RESUMO
BACKGROUND: Topical aluminum salts are a commonly used remedy for excessive axillary perspiration. To the contrary, less is known about their anhidrotic potential in the groin. This study sought to compare the anhidrotic efficacy and tolerability of an aluminum chloride-based antiperspirant to an innovative aluminum lactate-based antiperspirant in healthy study participants presenting with excessive axillary and inguinal perspiration. PARTICIPANTS AND METHODS: Fifty participants were enrolled in this open open-labeled, randomized, controlled trial. Following a baseline assessment, efficacy was analyzed at two time points throughout the study period by means of four physiological parameters (pH value, transepidermal water loss, gravimetric analysis, Minor test) and two questionnaires (Dermatology Life Quality Index, Hyperhidrosis Disease Severity Scale). Tolerability was evaluated via symptom diaries. RESULTS: Both study preparations were comparably effective in reducing axillary and inguinal perspiration and exhibited increasing effectiveness over time. In both treatment regions, the aluminum lactate-based antiperspirant had a more favorable tolerability profile than the aluminum chloride-based antiperspirant. CONCLUSIONS: Due to its comparable efficacy and - most noticeably in the groin - superior tolerability, this study supports the use of topical aluminum lactate as a first-line option to control excessive axillary and inguinal perspiration.
Assuntos
Antiperspirantes , Hiperidrose , Humanos , Antiperspirantes/efeitos adversos , Cloreto de Alumínio , Compostos de Alumínio , Hiperidrose/tratamento farmacológico , Hiperidrose/diagnóstico , AxilaRESUMO
Aluminium chloride-based antiperspirants are an effective topical therapeutic option for mild to moderate states of excessive perspiration. Its use is primarily limited by the occurrence of skin irritation, especially in sensitive skin types. The objective of this study was to compare the antiperspirant efficacy and tolerability of a novel antiperspirant with 12.5% aluminium lactate, and a 12.5% aluminium chloride-based antiperspirant. This cohort study was conducted as a two-sided self-assessment comparison between both preparations in healthy volunteers to generate selfcare-related data. Almost half of the participants stated that aluminium chloride was more efficacious than aluminium lactate; 22% stated aluminium lactate was more efficacious than aluminium chloride; 28% observed no difference in the efficacy of both preparations (p = 0.04). However, 88% described greater tolerability with aluminium lactate (p < 0.0001). In this study, aluminium lactate showed significantly greater tolerability than aluminium chloride, although the latter tended to show slightly greater efficacy.
Assuntos
Antiperspirantes , Ácido Láctico , Cloreto de Alumínio , Compostos de Alumínio , Estudos de Coortes , Humanos , Lactatos , Estudos ProspectivosRESUMO
BACKGROUND: Artificial skin substitute templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data. OBJECTIVE: The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases. MATERIALS AND METHODS: In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months. RESULTS: The mean size of the defects was 63 (±54) cm2. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer. CONCLUSION: The use of a dermal regeneration template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Pele Artificial , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , CicatrizaçãoRESUMO
BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as "two-body syndrome," the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. OBJECTIVE: To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. METHODS: International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. RESULTS: Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. CONCLUSION: Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.
Assuntos
Anestesia Local/métodos , Lipectomia/normas , Lipedema/cirurgia , Dor Processual/prevenção & controle , Guias de Prática Clínica como Assunto , Anestésicos Locais/administração & dosagem , Conferências de Consenso como Assunto , Progressão da Doença , Feminino , Humanos , Lidocaína/administração & dosagem , Lipectomia/efeitos adversos , Lipectomia/métodos , Lipedema/diagnóstico , Lipedema/etiologia , Pessoa de Meia-Idade , Dor Processual/etiologia , Planejamento de Assistência ao Paciente/normas , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Gordura Subcutânea , Resultado do TratamentoRESUMO
OBJECTIVES: It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome. METHODS: In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits. RESULTS: DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid). CONCLUSIONS: DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.
Assuntos
Deformidades Adquiridas Nasais/cirurgia , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia , Pele Artificial , Ferida Cirúrgica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Elastina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
The large conductance voltage- and Ca(2+)-activated K(+) (BK) channel is an important determinant of vascular tone and contributes to blood pressure regulation. Both activities depend on the ancillary BKß1 subunit. To determine the significance of smooth muscle BK channel activity for blood pressure regulation, we investigated the potential link between changes in arterial tone and altered blood pressure in BKß1 knockout (BKß1(-/-)) mice from three different genetically defined strains. While vascular tone was consistently increased in all BKß1(-/-) mice independent of genetic background, BKß1(-/-) strains exhibited increased (strain A), unaltered (strain B) or decreased (strain C) mean arterial blood pressures compared to their corresponding BKß1(+/+) controls. In agreement with previous data on aldosterone regulation by renal/adrenal BK channel function, BKß1(-/-) strain A mice have increased plasma aldosterone and increased blood pressure. Consistently, blockade of mineralocorticoid receptors by spironolactone treatment reversibly restored the elevated blood pressure to the BKß1(+/+) strain A level. In contrast, loss of BKß1 did not affect plasma aldosterone in strain C mice. Smooth muscle-restricted restoration of BKß1 expression increased blood pressure in BKß1(-/-) strain C mice, implying that impaired smooth muscle BK channel activity lowers blood pressure in these animals. We conclude that BK channel activity directly affects vascular tone but influences blood pressure independent of this effect via different pathways.
Assuntos
Subunidades beta do Canal de Potássio Ativado por Cálcio de Condutância Alta/fisiologia , Músculo Liso/fisiologia , Aldosterona/sangue , Animais , Aorta Torácica/fisiologia , Pressão Sanguínea/fisiologia , Técnicas In Vitro , Rim/fisiologia , Camundongos Transgênicos , Células Musculares/fisiologia , Oócitos/fisiologia , XenopusRESUMO
BACKGROUND: Direct wound closure, flaps or grafts are considered to be gold standards for the reconstruction of defects. However, these techniques may not be applicable in all cases, especially for the challenging closure of large defects. OBJECTIVE: We developed a technique to close large defects, of varying size and shape, using serial tightening loop sutures. In 64 consecutive patients, loop sutures were applied to defects from 3 cm(2) up to 173 cm(2) for a maximum of 42 days with tightening every 2-7 days. RESULTS: The median size of the defects was 20 cm(2). In 58 patients (91%) the defects were closed by direct approximation of the wound edges within a median time of 11 days (range: 4-42 days). Two patients received a skin transplant after a significant reduction of the defect size and four remaining defects healed by secondary intention. The skin stretching of defects located on the trunk was faster compared with defects on the extremities. Defects located on the scalp were closed hair bearing with little scarring. Overall, aesthetic results were satisfying. CONCLUSION: The use of loop sutures allows the delayed closure of large defects avoiding the need for skin flaps or grafts in most cases.
Assuntos
Suturas , Cicatrização , Ferimentos e Lesões/cirurgia , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: In Germany little data on the epidemiology and histology of lip cancers are available, as lip cancers are commonly pooled together with head and neck tumors. PATIENTS AND METHODS: Retrospective analysis of 181 patients with malignant tumors of the lips with respect to gender, location, histology, risk factors and comorbidity. RESULTS: There were 90 women and 91 men with a mean age of 71 years. 98 had a tumor on the upper lip and 83 patients on the lower lip. Tumors of the upper lip showed a slight female preference (61%). In contrast lower lip cancer was more common (64%) in men. Histological analysis revealed that in both regions nodular basal cell carcinomas as well as squamous cell carcinomas (NOS) are the most common subtypes. Vertical tumor thickness of squamous cell carcinomas was in most cases smaller than 6 mm (n = 71) and only in 4 cases was a tumor thickness of >6 mm detected. Altogether, 57% of the patients reported a high to very high sun exposure. CONCLUSIONS: In comparison to previous studies we found a weaker preference for women for tumors of the upper lip and also a weaker preference for men for tumors of the lower lip. The causes remain unclear, but could be causally related to an increased life expectancy and/or changed risk profile.
Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Labiais/epidemiologia , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Distribuição por SexoRESUMO
Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro-cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Dermatologia/tendências , Lipectomia/métodos , Lipectomia/tendências , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/tendências , HumanosRESUMO
Tumor-associated macrophages (TAMs) represent alternatively activated (M2) macrophages that support tumor growth. Previously, we have described a special LYVE-1(+) M2 TAM subset in vitro and in vivo; gene profiling of this TAM subset identified MS4A8A as a novel TAM molecule expressed in vivo by TAM in mammary carcinoma and malignant melanoma. In vitro, Ms4a8a mRNA and MS4A8A protein expression was strongly induced in bone marrow-derived macrophages (BMDMs) by combining M2 mediators (IL-4, glucocorticoids) and tumor-conditioned media (TCM). Admixture of MS4A8A(+) TCM/IL-4/GC-treated BMDM significantly enhanced the tumor growth rate of subcutaneously transplanted TS/A mammary carcinomas. Upon forced overexpression of MS4A8A, Raw 264.7 macrophage-like cells displayed a special gene signature. Admixture of these MS4A8A(+) Raw 264.7 cells also significantly enhanced the tumor growth rate of subcutaneously transplanted mammary carcinomas. To identify the signaling pathways involved in synergistic induction of MS4A8A, the major signaling cascades with known functions in TAM were analyzed. Although inhibitors of NF-κB activation and of the MAPK JNK and ERK did not show relevant effects, the p38α/ß MAPK inhibitor SB203580 strongly and highly significantly (p > 0.001) inhibited MS4A8A expression on mRNA and protein level. In addition, MS4A8A expression was restricted in M2 BMDM from mice with defective GC receptor (GR) dimerization indicating that classical GR gene regulation is mandatory for MS4A8A induction. In conclusion, expression of MS4A8A within the complex signal integration during macrophage immune responses may act to fine tune gene regulation. Furthermore, MS4A8A(+) TAM may serve as a novel cellular target for selective cancer therapy.
Assuntos
Antígenos CD20/imunologia , Glucocorticoides/metabolismo , Macrófagos/imunologia , Transdução de Sinais , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Animais , Linhagem Celular , Meios de Cultivo Condicionados , Feminino , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Transplante de Neoplasias , Análise de Sequência com Séries de Oligonucleotídeos , Receptores de Glucocorticoides/genética , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: Carcinoma of the lower lip is a common cancer of the head and neck region. The accepted standard of care is surgical resection and reconstruction. The delicate location poses a challenge to surgeons because they have to aim for conflicting goals: complete oncological resection and functional and aesthetic restoration. For over a century, this challenge led to the development of more than 100 different reconstructive procedures. OBJECTIVE: To develop a standardized surgical approach to simplify selection of an adequate reconstructive procedure. MATERIALS AND METHODS: We performed a review of the literature and a retrospective analysis of 59 patients treated according to a standardized surgical approach over the past 5 years. RESULTS: By taking into account the anatomic location, the width of the defect, and the amount of tissue loss, three flowcharts have been developed to guide the physician to a selection of suitable reconstructive procedures for each case. CONCLUSION: This surgical approach facilitated the successful reconstruction of all encountered defects, and over a mean period of 31 months, no recurrences or major complications were seen.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Labiais/cirurgia , Procedimentos de Cirurgia Plástica , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Labiais/patologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
BACKGROUND: Two stage reconstructions of deep scalp wounds with exposed calvarial bone require a vital granulation tissue. By evaluating different surgical approaches functional and cosmetic results as well as economic aspects have to be taken into account. PATIENTS AND METHODS: 52 patients undergoing three different surgical procedures for soft tissue reconstruction of complex scalp wounds with exposed bone were included into a retrospective study. All patients underwent a two stage procedure with 3D histologic control, soft tissue reconstruction and final split thickness skin grafting. Soft tissue reconstruction was carried out using allogenic fascia lata, an artificial skin substitute or a negative pressure wound therapy (NPWT). The costs for all used materials as well as personnel and infrastructure were calculated. RESULTS: Comparing the costs for the different treatments, the fascia lata group was least costly (4,475 ) followed by the artificial skin substitute group (4,557 ). The highest expenses occurred in the NPWT group (7,.521 ). The artificial skin substitute group had the fewest dressing changes and the shortest treatment time. CONCLUSIONS: Although dermal regeneration templates are expensive, their use may be economic. NPWT causes high treatment costs due to high daily rental rates and frequent and time-consuming dressing changes.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Couro Cabeludo/lesões , Couro Cabeludo/cirurgia , Pele Artificial/economia , Ferimentos Penetrantes/economia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Ferimentos Penetrantes/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery. PATIENTS AND METHODS: In a single center, retrospective study 23 consecutive cases were analyzed in which medicinal leeches had been used therapeutically after plastic reconstructive surgery. All cases were categorized regarding the indication for leech therapy, the onset, the duration, the number of leeches and the number of sessions. RESULTS: Among the group of patients there were 7 female and 16 male patients with a mean age of 73 ± 14 years (48-94 years) altogether. The main indications were venous congestion (12/23; 52 %) and hematoma (9/23; 39 %). Two cases were diagnosed with a necrosis of the tip of the flap and therefore received leech therapy (2/23; 9 %). The average number of leeches was 2.6 leeches/session, the number of sessions was 1.7 ± 0.8. 20/23 patients (87 %) showed a restitutio ad integrum after leech therapy, in 3/23 patients (13 %) a necrosis of the tip of the flap could not be prevented. A clinical improvement was noticed after an average of 1.1 ± 0.3 days. CONCLUSIONS: The early application of medicinal leeches can improve local hemodynamic conditions. Leech therapy is a simple and effective method; the cost efficiency of the treatment is high.
Assuntos
Sangria/métodos , Hematoma/etiologia , Hematoma/terapia , Hirudo medicinalis , Hiperemia/etiologia , Hiperemia/terapia , Cirurgia Plástica/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Treatment of choice for non-melanoma skin cancers is surgical excision. No study has analyzed the impact of the dermatologic surgeon's experience on the postoperative outcome. PATIENTS AND METHODS: In a single center, retrospective study, 196 cases of non-melanoma skin cancer of the head and neck treated with micrographically-controlled surgery were categorized with regard to type of tumor, location, size of defect, number of stages, complications, recurrence rate and cosmetic result. These data were analyzed in respect of the surgeon's experience (dermatology attendings [AT], senior residents with experience in dermatosurgery [SR], junior residents with less experience in dermatosurgery [JR]). RESULTS: AT and SR excised tumors in toto at roughly the same rate (AT: 42/75; SR: 59/104), JR less frequently (3/6). The patients graded 97% of the scars as very good to satisfactory. The grading of smaller defects (< 4 cm(2)) was not influenced by the surgeon's experience. Larger defects were graded equally in the two groups AT and SR. The complication rate was similar in all three groups, even though larger defects were treated by the attendings (AT). CONCLUSIONS: Micrographically-controlled surgery followed by plastic reconstruction is the treatment of choice for non-melanoma skin tumors of the head and neck area. Cosmetic results are excellent. Minor procedures can be performed by residents during their training; larger defects require more experience in dermatosurgery.
Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Médicos/estatística & dados numéricos , Competência Profissional/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Melanoma/epidemiologia , Melanoma/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Although dermal wounds are common, treatment remains limited and largely ineffective. Recent studies suggest that therapeutic application of progenitor cells is useful for tissue regeneration. OBJECTIVE: We here investigated the effects exerted by the recently characterized immortalized haematopoietic progenitor cell line DKmix and their conditioned medium in a murine wound healing model. METHODS AND RESULTS: Injection of both DKmix cells and their conditioned medium accelerated wound repair between days 3 and 10 compared with PBS-injected control mice (n = 8, P < 0.01 DKmix cells vs control, P < 0.01 conditioned medium vs control at day 6). The treated groups exhibited more CD31(+)-capillaries at day 6 after injury compared with the control group (n = 4, P < 0.01 DKmix cells vs control, P < 0.001 conditioned medium vs control), whereas there was no change in infiltrated CD68(+) macrophages. Conditioned medium of DKmix cells induced tube formation of human endothelial cells in Matrigel assays (n = 4-6, P < 0.05 conditioned medium vs control) as well as migration (n = 4, P < 0.01 conditioned medium vs control) and proliferation of murine 3T3 fibroblasts (n = 5, P < 0.05 conditioned medium vs control). Abundant levels of matrix metalloproteinase -2 and -9 in the supernatants were detected. Protein arrays of the supernatants revealed a strong secretion of cytokines and growth factors, such as monocyte chemoatractant protein-1 and GM-CSF from DKmix cells. CONCLUSION: DKmix cells improve skin-substitute wound healing by promoting angiogenesis as well as migration and proliferation of fibroblasts. These data suggest that immortalized haematopoietic progenitor cells significantly improve dermal wound healing by paracrine effects.