Delayed axial flaps for coverage of a fourth degree scalp burn.

Although free tissue transfers may be required to cover wounds of the head and neck with bone involvement and exposure, options lower on the reconstructive ladder should still be considered during the planning process. We present a case of an elderly gentleman with a history of cardiovascular comorbidity and neck radiotherapy, who sustained a deep flame burn injury to his scalp. Two delayed axial flaps, based on the superficial temporal and supraorbital arteries respectively, were used to obtain durable coverage of this complex wound.

Immediate fine-tuning of DIEP flaps using the Wise pattern mastectomy: Description of the technique and a retrospective analysis of complication rates.

INTRODUCTION: Elliptical skin-sparing mastectomy in patients with large or ptotic breasts usually leaves loose mastectomy skin flaps, which need to be either resected or gathered over the DIEP flap. This results in poor control of the breast footprint and under-projected DIEP flaps in a loose mastectomy skin pocket, that tend to slip laterally towards the axilla. We believe that the use of a Wise pattern mastectomy will allow for immediate treatment of these concerns. MATERIALS AND METHODS: A retrospective, uncontrolled analysis of a prospectively-maintained database of patients operated by the five surgeons performing breast reconstructions at the University of Montreal Hospital Centre. Study population was patients with a BMI of over 25 and grade II/III breast ptosis who underwent a Wise pattern mastectomy with immediate DIEP flap reconstruction. Analysis was performed of the complication rates of the technique in the first six months after the surgery. RESULTS: Out of a total of 53 breasts in 44 patients reconstructed with a DIEP flap immediately post Wise pattern mastectomy, we report nine cases of partial mastectomy-flap necrosis not needing revision, five cases of significant mastectomy flap necrosis needing debridement and skin grafting, and two cases of inability to adequately close the Wise pattern intraoperatively after DIEP placement, necessitating retention of DIEP skin in the inferior pole. None of the mastectomy flap complications occurred in irradiated breasts. CONCLUSION: In patients with large or ptotic breasts, the Wise pattern mastectomy before an immediate DIEP reconstruction allows for immediate shaping of the breast by controlling the breast pocket, footprint, and excess skin.

Choosing wisely in burn care.

BACKGROUND: The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. METHODS: The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™. RESULTS: Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations. CONCLUSIONS: The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.

Biocell-Initial patents versus user instructions guide: A discrepancy at the core of a crisis.

PURPOSE: Our aim is to do a comparative qualitative analysis of patents and "User Manuals" of the Biocell textured implants in order to determine if red flags were omitted when marketing and using Biocell textured implants. MATERIALS AND METHODS: We performed a systematic qualitative analysis using the NVivo software version 11 of the patents describing the Biocell textured implants prior to their approval by the FDA and of user guides published by the 3 companies owning the patents (McGhan, Inamed, Allergan). To guide our thematic analysis, we used a form of systems theory known as the complexity theory. RESULTS: Four patents related to Biocell and 2 user manuals (McGhan- Inamed and Allergan) were analyzed. Four themes emerged from the patents: invention description, mechanism of action (Tissue ingrowth), the timing of the mechanism of action and hypothetical actions on capsular contractures prevention. Of all patent's content, 34% described the invention, 29% the mechanism of action (tissue ingrowth), 1% the timing of this mechanism of action and 34% a hypothetical action against capsular contracture. Solid evidence was found on the concept of anchoring and very little on capsular contracture. On the user guide side, the main themes were indications and contraindications, surgical techniques and long-term effects. The "directed" content analysis approach of the user guides regarding the patent's themes reflected that 94% of the user guides content related to the patent thematics was about the hypothetical role on capsular contracture while only 4% was about invention description and 1.5% about tissue ingrowth. CONCLUSIONS: This analysis highlights the discrepancies between patents of Biocell textured implants and user guides for these implants. The indications of use of a treatment or device can evolve quicker than the study of its potential complications and side effects. The BIA-ALCL crisis should serve as a cautionary tale to the plastic surgery community which embraces new technologies eagerly, and sometimes precariously, in a mission to advance patient care.

Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: Does hormone therapy increases the risk of infection?

BACKGROUND: The use of hormone therapy (tamoxifen and aromatase inhibitors) has been shown to increase venous thromboembolism. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative breast reconstruction complications, including infections, necrosis, capsular contracture and seroma. As breast cancer patients undergoing Implants-ADMs breast reconstruction are often receiving hormone therapy, it is unclear whether this increased infection risk is associated with increased infections cases. METHODS: A prospective study was performed on patients undergoing breast reconstruction at an academic institution from 2013 to 2016. Patients were divided by use of hormone therapy at the time of surgery. Complication rates, including infections, necrosis, seroma and hematomas, were compared and analyzed using univariate and logistic regression models. RESULTS: Among a total of 112 patients (183breasts), 58 patients (91 breasts) were receiving hormone therapy and 54 patients (92 breasts) were not. The hormone therapy group had a higher incidence of postoperative mastectomy skin infection (20.7% versus 7.4%; P=0.0447), we didn't find any significant differences in necrosis. CONCLUSIONS: Hormone therapy was associated with a higher incidence of Infections after breast reconstruction with ADMs and implants. The authors propose an individualized approach to the preoperative cessation of tamoxifen or aromatase inhibitors. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: does hormone therapy increases the risk of infection?

Responses of Eucalyptus globulus and Ficus nitida to different potential of heavy metal air pollution.

The present study aimed to explore the tolerance potential of Cd, Pb and Cu and physiological alterations in two common tree species growing in Minia governorate (Egypt) namely: Eucalyptus globulus and Ficus nitida and to investigate the leaf features [leaf area (LA) and specific leaf area (SLA)] associated with the phytoremediation process. The findings may be useful for future surveillance as preliminary reference values for levels of heavy metals in urban and industrial settings. The levels of cadmium, lead and Cupper in plant leaf were determined. The results showed that heavy metals could inhibit the growth of plants including LA and SLA. The water content (WC) and photosynthetic pigments of Eucalyptus and Ficus decreased with the increased concentration of metals. Contrary to chlorophylls (a) and (b), carotenoids and chlorophyll ratio (a/b) showed a significant increase with increasing metals concentration especially that of Cd and Cu. Proline content was relatively increased and soluble carbohydrate content decreased in plants with high metal accumulation. Eucalyptus showed better tolerance capacity for Cd, Pb and Cu when compared to Ficus. The ability of Eucalyptus to accumulate and tolerate metal stress makes this species a good candidate to recuperate heavy metals-contaminated conditions.

Destabilizing the interplay between miR-1275 and IGF2BPs by Tamarix articulata and quercetin in hepatocellular carcinoma.

Insulin-like growth factor-2 binding proteins (IGF2BPs) are oncogenic RNA-binding proteins, highly up-regulated in HCC, and were recently validated as direct targets of the tumour suppressor miR-1275. It is worth noting that around 47% of FDA approved anticancer drugs are derived from plants. Modulation by miRNAs and their cellular signalling cascades could constitute new pathways by which these phytochemicals exert their effects. This study aimed to investigate the potential use of Tamarix articulata, quercetin and epigallocatechin gallate (EGCG) in HCC and how these phytochemicals could epigenetically modulate the IGF axis using their impact on miR-1275. T. articulata ethyl acetate fraction significantly reduced the viability of Huh-7 cells compared to control cells. Treatment with T. articulata ethyl acetate fraction, quercetin and EGCG significantly enhanced miR-1275, while suppressed IGF2BP1 and IGF2BP3 mRNA expression levels. In summary, T. articulata, quercetin and EGCG have important implications for HCC molecular-targeted therapy through destabilizing the interplay between miR-1275 and the IGF axis.

Dual Internal Standards with Metals and Molecules for MALDI Imaging of Kidney Lipids.

The quest for internal standards useful in MALDI imaging studies goes on to get not only lateral distribution but also reliable relative quantitative information. We developed a method based on application of matrix and dual internal standards to allow intra- and intersample normalization of lipids intensities in kidney sections of control and cisplatin-treated Wistar rats. An inkjet printer was used to deposit a custom-prepared ink with DHB as MALDI matrix, a primary lipids-based internal standard, and a spiked lanthanide as a secondary internal standard. We applied different laser energy and varied the amounts of matrix-internal standards mixture to evaluate the normalization potential of the internal standards. Successful correction of intensity artifacts caused by instrumental drifts was possible, but not those resulting from uneven matrix application. ICP-MS absolute quantification of the lanthanide in the printed layer ensured the reproducibility of the matrix and internal standards application with RSD of 10-15%. Internal standard-normalized data allowed intrasample modification of the MALDI image to make it compatible with the optical image. Normalization to internal standards corrected a 2-fold difference in lipids intensity, which allowed a meaningful comparison of tissue lipids in control and cisplatin-treated kidneys. More importantly, normalization of lipid relative abundances based on the same adduct type (H+, Na+, and K+) for analyte and internal standard corrected for different ionization efficiencies showing a realistic signal level and enabling reliable comparison of different samples on relative quantitative basis.

Application of higher energy collisional dissociation (HCD) to the fragmentation of new DOTA-based labels and N-termini DOTA-labeled peptides.

1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) derivatives are applied in quantitative proteomics owing to their ability to react with different functional groups, to harbor lanthanoides and hence their compatibility with molecular and elemental mass spectrometry. The new DOTA derivatives, namely Ln-MeCAT-Click and Ln-DOTA-Dimedone, allow efficient thiol labeling and targeting sulfenation as an important post-translational modification, respectively. Quantitative applications require the investigation of fragmentation behavior of these reagents. Therefore, the fragmentation behavior of Ln-MeCAT-Click and Ln-DOTA-Dimedone was studied using collision-induced dissociation (CID), infrared multiphoton dissociation (IRMPD) and higher-energy collision dissociation (HCD) using different energy levels, and the efficiency of reporter ion production was estimated. The efficiency of characteristic fragment formation was in the order IRMPD > HCD (normal energy level) > CID. On the other hand, the application of HCD at high energy levels (HCD@HE; NCE > 250%) resulted in a significant increase in reporter ion production (33-54%). This new strategy was successfully applied to generate label-specific reporter ions for DOTA amino labeling at the N-termini and in a quantitative fashion for the estimation of amino:thiol ratio in peptides. Copyright © 2017 John Wiley & Sons, Ltd.

5 -year complex clinical and histopathological follow-up of a case of early gastric carcinoma (signet ring cells type).

The paper presents the case of a male patient, hospitalized for acute abdomen due to perforated callous ulcer. Though the clinical appearance suggested a benign pathology, the histopathological exam of the resection piece showed multicentric early gastric carcinoma, signet ring cell type. At the patient's request, total gastrectomy was not performed, a conservative solution being chosen instead. Superior digestive endoscopy with biopsy and oncological dispensarization was performed one month after surgery, then at every 6 months. After 2 years of benign results, the histopathological exam revealed the presence of malign singlet ring cells in the bioptic specimen. Respecting the patient's option of preserving a good quality of life, subtotal gastrectomy with Pean type gastroenteroanastomosis was performed followed by postoperatory chemotherapy. Endoscopic and oncological follow-up were performed at every six months for another 3 years (up to present), and the evolution was favorable with no local or metastatic recurrence. Histopathological examination was of great help in the surgical management of this case, allowing a fortunate early diagnosis, a conservative surgical approach, and the preserving of a good quality of life.

Laparoscopic cholecystectomy in patients aged 60 years and over - our experience.

Aim. To analyze the efficiency of laparoscopic cholecystectomy for the population aged 60 years and over admitted with acute cholecystitis, the clinical features and associated pathology presented by these patients and the impact of these factors on the choice of surgical technique. Materials and method. A retrospective study was carried out between February 2010 and February 2015, on patients aged 60 years and over, operated in emergency for acute cholecystitis in our clinic. All data were extracted from the registered medical documents and operatory protocols. Results. A total of 497 surgeries were performed for acute cholecystitis, of which 149 were patients aged 60 years and over (30%). Open surgery is much better represented in the population aged over 60 years (61.75% vs. 29.98%). One major cause is the associated pathology that increases the anesthetic risk and hampers a laparoscopic procedure. The conversion rate in the study group presented a higher percentage, but not more exaggerated than in the general population (6.71% vs. 4.63 %).Patients who underwent laparoscopic surgery had a faster recovery and required lower doses and shorter term pain medication, in contrast to conventional surgery (1,8 days vs. 5.7 days). Bile leak has been of reduced quantity, short-term and stopped spontaneously. Only one case needed reintervention, in which aberrant bile ducts that were clipped were found in the gallbladder bed, was operated by laparoscopy. Wound infections and swelling were also encountered more frequently in patients that underwent classic surgery (3.24%). Conclusions. Performing laparoscopic cholecystectomy, when possible, has produced very good results, reducing the average length of stay of patients and even decreasing the number of postoperative complications, thus allowing a faster reintegration of patients into society. The main concern was related to the associated pathology that increased the anesthetic risk.

Gastrostomy with peritoneal collar versus percutaneous endoscopic gastrostomy.

Aim. The present study aimed to perform a medico-surgical comparative analysis of the 2 most widely used techniques: gastrostomy with peritoneal collar versus percutaneous endoscopic gastrostomy, based on the vast clinical experience in an Upper Digestive Surgery Clinic. Materials and method. A retrospective study was carried out between January 2010 and January 2015 on the patients admitted for a surgical solution for feeding. The indications, preoperative preparation, surgical techniques, and postoperative outcomes were analyzed. Results. Out of the 94 cases admitted for a surgical solution for feeding, 67 underwent gastrostomy with peritoneal collar (GPC) and in 27 cases percutaneous endoscopic gastrostomy (PEG) was performed. The indications for GPC were benign or malign causes of dysphagia, the most frequent being malign tumors of tongue, pharynx and larynx (47.76%), advanced inoperable esophageal or eso-cardiac cancers (26,86%), post-caustic esophageal stenosis (10.44%). PEG was performed in patients with functional difficulties of swallowing: sequelae of cerebral vascular accidents (44.44%), low Glasgow Coma Scale Score (29.62%) of different etiologies, Parkinson disease (18.51%) advanced dementia (7.4%), early nasopharyngeal cancer (2 cases). The intraoperatory and postoperatory complications were few and of minor importance in both techniques, but PEG allowed an immediate retake of alimentation (vs. at least 48 hours wait in GPC), with less gastric stasis, biliary reflux and aspiration related respiratory problems. Conclusions. Both techniques are easy and safe to perform, but an appropriate selection is required according to the cause of the swallowing difficulty. In cases with permeable digestive tube, PEG may be an excellent minimally invasive solution, but the costs and availability of the PEG kit and prehydrolyzed nutritive solution, as well as the co-existence of an upper digestive endoscopy service were limitations that had to be taken into account.

Complex histopathological and surgical aspects in a case of giant malignant gastric perforation.

We present the case of a 52-year-old male patient, hospitalized on an emergency basis in the University Emergency Hospital in Bucharest, after being diagnosed with pneumoperitoneum acute abdomen, for which emergency surgery was mandatory. A 3,5-4 cm malignant gastric perforation, ascitis and peritoneal carcinomatosis were found. The histopathological exam revealed infiltrative mucinous gastric carcinoma with epiploic metastasis. Due to the lack of available gastric material, an atypical surgical solution was performed: gastric packing with epiploic material by means of transgastric traction. The solution proved to be successful for short-term recovery. The underlying condition was not focused on, the patient being directed to the Oncology Department. Acute gastric perforation is a rare complication of gastric cancer, and the association with gastric linitis is uncommon. This specific histopathological condition made the classical surgical repair techniques unsuitable for the presented case and an atypical solution had to be performed.

Phenolic profiling of an extract from Eugenia jambos L. (Alston)--the structure of three flavonoid glycosides--antioxidant and cytotoxic activities.

Phenolic metabolite profiling and identification using high performance liquid chromatography (HPLC) coupled to high resolution accurate mass spectrometry (HR-ESI-MS) with detection of negative ions was used for assaying the complex mixture of phenolics of an aqueous ethanol leaf extract of Eugeniajambos L. (Myrtaceae). Eight known polyphenolics were tentatively identified, and, in addition, three hitherto unknown flavonol-O-glycosides were detected in the extract. These unknowns were taken as the targets and isolated by means of consecutive polyamide S6, MCI gel and repeated Sephadex LH-20 column fractionation. The isolation and purification were monitored by HPLC/ESI-MS. The isolates were subsequently identified as quercetin 3-O-xylosyl-(1"' --> 2")-O-xyloside, myricetin 7-methylether 3-O-xylosyl-(1"' --> 2")-rhamnoside and myricetin 3',5'-dimethyl ether 3-O-xylosyl-(1"'-->* 2")-O-rhamnoside. All known metabolites were also separated by applying the same chromatographic techniques. ESI-MS, ¹H and ¹³C NMR spectra were then recorded, completely interpreted and confirmed by HR-ESI-MS and 2D NMR spectroscopy. In order to get information about biological activities of E. jambos the extract was tested for radical scavenging activity by DPPH and ORAC assay. In addition, its cytotoxicity was assessed by the neutral red assay against non-tumorigenic HaCaT keratinocytes and the human bladder carcinoma cell line 5637.

Bioaccumulation potential and physiological responses of aquatic macrophytes to Pb pollution.

In view of their potential bioaccumulation of heavy metals, Ceratophyllum demersum and Myriophyllum spicatum was studied under hydroponic cultures enriched by different Pb concentrations (25, 50, 75 mg/l) for 1-7 days. Both species exerted remarkable capabilities to concentrate Pb in their tissues as compared to control. The highest accumulation value of Pb (164.26 mg/g x dw) was recorded in C. demersum and the most of metal (91.72 mg/g dw) accumulated after 1 d. Significant reduction in photosynthetic pigments and appearance of morphological symptoms such as chlorosis and fragmentation of leaves were evident after 7d at 75 mg/l. The activity of POX and APX, carotenoids and proline showed induction at lower concentration and duration followed by decline. Major re-shuffle in protein patterns appeared as a tolerant mechanism, which both species developed under Pb toxicity. Results suggest that both species responded positively to Pb concentration and accumulated high amount of metal. Due to metal accumulation coupled with detoxification potential, both species appear to have potential for use as phytoremediators and the developed responses can be used as reliable biomarkers for Pb water pollution.

Pressure garment therapy (PGT) of burn scars: evidence-based efficacy.

Hypertrophic burn scars pose a challenge for burn survivors and providers. In many cases, they can severely limit a burn survivor's level of function, including work and recreational activities. A widespread modality of prevention and treatment of hypertrophic scarring is the utilization of pressure garment therapy (PGT). Despite the magnitude of the problem of hypertrophic scarring and the ubiquitous use of pressure garments as therapy, strong clinical evidence of the efficacy of PGT in the literature is lacking. Some of the challenges facing measurement of efficacy of PGT on hypertrophic scarring are lack of clear definitions for degree of hypertrophic scarring, inability to quantify pressure applied to scars, patient noncompliance to strict PGT time schedules, and inability to conduct randomized controlled trials comparing PGT to no therapy for ethical reasons since PGT is considered a standard of care. In this review, we attempt to summarize and analyze evidence-based literature on PGT and its efficacy in burn hypertrophic scars published in English language in the past 15 years.

Les cicatrices de brûlures hypertrophiques représentent un défi pour les survivants de brûlures et les fournisseurs. Dans de nombreux cas, ils peuvent gravement limiter le niveau de fonction d'un survivant de brûlure, y compris au travail et pendant les loisirs. Une modalité généralisée de la prévention et le traitement des cicatrices hypertrophiques est l'utilisation de la thérapie de vêtement de compression (TVC). Malgré l'ampleur du problème des cicatrices hypertrophiques et l'utilisation omniprésente de vêtements compressifs en tant que thérapie, dans la littérature il n'y a pas de preuves cliniques solides de l'efficacité de la TVC. Quelques-uns des défis auxquels fait face la mesure de l'efficacité de ce traitement sur les cicatrices hypertrophiques sont: le manque de définitions claires pour degré de cicatrisation hypertrophique, l'incapacité de quantifier la pression appliquée sur les cicatrices, la non-conformité des patients en ce qui concerne les horaires strictes du traitement, et l'incapacité de mener des essais comparatifs randomisés comparant cette thérapie à aucun traitement pour des raisons éthiques car la TVC est considérée comme une norme de soins. Dans cette revue, nous tentons de résumer et d'analyser la littérature fondée sur des preuves de la TVC et son efficacité dans les cicatrices hypertrophiques des brûlures publiés en langue anglaise au cours des 15 dernières années.

[Clinical and morphological features in a case of recent gastric carcinoma (the signet ring cell carcinoma type)]. / Particularitati clinico-morfologice într-un caz de carcinom gastric incipient (tipul de carcinom în inel cu pecete).

The article presents the case of a male patient, hospitalized due to severe pain in the upper abdomen area, nausea, and vomiting. The patient was diagnosed with surgical acute abdomen, for which emergency surgery is performed. Upon penetration into the peritoneal cavity, stomach inspection shows at the medio-gastric level, on the greater curvature, a callous gastric ulcer, with a central perforation. A large excision is decided up to the healthy (normal) gastric tissue, and the resulting pieces are sent to the pathological anatomy laboratory. The histopathological exam reveals signet ring cell recent gastric carcinoma. The biopsy performed 1 month after surgery, prelevated from the antropyloric zone, reveals antropyloric gastritis with moderate activity and Helicobacter pylori positive. Due to the fact that such cases when this gastric cancer type is diagnosed in recent stages are extremely rare, we considered it useful to present it and look into its macroscopic and microscopic aspects, as well as into the differentiating diagnosis.

Thermal injury to the hand: review of the literature.

This paper is a comprehensive review of hand burn injuries. The different classifications of thermal burns, out- and inpatient care, indications for escharotomies as well as surgical management, skin substitutes, and paediatric hand burns are thoroughly reviewed.

Burn wound cleansing - a myth or a scientific practice.

Burn wound cleansing is an integral step in every wound management protocol. Yet a lot of this practice is based on myth rather than real scientific basis. The literature is poor in scientific papers comparing the outcome of patients who underwent wound cleansing to those who did not. A survey form was designed by the Mediterranean Council for Burns and Fire Disasters - MBC and sent by e-mail to its members as well as members of the European Burn Association and other burn specialists, and 76 replies were received. Responses showed wide inconsistencies in the methods of burn wound cleansing, the solutions used for cleansing, the added antiseptics or detergents used, and the frequency of cleansing. Wound cleansing and dressing is a process that should be based on evidence and not on a ritualistic behaviour or a personal preference. In order to optimize burn wound care and promote optimal healing, more clinical evidence-based studies are needed to confirm or negate the positive or negative effects of any topical solution currently in use for burn wound cleansing.

Short- and long-term response to corticosteroid therapy in chronic beryllium disease.

Chronic beryllium disease (CBD) is a granulomatous disorder that affects the lung after exposure to beryllium. The present study reports short- and long-term evolution of granulomatous and fibrotic components in eight patients with severe CBD receiving corticosteroid therapy. Eight patients with confirmed CBD were studied at baseline, after initial corticosteroid treatment (4-12 months), at relapse and at the final visit. Beryllium exposure, Glu(69) (HLA-DPB1 genes coding for glutamate at position beta69) polymorphism, symptoms, pulmonary function tests (PFT), serum angiotensin-converting enzyme (SACE) and high-resolution computed tomography (HRCT) quantification of pulmonary lesions were analysed. The CBD patients were observed for a median (range) of 69 (20-180) months. After stopping beryllium exposure, corticosteroids improved symptoms and PFT (vital capacity +26%, diffusing capacity of the lung for carbon monoxide +15%), and decreased SACE level and active lesion HRCT score. In total, 18 clinical relapses occurred after the treatment was tapered and these were associated with SACE and active lesion HRCT score impairment. At the final visit, corticosteroids had completely stabilised all parameters including both HRCT scores of active lesions and fibrotic lesions in six out of eight patients. Corticosteroids were beneficial in chronic beryllium disease. They were effective in suppressing granulomatosis lesions in all cases and in stopping the evolution to pulmonary fibrosis in six out of eight patients.