Q-switched Nd: YAG laser alone or with modified Jessner chemical peeling for treatment of mixed melasma in dark skin types: A comparative clinical, histopathological, and immunohistochemical study

Summary

Backgrounds

Treatment of mixed melasma remains challenging. Promising results have been achieved with low-fluence 1064-nm Q-switched Nd-YAG laser; however, multiple sessions are necessary with occurrence of complications especially in dark skin types. So, combination methods may be recommended.

Aims

To compare efficacy of Q-switched Nd-YAG laser alone or with modified Jessner's peel in mixed melasma in dark skin.

Patients/Methods

Nineteen patients with mixed melasma received 6 sessions of laser on left side of face and alternating laser and modified Jessner on right side. Evaluation was carried out clinically through modified melasma area and severity index at 1 month after last session. Using histopathological, immunohistochemical, and computerized morphometric analysis, objective evaluation of melanin particle surface area and MART-1-positive cells was performed for pre- and post-treated skin biopsies.

Results

There was significant clinical improvement on both sides of face (P < .001), without significant difference (P > .05). At the sixth laser session on left side of face, ill-defined mottled hypopigmentation was observed in 21.05% of patients. Histopathologically, melanin particle surface area and number of MART-1-positive cells (total, epidermal, and dermal) were significantly decreased after two treatment modalities (P < .001), without significant difference in their reduction percentage between both sides of face (P > .05).

Conclusion

Low-fluence Q-switched Nd-YAG laser alone and with modified Jessner's peel are equally effective regimens for mixed melasma clinically, histopathologically, and immunohistochemically. However, combined method is preferred, especially in dark skin, for obtaining better cosmetic result with fewer side effects of multiple laser sessions and decreasing cost rate of laser.

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Science as momentary truth

Publication date: Available online 19 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Leonardo Silva




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Side effects of intraoral devices for OSAS treatment

Publication date: Available online 14 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Andressa Otranto de Britto Teixeira, Ana Luiza Ladeia Andrade, Rhita Cristina da Cunha Almeida, Marco Antonio de Oliveira Almeida
IntroductionIntraoral devices have increasingly assumed a key role in the treatment of Obstructive Sleep Apnea Syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the Continuous Positive Airway Pressure (CPAP) device.ObjectivesTo evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices.MethodsA prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle (IMPA). An intraclass correlation test was performed and a correlation index>0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t Test), with a significance level set at 5%.ResultsThere was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences.ConclusionAfter a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.



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Neutrophil–lymphocyte ratios in the prognostication of primary non-metastatic Nasopharyngeal Carcinoma

Publication date: Available online 19 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Kong Yew Liew, Abu Bakar Zulkiflee
IntroductionNasopharyngeal Carcinoma is a geographically and racially variable disease which has a high incidence in Malaysia. Based on current concepts in tumour related inflammation the inflammatory marker, Neutrophil–Lymphocyte Ratio was tested to find its relationship with prognosis in Nasopharyngeal Carcinoma.ObjectiveTo investigate the effect of the Neutrophil–Lymphocyte Ratio on prognosis in non-metastatic primary Nasopharyngeal Carcinoma patients and to further refine the cut off between high and low Neutrophil–Lymphocyte Ratio values.MethodsThe medical charts of patients with histologically confirmed Nasopharyngeal Carcinoma from 1st January 2005 until 31st December 2009 were reviewed retrospectively and the Neutrophil–Lymphocyte Ratio was calculated to see if there was any association between their higher values with higher failure rates.ResultsRecords of 98 patients (n=98) were retrieved and reviewed. Only Neutrophil–Lymphocyte Ratio (p=0.004) and TMN staging (p=0.002) were significantly different between recurrent and non-recurrent groups, with the Neutrophil–Lymphocyte Ratio being independent of TNM staging (p=0.007). Treatment failure was significantly higher in the high Neutrophil–Lymphocyte Ratio group (p=0.001). Disease Free Survival was also significantly higher in this group (p=0.000077).ConclusionHigh Neutrophil–Lymphocyte Ratio values are associated with higher rates of recurrence and worse Disease Free Survival in non-metastatic Nasopharyngeal Carcinoma patients undergoing primary curative treatment.



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Molecular control of regulatory T cell development and function

Yohko Kitagawa | Shimon Sakaguchi

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Insights into immune tolerance from AIRE deficiency

Irina Proekt | Corey N Miller | Michail S Lionakis | Mark S Anderson

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Simultaneous Reconstruction of Columella and Philtrum Using Prolabial Flap Combined with Abbe Flap in Secondary Bilateral Cleft Lip and Nasal Deformity

Open rhinoplasty and Abbe flap techniques are traditionally useful tools for the reconstruction of secondary bilateral cleft lip nasal (BCLN) deformity. We aimed to investigate the long-term outcomes of simultaneous columella and philtrum reconstruction using prolabial flap combined with Abbe flap in secondary BCLN deformity.From January 2009 to July 2014, 26 patients (17 males and 9 females; mean age 21 years) with secondary BCLN deformity were recruited. All patients had severe short columella and philtrum deficiency.

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