Treatment of keloids using 5-fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non-invasive objective measures.

BACKGROUND: Intralesional 5-fluorouracil (5-FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone-based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data. OBJECTIVES: In this study, we evaluate the therapeutic effect of four courses of intralesional 5-FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS®pico ), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI). METHODS: Twenty-five patients with keloids were treated using 5-FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1- and 12-month follow-up (FU). Routine laboratory tests were performed at baseline and at 1-month FU. RESULTS: 3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1-month FU mean score: 1.5 ± 0.8 mm, 12-month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm3 , 1-month FU mean score: 416.1 ± 218.1 mm3 , 12-month FU mean sore: 431.2 ± 253.6 mm3 , P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12-month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a 'moderate effect' to a 'small effect' throughout the course of the study. CONCLUSIONS: Results of this study confirm the efficacy and safety of the combination of 5-FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12-month FU.

Comparison of Two Kinds of Lasers in the Treatment of Acne Scars.

Acne scars are common and stigmatizing for the affected patients. Besides surgery, chemical peels, microdermabrasion, and microneedling, the treatment with fractional laser is a standard therapy. The results of reducing acne scars treated either with a fractional Er:YAG (erbium-doped yttrium-aluminum-garnet [Er:Y3Al5O1]) or a carbon dioxide (CO 2 ) laser at different wavelengths were compared and evaluated in the pilot study presented here. Fourteen patients with severe scars on both cheeks were treated four times in a random split-face approach: on one side with Er:YAG laser and on the contralateral side with CO2 laser following a standardized protocol. Therapeutic success was evaluated through the use of a high-resolution, 3D small-field capture system (PRIMOS), digital photography, and the Patient and Observer Scar Assessment Scale (POSAS) questionnaire. The evaluation was performed by a blinded investigator. Treatment results displayed a higher efficacy of the fractional CO2 laser compared with the Er:YAG laser as displayed by digital photographs. Additionally, objective (high-resolution, 3D small-field capture; PRIMOS) and subjective (POSAS) measuring results correlated positively in certain qualities (color, stiffness, thickness, surface, overall opinion). Using a novel scientific approach, we evaluated the therapeutic efficacy of different fractional lasers on acne scars using a rater-blinded approach. Compared with an Er:YAG laser, better skin smoothening was achieved by fractional CO2 laser treatment.

The dermatology life quality index as a means to assess life quality in patients with different scar types.

BACKGROUND: Measuring quality of life through questionnaires is a common method to evaluate the impact of different afflictions on the patient's well-being, especially in the field of dermatology where appearance changing afflictions are common. OBJECTIVES: A variety of questionnaires has been used to distinguish different skin conditions like psoriasis, atopic dermatitis and scars. Using the Dermatology Life Quality Index (DLQI), we investigated different scar types regarding their impact on quality of life. METHODS: We assessed the quality of life in 130 patients presenting to our outpatient scar clinic for the first time using the DLQI. Scars were analysed according to their clinical appearance (physiological scars, keloids, hypertrophic scars, atrophic scars, self-harm scars). Physiological scars were established as a baseline for further comparison between groups. RESULTS: Patients in the physiological scar group scored a mean DLQI score of 2.07 ± 3.56, patients in the keloid-, hypertrophic scar-, atrophic scar- and self-harm scar group scored values of 6.06 ± 4.00, 2.53 ± 2.48, 7.26 ± 6.72 and 12.00 ± 3.85 respectively. When compared to the baseline group the difference in the overall score for keloids was +3.99 (P < 0.001), hypertrophic scars scored +0.45 (ns), atrophic scars +5.19 (P < 0.01) and self-harm scars +9.93 (P < 0.001). CONCLUSION: Using the DLQI, we could demonstrate that different subsets of pathological scars do affect patients in a different magnitude. The DLQI provides a promising adjunct for quantifying the quality of life in patients suffering from keloids, atrophic- and self-harm scars and may constitute an interesting additional tool for monitoring the progress of scar treatments.

[Differentiation of fattening and slaughtering performance and carcass quality of broiler genotypes with and without the dwarf factor and fast or slow feathering under heat stress]. / Differenzierung der Mast- und Schlachtleistung sowie Schlachtkörperqualität von Broilergenotypen mit und ohne Zwergwuchsfaktor und schneller und langsamer Befiederung unter Wärmebelastung.

In a comparative study the influences were tested of the origins NWR (normal-growth White Rocks) and ZWR (dwarf-growth White Rocks) with a speed for slow (K) and fast (k) feathering as well as the effect of a high environmental temperature (UT, 32 +/- 2.5 degrees C) on the fattening and slaughtering performance of male broilers and their meat quality. Also investigated were effects of these factors on the fatty acid pattern of the two valuable parts--breast and leg. Dwarf broilers kept under high UT had a lower liveweight (LM8) in their 8th week as compared with NWR and animals kept under the usual UT. No influence was found of the feathering on the fattening and slaughtering performance. The effect of heat stress (high UT) and of the dwarfing gene on the breast and leg parts was statistically highly significant (P < 0.001). Dwarfed broilers and animals under normal UT exhibited a smaller slaughtering proportion as compared with normal animals and animals under a higher UT. The abdominal fat content was significantly higher under heat stress. Meat quality showed no dependence on the origin or the climatic conditions. In the fatty acid analysis no dependence could be detected of the FS pattern on the origins (genotypes), whereas an effect was found of the UT on some unsaturated and saturated fatty acids. Palmitic acid and stearic acid formed the largest part of all saturated FS investigated. Among the unsaturated FS the oil, linoleic, and palmitic acids reached the highest share. The effect of higher UT was not uniform in the FS pattern. The sum of saturated FT was increased under heat stress, thus suggesting a more favourable fat quality of the meat.

[Bioclimatic assessment of a tropical site--a criterion for decisions concerning breeding and technology for successful animal production in the tropics]. / Apreciación bioclimática de un sitio tropical--un criterio para decisiones de cría y tecnológicas en producción animal exitosa en los trópicos.

The values of the body temperature and breathing frequency were taken from young pigs and sows at a tropical location in order to study the relations between measured climatic values and their complex derivations (the amount of cooling down, enthalpy, sultriness factor, and water vapour pressure). The relevance was weighted of the natural and calculated climatic values for the thermoregulation of the animals. A practical example is given of the discrepancies between a genuine tropical climate and the demands made by pigs and hens on their climatic environment. From this, conclusions are drawn for successfully keeping and breeding these species at tropical locations.

[Tolerance levels of growing swine for nonoptimal temperatures and their effect on swine production in the tropics (literature study)]. / Die Belastbarkeit wachsender Schweine durch nichtoptimale Temperaturen und deren Auswirkungen auf die Schweineproduktion in den Tropen (Literaturstudie).

The components of the thermohygric complex (air temperature, humidity, and speed) affect directly and indirectly pig production in the tropics. The indirect climatic influence is determined by climatic specifics of pig management and nutrition, especially by the available foodstuff. International findings are presented on the problems of the direct influence on pig production performance by the thermal stress on piglets, young and fattening pigs in tropical locations. This is intended to meet the demand for effectivating pig production in the tropics through improving the microclimatic rearing conditions and abolishing or reducing the thermal stress for the pigs in tropical production locations.

[Adaptation of breeding swine to high environmental temperatures and delimitation of tolerance ranges of thermically stressed swine populations]. / Anpassung von Zuchtschweinen an hohe Umgebungstemperaturen und Abgrenzung von Toleranzbereichen thermisch belasteter Schweine-populationen.

Proceeding from the morphological and physiological specifics of pigs as to their adaptation to high ambient temperatures, the paper presents recent international findings on problems of the thermal tolerance of breeding pigs active in reproduction. The effect of humidity and air speed near the animals are summarized in attempting to delimitate tolerance levels for thermal stress to pigs, and conclusions are drawn for the amelioration of the climate.