Radiofrequency therapy as an effective treatment for granulomatous cheilitis: A CARE case report.

INTRODUCTION: Granulomatous cheilitis is a rare disorder characterized by recurrent, idiopathic, and painless lip swelling. The diagnosis is proven by histopathological examination. The unknown aetiology and poorly understood underlying mechanism contribute to the difficulty in establishing an effective treatment. This case study proposes the effectiveness of radiofrequency therapy in the management of refractory granulomatous cheilitis. CASE SUMMARY: A 68-year-old patient presented with hypertrophy and swelling of the lower lip, and a biopsy revealed actinic cheilitis. The patient underwent lip shaving and an advancement mucosal flap, and definitive histologic examination confirmed the diagnosis of granulomatous cheilitis. No other signs of orofacial granulomatosis were observed, and the complementary aetiological study was negative for systemic disease. The lip swelling reappeared and persisted, which interfered with the quality of life. Hence, radiofrequency therapy was performed in the submucosal and subdermal layers of the lip, resulting in significant aesthetic and functional improvement and no further relapses after five years. DISCUSSION: The management of granulomatous cheilitis is challenging. The current mainstay treatment is corticotherapy or reduction cheiloplasty in severe cases. Radiofrequency has potential as a treatment option in debilitating macrocheilia, presenting worthy long-lasting functional and aesthetical results, with minimal morbidity.

Analytical method for the determination of strychnine in tissues by gas chromatography/mass spectrometry: two case reports.

This paper describes an analytical method for strychnine determination in biological samples by gas chromatography/mass spectrometry and their application in the investigation of two cases involving strychnine ingestion: A fatal case and a clinical one. The strychnine is isolated from biological samples using a liquid-liquid extraction procedure. The clean-up procedure is performed using an acid solution. Papaverine is used as internal standard in the quantification of strychnine. In the analysed specimens, the limits of quantification were 0.1 microg/ml or 0.1 microg/g. The recovery rate ranged from 75.0% to 98.7% and the coefficients of variation ranged from 4.8% to 10.5%.

Oesophageal lichen planus.

Lichen planus is a common skin and mucosal disease, with very rare symptomatic oesophageal involvement. We report a case of painful dysphagia due to oesophageal lichen planus in a 60-year-old woman who also had oral, cutaneous and genital lichen planus lesions. Steroid treatment produced considerable improvement of all lesions and a rapid symptomatic remission.

Gunshot wounds to the male external genitalia.

We report on 23 patients with genital gunshot wounds treated since 1977. Of these 23 patients 16 received 1 shot and 7 received multiple shots. The bullet affected the scrotum in 12 patients, the penis in 4, and the penis and scrotum in the remaining 7. The same missile also compromised the thigh in 15 patients, with major vascular damage in 2. Management was based on serial clinical evaluation and aggressive imaging, related to the missile trajectory. Staging studies were 100% accurate in the patients in whom they were done. Nine patients had damage to the testis (7, 1 bilaterally) and/or spermatic cord (2): 5 required orchiectomy, in 3 the testis was repaired and in 2 the bullet transected the vas, which was ligated with nonabsorbable suture for later repair. Six patients had damage to the corpora, which were repaired. Three patients had urethral rupture (bulbar in 2 and penile in 1): primary repair was feasible in 2 and in 1 (with extensive urethral loss after a shotgun blast) a suprapubic tube was placed for delayed reconstruction. Ten patients had skin penetration only, 5 of whom were managed nonoperatively. There were no major complications or mortality. Also, there were no delayed problems in the nonoperated patients. Erection and normal voiding were reportedly present in all who underwent reconstruction and returned for followup. Early surgical exploration with conservative debridement and primary repair of damaged structures is the preferred treatment for these injuries.