Complications of ambulatory major dermatological surgery in patients older than 85 years.

BACKGROUND: During the last decades, the progressive ageing of the population has resulted in a rising skin cancer incidence. Although previous studies detected no higher morbidity for dermatological surgery in senior patients, their exclusion from optimal surgical treatment remains as a common clinical practice. OBJECTIVE: The aim of this study was to determine the diseases treated with ambulatory major dermatological surgery, the surgical morbidity and the associated variables in ≥ 85 year-old patients. PATIENTS/METHODS: This is an observational study on 247 successive patients older than 85 years of age who underwent dermatological surgery in a single Ambulatory Mayor Surgery unit. Studied variables were age, gender, tobacco-alcohol exposure, co-morbid medical conditions, blood-thinning medication, antibiotic prophylaxis, number of lesions, location, histopathological diagnosis, area of skin removed, surgical technique, type of flap, length of surgery, entrance order, suture thread, surgical complications and need of post-operative admission. RESULTS: The most common site was head and neck (82.7%). The most frequent tumour was basal cell carcinoma (45.1%), followed by squamous cell carcinoma (38.7%) and melanoma (8.3%). Direct closure was the most frequent procedure (55.6%). Of the total number of patients, 7.9% of patients suffered complications; necrosis followed by cellulitis were the most frequent. Length of surgical procedure, area of skin removed and reconstruction with skin-graft were significantly related to higher risk of post-operative complications. CONCLUSIONS: No intra or post-surgical mortality or life-threatening local complications were detected. Most post-surgical local complications appeared after wide excisions and complex reconstruction techniques that prolonged the length of the surgery.

Treatment of multiple eruptive vellus hair cysts with carbon dioxide laser vaporization and manual lateral pressure.

Treatment of eruptive vellus hair cysts (EVHC) is often unsatisfactory. Laser treatment has been described as an adequate treatment in a few reports. Pulsed carbon dioxide (CO(2)) laser has been used effectively for facial EVHC and erbium:yttrium-aluminium-garnet laser has been used to treat truncal EVHC with variable outcomes. We report our experience with CO(2) laser and lateral manual pressure to extract the cysts as an effective treatment in two cases of EVHC. Good cosmetic results were obtained in both cases. No lesion recurrence was observed after a follow-up of 10 years in the first case and 3 years in the second one. CO(2) laser vaporization and further extraction of cysts by manual lateral pressure might be an effective method to treat EVHC, achieving good cosmetic results and no recurrence.

Indicaciones de la punción lumbar en pacientes con sífilis precoz activa coinfectados por el VIH. Casuística en un hospital terciario de La Coruña (España) 2003-2006 / Indications for lumbar puncture in patients with early active syphilis and human immunodeficiency virus coinfection: experience in a tertiary level hospital in La Coruña, Spain, 2003-2006

Introducción. En los últimos años se ha incrementado la incidencia de sífilis en España. En un porcentaje importante existe coinfección con el virus de la inmunodeficiencia humana (VIH). Dado que estos pacientes tienen mayor riesgo de complicaciones neurológicas y de fracaso del tratamiento, hay que seguirlos cuidadosamente por el riesgo de desarrollar neurosífilis. En los pacientes coinfectados por el VIH –si bien las guías coinciden en realizar punción lumbar en aquellos con sífilis latente tardía o de duración incierta– la indicación en pacientes con sífilis precoz activa es controvertida. Recientemente se han realizado estudios para determinar parámetros clínicos o analíticos que identifiquen a aquellos pacientes que se beneficiarían de la punción lumbar. Exponemos las diversas opiniones y aportamos la experiencia en nuestro servicio. Material y método. Hemos realizado punción lumbar de forma sistemática a todos los pacientes con sífilis precoz activa coinfectados por el VIH en el periodo 2003-2006. Resultados. En el 100 % no se objetivó neurosífilis en LCR, y los parámetros entraban dentro de la normalidad o eran compatibles con la infección por el VIH. Un 38 % presentó un recuento de linfocitos CD4 + <= 350 y un87,5 % tenía una titulación en suero RPR >= 1:32. Conclusión. Es posible que en la práctica clínica se abuse de la realización de PL en estos pacientes, debido a la ausencia de criterios bien definidos. Nuestros datos están en correlación con los criterios actuales que apoyan la idea de restringir la realización de PL a determinados grupos (AU)

Introduction: In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience. Methods. We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006. Results. Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38%) had a peripheral blood CD4 cell count CD4 + <= 350 cells/mL. Seven of eight (87’5%) had RPR >= 1:32. Conclusion. In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups (AU)

Erupción liquenoide inducida por olanzapina / Lichenoid drug eruption induced by olanzapine

Las erupciones liquenoides inducidas por fármacos pueden simular un liquen plano idiopático y otras dermatosis. La lista de fármacos que pueden inducirlas es amplia y se incrementa constantemente. Aunque los efectos secundarios cutáneos en relación con antipsicóticos son raros, se han descrito diversas manifestaciones cutáneas en relación con la olanzapina. Presentamos el caso de una paciente que desarrolló una erupción liquenoide atípica debida a olanzapina. En la revisión de la literatura que hemos realizado (Medline desde 1951 hasta 2007 e Índice Médico Español) no hemos encontrado ningún caso descrito de erupción liquenoide relacionado con este fármaco (AU)

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Índice Médico Español (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug (AU)

[Lichenoid drug eruption induced by olanzapine]. / Erupción liquenoide inducida por olanzapina.

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Indice Médico Español (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug.