Scar outcomes in dermatological surgery

Abstract

Background/Objectives

Significant functional impairment and psychological burden may result from poor scar quality and its impact on patient's quality of life has been well-established. It is important to identify measures to reduce the risk of surgical complications.

Method

212 patients undergoing dermatological surgery were recruited from March 2011 to February 2014. Their age, sex, surgical site, closure type, defect size (length and width), scar length, number of deep sutures, suture type and size were recorded. The patients were followed up at 6 weeks and 6 months for complications including abscess formation, granuloma formation, scar spreading, suture spitting and hypertrophic scar formation.

Results

At 6 weeks complications included suture spitting (14%), granuloma (11%), scar spreading (7%), hypertrophic scarring (3%) and abscess formation (1%), and at 6 months; scar spreading (17%), hypertrophic scarring (2%) and suture spitting (1%). In our multivariate analysis there were no predictors for spreading or spitting at 6 weeks, and only the defect size width was a predictor for granulomas in the stepwise analysis. For scar spreading at 6 months, younger age, site (trunk or limbs), higher number of deep sutures and surgeon were independent predictors (P < 0.0001 for the model).

Conclusion

Complications following dermatological surgery are low and tend to resolve with time, except for scar spreading. The surgeon who experienced more complications was placing sutures more superficially to the skin surface and was throwing more knots per closure; factors that we did not record in our study and merit further study.

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Novel B7-H4-mediated crosstalk between human non-Hodgkin lymphoma cells and tumor-associated macrophages leads to immune evasion via secretion of IL-6 and IL-10

Abstract

Non-Hodgkin lymphoma (NHL) is an incurable lymphoproliferative cancer, and patients with NHL have a poor prognosis. The present study explored the regulatory mechanism of expression and possible roles of the immunosuppressive B7-H4 molecule in human NHL. For functional studies, NHL-reactive T cell lines were generated via the isolation of allogeneic CD3⁺ T cells from healthy donors and repeated in vitro stimulation with irradiated NHL cells isolated from patients. B7-H4 was found to be distributed in NHL cells and tissues, and its surface protein expression levels were further upregulated by the incubation of NHL cells with interleukin (IL)-6, IL-10, or interferon-γ. Additionally, the supernatants of tumor-associated macrophages (tMφs) upregulated B7-H4 surface expression by producing IL-6 and IL-10. B7-H4 expressed in NHL cells inhibited the cytotoxic activity of NHL-reactive T cells. Conversely, the inhibition of B7-H4 in NHL cells promoted T cell immunity and sensitized NHL cells to cytolysis. Furthermore, tMφs induced B7-H4 promoted NHL cell evasion of the T cell immune response. In conclusion, this study shows that NHL-expressed B7-H4 is an important immunosuppressive factor that inhibits host anti-tumor immunity to NHL. Targeting tumor-expressed B7-H4 may thus provide a new treatment strategy for NHL patients.

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Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids

A relationship between the development of osteonecrosis of the femoral head and systemic corticosteroids has been well established in the literature, particularly in adults. However, the link between osteonecrosis and inhaled corticosteroids is less researched and understood. We report an usual case report of a 10-year-old male who developed ipsilateral femoral head osteonecrosis after long-term inhalational corticosteroid and intermittent short courses of oral steroid usage with a unique presentation and delayed diagnosis.

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Cervical Stimulation in the Treatment of Children with Lymphedema of All Four Extremities: A Case Report and Literature Review

Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers' ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema.

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Photodynamic Therapy Incubation Times for Actinic Keratosis

Condition:   Actinic Keratoses
Interventions:   Drug: ALA (5-aminolevulinic acid);   Device: Blue light therapy
Sponsor:   Northwestern University
Not yet recruiting - verified February 2017

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Return to Work and Living Healthy After Head and Neck Cancer

Condition:   Head and Neck Cancer
Interventions:   Behavioral: Return to work and living healthy after head and neck cancer;   Behavioral: socio-legal counseling
Sponsors:   University of Leipzig;   Universitätsklinikum Leipzig;   Jena University Hospital;   Klinikum St. Georg gGmbH;   Städtisches Klinikum Dresden;   German Cancer Aid
Recruiting - verified February 2017

http://ift.tt/2m7ydAW

A Study of LGK974 in Patients With Malignancies Dependent on Wnt Ligands

Conditions:   Pancreatic Cancer;   BRAF Mutant Colorectal Cancer;   Other Tumor Types With Documented Genetic Alterations Upstream in the Wnt Signaling Pathway;   Melanoma;   Triple Negative Breast Cancer;   Head and Neck Cancer
Interventions:   Drug: LGK974;   Biological: PDR001
Sponsor:   Novartis Pharmaceuticals
Recruiting - verified February 2017

http://ift.tt/2lutDcv