Keloids treated with excision followed by radiation therapy.

BACKGROUND: In the treatment of keloids surgical excision followed by radiation therapy provides the highest reported control rates of 72% to 92%. OBJECTIVE: We evaluated the effectiveness of excision followed by radiation therapy in the treatment of keloids and compared the efficacy of orthovoltage and electron beam radiation. METHODS: One hundred twenty-six keloids were treated with radiation therapy after surgical excision. Median follow-up period was 12 years. Recurrence rate, side effects, and effectiveness of therapy were assessed. Data were analyzed with multivariate analysis for significant objective and subjective factors. RESULTS: Higher posttreatment recurrence rates were noted with keloids forming at infected sites and in patients with a family history. No increased likelihood of recurrence was noted with respect to patient age, sex, or ethnicity; keloid size or location; individual keloid history; or prior therapy or radiation type used. CONCLUSION: Excision followed by radiation therapy is a useful and effective method of keloid eradication, particularly in cases in which lesions are disfiguring or refractory. Electron beam radiation offers no advantage over orthovoltage as a treatment.

Factor VIII complex in chronic renal failure: influence of protein C, fibrinolysis and diabetes mellitus.

Chronic renal failure causes elevations of factor VIII coagulant activity and Factor VIII-related antigen even before the patients enter chronic hemodialysis. The change from control of Factor VIII ristocetin cofactor does not reach significance. The elevations are not effected by entering onto hemodialysis. These parameters are the same for non-diabetic and diabetic patients. Protein C, plasminogen and total fibrinolytic capacity are normal in diabetic and non-diabetic patients, with or without hemodialysis for chronic renal failure. However, before entering onto hemodialysis some of these parameters had negative correlation coefficients with parts of the factor VIII complex among the diabetic and non-diabetic patients. These negative correlates turned positive after hemodialysis. Thus, there are differences in these catabolic mechanisms for factor VIII when hemodialysis is used for diabetic and non-diabetic patients with chronic renal failure.