Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma.

INTRODUCTION: Few studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure. METHODS: A total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure ("Hautkrebs"). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment. RESULTS: Ninety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05). CONCLUSION: Impaired health-related quality of life is correlated with a patient with skin cancer's age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.

Mucosal advancement flap versus primary closure after vermilionectomy of the lower lip.

BACKGROUND: Post-vermilionectomy defect closure by a mucosal advancement flap is a well-established method, although moderate morbidity may accompany the procedure, especially in elderly patients. The objective of the present study was to compare a simple primary closure (PC) for reconstruction after complete resection of the vermilion (vermilionectomy) with closure using a mucosal advancement flap (MAF). METHODS: After margin-controlled vermilionectomy, 18 patients with actinic cheilitis (n=5) or squamous cell carcinoma in situ (n=13) of the lower lip were included in the present study. Patients were randomized into one group receiving PC (n=8) and a second group receiving MAF closure (n=10) for reconstruction of the surgical defect on the lower lip. All complications, esthetic outcomes (EOs), and cut-suture times were documented. RESULTS: In the MAF group, patients' mean EO score on a 10-point scale was 8.4, and the surgeons' mean EO rate was 7.8. In the PC group the patients' mean EO score was 7.5 and the surgeons' mean EO rate was 6.4 for the reconstruction achieved. The rate of side effects was significantly higher in the MAF group than in the PC group (p<.05). The cut-suture times were significantly shorter for PC (29 minutes) than MAF (37.8 minutes; p<.05). CONCLUSION: MAF is the method of choice and has good functional and cosmetic outcomes, although elderly patients with different comorbidities that need to be protected from unnecessary strain could potentially benefit from PC.

Epidemiology of aeromedical evacuation: an analysis of 504 cases.

BACKGROUND: Increasing air travel has resulted in a significant increase in aeromedical evacuation (AE) over the past decade. However, there are limited epidemiological data available on the diagnosis, costs, and transport characteristics of AE cases. METHODS: Cases of AE by a relief organization (Workers' Samaritan Federation Germany) were analyzed based on the following criteria: age, sex, and diagnosis of the patient, ventilation mode, days of illness before transport, type of transport, flight routes, flying time, flight distance, type of aircraft, type and distance of connecting transport from the destination airport to the final hospital, total cost per repatriation, cost per flight-minute, and cost per flight-kilometer of each transport type. RESULTS: A total of 504 patients (273 males, 231 females, aged 42 d-96 y, median 66 y) were included in the study. The top three diagnoses for adults were fracture of the femoral neck (n = 74, 15%), stroke (n = 69, 14%), and myocardial infarction (n = 39, 8%). Transport was carried out with an air ambulance (n = 391, 78%, 73.67 €/min), a scheduled aircraft with regular seating (n = 62, 12%, 17.57 €/min), a stretcher in a scheduled aircraft (n = 48, 10%, 35.28 €/min), or a patient transport compartment installed on board a scheduled aircraft (n = 3, < 1%). CONCLUSIONS: As the demand for AE is likely to increase in the future, the cost-effectiveness and selection of the appropriate form of air transportation, while assuring the right medical response, will be of increasing importance. Patients are likely to benefit from further epidemiological assessments like those presented in this study.

An inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis: a case report.

INTRODUCTION: Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We describe a patient with an inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis mimicking acute appendicitis. Considering the rare localization, this is the first report of this kind in the literature. CASE PRESENTATION: We present the case of a 50-year-old Caucasian man who presented with classic signs of acute appendicitis. On clinical exam, McBurney and Blumberg signs were positive. Additionally he had fever, leucocytosis (12/nl) and a slight increase in C-reactive protein (1 mg/dl). Based on the clinical presentation, the patient was taken to the operating room to perform an appendicectomy. Surprisingly, we found an inflamed necrotic appendix epiploicum, located immediately on a non-inflamed appendix vermiformis, which was ligated and excised. CONCLUSION: This case report demonstrates that epiploic appendagitis can mimic acute appendicitis on clinical exam and should be considered in the broad spectrum of abdominal disease presenting with right lower quadrant pain.

Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases.

INTRODUCTION: In-flight medical and surgical emergencies (IMEs) onboard commercial aircrafts occur quite commonly. However, little epidemiological research exists concerning these incidents. METHODS: Thirty-two European airlines were asked to provide anonymous data on medical flight reports of IMEs for the years 2002 to 2007. The total number of incidents was correlated to revenue passenger kilometers (rpk). Additionally, on-board births and deaths, flight diversions, flight routes (continental/intercontinental) and involvement of a physician or medical professional in providing therapy were analysed. RESULTS: Only four airlines, of which two participated in this study, were able to provide the necessary data. A total of 10,189 cases of IMEs were analysed. Syncope was the most common medical condition reported (5307 cases, 53.5%) followed by gastrointestinal disorders (926 cases, 8.9%) and cardiac conditions (509 cases, 4.9%). The most common surgical conditions were thrombosis (47 cases, 0.5%) and appendicitis (27 cases, 0.25%). In 2.8% of all IMEs, an aircraft diversion was performed. In 86% of cases, a physician or medical professional was involved in providing therapy. A mean (standard deviation) of 14 (+/- 2.3, 10.8 to 16.6 interquartile range) IMEs per billion rpk was calculated. CONCLUSIONS: The study demonstrates that although aviation is regulated by a variety of national and international laws, standardised documentation of IMEs is inadequate and needs further development.

Characteristics of refractory sweating areas following minimally invasive surgery for axillary hyperhidrosis.

BACKGROUND: Several surgical strategies have evolved for the treatment of focal axillary hyperhidrosis (FAH). However, nonresponders are found in every procedure. Until now no characterization of the recurrent sweating areas has been reported. The aim of this study was to characterize the axillary sweat area by using the iodine starch test in nonresponders prior to surgery. METHODS: Prior to minimally invasive surgery, 24 (15 females, 9 males) nonresponders underwent a repetitive iodine starch test to define the area of recurrent sweating. Size and distribution of the hyperhidrotic area were documented. RESULTS: Eighteen patients had undergone previous liposuction and six liposuction curettage. The size of recurrent sweating area was 10.2 cm(2) (range = 5.5-24.5 cm(2)). We were able to identify three different patterns of recurrent sweating: crescent (33%), circular (41%), and insertion-spot type (26%). CONCLUSION: Patterns of recurrent sweating areas may partially indicate insufficient planning and implementation of surgery, resulting in nonresponders. We suggest that exact preoperative identification of the hyperhidrotic area be mandatory.

HIV-associated facial lipoatrophy--review of current therapy options.

Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy for HIV-infected patients. Long-term complications of both HIV-infection and antiretroviral agents are therefore of increasing concern. Facial lipoatrophy (FLA) is a stigmatizing complication associated with sever social impact and a reduced quality of life for the patient. - We aimed to review the treatment options of HIV-associated FLA. The current treatments available for treating FLA are limited and can be classified in three main categories: I. Medial therapy, II. Injectables with different duration of effect, and III. Surgical treatment options. Medical therapy can provide a small benefit but improvement is, at best, slow and partial. Injectables can yield marked results but are costly, time consuming and may be associated with complications such as granuloma formation. Surgical options such as augmentation with specially designed silicone implants may be of benefit for severe cases of FLA, however, they are associated with higher surgical complications and do not account for the dynamic process of FLA. - To summarize, until today no ideal strategies for treatment of HIV-associated FLA are available, and new therapies are strongly required. heart disease.

Polymorphisms in NACHT-LRR (NLR) genes in atopic dermatitis.

Atopic dermatitis (AD) is a chronic skin disease affecting up to 15% of children in industrialized countries. AD belongs to the group of atopic disorders characterized by excessive immune reactions to ubiquitous antigens. Complex interactions between genetic and environmental factors have been suggested for atopic disorders. Dysregulation of the innate immune system appears crucial for the pathogenesis of AD. The NACHT-LRRs (NLRs) represent a group of innate immune receptors with special relevance for inflammatory processes. In order to investigate the role of variation in NLR genes for AD, we genotyped 23 single nucleotide polymorphisms (SNPs) in seven selected NLR genes (CARD4, CARD15, CARD12, NALP1, NALP3, NALP12, MHC2TA) in 392 AD patients and 297 controls by restriction enzyme digestion or TaqMan assays. Single-SNP analysis demonstrated significant associations of the CARD15_R702W variation and the NALP12_In9 T-allele with AD (P = 0.008 and P = 0.03, resp.; insignificant after Bonferroni correction). In the CARD4 gene, a rare haplotype was more frequent in AD patients than in controls. Interactions between all pairs of SNPs in the seven genes were analysed by logistic regression. Significant interactions comprised SNPs in the CARD4 gene (CARD4_In1 and CARD4_Ex6, P = 6.56 x 10(-7); CARD4_Prom und CARD4_Ex6, P = 2.45 x 10(-4)) and promoter polymorphisms in the CARD12 and NALP1 genes (P = 4.31 x 10(-4)). In conclusion, variation in individual genes from the NLR family as well as interactions within this group of innate immune receptor genes could play a role in AD pathogenesis. Investigations in other populations and functional studies are warranted to clarify contributions of NLR variation for this frequent skin disease.

A randomized, controlled, double-blind study evaluating melanin-encapsulated liposomes as a chromophore for laser hair removal of blond, white, and gray hair.

INTRODUCTION: Laser hair removal of blond and white hair is a complicated task with often unsatisfactory results as a result of a lack of laser-absorbing chromophore. In the present study, we investigated if repetitive external application of liposomal melanin (Lipoxome; Dalton Medicare B.V., Zevenbergschen Hoek, The Netherlands) enables removal of blond/white and gray hair with a diode laser. METHODS: Forty-two areas of blond, gray, or white facial and body hair of 16 patients were treated with a liposomal melanin spray (Lipoxome) and 3 cycles of 800 nm diode laser at intervals of 8 weeks (28-40 J/cm). A control group of 16 patients applied physiological saline spray before diode laser treatment. Hair regrowth was measured 8 weeks after each cycle and additionally 6 months after the last treatment by counting the number of terminal hairs compared with baseline pretreatment values. Complications and treatment outcomes were documented. RESULTS: Mean regrowth in the liposomal melanin group was 83% after 3 treatment cycles. Six months after therapy, average terminal hair count compared with baseline pretreatment showed 14% reduction. Although significant difference was seen compared with the control group showing a 10% reduction of hair growth after 6 months (P < 0.05), the clinical outcome was disappointing. CONCLUSIONS: Melanin-encapsulated liposomal spray in combination with diode laser treatment showed significant higher efficacy in the treatment of white and blond hair compared with a control group. However, the clinically observed hair reduction was so weak that additional effort as well as higher costs argues against the application of the tested formulation.

Angiokeratoma circumscriptum arranged in a systematized band-like pattern suggesting mosaicism.

A 10-year-old girl with vascular lesions that had been present since birth is reported. Initially, small red macules were limited to the legs, but later the lesions became more extensive. A hyperkeratotic aspect of the lesional skin surface had developed at the age of 2 years. On clinical examination, hyperkeratotic vascular lesions in a band-like distribution on the trunk, legs and face were observed. The type of lesion varied from discrete macules with no or slight hyperkeratosis to confluent, protruding verrucous plaques. The clinical and histopathological findings were consistent with a diagnosis of angiokeratoma circumscriptum. The systematized band-like arrangement observed in the present case strongly supports the concept that angiokeratoma circumscriptum reflects a mosaic state of a mutation that is so far unknown.

Surgical treatment of axillary hyperhidrosis: a study comparing liposuction cannulas with a suction-curettage cannula.

BACKGROUND: Suction-curettage is a minimally invasive surgical approach for the treatment of focal axillary hyperhidrosis. Studies comparing the efficacy of different surgical cannulas are missing. Therefore, we gravimetrically compared a specially designed cannula versus 2 standard liposuction cannulas. METHODS: Axillary suction-curettage was performed in 42 patients (n = 42). Fourteen patients (n = 14) were operated with a 1-hole liposuction cannula, 14 patients (n = 14) with a larger 3-hole liposuction cannula, and 14 (n = 14) with a sharp suction-curettage cannula. Sweat rates in mg/min were measured by gravimetry before and 6 months after surgery. RESULTS: Sweat rate in the 1-hole liposuction cannula group was significantly reduced from 57.65 +/- 5.85 mg/min to 32.58 +/- 4.64 mg/min (P < 0.001), corresponding to a reduction of 44.15%. Patients operated with the larger 3-hole liposuction cannula showed a significant reduction of sweat rate from 63.95 +/- 8.25 mg/min to 33.14 +/- 6.25 mg/min (P < 0.001), corresponding to a reduction of 49.19%. The largest reduction of sweat rates (63.07%) was achieved with the suction-curettage cannula (61.85 +/- 9.03 mg/min to 21.27 +/- 4.42 mg/min (P < 0.001). No severe side effects were observed. CONCLUSION: Due to the higher efficacy we recommend performing suction-curettage with a sharp suction-curettage cannula.

Shave therapy for chronic venous ulcers: a guideline for surgical management and postoperative wound care.

This article presents a practice-oriented concept in the treatment of chronic venous ulcers with accompanying lipodermatosclerosis by shave therapy. Besides the indication for shave therapy, we focus on the operative technique and important therapy during postoperative convalescence time.