to evaluate adjusting the dose of OOx according to the time of year. Prospective study of patients who began OOx for HH between 2007 and 2017, and maintained treatment for at least 1 year, with a progressively increasing dose was performed. All patients were recommended to vary the dose of medication according to the time of year. Baseline epidemiological data, the response to treatment and AE were analyzed. About 122 patients were included (average age of 33.8 years). Up to 60.7% varied the dose. Significantly better results were obtained in the group that varied the dose. Twenty patients suspended the treatment in winter. Among them the adjusted OR was 3.04 (95% CI 1.24-7.45) for an excellent response. The frequency of AE was 74.6% with no differences among groups. Most patients are able to control their HH without requiring the same dose of OOx throughout the year. Given that the possible AE of OOx are dose-dependent, it seems reasonable to vary it according to the time of year.

Carcinoma espinocelular manifestado como cuerno cutáneo que simula un pico de pájaro / Squamous cell carcinoma presenting as bird beak-like cutaneous horn

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Microcystic Lymphatic Malformation Successfully Treated With Topical Rapamycin.

Microcystic lymphatic malformations (MLM) are low-flow vascular malformations composed of multiple small cysts. MLM usually affect deep-lying structures, which makes their treatment even more difficult and complex. A novel and interesting treatment is rapamycin, a mammalian target of rapamycin inhibitor that when orally administrated has offered favorable results. However, until recently, topical rapamycin had not been used in the treatment of MLM. Case 1 is a girl aged 13 years with extensive MLM affecting the muscles in the right buttock. The patient had received frequent cycles of cryotherapy, but they had failed to control the associated symptoms. In the previous 12 months, the patient had reported greater discomfort, swelling, exudate, and superinfection of the affected region. Because no specific treatment has yet been approved for MLM, and as a step before the use of aggressive systemic or intralesional treatments, it was decided to initiate treatment with 1% rapamycin ointment. After 4 months of treatment, the patient presented a marked improvement, with a significant reduction of associated complications and no major side effects. Case 2 is a boy aged 5 years who underwent surgery for an intergluteal lipoblastoma at 3 weeks of life and developed a MLM on the scar 6 months afterward. The lesion showed slow growth and continuous exudation with frequent episodes of superinfection. Treatments with laser multiplex and intralesional bleomycin were performed unsuccessfully. In the previous 4 months, the patient had been treated with 1% rapamycin ointment with significant improvement and no side effects.

Initial study of transdermal oxybutynin for treating hyperhidrosis.

Oral oxybutynin for treating hyperhidrosis is effective and safe. Its side-effects are mild but frequent so we consider whether transdermal oxybutynin (considered to have a better side-effect profile) could be an alternative for treating hyperhidrosis. During 2015, a prospective study was conducted. Epidemiological variables, effectiveness (using the Hyperhidrosis Disease Severity Scale) and tolerance to transdermal oxybutynin were compiled concerning two different groups (patients previously treated or untreated with oral oxybutynin), at baseline, and at 3 and 12 months. Seven previously treated and six previously untreated patients were included. Five patients in the first group discontinued the treatment within 3 months. Of the two remaining patients, one reported ineffectiveness and the other obtained an excellent response but discontinued due to local irritation. Among the untreated patients, two showed no response and four experienced improvement (three with "partial response" and one with "excellent response"). All patients discontinued treatment within 12 months. No major adverse effects were observed. The absence of active metabolites after transdermal oxybutynin could result in less effectiveness than oral oxybutynin, although it is usually well tolerated. In conclusion, transdermal oxybutynin could have low effectiveness for the treatment of hyperhidrosis in patients following intolerance to oral oxybutynin but could provide good results in patients who have never tried systemic drugs.

Absceso hepático piógeno: presentación clínica y predictores de evolución desfavorable / Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome

Objetivos Describir clínicamente el absceso hepático piógeno (AHP) e identificar factores asociados a evolución desfavorable. Material y métodos Revisión retrospectiva de historias de pacientes con absceso hepático (1996-2009), incluyendo los que cumplían criterios diagnósticos de AHP. Se clasificaron en evolución favorable y desfavorable (sepsis grave, complicaciones infecciosas a distancia, complicación local, ingreso en cuidados intensivos, ingreso > 30 días, fallecimiento, reingreso).Resultados Se incluyen 54 AHP, 65% hombres, edad media 61 años. Factores predisponentes: enfermedad biliopancreática, 33%; ingreso reciente, 20%; enolismo, 15%; diabetes mellitus, 15%; antecedente de neoplasia digestiva, 11%, y de cirugía abdominal, 11%. Origen: criptogénico, 65%; biliar, 31%; portal, 4%. Sintomatología: fiebre, 100%; dolor abdominal, 65%; vómitos, 37%; hepatomegalia, 33%; síndrome de respuesta inflamatoria sistémica, 26%; ictericia, 9%. Hemocultivos positivos, 40%, y cultivo de pus, 65%. Escherichia coli y Streptococcus spp. fueron los aislamientos más frecuentes. Se efectuó drenaje percutáneo en el 72% (el 6% también quirúrgico), y recibieron solo antibioterapia el 28%. Evolución desfavorable 52%, asociada a mayor edad (p=0,016), antecedentes de enfermedad biliopancreática (p=0,007), síndrome de respuesta inflamatoria sistémica al diagnóstico (p=0,005), alteración de la coagulación (p=0,043), elevación de AST (p=0,033) y etiología biliar (p<0,001). Conclusiones El AHP se desarrolla en pacientes con comorbilidad, si bien más frecuentemente son criptogénicos. La mayoría curan con antibioterapia y drenaje percutáneo, sin cirugía. La mortalidad es del 9%, pero la mitad sigue una evolución desfavorable, que se asocia a la etiología biliar y a determinadas alteraciones analíticas (AU)

Objectives To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome. Material and methods We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for>30 days, death, readmission).Results There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p=0.016), a history of biliopancreatic disease (p=0.007), systemic inflammatory response syndrome at diagnosis (p=0.005), coagulation alterations (p=0.043), aspartate aminotransferase elevation (p=0.033), and biliary etiology (p<0.001).Conclusions PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations (AU)

[Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome]. / Absceso hepático piógeno: presentación clínica y predictores de evolución desfavorable.

OBJECTIVES: To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome. MATERIAL AND METHODS: We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for>30 days, death, readmission). RESULTS: There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p=0.016), a history of biliopancreatic disease (p=0.007), systemic inflammatory response syndrome at diagnosis (p=0.005), coagulation alterations (p=0.043), aspartate aminotransferase elevation (p=0.033), and biliary etiology (p<0.001). CONCLUSIONS: PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations.

Meningitis bacteriana por bacilos gramnegativos en adultos inmunodeprimidos no neuroquirúrgicos. Réplica / Bacterial meningitis due to gram-negative bacilli in immunosuppressed adults who have not undergone neurosurgery. Reply

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[Bacterial meningitis due to gram-negative bacilli in adults]. / Meningitis bacteriana por bacilos gramnegativos en adultos.

INTRODUCTION: Gram-negative bacilli are causative agents of bacterial meningitis in the neonatal period but rarely cause meningitis in adults without risk factors. AIM: To report on meningitis due to gram-negative bacilli (MGNB) in adults diagnosed in a hospital over a 25-year period. PATIENTS AND METHODS: We reviewed the medical records of all patients with an age > or = 14 years who had been diagnosed with MGNB between 1982 and 2006. RESULTS: Fifteen cases of MGNB are included (10.5% of the cases of bacterial meningitis with an identified aetiology), with a mean age of 48 years (14-79). Twelve (80%) were post-operative: recent neurosurgery (9 cases, 75%) and having a neurosurgical device (8 cases, 67%) were risk factors. Three (20%) were spontaneous: two were of a urinary origin and one had an undetermined origin. The aetiology was: Pseudomonas aeruginosa (3 cases), Escherichia coli (3 cases), Enterobacter aerogenes (2 cases), Pseudomonas fluorescens (1 case), Klebsiella pneumoniae (1 case), Morganella morganii (1 case), Acinetobacter anitratus (1 case), Acinetobacter iwoffii (1 case) and Flavobacterium brevis (1 case); in one patient with Gram positive staining for gram-negative bacilli, the culture was negative, and three of them (20%) were mixed infections (Staphylococcus spp.). Three patients (20%) died. CONCLUSIONS: In adults, gram-negative bacilli rarely cause spontaneous meningitis, but are a common causation of post-neurosurgical meningitis and in those with neurosurgical devices. The mortality rate of MGNB is high.

Meningitis bacteriana por bacilos gramnegativos en adultos / Bacterial meningitis due to gram-negative bacilli in adults

Introducción. Los bacilos gramnegativos son agentes etiológicos de meningitis bacteriana en el período neonatal pero raramente causan meningitis en adultos sin factores de riesgo. Objetivo. Describir las meningitis por bacilos gramnegativos en adultos, diagnosticadas en un hospital durante un período de 25 años. Pacientes y métodos. Se revisaron las historias clínicas de los pacientes con edad >= 14 años que habían sido diagnosticados de meningitis por bacilos gramnegativos entre 1982 y 2006. Resultados. Se incluyen 15 casos de meningitis por bacilos gramnegativos (10,5% de las meningitis bacterianas de etiología identificada), con una mediana de edad de 48 años (intervalo: 14-79 años). Doce (80%) fueron postoperatorias:neurocirugía reciente (9 casos, 75%) y ser portador de un dispositivo neuroquirúrgico (8 casos, 67%) fueron los factores de riesgo. Tres (20%) fueron espontáneas: dos de origen urinario y una de origen no determinado. La etiología fue: Pseudomonas aeruginosa (3 casos), Escherichia coli (3 casos), Enterobacter aerogenes (2 casos), Pseudomonas fluorescens (1 caso), Klebsiella pneumoniae (1 caso), Morganella morganii (1 caso), Acinetobacter anitratus (1 caso), Acinetobacter iwoffii (1 caso) y Flavobacterium brevis (1 caso); en un enfermo con tinción de Gram positiva para bacilos gramnegativos el cultivo resultó negativo, y tres (20%) fueron infecciones mixtas (Staphylococcus spp.). Tres pacientes (20%) fallecieron. Conclusiones. En adultos, los bacilos gramnegativos raramente causan meningitis espontánea, pero son una etiología frecuente de meningitis posneuroquirúrgicas y en portadores de dispositivos neuroquirúrgicos. La mortalidad de la meningitis por bacilos gramnegativos es elevada (AU)

Introduction Gram-negative bacilli are causative agents of bacterial meningitis in the neonatal period but rarely cause meningitis in adults without risk factors. Aim. To report on meningitis due to gram-negative bacilli (MGNB) in adults diagnosed in a hospital over a 25-year period. Patients and methods. We reviewed the medical records of all patients with an age >= 14 years who had been diagnosed with MGNB between 1982 and 2006. Results. Fifteen cases of MGNB are included (10.5% of the cases of bacterial meningitis with an identified aetiology), with a mean age of 48 years (14-79). Twelve (80%) were post-operative: recent neurosurgery (9 cases, 75%) and having a neurosurgical device (8 cases, 67%) were risk factors. Three (20%) were spontaneous: two were of a urinary origin and one had an undetermined origin. The aetiology was: Pseudomonas aeruginosa (3 cases), Escherichia coli (3 cases), Enterobacter aerogenes (2 cases), Pseudomonas fluorescens (1 case), Klebsiella pneumoniae (1 case), Morganella morganii (1 case), Acinetobacter anitratus (1 case), Acinetobacter iwoffii (1 case) and Flavobacterium brevis (1 case); in one patient with Gram positive staining for gram-negative bacilli, the culture was negative, and three of them (20%) were mixed infections (Staphylococcus spp.). Three patients (20%) died. Conclusions. In adults, gram-negative bacilli rarely cause spontaneous meningitis, but are a common causation of postneurosurgical meningitis and in those with neurosurgical devices. The mortality rate of MGNB is high (AU)