Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects.

PURPOSE: To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. METHODS: Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. RESULTS: Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). CONCLUSIONS: The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects

ABSTRACT Purpose To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. Methods Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. Results Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). Conclusions The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease.

OBJECTIVES: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +- 5.18 (range, 14 - 36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. CONCLUSION: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.

Randomized control trial assessing the efficacy of pain control strategies for caustic paste disbudding in dairy calves younger than 9 days of age.

Disbudding is a common procedure practiced in the dairy industry and is known to cause pain when performed without pain control. Dairy producers who disbud calves with caustic paste are less likely to provide pain control than those using cautery. Little research has been conducted on pain control for caustic paste disbudding and no studies have specifically examined calves under 9 d of age. The objective of this study was to evaluate the efficacy of local anesthesia and nonsteroidal anti-inflammatory drug analgesia on indicators of pain and inflammation in dairy calves disbudded using caustic paste. One hundred forty Holstein heifer calves 1 to 9 d of age were enrolled in 28 blocks and randomly allocated to 1 of 5 treatments: sham control (SH); positive control (POS); lidocaine cornual nerve block (LC); meloxicam (MEL); and lidocaine cornual nerve block plus meloxicam (LCM). We measured outcomes including serum cortisol and haptoglobin, pressure sensitivity, and lying behavior. Data were analyzed using mixed linear regression models with treatment as a fixed effect, baseline values as a covariate, and trial block as a random effect. Compared with the POS group, the LCM group had reduced serum cortisol at 15, 30, 45, and 60 min post-disbudding; cortisol values were not different between LC, LCM, and SH calves at these time points. At 60, 90, 120, and 180 min post-disbudding, LCM calves had reduced cortisol compared with LC calves, whereas, values did not differ between LCM and SH calves at these time points. At 3 to 4 d post-disbudding, the LCM group tended to have reduced haptoglobin, but no differences were found between groups at 180 min and 7 d post-disbudding. At 60, 90, and 120 min post-disbudding, LC and LCM treated calves had decreased pressure sensitivity compared with other groups. No differences were seen in pressure sensitivity between groups at 180 min, 3 to 4 or 7 d post-disbudding. No differences in lying behavior were found between treatment groups on any of the 7 d following disbudding. These findings demonstrate that the combination of a local anesthetic with a nonsteroidal anti-inflammatory drug is beneficial for reducing indicators of pain and inflammation in young calves disbudded with caustic paste.

Management of orbital conjunctival epithelial inclusion cyst using trichloroacetic acid (20%) in an outpatient setting.

Conjunctival epithelial inclusion cysts are an infrequent complication in anophthalmic sockets. The ocular prosthesis may become difficult to retain or it may cause local discomfort. Treatment options described include surgical resection, marsupialisation, and the use of injected sclerosing agents. We present a case of a 27-year-old female who developed a conjunctival epithelial inclusion cyst two years after a left eye evisceration. This invariably caused the ocular prosthesis to become cosmetically unacceptable. Trichloroacetic acid 20% (TCA) was injected intracystically as a minor procedure at the slit lamp. Four months later there was no recurrence of the cyst and the prosthesis retained an excellent position in the socket. This case highlights the successful treatment of a conjunctival epithelial inclusion cyst with TCA (20%) without the need for a surgical procedure.

Trichloroacetic acid 10% injection for treatment of conjunctival inclusion cysts.

Purpose: To evaluate the effect of intra-lesional injection of Trichloroacetic acid (TCA) 10% in patients with conjunctival inclusion cysts.Methods: This prospective case series study included all patients with conjunctival inclusion cyst who were referred to our referral center from August 2016 to August 2018. All patients received TCA 10% injection into the conjunctival cyst, and outcomes of the intervention were evaluated at least 6 months later.Results: Ten patients with mean age of 24 ± 17.6 (range 6-65) years including three children received TCA 10% injection into the conjunctival cyst. We included 6 anophthalmic and 4 ophthalmic cases. All patients were treated successfully and no recurrence of the lesion was observed in any case. Mean follow up duration was 18.1 ± 8.3 (range 6-28) months.Conclusion: Intra-lesional injection of TCA 10% is a safe, simple, and effective treatment in patients with conjunctival inclusion cysts including ophthalmic cases and anophthalmic cases, both in adults and in children. This concentration may avoid ocular surface complications.

A patient with squamous cell carcinoma in-situ successfully treated with intralesional 5-Fluorouracil and topical trichloroacetic acid.

Background: The current gold standard and the first line of treatment for non-melanoma skin cancer is surgical excision. Nevertheless, some patients are not good candidates for surgery when wound healing may be impaired.Methods: A 96-year-old male presented with 1.2 cm by 1.5 cm tumoral lesion with an ill-infiltrated border and central ulceration located on the mid right lower leg. Biopsy confirmed the diagnosis of squamous cell carcinoma (SCC) in situ. The primary lesion was treated centrally to peripherally with multiple intralesional injections of 1.5 mL 5-Fluorouracil (5-FU) (50 mg/mL). The lesion was also treated with a single layer application of 80% Trichloroacetic acid (topical solution). One additional and final treatment of only 80% TCA was performed after three weeks.Results: There was a complete regression of the SCC three weeks after the second treatment.Conclusions: We demonstrate a case of SCC successfully treated with intralesional 5-FU and topical Trichloroacetic acid. Additionally, the SCC in situ was successfully cleared in two treatment sessions with the lowest cumulative dose of 5-FU reported. Intralesional injections of 5-FU and subsequent topical Trichloroacetic acid may be an effective option for patients with SCC who are not eligible for cutaneous surgery.

Comparison of Chemical Matricectomy with Trichloroacetic Acid, Phenol, or Sodium Hydroxide for Ingrown Toenails: A Systematic Review and Network Meta-Analysis.

is missing (Short communication).

Effectiveness of topical and ablative therapies in treatment of anogenital warts: a systematic review and network meta-analysis.

OBJECTIVE: To generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs). DESIGN: Systematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PARTICIPANTS: People aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation). INTERVENTIONS: Topical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other. OUTCOME MEASURES: Complete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence. RESULTS: Thirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence. CONCLUSION: Of the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other. TRIAL REGISTRATION NUMBER: CRD42013005457.

Treatment of periorbital dark circles: Comparative study of carboxy therapy vs chemical peeling vs mesotherapy.

OBJECTIVE: Evaluation and comparison of the efficacy and safety of 3 different modalities of treatment for dark circles that function via different modes of action. METHODS: In total, 45 female patients with periorbital hyperpigmentation were randomly selected to participate from those attending the outpatient dermatology clinic of Al-Zahraa University Hospital within a 6-month period. Patients were divided into 3 groups, and the groups were subjected to different types of therapy: group A, carboxy therapy; group B, chemical peel; and group C, vitamin C mesotherapy. RESULTS: No statistically significant differences were detected in improvements in pigmentation or the degree of patient satisfaction between any of the groups. However, the mesotherapy group reported more of a burning sensation following treatment than the other 2 groups but also showed a significant improvement in pigmentation and patient satisfaction compared with the carboxy group. CONCLUSION: All 3 treatment modalities were effective in the reduction in periorbital pigmentation. However, mesotherapy showed a significant improvement in pigmentation and a higher level of patient satisfaction compared with the other types of treatment.

Basic chemical peeling: Superficial and medium-depth peels.

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

[Ingrown toenails-options for daily practice]. / Eingewachsene Zehennägel ­ Optionen für die tägliche Praxis.

The ingrown toenail is a common, painful and inflammatory clinical presentation, especially, but not exclusively, in adolescent patients. Numerous conservative treatment methods are available. Usually, however, the surgical treatment is at the end of a chain of suffering. While classified as obsolete, the so-called Emmert plasty is still used for surgical treatment. As a gentle alternative, selective treatment of the lateral matrix horn by resection or phenol caustics is increasingly used. The latter methods offer numerous benefits with little postoperative pain and faster recovery to normal quality of life.

Efficacy of Silver-based Gel Compared With Fusidic Acid Cream in Topical Treatment Following Trichloroacetic Acid Facial Skin Peeling: A Pilot Study

BACKGROUND: Trichloroacetic acid (TCA) is a nontoxic chemical that has been used for more than 20 years in skin rejuvenation treatments for various skin conditions. Currently, there is no single accepted protocol for local burn care following TCA peeling. OBJECTIVE: This pilot study assesses the efficacy and tolerability of a silver-based gel compared with fusidic acid cream as a complementary topical treatment for burns following TCA peeling. MATERIALS AND METHODS: The authors conducted a comparative study on healthy female patients in the Department of Plastic and Reconstructive Surgery at Assaf Harofe Medical Center (Zerifin, Israel). Patients were treated with TCA 15% for superficial facial skin peeling, followed by applications of both the silver-based gel and fusidic acid cream on opposite sides of their face. Patient evaluation included high-resolution photographic evaluation pre- and post-peeling; physician assessment for the presence of complications such as infection, edema, and allergic reactions; and a self-completed questionnaire in reference to the outcomes and side effects (eg, burning, itching) experienced. RESULTS: Seventeen women were included in the study. None of the patients experienced an infection or allergic reaction. Photographic analysis found no significant differences in the outcomes between topical treatments, with a trend for better results with the silver-based gel. Pain, edema, and burning sensations were not significantly different between the topical treatments. Itching was less prevalent in the silver-based gel group (P = .046). CONCLUSIONS: Comparing between the groups treated with silver-based gel and fusidic acid cream, the authors found no inferiority in the outcomes or the prevalence of any complaints, and a superior effect on the prevention of wound itch using a silver-based gel.

The treatment of ingrown nail: Chemical matricectomy with NAOH versus wedge resection.

Ingrown nail is a common problem seen in the dermatology clinics. The aim of this study is to compare the wedge resection method and chemical matricectomy with NaOH in terms of operation time, postoperative pain severity, postoperative drainage, recurrence rates, recovery time, and the effects of these two methods on Dermatology Quality of Life Index. This study included 60 patients. About 42 nail edges of 30 patients were treated with NaOH for chemical matricectomy and wedge resection was performed for 33 nail edges of 30 patients. Operation time for chemical matricectomy and wedge resection was an average of 7.66 ± 3.65 and 19.25 ± 5.54 min (p < .001). Recovery time was an average of 17.27 ± 14.22 days for chemical matricectomy and an average of 28.85 ± 17.03 days for wedge resection (p = .004). Recurrence was detected in 5.4% of the nail edges treated with chemical matricectomy and 3.6% of the nail edges treated with wedge resection (p = 1.000). Absence of differences for the recurrence rates between wedge resection method and chemical matricectomy method with NaOH shows that effectiveness of these approaches are similar. It seems that quite short operation and recovery times in the chemical matricectomy are the main advantage of the method.

Combining microneedling with other minimally invasive procedures for facial rejuvenation: a split-face comparative study.

BACKGROUND: The introduction of minimally invasive procedures has increased acceptance due to their efficacy, safety, and relatively long-lasting and natural results. At least two different and unrelated modalities are employed to consider a combination treatment. OBJECTIVES: This study aims to evaluate and compare the use and effectiveness of combined microneedling with platelet-rich plasma (PRP) or trichloroacetic acid (TCA) peeling for facial rejuvenation. PATIENTS/METHODS: Twenty-four volunteers with photoaging were randomly divided into three equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with PRP or TCA 15% peeling). They had received one session every 2 weeks for six sessions of treatment. Photography and punch biopsies were performed before and after 3 months of treatment for clinical, histometrical, and histological evaluation. RESULTS: Combined treatment of dermaroller and PRP or dermaroller and TCA showed significant improvement when compared with dermaroller alone. Significant increase in epidermal thickness was apparent in studied groups, especially after combined treatment with TCA. Organized collagen bundles with newly formed collagen formation and markedly decreased abnormal elastic fibers were noticed in the three studied groups. However, improvement of dermal structures was better demonstrated after combined treatment of Dermaroller and PRP than Dermaroller and TCA 15%. CONCLUSIONS: Most volunteers showed significant clinical improvement after treatment supported by the histometrical and histochemical evaluation; however, the combined use of dermaroller with PRP is apparently more beneficial for facial rejuvenation.

Asymptomatic intrathyroidal pyriform sinus fistula mimicking thyroid cancer: A case report and literature review.

RATIONALE: There have been many reports of non-thyroidal lesions which can be mistaken for thyroidal lesions on ultrasound (US) examination. However, it is not known that pyriform sinus fistula (PSF) can manifest as an incidental thyroid nodule and cause serious complication on fine-needle aspiration (FNA). PATIENT CONCERNS: We present a 34-year-old man with PSF incidentally detected on US. US examination showed hypoechoic nodule with several bright echogenic spots at the uppermost part of left thyroid gland. With the suspicion of thyroid cancer, although there would have been some morphologic changes between the 2 US examinations, FNA was performed. DIAGNOSES: Cytologic specimen revealed some clusters of ciliated columnar cells mixed with inflammatory and lymphoid cells. On computed tomography (CT) before FNA, there were tiny air bubbles within the thyroid nodule. Laryngoscopy revealed fistula originating from the pyriform sinus. INTERVENTIONS: After FNA, he had to undergo tracheostomy and removal of abscess due to infectious complication. OUTCOMES: The deep neck abscesses and infections were controlled after the treatment. At 1 year after FNA, successful chemocauterization with 40% trichloracetic acid solution was performed for PSF found on laryngoscopy. LESSONS: PSF can manifest as an incidental thyroid nodule mimicking thyroid cancer. Special care should be taken when FNA is planned for the nodule with air foci and morphologic changeability at the uppermost part of left thyroid gland.

Use of trichloroacetic acid for management of oral lesions caused by human papillomavirus.

The human papillomavirus (HPV) has an affinity for squamous cells of stratified keratinized epithelium, thus affecting the lower genital, nasal, and oral tracts. In the oral cavity, HPV is associated with pathoses such as the verruca vulgaris (common wart), squamous cell papilloma, condyloma acuminatum (venereal wart), and focal epithelial hyperplasia (Heck disease). Among the treatments available for these lesions are cryotherapy, electrosurgery, surgical removal, laser therapy, and trichloroacetic acid (TCA). The objective of this research was to determine the behavior of HPV-associated oral pathoses treated with TCA. A prospective cohort study was performed in 20 patients who attended a dental consultation at 2 universities in Cartagena, Colombia. Among the patients, 65% were diagnosed as having focal epithelial hyperplasia, 20% as having verrucae vulgares, and 15% as having condylomata acuminata. Application of TCA to HPV-associated oral lesions proved to be a useful nonsurgical alternative treatment, as the resolution of the lesions was achieved atraumatically in a span of 45 days with 3 applications of 30-60 seconds each.

Trichloroacetic acid (80%) as a chemical debridement method for chronic venous leg ulcers-A pilot study.

Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.

Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report.

OBJECTIVE: Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar. METHODS: This procedure was applied in four pediatric patients whose parents were reluctant to undergo surgical excision for a second BCF. Under general anesthesia, a thin metal suction tip or cut down tube was inserted through the skin opening. Normal saline with or without dye was injected to identify the pharyngeal opening around the palatine tonsil, and 75% TCA solution mixed with dye was injected. Leaked TCA at the pharynx was sucked out meticulously to avoid extensive and unexpected injury to the mucosa, and the external opening was sealed with a thin adhesive film. RESULTS: There were no immediate complications and recurrence of a second BCF in all patients during the median follow-up of 23 months (range, 18-88 months) with minimal neck scarring. CONCLUSION: TCA chemocauterization of second BCF could be a simple, less invasive, and feasible treatment option in pediatric patients.