Is carboxytherapy a good alternative method in the removal of various skin defects?

Carbon dioxide is a physiologic compound present in our body, mainly as a result of cellular metabolism. The frequency of carboxytherapy use by dermatologists and cosmetologists increased significantly in the second half of the 20th century due to the fact that it improves blood circulation within skin tissues. This article focuses on the use of carboxytherapy in case of various skin problems, such as stretch marks, scars, loss of elasticity, redundancy of fatty tissue, cellulite, morphea, and alopecia. The review of sparse studies that are available indicate increasing interest in this method.

New patient setup procedure using surface-guided imaging to reduce body touch and skin marks in whole-breast irradiation during the COVID-19 pandemic.

This study aimed to assess the effectiveness of a new patient-setup procedure using surface-guided imaging during the coronavirus disease 2019 (COVID-19) pandemic for left-sided whole-breast irradiation with deep inspiration breath-hold. Two setup procedures were compared regarding patient positioning accuracy for the first 22 patients. The first was a traditional setup (T-setup) procedure that used a surface-guided system after patient setup with traditional skin marks and lasers. The second procedure involved a new setup (N-setup) that used only a surface-guided system. The positioning accuracy of the remaining 23 patients was assessed using a setup that combined marker reduction and the N-setup procedure. No significant difference was observed in positioning accuracy between the two setups. The positioning accuracy of the marker-reduction setup was within 3 mm in all directions. The N-setup procedure may be a useful strategy for preventing infection during or after the COVID-19 pandemic.

Defining dose constraints for catheter insertion sites to minimize toxicity after interstitial breast brachytherapy.

PURPOSE: The purpose of this study was to define dose constraints for catheter insertion sites to minimize probability of prominent post-therapy skin marks after interstitial breast brachytherapy. METHODS AND MATERIALS: Forty patients who had undergone interstitial breast brachytherapy were studied at followup at least 2 years after the procedure. Their implant marks were compared with background skin and areola and scored as Gr0 = invisible (same color as surrounding skin), Gr1 = darker than surrounding skin but lighter than areola or hypopigmentation, and Gr2 = same color as areola or darker. Highest point doses received in each plane of implant and their corresponding closest distances from clinical target volume, 85% isodose, and closest catheter dwell point were used for analysis. A logistic regression was performed to ascertain effects of various dosimetric parameters on the probability of Gr2 marks. Receiver operating characteristic curve was generated to derive cutoffs. RESULTS: A total of 280 dose points were studied. Median values for various parameters were 1.4 Gy (0.24-3.74) for Dose max and 1.6 cm, 1.5 cm, and 1.0 cm for Dist CTV min, Dist Iso min, and Dist Dwell min, respectively. On logistic regression, increasing Dose max alone was associated with an increased likelihood of developing Gr2 marks. Each unit increase of Dose max increased probability of development of Gr2 skin marks by 5.0% (2.391-10.328). Receiver operating characteristic analysis also showed greatest odd ratio (8.0), sensitivity (74.8%), and specificity (73%) for Dose max. CONCLUSIONS: It seems prudent to restrict dose to catheter insertion sites for better cosmesis.

Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer.

Purpose Prostate motion occurs during radiotherapy for localized prostate cancer. We evaluated the input of intraprostatic fiducials for image-guided radiation therapy and compared it with bony anatomy and skin marks. Methods Eleven patients were implanted with three fiducial markers in the prostate. Daily sets of orthogonal kV-kV images were compared with digitally reconstructed radiography. Data were recorded for skin marks, bony anatomy, and fiducial markers. The variations were analyzed along three principal axes (left-right: LR, superoinferior: SI, and anteroposterior: AP). Results A total of 2,417 measures were recorded over 38 fractions of radiotherapy (76 Gy). Fiducial marker movements from bony anatomy were ≤ 5 mm for 84.2% (confidence interval: CI 95%±1.5), 91.3% (CI 95%±1.1), and 99.5% (CI 95%±0.4) of the measures along the AP, SI, and LR axes, respectively. Ninety-five percent of the shifts between a fiducial marker and the bony anatomy were < 8 mm in the AP and SI axes, and < 3 mm in the LR axis. Fiducial marker movements from skin marks were ≤ 5 mm for 64.8% (CI 95%±1.9), 79.2% (CI 95%±1.6), and 87.2% (CI 95%±1.3) of the measures along the AP, SI, and LR axes, respectively. Bony anatomy movements from skin marks were ≤ 5 mm for 84% (CI 95%±1.4), 92% (CI 95%±1.1), and 87% (CI 95%±1.3) of the measurements along the AP, SI, and LR axes, respectively. Conclusion Using fiducial markers provides better accuracy of repositioning of the prostate than using bony anatomy and skin marks for image-guided radiotherapy of prostate cancer.

O corpo: traço, imagem, afeto / El cuerpo: trazo, imagen, afecto / Body: trace, image, affection / Le corps: trait, image, affection

O presente artigo resulta de investigações sobre questões clínicas de difícil abordagem, cuja expressão situa-se na passagem adolescente. Dentre essas questões encontramos uma grande incidência da busca por marcar o corpo, seja num sentido ornamental, com tatuagens e piercings; ou mesmo na produção de auto-incisões na pele. Serão abordados fundamentos em Freud e Lacan para dar conta dessas questões.

El presente artículo es el resultado de investigaciones sobre cuestiones clínicas difíciles de abordar, cuya expresión se sitúa en el pasaje de la adolescencia. Entre esas cuestiones encontramos una gran incidencia de la búsqueda de marcar el cuerpo, ya sea en un sentido ornamental, con tatuajes y piercings, o en la producción de autoincisiones en la piel. Se abordarán fundamentos en Freud y Lacan para dar cuenta de tales cuestiones.

This article results from research on clinical issues difficult to approach, which expression is located in the adolescent passage. Among these issues it is found a high incidence of searching for body marks, either in an ornamental sense –with tattoos and piercings– or even in the production of auto-incisions on the skin. These issues will be developed from Freud and Lacan's theories.

Cet article est le résultat de recherches faites à propos de sujets cliniques difficiles à aborder, manifestations qui se présentent lors du passage à l’adolescence. Le fait de marquer le corps, soit dans un sens ornemental avec des tatouages et des piercings, soit en se scarifiant, compte parmi ces manifestations. Des principes chez Freud et Lacan seront abordés pour traiter ces sujets.

Skin lesions in envenoming by cnidarians (Portuguese man-of-war and jellyfish): etiology and severity of accidents on the Brazilian coast / Lesões dermatológicas observadas nos acidentes por cnidários (águas-vivas e caravelas): etiologia e gravidade dos envenenamentos no litoral do Brazil

This work attempts to establish dermatological identification patterns for Brazilian cnidarian species and a probable correlation with envenoming severity. In an observational prospective study, one hundred and twenty-eight patients from the North Coast region of São Paulo State, Brazil were seen between 2002 and 2008. About 80 percent of these showed only local effects (erythema, edema, and pain) with small, less than 20 cm, oval or round skin marks and impressions from small tentacles. Approximately 20 percent of the victims had long, more than 20 cm, linear and crossed marks with frequent systemic phenomena, such as malaise, vomiting, dyspnea, and tachycardia. The former is compatible with the common hydromedusa from Southeast and Southern Brazil (Olindias sambaquiensis). The long linear marks with intense pain and systemic phenomena are compatible with envenoming by the box jellyfish Tamoya haplonema and Chiropsalmus quadrumanus and the hydrozoan Portuguese man-of-war (Physalis physalis). There was an association between skin marks and probable accident etiology. This simple observation rule can be indicative of severity, as the Cubozoa Class (box jellyfish) and Portuguese man-of-war cause the most severe accidents. In such cases, medical attention, including intensive care, is important, as the systemic manifestations can be associated with death.

Cnidários são animais que apresentam no corpo (especialmente nos tentáculos) organelas de defesa chamadas nematocistos, podendo causar graves envenenamentos. Este trabalho procura estabelecer padrões clínicos auxiliares na identificação das espécies de cnidários brasileiros e pesquisar provável correlação das lesões na pele com a gravidade do acidente. Cento e vinte e oito pacientes foram observados no Pronto-Socorro de Ubatuba (Litoral Norte do estado de São Paulo) em período de seis anos (2002-2008). Cerca de 80 por cento dos acidentes mostraram apenas manifestações locais (dor, eritema e edema). Nestes casos, as marcas cutâneas foram pequenas, ovais e arredondadas, algumas vezes com impressões de pequenos tentáculos. As marcas foram menores que 20 cm. Aproximadamente 20 por cento das vítimas tinham lesões longas, lineares e cruzadas, maiores que 20 cm com frequente observação de fenômenos sistêmicos, como mal estar, vômitos, dispnéia e taquicardia. O padrão das marcas arredondadas e curtas é compatível com hidromedusa muito comum nas regiões Sudeste e Sul do Brasil (Olindia sambaquiensis), que causa acidentes de pequena magnitude. As marcas longas e lineares, associadas à dor intensa e fenômenos sistêmicos, são compatíveis com envenenamento pelas cubomedusas Tamoya haplonema e Chiropsalmus quadrumanus e o hidrozoário Physalis physalis, a caravela. Houve associação entre as marcas cutâneas e a provável etiologia do acidente. Esta regra simples de observação clínica pode ter valor clínico, uma vez que a Classe Cubozoa (vespas-do-mar) e as caravelas causam os acidentes mais graves. Nestes casos, a atenção médica deve ser redobrada, incluindo cuidados intensivos, uma vez que fenômenos sistêmicos podem se associar a óbitos.