Included Skin Erythema Research Articles

High endogenous CCL2 expression promotes the aggressive phenotype of human inflammatory breast cancer

Inflammatory Breast Cancer (IBC) is a highly aggressive malignancy with distinct clinical and histopathological features whose molecular basis is unresolved. Here we describe a human IBC cell line, A3250, that recapitulates key IBC features in a mouse xenograft model, including skin erythema, diffuse tumor growth, dermal lymphatic invasion, and extensive metastases. A3250 cells express very high levels of the CCL2 chemokine and induce tumors enriched in macrophages. CCL2 knockdown leads to a striking reduction in macrophage densities, tumor proliferation, skin erythema, and metastasis. These results establish IBC-derived CCL2 as a key factor driving macrophage expansion, and indirectly tumor growth, with transcriptomic analysis demonstrating the activation of multiple inflammatory pathways. Finally, primary human IBCs exhibit macrophage infiltration and an enriched macrophage RNA signature. Thus, this human IBC model provides insight into the distinctive biology of IBC, and highlights potential therapeutic approaches to this deadly disease.

Simulated Angiography Using a Bleomycin Mixture for Sclerotherapy of Lymphatic Malformations.

Objective: Repeat sclerotherapy of lymphatic malformations (LMs) is challenging. Accordingly, the aim of the present article is to describe a simulated angiography technique—a new method of bleomycin infusion for the treatment of LMs to achieve better outcome(s) in fewer sessions.Materials and Methods: A retrospective analysis of information housed in a prospectively collected LM database was performed. Patients with LM, revealed on imaging examination and treated using a simulated angiography technique with a bleomycin mixture, were included in the study. Visual evaluation and imaging examinations were performed to evaluate clinical improvement.Results: A total of 151 patients (82 male, 69 female; mean age, 28.29 months [range 1 month−12 years]) with LMs were included in this study. Excellent visual and radiological resolution was observed in 77% (117/151) of lesions, 17% (26/151) had significant improvement, and 8 patients exhibited a slight response. The number of procedures per patient varied from 1 to 5, and the average number of treatment sessions for LM was 1.34. Side effects included skin erythema at the injection site, local swelling, mild tenderness, and fever, which were controlled by oral antipyretics. No serious side effects were observed.Conclusions: Simulated angiography using a bleomycin mixture for sclerotherapy of LMs in children was feasible and demonstrated good effect with little trauma and less time per treatment.

Rash and neutropenia after the administration of oxaliplatin and 5-fluorouracil plus calcium folinate injection: a case report

A 56-year-old male patient was admitted due to a "rectal malignant tumor". He suffered from rash and neutropenia after multiple chemotherapy sessions including oxaliplatin, 5-fluorouracil (5- FU), and calcium folinate injection (CF) which are called FOLFOX regimen for short. The rash was treated with methylprednisolone + promethazine + calcium gluconate, and the neutropenia was treated by subcutaneous injection of the Recombinant Human Granulocyte Colony-Stimulating Factor Injection, the symptoms were relieved. Moreover, rashes and neutropenia are known common adverse reactions after intravenous administration of FOLFOX regimen. Based on the patient's symptoms and the timing of drug administration, a diagnosis of "rash and neutropenia due to the use of FOLFOX regimen" was made. Oxaliplatin and CF may also cause allergic reactions, including skin erythema and anaphylactic shock, etc. Once allergic reaction occurs, the fatality rate is higher than that of Penicillin. Therefore, sufficient attention should be paid to the patients reported in this paper who received FOLFOX regimen for multiple times and had multiple rashes and adverse reactions of neutropenia. Medical staff should closely monitored the adverse reactions and changes in vital signs of patients treated with this regimen during chemotherapy, and the chemotherapy regimen should be adjusted or terminated when necessary. The adverse reactions reported in this article deserve clinical attention.

Protection against UVB-Induced Photoaging by Nypa fruticans via Inhibition of MAPK/AP-1/MMP-1 Signaling.

Ultraviolet B (UVB) irradiation is major causative factor in skin aging. The aim of the present study was to investigate the protective effect of a 50% ethanol extract from Nypa fruticans (NF50E) against UVB-induced skin aging. The results indicated that NF50E exerted potent antioxidant activity (IC50 = 17.55 ± 1.63 and 10.78 ± 0.63 μg/mL for DPPH and ABTS-radical scavenging activity, respectively) in a dose-dependent manner. High-performance liquid chromatography revealed that pengxianencin A, protocatechuic acid, catechin, chlorogenic acid, epicatechin, and kaempferol were components of the extract. In addition, the extract exhibited elastase inhibitory activity (IC50 = 17.96 ± 0.39 μg/mL). NF50E protected against UVB-induced HaCaT cell death and strongly suppressed UVB-stimulated cellular reactive oxygen species generation without cellular toxicity. Moreover, topical application of NF50E mitigated UVB-induced photoaging lesions including skin erythema and skin thickness in BALB/C mice. NF50E treatment inhibited UVB-induced collagen degradation as well as MMP-1 and IL-1β expressions and significantly stimulated SIRT1 expression. Furthermore, the extract treatment markedly suppressed the activation of NF-κB and AP-1 (p-c-Jun) by deactivating the p38 and JNK proteins. Taken together, current data suggest that NF50E exhibits potent antioxidant potential and protection against photoaging by attenuating MMP-1 activity and collagen degradation possibly through the downregulation of MAPK/NF-κB/AP-1 signaling and SIRT1 activation.

Side effects of radiotherapy on breast cancer patients in the Department of Radiotherapy, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria

Background: Side effects of radiotherapy (RT) could be temporary or permanent, can be severe, and affect quality of life. An investigation into the side effects of RT on breast cancer patients would help evaluate the incidences and associated risk factors in the low-income countries for patients undergoing RT in order to ensure maximum treatment with very minimal side effects. Objective: To assess the side effects of RT in patients with breast cancer undergoing RT in Lagos University Teaching Hospital. Materials and Methods: This was a descriptive, cross-sectional study. Self-administered questionnaires were distributed to breast cancer patients on RT that have received treatment for at least 2 weeks at the RT Department between March and August 2016. A total of 146 questionnaires were distributed, whereas 139 were completely filled and returned for the evaluation and analysis, given a response rate of 95.2%. Results: The common side effects noticed from the analysis of this research work included skin erythema (87.1%), fatigue (74.1%), telangiectasia (69.1%), pain (89.9%), breast swelling (45.3%), and loss of hair in the armpit and chest area (87.1%), and the less common ones were breast shrinkage (20.1%), lymphedema (41.0%), cardiac complications (30.9%), lung problems (12.9%), sore throat (7.9%), brachial plexopathy (24.5%), and damage to the bones (ribs; 3.6%). Management of the side effects by patients revealed that 30 (21.6%) used analgesics, 28 (20.1%) used steroidal cream, 27 (19.4%) avoided deodorants and antiperspirant, 22 (15.8%) exercised, 15 (10.8%) took antibiotics, 10 (7.2%) took herbs, and 7 (5%) had to stop treatment temporarily for minimum of a week due to severe morbidity. Conclusion: A large percentage of breast cancer patients undergoing RT experience painful side effects (89.9%), of these 87% experience skin erythema, 74% experience fatigue, and 69% experience telangiectasia.

Imiquimod-induced skin inflammation is relieved by knockdown of sodium channel Nax.

Nax is an atypical sodium channel that mediates inflammatory pathways in pathological conditions of the skin. In this study, we developed a skin inflammation model in the rabbit ear through application of imiquimod (IMQ). Knockdown of Nax using RNAi attenuated IMQ-induced skin inflammation, including skin erythema, scaling and papule formation. Histologic analysis showed that thickening and insufficient differentiation of the epidermis found in psoriasis-like skin were normalized by administration of Nax -RNAi. Excessive infiltration of inflammatory cells found in inflammatory lesions, such as mast cells, eosinophils, neutrophils, T cells and macrophages, was reduced by Nax -RNAi. Expression of S100A9, which is a downstream gene of Nax and a mediator of inflammation, was decreased by Nax -RNAi. Our results demonstrated that knockdown of Nax ameliorated IMQ-induced psoriasis-like skin inflammation in vivo. Thus, targeting of Nax may represent a potential therapeutic option for the treatment of psoriasis.

Commercial kitchenware glass as a potential thermoluminescent media for retrospective dosimetry

Study has been made of the thermoluminescence (TL) yield of various glass-based commercial kitchenware (Reko-China, Skoja-France, Godis-China, Glass Tum-Malaysia, Lodrat-France). Interest focuses on their potential for retrospective dosimetry. Use was made of a60Co gamma-ray irradiator, delivering doses in the range 2–10 Gy. Results for the various media show all the glassware brands to yield linearity of response against dose, with a lower limit of detection of ∼0.06 and ∼0.08 Gy for loose and compact powdered samples. Among all of the brands under study, the Lodrat glassware provides the greatest sensitivity, at 6.0 E+02 nC g−1 Gy−1 and 1.5E+03 nC g−1 Gy−1 for compact- and loose-powdered forms respectively. This is sufficiently sensitive to allow its use as a TL material for accident dosimetry (2 Gy being the threshold dose for the onset of a number of deterministic biological effects, including skin erythema and sterility). Energy Dispersive X-ray (EDX) analyses have been conducted, showing the presence of a number of impurities (including C, O, Na, Mg, Al, Si, Ca and Br). Fading of the irradiated glasses show the amount of better than 3% and 5% of the stored energy for both loose and compact powdered samples within 9 days post irradiation. As such, commercial kitchenware glass has the potential to act as relatively good TL material for gamma radiation dosimetry at accident levels. This is the first endeavour reporting the TL properties of low cost commercial kitchenware glasses for gamma-ray doses in the few Gy range, literature existing for doses from 8 Gy to 200 Gy.

Rat VCA Heterotopic Hindlimb Model of Rejection and Vasculopathy in the Presence of Maintenance Immunosuppression

IntroductionVascularized composite allograft (VCA) is an emerging medical field that has advanced rapidly over the past two decades, following advances in microsurgery and immunosuppressive therapy. Since VCA is a relatively new field, our knowledge regarding long term outcomes and potential complications is limited. Although VCA is regarded as a success in improvement of quality of life for patients with severe facial or hand injuries, we are far from understanding the biological processes involved in graft acceptance. While acute rejection episodes respond well to standard immunosuppression, chronic rejection and especially vasculopathy remains an unsolved problem. Two hand recipients in our clinical program have suffered graft loss due to ischemic vasculopathy. Frequently there are no clinical signs to suggest that vasculopathy is advancing, making diagnosis and treatment even more complex. The purpose of this study was to develop an adaptable rat model of VCA which, with carefully titrated immunosuppression, mimics acute rejection, chronic rejection, and vasculopathy as seen in a clinical setting.MethodsBrown Norway and Lewis rats were used as VCA donor and recipients, respectively. Heterotopic vascularized osteomyocutaneous flap composed of disarticulated fibula and tibia, including its related muscles and dorsal skin were transplanted in the recipient groin area. The pedicle was anastomosed to the recipient femoral artery and vein. All VCA recipients were treated with full dose Tacrolimus for the first 11 post operative days. Following that, the recipient animals were divided into three groups, in which each group treated with different immunosuppressive protocol to induce acute rejection, chronic rejection and vasculopathy. Each group was followed for clinical and histopathological signs of rejection.ResultsThe acute rejection group presented clinical signs after 2 weeks and included skin erythema, atrophy, fur loss and de‐epithelization. Histopathology revealed lack of adnexa, epidermal necrosis, mononuclear cell infiltration, and massive perivascular infiltration. The chronic rejection group presented gradual fur loss, atrophy and shrinkage. Histopathology revealed lack of adnexa, epidermal necrosis and mononuclear cell infiltration as well as capillary thrombosis and intimal hyperplasia in small and large arteries. In the vasculopathy group no clinical sign of rejection was observed, and histopathology as well did not show any sign of rejection in the skin. The vasculature however revealed intimal hyperplasia of large and small arteries.ConclusionThis model allows induction of acute and chronic rejection as well as vasculopathy, and this is supported by clear clinical and histopathological results. This model is applicable for mechanistic studies of chronic rejection and vasculopathy, as well as testing potential therapies to prevent their development.Support or Funding InformationDoD grant W81XWH‐13‐2‐0057This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis

Rosacea is a chronic inflammatory cutaneous disease characterized by immune system anomalies and vascular hyperreactivity. Recently, therapy of rosacea has improved substantially with the approval of Tranexamic acid (TXA), an antifibrinolytic agent. However, we know little about the underlying mechanism. In this study, we evaluated the effects of TXA and its molecular mechanism on rosacea by using LL37-induced mouse model and HaCaT cell model. Rosacea-like symptoms including skin erythema and histopathological alterations, as well as the elevated pro-inflammatory cytokines (IL-6 and TNFα) and MMP9 expression were significantly ameliorated by TXA treatment. In addition, TXA reduced the expression levels of innate immune gene (TLR2, KLK5 and Camp) and neutrophils relative gene in rosacea-like lesion. For adaptive immune, CD4+ T cell infiltration and the gene expression of Th cytokines and chemokines were regulated by TXA in skin lesion. Furthermore, the anti-inflammatory effects of TXA were associated with the inhibition of TLR2, pro-inflammatory cytokines (IL-6 and TNFα) and chemokines (CCL10) expression in LL37-activated HaCaT cells. Finally, TXA repressed the angiogenesis by reducing the number of CD31+ cell and downregulating the expression levels of VEGF in rosacea. In conclusion, our finding defines a treatment mechanism by which TXA ameliorates rosacea symptoms by regulating the immune response and angiogenesis.

Efficacy of topical administration of Radix Euphorbiae Ebracteolatae on multiple plantar warts: A parallel randomized trial.

To investigate the clinical efficacy of Radix Euphorbiae Ebracteolatae in treating multiple plantar warts. Twenty-eight patients with multiple plantar warts on both left and right feet were recruited. Warts on the left feet (treatment group) of all patients were externally treated with moderate ethanol extract of Radix Euphorbiae Ebracteolatae which was made of 30 g Radix Euphorbiae Ebracteolatae putting into 100 mL of medical ethanol (75%). For the control group, moderate dose of 0.1% vitamin A acid ointment was externally applied onto the right-foot warts. The topical application of each treatment was conducted 3 times a day for both groups. After 4 and 8 weeks, the efficacy and side effects including skin erythema and blister were evaluated and observed. Compared with the pre-treatment, warts size of the control group was reduced after 8-week treatment (P<0.05). After 4 and 8 weeks, the average wart size in the treatment group was both significantly reduced respectively (P<0.01). There were significant differences in warts size and total effective rate between the two groups after 4-week treatment respectively (P<0.05 or P<0.01). More significant differences in wart size and total effective rate were observed after 8-week treatment (P<0.05 or P<0.01). The percentage reduction in wart size was significantly different between the two groups after 4 and 8-week treatment (P<0.01). Radix Euphorbiae Ebracteolatae was significantly superior to vitamin A acid ointment in treating multiple plantar warts.

The role of cavitation in vascular occlusion

Ed Carstensen’s papers on the effects of ultrasound on plants were amongst the first that attracted me to study ultrasound bio-effects. It was little surprise to me that, when I first started looking at HIFU, his name was on many of the seminal papers in this area. And now, his papers on cavitation and vasculature inform our current research. Ed’s influence on bio-effects research stretches far beyond the borders of the USA Vascular occlusion has the potential to treat life-threatening conditions including twin-twin transfusion syndrome (occurring in fetuses that share a placenta). Sheep placental vessels have been used to develop HIFU treatment guidance, delivery (1.66MHz) and monitoring. Ultrasound imaging guidance/flow monitoring, with simultaneous acoustic cavitation detection in 82 targets in 14 pregnant sheep resulted in flow occlusion in 90%. Adverse events included skin erythema (18/82) and burns (10/82), but all resolved over 21 days. Analysis of acoustic cavitation required low pass (software) filtering and careful choice of broadband integration range (0.1 to 1.1 MHz). 9% of successful treatments displayed detectable broadband, 32% with half-harmonic and 1% with drive-voltage fluctuations. In conclusion, treatment is possible, side effects are manageable, and acoustic cavitation appears not to be essential for successful occlusion.

Prodromal symptoms in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease, which presents as recurrent nodules and sinus tracts (tunnels) with subsequent scarring, predominantly involving the intertriginous regions. Although prodromal symptoms (i.e. various symptoms preceding the eruption of the HS lesions) are often mentioned, there have been no formal investigations into this aspect. Insight into prodromal symptoms may enable patients with HS or dermatologists in choosing a more targeted treatment at a much earlier stage, potentially increasing treatment efficacy and quality of life. To characterize the spectrum of prodromes in patients with HS. An extensive questionnaire that explored the frequency, type and time of occurrence of the prodromal symptom(s) and the degree of certainty of the perceived association was administered to 72 patients. The majority of the 72 patients (83.3%; n = 60) confirmed that they experienced one or more symptom(s) prior to the development of inflamed nodules or abscesses. These included: fatigue (32%), malaise (defined as a fever-like sensation) (23%), headache (11%) and nausea (2%). Localized symptoms included skin erythema (75%), paraesthesia (63%) and itching (20%). the majority of the patients stated that the prodromes usually occurred > 24 h (45%) or 12-24 h (20%) before the eruption. Our data suggest that the majority of patients with HS experience prodromal symptoms, heralding a flare of their HS. The findings may give rise to important new treatment approaches for the management of HS.

Assessment of efficacy of narrow-band ultraviolet B for the treatment of early-stage mycosis fungoides

Objective To evaluate the efficacy of narrow-band ultraviolet B(NB-UVB) for the treatment of early-stage mycosis fungoides (MF). Methods A retrospective study was performed on 98 patients with early-stage MF treated with NB-UVB from January 2003 to December 2013. The rate of and time to recurrence of MF were assessed, and long-term side effects were evaluated in these patients. Results Among 52 patients achieving complete remission, the median number of sessions of NB-UVB radiation was 30 (range, 18- 87), the median cumulative radiation dose was 24.16 J/cm2 (range, 9.11- 108.86 J/cm2), and the median follow-up duration was 41 months (range, 11- 90 months). Relapse occurred in 14 (26.9%) patients with the median time to recurrence being 8.2 months (range, 3- 60 months). The patients suffering from relapse achieved complete remission after treatment with NB-UVB again. Adverse reactions mainly included skin erythema and itching at the early stage of radiation, as well as temporary pigmentation after radiation. Cutaneous carcinoma occurred in none of these patients during 11- 90 months of follow-up. Conclusions NB-UVB phototherapy appeared to be effective for the treatment of early-stage MF, and no cutaneous carcinoma occurred in these patients during the follow-up. Although MF may relapse in some cases, repeated NB-UVB phototherapy is still effective. Key words: Ultraviolet therapy; Treatment outcome; Mycosis fungoides

AB0632 Paraneoplastic Myositis: the Features of Debut, Clinic Tendency, and Responsiveness to Steroid Therapy

BackgroundSimilarity of muscle and skin symptoms during idiopathic polymyositis/dermatomyositis (DM/PM) and paraneoplasic myositis (PNM) makes clear the clinical tendencies of PNM.ObjectivesTo determine the clinical tendencies of PNM.MethodsWe investigated 139 patients...

Naja naja atra Venom Protects against Manifestations of Systemic Lupus Erythematosus in MRL/lpr Mice.

Systemic lupus erythematosus (SLE) is an autoimmune disease and effective therapy for this pathology is currently unavailable. We previously reported that oral administration of Naja naja atra venom (NNAV) had anti-inflammatory and immune regulatory actions. We speculated that NNAV may have therapeutic effects in MRL/lpr SLE mice. Twelve-week-old MRL/lpr mice received oral administration of NNAV (20, 40, and 80 μg/kg) or Tripterygium wilfordii polyglycosidium (10 mg/kg) daily for 16 weeks. The effects of NNAV on SLE manifestations, including skin erythema, proteinuria, and anxiety-like behaviors, were assessed with visual inspection and Multistix 8 SG strips and open field test, respectively. The pathology of spleen and kidney was examined with H&E staining. The changes in autoimmune antibodies and cytokines were determined with ELISA kits. The results showed that NNAV protected against the manifestation of SLE, including skin erythema and proteinuria. In addition, although no apparent histological change was found in liver and heart in MRL/lpr SLE mice, NNAV reduced the levels of glutamate pyruvate transaminase and creatine kinase. Furthermore, NNAV increased serum C3 and reduced concentrations of circulating globulin, anti-dsDNA antibody, and inflammatory cytokines IL-6 and TNF-α. NNAV also reduced lymphadenopathy and renal injury. These results suggest that NNAV may have therapeutic values in the treatment of SLE by inhibiting autoimmune responses.

Effect of Adjuvant Radiotherapy in the Management of Hemangiopericytoma of the Central Nervous System:Report of 5 Cases

Objective: Primary intracranial or spinal hemangiopericytoma (HPC) represents a rare tumour that is more difficult to distinguish from other CNS tumours based on clinical symptoms and imaging findings. In this article, here we present 5 cases with HPC (3 intracranial and 2 spinal) with histologically confirmed were treated at our hospital between June 2009 to January 2010, and a review of the literature pertaining to the diagnosis, clinical management, and so on. Methods: Clinical data of the 5 patients with HPCs from cerebra and spinal cord including the manifestations of imaging, pathology, treatment and prognosis factors were investigated, and relevant literatures were reviewed. Of which, 3 males, 2 females, age ranged from 6-35 years old, median age at primary diagnosis was 29 years. Results: 3 patients underwent craniotomy and the other 2 patients underwent spinal surgery. Total mass removal was achieved in 1 case and subtotal removal in 4 cases. All 5 patients received radiotherapy after resection, A total dose of 59.4 Gy/33f was delivered in a fractionation of 5 x1.8 Gy per week for the 3 patients with cerebral lesions using three dimensional conformal radiation therapy (3D-CRT) or intensive modulated radiation therapy (IMRT) technique, and 45Gy in 25 fractions for the 2 patients with spinal lesions. The patients were followed up varied from 6 to 27 months, and none of the patients was found with evidence of radiation complications. Acute toxicity was mild including skin erythema and alopecia. Follow-up of the patients has not yet discovered that a tumour recurrence and extra-cranial metastasis all remain alive up to date. Conclusions: Multidisciplinary care should be highly advocated in the management of intracranial or spinal HPC. Surgical resection, either complete or subtotal excision, followed by postoperative radiotherapy, will provide the patients with higher probability for disease-free survival.

Intensity modulated radiotherapy (IMRT) and fractionated stereotactic radiotherapy (FSRT) for children with head-and-neck rhabdomyosarcoma

9065 Background: To evaluate intensity-modulated radiotherapy (IMRT) and fractionated stereotactic radiotherapy (FSRT) for children with head-and-neck rhabdomyosarcoma (RMS) with special regard to radiation induced toxicity. Methods: From 1995 to 2005, we treated 19 children with head-and-neck RMS with FSRT (n=14) or IMRT (n=5). The median age at the time of RT was 62.5 months. All children received systemic chemotherapy according to the German Soft Tissue Sarcoma Study protocols (CWS). Patients were grouped classified according to the grouping system used in Intergroup Rhabdomyosarcoma Study Group (IRSG) trials. Patients were immobilized using an individual mask fixation system. For treatment planning contrast-enhanced MRI- and CT-scans were performed. Median size of PTV for RT was 93,4 ml. We applied a median total dose of 45 Gy (range 32 - 54 Gy) using a median fractionation of 5 × 1,8 Gy/week (range 1,6 - 1,8 Gy / week). Deep sedation or general anaesthesia was required for children &lt; 5 years. Results: RT was well tolerated in all children and could be completed without interruptions &gt; 4 days. Minor RT-induced side effects included skin erythema, alopecia, conjunctivitis, mucositis and nausea / vomiting, however no toxicities &gt;CTC grade II developed. The median follow-up time after precision RT was 17 months. Until now, no secondary malignancies developed. After RT, the 3- and 5-year survival rate was 94%. The 3- and 5-year actuarial local control rate after RT was 89%. With respect to tumor localization, the 3- and 5-year local control rates were 100% for patients with RMS of the orbit and 91% for patients with parameningeal tumors. The actuarial freedom of distant metastases rate was 89% at 5 years. For patients with RMS of the orbit only, the actuarial distant progression-free survival rate was 100% at 5 years. The actuarial 3- and 5-year distant metastases-free survival rate was 91%, in children with parameningeal RMS. Conclusions: High precision RT techniques such as IMRT and FSRT offer good coverage of complex shaped target volumes in critical locations with the necessary RT dose while adhering to the tolerance doses of nearby critical normal tissue structures. Local and distant control rates are not reduced. No significant financial relationships to disclose.

Evaluation of a low-dose lidocaine lontophoresis system for topical anesthesia in adults and children: A randomized, controlled trial

Background: Commonly used classes of topical anesthetics require 30 to 60 minutes to provide effective anesthesia. A new low-dose lidocaine iontophoresis system (LDLIS) may provide topical anesthesia in 10 minutes at a lower dose than previous systems, thereby limiting adverse events.Methods: This was a prospective, randomized, multicenter, double-blind, placebo-controlled, clinical trial. Adults and children aged 5 to 17 years (inclusive) received a 10-minute ionntophoretic treatment with either lidocaine or a saline placebo before venipuncture or venous cannulation. Intensity of pain associated with venipuncture or venous cannulation was assessed using either a 10-cm Visual Analog Scale (VAS) for adults and children aged 12 to 17 years or the Facial Affective Scale (FAS) for all children enrolled.Results: Five hundred forty-eight patients (276 adults, 272 children) participated. Mean (SD) VAS pain scores were lower in adults who received iontophoresis with lidocaine rather than with placebo (0.77 [1.49] vs 2.52 [2.30], P < 0.001) and in children aged 12 to 17 years (1.50 [1.87] vs 2.58 [2.26], P = 0.011). FAS pain scores were lower among children who received iontophoresis with lidocaine rather than with placebo (0.36 [0.26] vs 0.51 [0.27], P < 0.001). Similar results were found for children stratified by age group (5–7 years: 0.40 [0.30] vs 0.60 [0.31], P = 0.011; 8–11 years: 0.35 [0.27] vs 0.48 [0.27], P = 0.021; 12–17 years: 0.33 [0.21] vs 0.48 [0.24], P = 0.001). Mean (SD) parental ratings of pain on the FAS for children aged 5 to 11 years were also lower for the lidocaine group (0.45 [0.28] vs 0.55 [0.25], P = 0.018). Adverse events were similar between groups and included skin erythema and edema. One patient in the study experienced a partial-thickness burn.Conclusion: In this study of adults and children, the LDLIS provided effective topical anesthesia for venipuncture and venous cannulation within 10 minutes.

Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis

Purpose: Women with large breasts have marked dose inhomogeneity and often an inferior cosmetic outcome when treated with breast conservation compared to smaller-sized patients. We designed a prone breast board, which both minimizes breast separation and irradiated lung or heart volume. We report feasibility, cosmesis, and preliminary local control and survival for selected women with Stage 0–II breast cancer. Materials and Methods: Fifty-six patients with clinical Stage 0–II breast cancer were treated with lumpectomy and breast irradiation utilizing a prototype prone breast board. A total of 59 breasts were treated. Indications for treatment in the prone position were large or pendulous breast size ( n = 57), or a history of cardiopulmonary disease ( n = 2). The median bra size was 41D (range, 34D–44EE). Cosmesis was evaluated on a 1–10 (worst-to-best) scale. Results: Acute toxicity included skin erythema (80% of patients experienced Grade I or Grade II erythema), breast edema (72% of patients experienced mild edema), pruritus (20% of patients), and fatigue (20% of patients reported mild fatigue). One patient required a treatment break. The only late toxicity was related to long-term cosmesis. The mean overall cosmesis score for 53 patients was 9.37 (range, 8–10). Actuarial 3- and 5-year local control rates are 98%. Actuarial overall survival at 3 and 5 years are 98% and 94%. Conclusion: Our data indicate that treating selected women with prone breast radiotherapy is feasible and tolerated. The approach results in excellent cosmesis, and short-term outcome is comparable to traditional treatment techniques. This technique offers an innovative alternative to women who might not otherwise be considered candidates for breast conservation.

Kaposi Sarcoma of the Conjunctiva and Eyelids Associated With the Acquired Immunodeficiency Syndrome

Three studies were performed to assess more accurately the prevalence, natural history, and appropriate treatment of acquired immunodeficiency syndrome (AIDS)-related Kaposi sarcoma involving ocular structures. The first study was a prospective examination of 100 male homosexuals with AIDS-related Kaposi sarcoma for signs of ophthalmic involvement. Of the 20 patients who had ophthalmic lesions, 16 had eyelid lesions and seven had conjunctival lesions. In four patients, the ophthalmic lesion was the first, and initially the only, clinically identified manifestation of Kaposi sarcoma. The second study was a retrospective review of all patients with ophthalmic Kaposi sarcoma examined at one institution over a six-year period to determine its natural history and response to therapy. Most lesions were slowly progressive and responded to systemic drug therapy. Six patients were successfully treated with radiation therapy to prevent complications. The third study was a retrospective review of all patients with AIDS-related ophthalmic Kaposi sarcoma treated with local irradiation by one radiation oncologist. Each of 12 patients showed a response to treatment, and ten had a complete resolution of lesions, but recurrences were common. Side effects included skin erythema in six patients and hair loss in one patient. For local treatment of ophthalmic Kaposi sarcoma, irradiation appears to be safe and effective for palliative therapy.