Interventions for chronic palmoplantar pustulosis: abridged Cochrane systematic review and GRADE assessments.

BACKGROUND: Palmoplantar pustulosis (PPP) is a chronic inflammatory disease in which sterile and relapsing pustules appear on the palms and soles. OBJECTIVES: To assess the effects of interventions for chronic PPP to induce and maintain complete remission. METHODS: We searched for randomized controlled trials (RCTs), including people with PPP or chronic palmoplantar pustular psoriasis, in the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and eight trials registers up to July 2020. Study selection, data extraction and risk-of-bias assessment were carried out independently by two review authors. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. RESULTS: We included 37 RCTs (1663 participants, 76% women, mean age 50 years). Mean treatment duration was 11 weeks. Topical vitamin D derivative may be more effective than placebo in achieving clearance [risk ratio (RR) 7·83, 95% confidence interval (CI) 1·85-33·12; low-certainty evidence from two trials]. Concerning biological therapies, there was little or no difference between etanercept and placebo in achieving clearance (low-certainty evidence from one trial), ustekinumab is less effective than placebo in reducing severity (low-certainty evidence from one trial), and guselkumab (RR 2·88, 95% CI 1·24-6·69) and secukinumab (RR 1·55, 95% CI 1·02-2·35) are probably better in reducing disease severity (moderate-certainty evidence from two and one trial(s), respectively) but may cause more serious adverse events than placebo. CONCLUSIONS: Evidence is lacking for or against major chronic PPP treatments. Risk of bias and imprecision limit our confidence in the results.

Variability in circulating gas emboli after a same scuba diving exposure.

PURPOSE: A reduction in ambient pressure or decompression from scuba diving can result in ultrasound-detectable venous gas emboli (VGE). These environmental exposures carry a risk of decompression sickness (DCS) which is mitigated by adherence to decompression schedules; however, bubbles are routinely observed for dives well within these limits and significant inter-personal variability in DCS risk exists. Here, we assess the variability and evolution of VGE for 2 h post-dive using echocardiography, following a standardized pool dive in calm warm conditions. METHODS: 14 divers performed either one or two (with a 24 h interval) standardized scuba dives to 33 mfw (400 kPa) for 20 min of immersion time at NEMO 33 in Brussels, Belgium. Measurements were performed at 21, 56, 91 and 126 min post-dive: bubbles were counted for all 68 echocardiography recordings and the average over ten consecutive cardiac cycles taken as the bubble score. RESULTS: Significant inter-personal variability was demonstrated despite all divers following the same protocol in controlled pool conditions: in the detection or not of VGE, in the peak VGE score, as well as time to VGE peak. In addition, intra-personal differences in 2/3 of the consecutive day dives were seen (lower VGE counts or faster clearance). CONCLUSIONS: Since VGE evolution post-dive varies between people, more work is clearly needed to isolate contributing factors. In this respect, going toward a more continuous evaluation, or developing new means to detect decompression stress markers, may offer the ability to better assess dynamic correlations to other physiological parameters.

Fractional laser for vitiligo treated by 10,600 nm ablative fractional carbon dioxide laser followed by sun exposure.

BACKGROUND: Vitiligo is an acquired disorder of the skin and mucous membranes. Many patients with vitiligo remain in the refractory state despite the availability of numerous potential treatments. To the best of our knowledge, only one trial considers ablative fractional CO2 laser in the treatment of vitiligo. OBJECTIVE: To investigate the effects of fractional CO2 laser followed by systemic sun exposure on non-segmental vitiligo (NSV). METHODS: Ten patients presenting refractory NSV were enrolled in this study. The patients underwent three sessions, one month apart, of fractional CO2 laser therapy on the affected areas of the skin (L-group). Five days after each laser treatment, patients were asked to expose themselves to the sun for 2 hours on a daily basis. Objective and subjective clinical assessments were performed at the beginning and at the end of the treatment. The L-group was then compared to a control group (C-group) that consisted of vitiligo lesions in the same patients but with sun exposure as the exclusive therapy. RESULTS: Compared to the C-group, the L-group showed better improvement in both objective and subjective assessments. There were no noticeable adverse events in terms of scarring and Koebner phenomenon among others. CONCLUSIONS: All patients treated with both, laser sessions and sun exposure, improved their chronic NSV lesions. Improvement was less significant in patients who exhibited vitiligo lesions over articular surfaces such as elbows and underarms. The best results were observed in vitiligo plaques located on the face, neck and legs. Consequently, fractional CO2 laser followed by sun exposure could be considered as an alternative modality for the treatment of refractory vitiligo, especially in sunny regions.

Nitric oxide-related endothelial changes in breath-hold and scuba divers.

OBJECTIVE: Scuba and breath-hold divers are compared to investigate whether endothelial response changes are similar despite different exposure(s) to hyperoxia. DESIGN: 14 divers (nine scuba and five breath-holding) performed either one scuba dive (25m/25 minutes) or successive breath-hold dives at a depth of 20 meters, adding up to 25 minutes of immersion time in a diving pool. Flow-mediated dilation (FMD) was measured using echography. Peripheral post-occlusion reactive hyperemia (PORH) was assessed by digital plethysmography and plasmatic nitric oxide (NO) concentration using a nitrate/nitrite colorimetric assay kit. RESULTS: The FMD decreased in both groups. PORH was reduced in scuba divers but increased in breath-hold divers. No difference in circulating NO was observed for the scuba group. Opposingly, an increase in circulating NO was observed for the breath-hold group. CONCLUSION: Some cardiovascular effects can be explained by interaction between NO and superoxide anion during both types of diving ending to less NO availability and reducing FMD. The increased circulating NO in the breath-hold group can be caused by physical exercise. The opposite effects found between FMD and PORH in the breath-hold group can be assimilated to a greater responsiveness to circulating NO in small arteries than in large arteries.

[Subcutaneous infection spread by Scytalidium (Neoscytalidium) dimidiatum]. / Infection sous-cutanée disséminée par Scytalidium (Neoscytalidium) dimidiatum.

INTRODUCTION: S. dimidiatum (recently reclassified as N. dimidiatum) is a fungus that causes nail and/or superficial skin infection. It may also cause subcutaneous and deep infection, chiefly in immunocompromised patients. CASE REPORT: An 87-year-old male treated with oral corticosteroids for sarcoidosis consulted for violaceous cutaneous nodules on the back of his hands. Histopathological examination revealed epithelioid cell granulomas with numerous mycelial filaments and multiple spores. Culture of a biopsy sample resulted in growth of numerous colonies of S. dimidiatum and the patient was treated with intravenous amphotericin B. DISCUSSION: This organism is transmitted by direct or indirect contact with contaminated soil or plants. It mainly causes superficial skin and nail infections, and may result in deeper infections on rare occasions. We report a case of subcutaneous infection with S. dimidiatum in an immunocompromised patient (due to general steroid therapy) that was successfully treated using amphotericin B.

Effect of ibuprofen on the healing and remodeling of bone and articular cartilage in the rabbit temporomandibular joint.

The purpose of this study was to determine the effect of ibuprofen on the healing and remodeling of bone and cartilage in the temporomandibular joint of the rabbit. Forty-two rabbits were operated on to create a groove and a hole in the articular surface of both the right and left mandibular condyles. Following surgery, the animals were divided into three groups. Group A (12 rabbits) was used as a control and the animals did not receive any medication. Group B (15 rabbits) was given a daily dose of 17 mg/kg of ibuprofen. Group C (15 rabbits) was given a daily dose of 34 mg/kg of ibuprofen. All animals were killed after 4 weeks. The 84 condyles were examined clinically and histologically. Statistical analysis showed a highly significant difference in the healing of bone and cartilage between groups A and C (P less than .01) and a significant difference between groups A and B (P less than .05). The results of this study indicate that ibuprofen has an adverse effect on the healing of bone and cartilage in the temporomandibular joint of the rabbit.

A comparative study of the treatment of unilateral fractured and dislocated mandibular condyles in the rabbit.

This study evaluated the results of three methods of managing simulated unilateral dislocated fractured mandibular condyles in the rabbit. The first method consisted of surgical reduction of the fractured condyle to its anatomic position and its subsequent fixation with a titanium plate. The second method differed from the first by completely detaching the condyle, then replacing it as free graft. The third method left the fractured condyle in its dislocated position outside the glenoid fossa. Eighteen rabbits were used, 6 animals for each method. Half the animals in each group were killed at 4 weeks, the other half at 14 weeks postoperatively. Clinical, morphologic, functional, radiologic, and histologic examinations were conducted on all animals. The results indicated that open reduction with internal fixation with no disruption of the blood supply to the condyle provided the most favorable results. While closed reduction without internal fixation gave good functional results, definite reduction in ramus height on the operated site was observed in this group of animals. Animals that had open reduction and internal fixation using the condyle as a free graft did not do as well as the other two groups. Despite good mouth opening and occlusion, more animals showed facial asymmetry and it was more severe. None of the condyles were lost as result of necrosis, but healing took longer when compared with the other group of animals.

Optimal placement of bicortical screws in sagittal split-ramus osteotomy of mandible.

When a bicortical screw is used for the rigid fixation of sagittal split-ramus osteotomy, by definition the threads of the screw should engage in the buccal plates as well as in the lingual plates. In a study of six dry mandibles we found that when 2 and 2.7 mm screws are used in noncountersunk holes, it is almost certain that a thread will engage the buccal cortical plate. With countersinking 55% of the 2.7 mm and 27% of the 2.0 mm screws had no threads engaged in the buccal cortical plate. This changes these screws from bicortical to compression type. An anatomic study of bone thickness demonstrated that the thickest buccal and lingual cortical plates were in the superior border of the ramus, just distal to the last molar. In addition, a change in the intercondylar distance before and after surgery was observed in every mandible.

Complications of genioplasty done alone or in combination with sagittal split-ramus osteotomy.

Thirty-one patients who had genioplasty done alone or in combination with bilateral sagittal split-ramus osteotomy of the mandible (BSSRO) were examined within 12 to 68 months after surgery. Neurosensory tests revealed that 10% of the mental nerves in patients who had had isolated genioplasties showed altered sensation of the lower lip, compared to 28.5% of the nerves in patients who had genioplasties and bilateral sagittal split-ramus osteotomies. However, when questioned, 71% of the patients in the latter group indicated awareness of abnormal feeling in the lower lip. Fourteen teeth in isolated genioplasty cases gave an abnormal response to electric pulp testing. The incision lines healed satisfactorily in most patients. Of the intraosseous wires used for fixation, 5.38% were removed 3 to 10 months after surgery. A notch at the osteotomy site on the lower border of the mandible was noted radiographically in 72.5% of the sites. Chin ptosis was noted in one patient. The cosmetic results satisfied 93.6% of the patients.

Costochondral grafting in condylar replacement and mandibular reconstruction.

Thirty costochondral grafts in 22 patients were retrospectively studied with a mean follow-up of five (range, 2 to 11) years. The functional results, esthetics, and incidence of complications in these patients were determined. A discussion of these findings as well as the surgical technique is included. The results confirm previous studies and indicate that free costochondral grafting is a successful and physiologically sound method for reconstruction of portions of the mandible and its temporal articulation.

A simplified method for the internal fixation of fractures of the mandibular condyle.

The morbidity following conservative management of fracture dislocations of the mandibular condyle is considered, and the theoretical advantages of open reduction discussed. The various methods described in the past are reviewed and a new technique is described whereby a Kirschner wire is drilled into the condylar fragment and then inlaid into the ramus. Advantages over previous methods include easy manipulation of the fragment and lack of danger to the facial nerve.