The long-term efficacy of heliotherapy in ameliorating disease severity and improving the quality of life in patients with atopic dermatitis.

Introduction: Atopic dermatitis is one of the most common chronic inflammatory skin diseases adversely affecting the quality of life of both patients and their families. Heliotherapy, a treatment modality with high anti-inflammatory effects, is unjustifiably neglected in a country that has plenty of sunshine days throughout the year, but does not own the Cabinet for artificial phototherapy. Aim: To evaluate the power of individual heliotherapy in ameliorating disease severity and improving the quality of life, as well as to compare the results with those obtained from the studies evaluating group heliotherapies. Material and methods: We assessed disease severity and quality of life at three times: before commencing heliotherapy (Time 1), immediately after heliotherapy (Time 2), and 3 months after heliotherapy (Time 3). The tools we used are authorized scoring systems and questionnaires: SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI) and Severity of Pruritus Scale (SPS). Results: A total of 24 patients were analysed in this observational study. Good clinical results were observed with a statistically significant decrease in SCORAD index by 40% and 31.1% at Time 2 and Time 3, respectively (p < 0.001). Improvement in the quality of life was statistically significant showing a decrease in DLQI score by 31.57% 3 months after heliotherapy, comparing to baseline values (p < 0.001). Conclusions: Our results revealed that 2-week heliotherapy has shown satisfying, long-lasting effects in clearing the skin changes, reducing and ameliorating pruritus intensity, as well as improving the quality of life.

Clinical aspects of reconstruction of the lower third of the leg with fasciocutaneous flap based on peroneal artery perforators.

BACKGROUND/AIM: Fasciocutaneous flaps are tissue flaps that include the skin, subcutaneous tissue and underlying fascia, and are based on the septocutaneous system of blood vessels. They have a number of characteristics that give them an advantage in many cases, especially in treatment of lower extremity defects. The aim of this study was to clinically analyse the outcomes of patients surgically treated with a. peroneae perforator-based reverse flaps of the lower leg. METHODS: This prospective study was conducted on a group of 22 patients with tissue defects in the lower third of the lower leg and foot. All the 22 patients underwent standard diagnostic procedures and the preoperative preparation for spinal anesthesia. During the surgery, the location of the recipient site with a future flap and an accompanying vascular stem was marked. Having prepared the recipient site in accordance with the surgical principles, the lobe was prepared, rotated and positioned in the defect region. RESULTS: The proportion of male to female patients in our study group was 19 (86%) to 3 (14%), respectively. The maximal defect frequency (14 or 63%) was found in the age group of 30-50 years, i.e. working-age people. Trauma in 16 (72%) of patients was the most common reason for surgical treatment. The most common defects our patients had were found in the distal third of the leg (5, 22%), medial malleolus (4, 18%), the dorsum of the foot (3, 13%) and the foot (4, 18%). The number of lobes (18, 81%) applied in the course of our clinical study was statistically more significant (p < 0.05) than the number of lobes applied along with the skin autografts (4, 19%). During the final follow-up of the applied lobes, 6 (27.2%) of early and 2 (9%) of late complications were observed, making a total of 36.2% of complications occurring in the applied lobes, of which only 1 was lost. CONCLUSION: Clinical application of a. suralis superficialis mediani-based reverse flap is justified by a high percentage (95.50%) of preserved lobes. Functional recovery of Achilles tendon injuries treated with the fasciocutaneous flap appeared to be effective. The results obtained during the clinical investigation can be very helpful in using this flap more optimally and more often in a wide range of different reconstructive surgical procedures in the field of plastic surgery.

Liver enlargement associated with opportunistic infections in patients with human immunodeficiency virus infection.

BACKGROUND AND AIM: Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to determine the frequency of liver enlargement and its association with opportunistic infections in patients with HIV infection. PATIENTS AND METHODS: A total of 400 HIV-infected patients were investigated. Commercial kits (Ortho EIA; BioRad, ELISA) were used for detection of serum specific antibodies to HIV, hepatitis C virus, surface antigen of hepatitis B virus, and cytomegalovirus. Liver tissues were stained for various microorganisms. The electronic data base SPSS for Windows (version 10.0) was used for statistical analysis. A p <0.05 was considered significant. RESULTS: Ultrasonographic screening revealed liver enlargement in 63.75% of HIV patients. In 40.7% the right lobe size varied from 140 mm to 160 mm. Of those with hepatomegaly, 60.7% had AIDS. Hepatitis C and B viruses and Mycobacterium tuberculosis were detected in 50%, 29% and 18% of patients, respectively. Histological changes were mostly non-specific. Liver pathology depended on the degree of cellular immune deficiency, particularly in patients with HBV co-infection. In a minority of patients (32.5%), the histology revealed granulomatous hepatitis. Liver function tests were abnormal in 46%. CONCLUSION: Liver enlargement is common in HIV-infected patients mostly in association with hepatitis C and B viruses and Mycobacterium tuberculosis.