Síndrome DRESS asociado a fenitoína: informe de caso / DRESS syndrome associated with phenytoin: case report

El síndrome DRESS es una reacción adversa dermatológica que puede presentarse debido a diversos medicamentos, y constituye uno de los diagnósticos más importantes por encima del síndrome de Stevens-Johnson. Se trata de un caso relacionado con una reacción adversa de muy baja frecuencia, que está documentada en la literatura científica, a varios medicamentos, entre ellos la fenitoína. Por lo mencionado, la publicación de estos casos resulta escasa y limitada. Las principales preocupaciones del paciente relacionadas con su cuadro clínico radicaban en el gran compromiso cutáneo que lo llevó a hospitalización, dolor e incomodidad, por el cual recurrió al manejo tópico generalizado con vaselina. Los hallazgos clínicos relevantes fueron: eosinofilia severa, ulceraciones cutáneas, hepatitis química y fiebre. Con los hallazgos del cuadro clínico y la evaluación de la escala RegiSCAR se hace el diagnóstico de síndrome DRESS inducido por fenitoína. Se suspende la fenitoína, se inicia levetiracetam y se administran corticosteroides y acetaminofén con evolución favorable. (AU)

DRESS syndrome is a dermatological adverse reaction can occur due to various medications, being one of the most important diagnoses above Steven-Johnson syndrome. This is a case related to a very low frequency adverse reaction that is documented in the scientific literature to several medicines among those, the phenytoin. Therefore, the publication of these cases is scarce and limited. The main concerns of the patients related to their clinical picture were due to the great cutaneous compromise that lead to hospitalization, pain and discomfort for which they resorted to generalized topical management with vaseline (petrolatum). Relevant clinical findings were severe eosinophilia, skin ulcerations, chemical hepatitis and fever. With clinical picture findings and evaluation of the RegiSCAR scale, the diagnosis of Phenytoin-induced DRESS syndrome is made. Phenytoin is discontinued, levetiracetam is started and corticosteroids and acetaminophen are administrated with favorable evolution. (AU)

Gaze vaselinada para prevenção de lesões por pressão em pessoas com dermatoses imunobolhosas / Vaseline gauze for prevention of pressure injuries in people with immunobullous dermatoses / Gasa con vaselina para la prevención de lesiones por presión en personas con dermatosis inmunobulosa

Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.

Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.

Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.

Neumonia lipoidea: causa infrecuente de infiltrados pulmonares / Lipoid pneumonia: an infrequent cause of pulmonary infiltrates

La presencia de infiltrados pulmonares es un hallazgo frecuente que incluye un amplio diagnóstico diferencial basado en muchas ocasiones en la historia clínica. Entre ellas, la neumonía lipoidea exógena representa una entidad poco frecuente y es preciso un elevado índice de sospecha para alcanzar su diagnóstico y evitar su progresión. En estos casos, un contexto clínico adecuado y una TC con opacidades y áreas de baja densidad pueden ser altamente sugestivos de la enfermedad. Se presenta un caso de neumonía lipoidea exógena secundaria a la utilización continuada de sustancias oleosas intranasal, que debido a los antecedentes del paciente y a las posibilidades diagnósticas tras los hallazgos de la TC, precisó confirmación histológica.

The presence of pulmonary infiltrates is a frequent finding that includes a large differential diagnosis based on many occasions in the clinical history. Among them, exogenous lipoid pneumonia represents a rare entity and a high index of suspicion is necessary to reach its diagnosis and prevent its progression. In these cases, an adequate clinical context and a CT with opacities and low density areas are highly suggestive of the disease. We present a case of exogenous lipoid pneumonia secondary to the continued use of oily substances at the nasal level, due to his antecedents and the diagnostic possibilities after the CT findings, histological confirmation was required.

Usefulness of Unilateral Nasal Packing for Recurred Septal Deviation within a Month after Septoplasty: Preliminary Study

BACKGROUND AND OBJECTIVES: To investigate the effect of unilateral nasal packing on the correction of recurred septal deviation after septoplasty. MATERIALS AND METHOD: We analyzed 12 patients who had undergone septoplasty and developed septal deviation recurrence. Polyvinylacetate and Vaseline gauze were inserted into the nasal passage on the convex side of the septum for 4 days in order to shift the septum to the midline. We analyzed nasal symptoms, acoustic rhinometric results, and endoscopic findings before and after unilateral packing in order to evaluate the treatment outcomes. RESULTS: Ten (83%) out of 12 patients showed improvements in nasal obstruction, acoustic rhinometric results, and endoscopic findings. The mean visual analogue scale (VAS) score for nasal obstruction was 5.25±1.60 before and 2.08±1.50 after packing (p=0.004). The minimal cross-sectional area (MCA) improved from 0.17±0.14 to 0.27±0.13 (p=0.002), and the mean endoscopic score improved from 2.0±0.43 to 1.08±0.29 (p=0.002). CONCLUSION: Unilateral nasal packing was a safe, easy, and effective method for correcting recurred septal deviation after septoplasty.

Glicose como causa e tratamento de necrose cutânea / Glucose as a cause of and treatment for cutaneous necrosis

A escleroterapia continua sendo um dos procedimentos mais executados pelos cirurgiões vasculares brasileiros. O conhecimento das suas complicações é imprescindível para que possamos evitá-las. Os efeitos colaterais graves desse método de tratamento para as telangiectasias dos membros inferiores são raros e frequentemente associados a um erro técnico ou à dosagem injetada. São predominantemente locais, apresentando-se, algumas vezes, como uma situação de difícil resolução. Relatamos um caso de formação de necrose cutânea após escleroterapia química com glicose hipertônica (75%) e sua cicatrização utilizando preparação tópica contendo vaselina e glicose 60%, cujo resultado estético foi satisfatório

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results

Blocking or enhancing effects of some basic emollients in UVA penetration

Abstract: Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Versatile Scalp Donor Split Thickness Skin Graft in Burn Patients

PURPOSE: It is well known the advantages of scalp donor split thickness skin graft(STSG) in deep burn wound because of its scarless donor healing, and good color match in face. Inspite of the advantages of scalp as a skin donor site during split thickness skin graft some authors report the frequent postoperative folliculitis, and partial alopecia on scalp donor site. We had experienced 21 burn patients, who had full thickness skin defects caused by burn injuries, were successfully managed with scalp donor split thickness skin graft with our optimal donor management protocols. METHODS: We had 21 deep burn patients, who were managed with thin STSG from scalp donor for coverage of full thickness skin defects. The operative techniques of the harvesting scalp STSG, and scalp donor dressing care are such as followings. After the infiltration of the donor scalp area with 1:1,000,000 epinephrine diluted with saline, then usually 0.012~0.015 inch thickness skin were harvested with air driven Zimmer® dermatome. On postoperative 6days, the one layer of adhered Vaseline gauze at donor scalp site was manually removed, and the entire scalp was cleansed with water. After then the daily hair washing was continued to remove the desiccated scaly crust with thick exudate at the growing hair and follicle. RESULTS: The scalp split thickness skin graft at the recipient sites in 21 burn patients were survived completely. Ranges of patient's age were 8 months to 56. The size ranges of scalp STSG were 2×2 cm~12×15 cm. The grafted scalp donor STSG were survived in all cases. The mean epithelialization period of scalp donor was 7.2 days. The one case of transient folliculitis (5%) from the postoperative 8days was occurred, and it was disappeared slowly with vigorous daily hair washing, antiseptics and systemic antibiotics. In all cases, there was no micro-alopecia or alopecia, and scars in scalp donor after follow ups. The donor site pain was markedly disappeared within 1~2 postoperative day. The hemorrhage from the scalp donor site during operation was not noticeable. The newly growing hair at the scalp donor was noted from the 3 postoperative days by palpation or unaided eye through the Vaseline gauze dressing. The average lengths of newly growing hair shaft are 2~3 mm in postoperative 8 days, 5~6 mm in postoperative 14 days. CONCLUSION: We had successful reconstruction of postburn skin defects using scalp donor split thickness skin graft without donor scars, persistent folliculitis or alopecia on scalp donor. From the postoperative 6~7 days after harvesting the scalp donor STSG, early vigorous daily washing with water and open dressing of scalp donor site should be recommended in order to prevent folliculitis. After long-term follow ups, the scalp split skin grafted recipient sites showed reliable, and relatively good color match with surrounding skin in face and dorsum of hand.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating

Abstract High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. Objective: The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. Material and Methods: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). Results: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

Speckled pigmentation and palmoplantar keratoses leading to the mass detection of chronic arsenic poisoning

Arsenic is a known human carcinogen and skin manifestations are the earliest and most specific markers of chronic arsenic poisoning. A 43-year-old man from Luzon presented at the Section of Dermatology with a one-year history of hyperkeratotic papules and plaques on the palms and soles. Numerous round hypopigmented macules were scattered on the upper back. Initial 24-hour urine arsenic level was elevated at 288mcg/liter. The patient underwent successful chelation with N-acetylpenicillamine and the palmoplantar keratoses were treated with cryotherapy and topical 20% salicylic acid in white petrolatum. In cooperation with the Department of Health, a comprehensive health and environmental assessment was conducted in the affected communities. This case highlights the role of dermatologists in the diagnosis and management of this public health problem.

Neumonía lipoidea tras aspiración accidental de vaselina / Lipoid pneumonia after accidental aspiration of vaseline

La neumonía lipoidea es una patología pulmonar poco conocida que resulta de la acumulación de lípidos de origen endógenos o exógenos a nivel alveolar pulmonar. Suele ser subdiagnosticada dada que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares, muchas veces no llegándose al diagnóstico preciso de esta. Dentro de los datos anamnesticos el antecedente, ya sea de uso reciente o de larga data, de la ingesta y/o inhalación accidental o voluntaria de alguna sustancia que contenga algún componente lipídico en su base es primordial. Pacientes de edades extremas suelen ser los más afectados y en quienes debemos tener la sospecha diagnóstica. Su diagnóstico es complejo requiriendo historia clínica, imágenes que apoyen un compromiso pulmonar (de preferencia tomografía computada) e idealmente la detección intraalveolar de lípidos y macrófagos cargados de éstos en el lavado broncopulmonar. Actualmente, no existe consenso sobre el manejo específico de esta patología. Lo importante es identificar la causa y descontinuar su uso. En neumonía lipoidea de causa exógena se recomienda manejo de soporte según sea la presentación clínica del paciente.

Lipoid pneumonia (LN) is an unknown lung disease due to lipid accumulation, of endogenous or exogenous origin, at the pulmonary alveolar level. Often it is underdiagnosed because of its nonespecific presentation whose differential diagnosis are other bronchopulmonary diseases. Anamnestic data, either recent or long-standing use of the intake and / or accidental or deliberate inhalationof any substance containing a lipid component as its base is relevant information. Extreme age groups are the most affected, and in whom wemust suspect LN diagnosis. The diagnosis of LN is complex and requires a complete medical history, images that support lung involvement (preferably computed tomography), and ideally intraalveolar detection of lipid-ladenmacrophages in the bronchoalveolar lavage. Currently, there is no consensus on the specific management of this disease. It is important to identify the cause and discontinue its exposure. Whatever the varity of the clinical presentation, support magement is recommended to treat LN.

Efficacy and safety of petroleum jelly versus permethrin 1% shampoo in the treatment of Prediculosis capitis: An assessor-blinded, randomized controlled trial

BACKGROUND: The high rates of infestation, treatment failures and treatment costs have created the search for new therapies againts head lice. OBJECTIVE: We compared the efficacy and safety of scalp occlusion with petroleum jelly (PJ) versus permethrin 1% shampoo against Pediculus humanus capitis among school-aged children METHOD: Seventy-seven children were diagnosed with Pediculosis capitis. Thirty-eight subjects did eight-hour scalp occlusion with PJ, and 39 used permethrin shampoo, both followed by nit combing. Treatments were applied once weekly for three consecutive weeks. Patients were assessed at weeks 1,2,3 and 11. The primary outcome was the proportion of cured subjects and change in quality of life (QOL) scores om week 3 of follow-up. Cure was defined as the absence of variable lice on the hair/scalp or nits on the hair shaft attached within one centimeter from the scalp on visual examination.Secondary outcomes were relapse rate at week 11 ,cosmetic acceptability and adverse events. Effects on QOL were measured using the Dermatology Life Quality Index at baseline and at the end of the third week of treatment. RESULTS: At Week 3, cure achieved in 47% (18/38) in PJ group 52% (17/33) in permethrin group (RRR 6.7%, 95% Cl: -40.4% to 38%). Relapse rate in the 12th week were 44% (8/18) and 58% (10/17), respectively (p=0.486, Fisher's test ). The differences in treatment effects were not statistically significant. CONCLUSION: Petroleum jelly scalp occlusion was comparable in cure rates to permethrin. PJ can be a safe, affordable alternative to permethrin as a pediculicide.

Usefulness of Silicone Net Dressing in Fixation of Skin Grafts

PURPOSE: Skin graft may fail for a number of reasons. Hematoma or seroma formation prevents graft adherence. Traditionally tie-over dressing has been used in skin graft fixation, but skin graft in convex and narrow place like fingers or toes, tie-over dressing is hard to be applied. And Vaseline gauze over graft often adheres to graft by exudate into gauze fibers and hardening, and may cause damage to graft in dressing change. We report successful results of using silicone net dressing in fixation of split thickness skin graft over these place. METHODS: After skin graft, the silicone net, Mepitel(R) (Molnlycke Health Care, Box 13080, SE-402 52 Goteborg, Sweden) was applied over the graft followed saline wet gauze dressing in 25 patients. 13 cases were on finger, 8 cases were on foot or toes, 4 cases were on anterior chest. RESULTS: In 22 cases, there were no hematoma or seroma formation, Mepitel(R) maintained 5 days after skin graft. And then, Mepitel(R) was removed from the graft. In 3 cases, there were hematoma formation, Mepitel(R) was removed at 3 days after skin graft. In all cases, grafts were taken well without maceration or skin eruption. CONCLUSION: The silicone net, Mepitel(R), is dressing material made of silicone gel bound to a pliable polyamide net, and it can provide uniform pressure to the graft, even in convex and narrow place. And net like structure allows the exudates of the wound to pass freely into the secondary absorbent dressing and easier to remove from the grafts than Vaseline gauze. We think that the use of a Mepitel(R) is a efficient tool for securing skin grafts.

Retrospective Clinical Trial of Fusidic Acid versus Petrolatum in the Postprocedure Care of Clean Dermatologic Procedures

BACKGROUND: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. OBJECTIVE: This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. METHODS: Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. RESULTS: A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. CONCLUSION: Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.

Evaluation of wound healing effects between Salvadora a persica ointment and Solcoseryl jelly in animal model

In this research study very first time a herbal ointment contain 10% Salvadora persica extract was compared with Solcosseryl jelly 10% and blank Vaseline to evaluate wound healing effects using excision wound healing model in animals. Three groups of rats [n-6] were experimentally wounded on the back of their neck. Group I was dressed with Vaseline containing 10% test drug, Group II was treated with thin layer of Solcoseryl jelly 10% as reference drug while Group III was dressed with thin layer of blank Vaseline as control group. The effect of vehicle on rate of wound healing were assessed and in all cases there were progressive decreased in wound area with time but wound dress with Vaseline containing S. persica extract and wound treated with Solcosseryl jelly significantly healed earlier than those treated with Vaseline. It is concluded that S. persica extract significantly enhance the acceleration rate of wound enclosure in rats

Pseudoaneurysm of the Inferior Alveolar Artery after Surgical Curettage for Keratocystic Odontogenic Tumor: A Case Report

A Case of Allergic Contact Dermatitis to Petrolatum / 대한피부과학회지

No abstract available.

The Effects of Topical Agent (Kelo-Cote or Contractubex) Massage on the Thickness of Post-Burn Scar Tissue Formed in Rats

BACKGROUND: We conducted an experimental study to compare the effect of massage using topical agents (Kelo-cote or Contractubex) on scar formation by massaging the healed burn wound on the dorsal area of Sprague-Dawley (SD) rats. METHODS: Four areas of second degree contact burn were made on the dorsal area of each of 15 SD rats, using a soldering iron 15 mm in diameter. After gross epithelialization in the defect, 15 SD rats were randomly divided into four groups: the Kelo-cote group, Contractubex group, Vaseline group, and control group. Rats in three of the groups (all but the Control group) were massaged twice per day for 5 minutes each day, while those in the Control group were left unattended. For histologic analysis, we performed a biopsy and evaluated the thickness of scar tissue. RESULTS: In the Kelo-cote and Contractubex groups, scar tissue thicknesses showed a significant decrease, compared with the Vaseline and control groups. However, no significant differences were observed between the Kelo-cote and Contractubex groups. In the Vaseline group, scar tissue thicknesses showed a significant decrease, compared with the control groups. CONCLUSIONS: The findings of this study suggest that massage using a topical agent is helpful in the prevention of scar formation and that massage only with lubricant (no use of a topical agent) also has a considerable effect, although not as much as the use of a topical agent. Thus, we recommend massage with a topical agent on the post-burn scar as an effective method for decreasing the scar thickness.

Petroleum jelly versus tea tree oil and tea tree facial wash lid scrub in patients with Blepharitis associated with above-normal Demodex count

Purpose@#To determine the effectiveness of lid scrub with petroleum jelly versus lid scrub with tea tree oil and tea tree facial wash in patients with symptomatic blepharitis associated with above-normal Demodex counts@*Methods@#Patients with symptomatic anterior blepharitis (AB), meibomian gland dysfunction (MGD), or mixed blepharitis (MB) were recruited into the study. Pertinent data, including ocular symptoms and findings, were recorded. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston method for lash epilation. Patients with below-normal Demodex counts (DC <5) were excluded while those with DC ≥5 were randomly assigned to one of either treatment regimen: (1) lid scrub with tea tree oil and tea tree facial wash (The Body Wash®, control group), or (2) lid scrub with petroleum jelly (Apollo Pure Petroleum Jelly®, study drug). Lid scrub with the tea tree oil (TTO) or petroleum jelly was administered at the clinic during the initial visit and at 2-week intervals thereafter for 6 weeks. Patients were instructed to apply tea tree (TT) facial wash or petroleum jelly at home on specified intervals daily. DC posttreatment was recorded, and digital photographs of the eyelids were taken at the end of treatment.@*Results@#Thirteen patients were included in the study; 5 in the TTO and 8 petroleum jelly. In the TTO group, 3 patients had decrease in DC and 2 an increase, but all patients reported decrease in the severity and frequency of ocular symptoms. In the petroleum jelly group, 5 patients had decrease in DC after 6 weeks, while the remaining 3 had opposite results. All reported a general improvement in their symptoms. No adverse reactions were observed in either treatment groups.@*Conclusion@#Lid scrub with petroleum jelly caused a significant reduction (p<0.05) in Demodex counts compared to lid scrub with tea tree oil and tea tree facial wash. Petroleum jelly may have some effect in the eradication of Demodex mites in cases of Demodex-induced blepharitis. Although lid scrub with petroleum jelly and tea tree oil and tea tree facial wash both produced a decrease in Demodex counts and a decrease in the frequency and severity of ocular symptoms after 6 weeks of treatment, the presence of some conflicting results suggests that further studies with more patients should be initiated.

Clinical Application of Polyether Ester Urethane in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the clinical effect of intraoperative application of polyether ester urethane (Nasopore(R)) in endonasal dacryocystorhinostomy. METHODS: Endonasal dacryocystorhinostomy was performed on 77 eyes diagnosed with nasolacrimal duct obstruction between January 2010 and February 2011. Nasopore(R) was applied to the newly-formed internal lacrimal opening in the experimental group (41 eyes), and vaseline gauze was applied in the control group (36 eyes). For the evaluation of clinical effects regarding postoperative adhesion and stenosis of the internal lacrimal opening, subjective symptom improvement, lacrimal irrigation tests, and endoscopic examinations were performed at 1 week, 2 weeks, 1 month, 3 months, and 6 months, postoperatively. RESULTS: In subjective symptom improvement and lacrimal irrigation tests, differences between the 2 groups were not statistically significant. In endoscopic findings, the Nasopore(R) group showed significantly lower severity of adhesion and stenosis of the internal lacrimal opening at 1 week, 2 weeks, and 1 month after operation (p < 0.05). CONCLUSIONS: Application of the Nasopore(R) may effectively reduce initial postoperative adhesion or stenosis of the internal lacrimal opening after endonasal dacryocystorhinostomy and has usefulness as an auxiliary method.

The Usefulness of Nasal Packing with Vaseline Gauze and Airway Silicone Splint after Closed Reduction of Nasal Bone Fracture

BACKGROUND: Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. METHODS: Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. RESULTS: In the experimental group, the nasal respiration volume 1 day after surgery remained at 71.3%+/-6.84% on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group (2.80+/-0.4) was not significantly different from the control group (2.88+/-0.33). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. CONCLUSIONS: The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.