Effective treatment of Hailey-Hailey disease with a long-pulsed (5 ms) alexandrite laser.

Familial benign pemphigus (Hailey-Hailey disease) is often resistant to conventional treatments. This report describes a 35-year-old Asian American male with a 12-year history of recalcitrant Hailey-Hailey disease who was treated with a long-pulsed alexandrite laser. Fluences ranged from 12 to 20 J/cm with a 5-ms pulse duration (spot sizes: 10-15 mm). Cold air cooling was used during the sessions. There was 50% improvement noted after the first treatment. Within 10 treatments, there was 95% clearance. Complete resolution was achieved by the thirteenth treatment. The lesions have been clear or nearly clear (greater than 95%) for the past 2 years. Once clearance was achieved, five maintenance laser treatments were initiated at 3-month intervals and eventually discontinued for 12 months without relapse.

Microfluidics for T- lymphocyte cell separation and inflammation monitoring in burn patients.

Severe burns result in T lymphocyte specific immunologic changes. In addition to decreased levels of circulating lymphocytes, changes in cytokine secretion and receptor expression also take place. Our finer understanding of the inflammatory response has led to the development of immune-targeted therapeutics, requiring specialized gene-expression monitoring. The emerging field of bio-micro-electromechanical systems can be used to isolate highly pure T lymphocytes in a clinically relevant and timely manner for downstream genomic analysis. Blood samples from healthy volunteers and burn-injured patients were introduced into microfluidic devices developed in our laboratory. Utilizing cell-affinity chromatography for positive selection of T lymphocytes, the devices served as a platform for RNA extraction and downstream cytokine analysis via quantitative real-time polymerase chain reaction (PCR). From a 0.5-mL whole blood sample, the microfluidic devices captured highly pure T lymphocytes from healthy volunteers and burn-injured patients. Cell capture was of sufficient quantity, and extracted RNA was of sufficient quality, for evaluating the gene expression of cytokines: interferon-gamma, interleukin-2, interleukin-4, and interleukin-10. Microfluidics is a useful tool in processing blood from burn-injured patients. Though in its very early stages of development, cell-specific information obtained by this platform/technology will likely be an important component of near-patient molecular diagnostics and personalized medicine.

Clinical microfluidics for neutrophil genomics and proteomics.

Neutrophils have key roles in modulating the immune response. We present a robust methodology for rapidly isolating neutrophils directly from whole blood with 'on-chip' processing for mRNA and protein isolation for genomics and proteomics. We validate this device with an ex vivo stimulation experiment and by comparison with standard bulk isolation methodologies. Last, we implement this tool as part of a near-patient blood processing system within a multi-center clinical study of the immune response to severe trauma and burn injury. The preliminary results from a small cohort of subjects in our study and healthy controls show a unique time-dependent gene expression pattern clearly demonstrating the ability of this tool to discriminate temporal transcriptional events of neutrophils within a clinical setting.

Effects of ambient room temperature on cold air cooling during laser hair removal.

Forced air cooling is a well-established technique that protects the epidermis during laser heating of deeper structures, thereby allowing for increased laser fluences. The goal of this prospective study was to identify whether an elevation in ambient room temperature influences the efficacy of forced air cooling. Skin surface temperatures were measured on 24 sites (12 subjects) during cold air exposure in examination rooms with ambient temperatures of 72 degrees F (22.2 degrees C) and 82 degrees F (27.8 degrees C), respectively. Before cooling, mean skin surface temperature was 9 degrees F (5 degrees C) higher in the warmer room (P < 0.01). Immediately after exposure to forced air cooling (within 1 s), the skin surface temperature remained considerably higher (10.75 degrees F, or 5.8 degrees C, P < 0.01) in the warmer room. We conclude that forced air cooling in a room with an ambient temperature of 82 degrees F (27.8 degrees C) is not as effective as in a room that is at 72 degrees F (22.2 degrees C).

Heroin dependence in an English town: 33-year follow-up.

BACKGROUND: There has been no long-term study of people addicted to injected heroin who have been treated without the prescribing of substitute opioids. AIMS: To investigate the outcome for patients treated for injected heroin addiction 33 years after they were first seen, and 26 years after they were first followed up, in terms of sustained abstinence, continuing maintenance on methadone and deaths. METHOD: Eighty-six people with heroin addiction first seen in in 1966-1967 in a small town in the south-east of England were located and their clinical state assessed using multiple sources, including personal interviews with a proportion of the cohort. RESULTS: Forty-two per cent of the cohort had been abstinent for at least 10 years; 10% were taking methadone and were classified as addicted; and 22% had died. Eight percent of the cohort could not be located. CONCLUSIONS: Results proved favourable in the above three parameters compared with other long-term studies.

Treatment of Acanthosis nigricans of the axillae using a long-pulsed (5-msec) alexandrite laser.

BACKGROUND: Acanthosis nigricans of the axillae is a common cutaneous disorder that is difficult to treat. OBJECTIVE: The objective was to assess the efficacy and safety of a long-pulsed alexandrite laser (5 msec) in the treatment of acanthosis nigricans of the axillae. METHODS: A single axilla was treated using the long-pulsed alexandrite laser. Ten sessions were required, at fluences of 16 to 23 J/cm2 using either 10- or 12.5-mm spot sizes. The untreated axilla served as a control. RESULTS: Greater than 95% clearance was achieved after seven sessions. There was no recurrence after 2 years. The untreated axilla was unchanged. CONCLUSIONS: The long-pulsed alexandrite laser can effectively and safely treat acanthosis nigricans of the axillae.

The Effects of TENS, Heat, and Cold on the Pain Thresholds Induced by Mechanical Pressure in Healthy Volunteers.

This study was aimed to test whether the administration of transcutaneous electrical neural stimulation (TENS), heat or cold alone, or the coadministration of TENS in combination with heat or with cold may alter the thresholds of the sensory (algosity) and the affective (unpleasantness) dimensions of experimental pain. Mechanical pain induced by a pressure algometer was applied to the tibial shaft of 180 healthy volunteers before and after random application of one of the six following modalities: sham-stimulation, cold, heat, TENS, combination of TENS + cold, or combination of TENS + heat. All modalities were applied in the same (L4) dermatome with the use of Thermotens (Mediseb Technologies Ltd., Hertzelia, Israel), a device which produces quantifiable combinations of thermal and electrical modalities separately or simultaneously. Only the combination of TENS + heat significantly elevated the thresholds of algosity (from 221 mmHg to 262 mmHg, p < 0.01) and of unpleasantness (from 134 ± 9 to 197 ± 9 mmHg; p < 0.001). These findings suggest that the coadministration of several physical modalities can be more efficacious in the treatment of pain than each modality alone.