Mild Erythema Research Articles

Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs.

BackgroundA novel flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, UK) was recently developed for humans. It continuously measures the interstitial glucose (IG) concentrations for 14 days.ObjectivesTo assess the clinical and analytical accuracy of the FGMS in diabetic dogs.AnimalsTen client‐owned diabetic dogs on insulin treatment.MethodsProspective and observational study. The FGMS was placed on the neck for up to 14 days. During the 1st–2nd, 6–7th, and 13–14th days from application, the IG measurements were compared with the plasma (EDTA) glucose (PG) concentrations analyzed by a reference hexokinase based method.ResultsThe application and the use of the FGMS were apparently painless, easy, and well tolerated by all dogs. Mild erythema at the site of the application was found in 5/10 dogs at the end of the wearing period. A good correlation between IG and PG concentrations (rho = 0.94; P < .001) was found. The FGMS was 93, 99, and 99% accurate at low, normal, and high blood glucose concentrations. Mean ± standard deviation difference from the reference method was 2.3 ± 46.8 mg/dL.Conclusion and clinical importanceThe FGMS is easy to use and is accurate for IG glucose measurement in diabetic dogs.

Preclinical safety study of a recombinant Streptococcus pyogenes vaccine formulated with aluminum adjuvant.

A recombinant vaccine composed of a fusion protein formulated with aluminum hydroxide adjuvant is under development for protection against diseases caused by Streptococcus pyogenes. The safety and local reactogenicity of the vaccine was assessed by a comprehensive series of clinical, pathologic and immunologic tests in preclinical experiments. Outbred mice received three intramuscular injections of 1/5th of the human dose (0.1 ml) and rabbits received two injections of the full human dose. Control groups received adjuvant or protein antigen. The vaccine did not cause clinical evidence of systemic toxicity in mice or rabbits. There was a transient increase of peripheral blood neutrophils after the third vaccination of mice. In addition, the concentration of acute phase proteins serum amyloid A and haptoglobin was significantly increased 1 day after injection of the vaccine in mice. There was mild transient swelling and erythema of the injection site in both mice and rabbits. Treatment-related pathology was limited to inflammation at the injection site and accumulation of adjuvant-containing macrophages in the draining lymph nodes. In conclusion, the absence of clinical toxicity in two animal species suggest that the vaccine is safe for use in a phase I human clinical trial. Copyright © 2016 John Wiley & Sons, Ltd.

Chest Pain - Cross Country

HISTORY: A 21-year-old female college cross country runner presented with chest pain, upper abdominal pain, and thoracic back pain for the last week. She was seen 5 days previously for fever/chills, muscle aches, and pleuritic chest pain. She was diagnosed with influenza, took Oseltamivir, and her symptoms resolved except for chest and upper abdominal pain with fatigue. Chest pain is mid- to slightly left-sided. She complains of fatigue with any exertion. She has been taking a large amount of Ibuprofen. PHYSICAL EXAMINATION: Examination revealed regular heart rate and rhythm without friction rub while sitting or in hip forward flexion. Normal lung auscultation. Nasal exam showed boggy, erythematous, and edematous turbinates with rhinorrhea bilaterally. There was mild oropharynx erythema with normal tonsils. Abdominal exam showed mild epigastric tenderness. Kernig and Brudzinski tests were negative. DIFFERENTIAL DIAGNOSIS: 1. Acute Gastritis 2. Acute Pericarditis or Myocarditis 3. Community-Acquired Pneumonia TEST AND RESULTS: Chest radiographs: — mildly enlarged cardiac silhouette, blunting of the costophrenic angles bilaterally 12-lead Electrocardiogram: — Diffuse ST elevation sparing AVR, V1 and lead 3; reciprocal changes in AVR; periodic PR depression Echocardiogram: — normal left ventricle size, motion, and function with an ejection fraction of 60%. — small, generalized pericardial effusion. — no evidence of cardiac tamponade FINAL/WORKING DIAGNOSIS: Acute Pericarditis TREATMENT AND OUTCOMES: 1. Referred to Cardiology. Placed on scheduled Ibuprofen. Cardiology returned her to activity 2 weeks after symptoms stopped. 2. Hospitalized for chest pain flare after return to activity. Repeat echocardiogram showed moderate pleural effusion. Started on Prednisone and told to rest for 3 months. 3. Referred to Rheumatology who felt this was likely viral but placed her on Hydroxychloroquine in addition to Prednisone. 4. Now tapering Hydroxychloroquine and Prednisone per Rheumatology. 5. Undergoing a gradual return-to-run progression over a 2-3 month time period with frequent monitoring. Started progression when she had normal inflammatory markers and no effusion on echocardiogram 9 months after symptoms began.

Pilot, multicenter, open-label evaluation of safety, tolerability and efficacy of a novel, topical multipotent growth factor formulation for the periorbital region

This multicenter, open-label pilot study evaluated safety, efficacy and tolerability of a topical formulation containing a multipotent growth factor resignaling complex (MRCx), when applied to infraorbital and lateral canthal skin.Thirty-nine female subjects with mean age of 56.8 years who had periorbital lines and wrinkles, uneven skin texture, puffiness, and lack of skin firmness were enrolled, and 38 completed the study. All subjects applied the multipotent growth factor formulation bilaterally to the periorbital area, twice daily for 60 days. Efficacy and treatment-related adverse events were evaluated at Baseline and days 14, 30, and 60. Investigators rated the periorbital areas based on 10-point scales.Subjects' self-reported compliance with treatment was greater than 99% throughout the study. At day 60, all subjects had improvement in infraorbital brightness (≥ 2 points), moistness (≥ 2 points), wrinkles (≥ 1 point), sallowness (≥ 1 point), crepiness (≥ 1 point), smooth texture (≥ 1 point), skin tightness (≥ 1 point), and skin tone (≥ 1 point). Investigator-rated assessments showed ≥ 1-point improvement for lateral canthal wrinkles, dyschromia/mottled pigmentation, skin tone, overall brightness, and moistness. Investigator-rated scoring on the Global Aesthetic Improvement Scale (GAIS) demonstrated that 67.6% of subjects were much improved/improved at day 14, and 63.1% remained improved at day 60. Overall, 76.2% and 79.0% of subjects were very pleased/pleased/mostly pleased with the appearance of their infraorbital and lateral canthal areas at day 60. Adverse events comprised one case of mild canthal erythema, and one case of mild eye irritation, both of which were respectively resolved.This pilot study demonstrated that the topical multipotent growth factor formulation was safe, effective and well tolerated for periorbital skin rejuvenation.

Retrospective analysis of the treatment of melasma lesions exhibiting increased vascularity with the 595-nm pulsed dye laser combined with the 1927-nm fractional low-powered diode laser.

Melasma presents a significant challenge to laser surgeons. Aggressive treatments often result in rebound melasma or post-inflammatory pigmentary alteration. Recent reports suggest melasma pathogenesis may have a vascular component. Spectrocolorimetry can detect subtle or sub-clinical telangiectatic erythema within melasma lesions. For certain patients identified by spectrocolorimetry, effective melasma treatment may include vascular-targeted therapy together with pigment-specific treatment modalities. Such combined therapies may reduce the likelihood of melasma recurrence. To evaluate the efficacy of treating melasma lesions exhibiting subtle or sub-clinical telangiectatic erythema with the 595-nm pulsed dye laser (PDL) combined with the 1927-nm fractional low-powered diode laser (FDL). A retrospective review was performed over a 2-year period as follows. Evaluated patients (n = 11) include 10 women and 1 man, average age of 38.7 years, and Fitzpatrick skin types II-IV. Each patient exhibited melasma lesions with subtle or sub-clinical telangiectatic erythema identified by spectrocolorimetry. Each underwent a series of treatments (average of four) at approximate 4-6 week intervals of the PDL followed by the FDL. Treatments were performed same-day, sequentially, with 10-15 minute interim time allowance for skin cooling. The following PDL parameters were utilized: 10 mm spot, 10-20 ms pulse duration, 7.5-8.5 J/cm2 fluence, 30/30 DCD. Eight passes with the FDL (Clear + Brilliant® Permea™, Solta Medical, Hayward, CA) were then performed utilizing a "low" treatment level. Clinical endpoint was mild erythema and edema. Patients were encouraged to practice strict photoprotection and apply topical skin lightening agents, but compliance was not measured. An independent physician evaluated photographs taken at baseline and at follow-up after last treatment session (average follow-up of 96 days). A quartile improvement score was used to grade the improvement of melasma and underlying telangiectatic erythema. At time of data analysis, patient satisfaction was self-graded on a three-point scale (0 = not satisfied, 1 = satisfied, 2 = very satisfied). Six out of eleven patients (54%) demonstrated greater than 50% improvement in melasma presentation. Improvement in melasma generally paralleled improvement in erythema. No rebound melasma, post-inflammatory changes, or adverse events were noted. Patient satisfaction responses averaged 1.6, with all (10) patients reporting 1 "satisfied" or 2 "very satisfied." Melasma lesions exhibiting subtle or sub-clinical telangiectatic erythema may be improved by combined vascular-targeted laser therapy together with fractional low-powered diode laser therapy. A parallel improvement in telangiectatic erythema suggests a relationship between the underlying vasculature and hyperpigmentation. There is a low risk of adverse effects and overall patient satisfaction is high. Follow-up to optimize treatment parameters and determine long-term durability is needed. Lasers Surg. Med. 49:20-26, 2017. © 2016 Wiley Periodicals, Inc.

UVA1 Laser in the Treatment of Vitiligo.

The purpose of this article was to evaluate the clinical efficacy and safety of a monochromatic 355 nm ultraviolet (UVA) laser in the treatment of vitiligo. Broadband and narrow-band UV phototherapy has been proposed as an effective therapeutic option in vitiligo patients. Seventeen consecutive, unselected patients (7 men and 10 women) were enrolled in an open-label, prospective study and treated twice weekly for 8 weeks at a fixed dose of 80-140 J/cm(2). Follow-up was 12 weeks. Clinical repigmentation was observed in 15/17 patients (88.23%), with limited side effects (mild post-treatment erythema and itching). Results were maintained during the 12 week phototherapy-free follow-up period. the present report suggests that UVA1 laser could be an applicable therapeutic option in patients with vitiligo.

First report of a mecA-positive multidrug-resistant Staphylococcus pseudintermedius isolated from a dog in New Zealand

CASE HISTORY: A 14-year-old neutered male Sealyham terrier was referred for assessment of a persistent pyoderma. It had experienced numerous episodes of dermatitis involving pododermatitis, pyoderma and otitis over the previous 6 years.CLINICAL FINDINGS: Superficial, focally deep and mucocutaneous pyoderma were present, with yellow mucoid exudate on both nares and the lower lips crusted with haemopurulent exudate. Epidermal collarettes were present on the dorsal and lateral trunk. There were peri-anal crusts and mild erythema was present on the concave aspect of both pinnae.MICROBIOLOGICAL FINDINGS: Culture and microbiological testing identified Staphylococcus pseudintermedius as the infecting organism. Kirby-Bauer disc susceptibility testing revealed the isolate was resistant to numerous antimicrobials including oxacillin. PCR testing of the isolate identified the presence of the mecA gene which confers resistance to β-lactam antimicrobials. Pulsed field gel electrophoresis typing suggested the isolate was not related to the methicillin-resistant S. pseudintermedius that had been reported to be associated with canine infections in Western Australia.DIAGNOSIS: Superficial, deep and mucus membrane pyoderma associated with a multi-drug resistant S. pseudintermedius.CLINICAL RELEVANCE: This is the first recorded case of canine pyoderma involving methicillin-resistant multidrug-resistant S. pseudintermedius in New Zealand. Treatment of such cases is difficult because the number of effective and available antimicrobials is limited. This finding should raise the awareness of the veterinary and medical professions to the presence of such organisms in New Zealand and stimulate a discussion about possible biosecurity barriers, treatment strategies and prevention of zoonotic and nosocomial infections.

The Receptor-Binding Domain in the VP1u Region of Parvovirus B19.

Parvovirus B19 (B19V) is known as the human pathogen causing the mild childhood disease erythema infectiosum. B19V shows an extraordinary narrow tissue tropism for erythroid progenitor cells in the bone marrow, which is determined by a highly restricted uptake. We have previously shown that the specific internalization is mediated by the interaction of the viral protein 1 unique region (VP1u) with a yet unknown cellular receptor. To locate the receptor-binding domain (RBD) within the VP1u, we analyzed the effect of truncations and mutations on the internalization capacity of the recombinant protein into UT7/Epo cells. Here we report that the N-terminal amino acids 5–80 of the VP1u are necessary and sufficient for cellular binding and internalization; thus, this N-terminal region represents the RBD required for B19V uptake. Using site-directed mutagenesis, we further identified a cluster of important amino acids playing a critical role in VP1u internalization. In silico predictions and experimental results suggest that the RBD is structured as a rigid fold of three α-helices. Finally, we found that dimerization of the VP1u leads to a considerably enhanced cellular binding and internalization. Taken together, we identified the RBD that mediates B19V uptake and mapped functional and structural motifs within this sequence. The findings reveal insights into the uptake process of B19V, which contribute to understand the pathogenesis of the infection and the neutralization of the virus by the immune system.

Eyelid Swelling and Proptosis with Systemic Implications

PRESENTATION A 20-year-old woman presented with a 4-day history of left upper eyelid swelling with erythema and tenderness (Figure 1). Two months prior to presentation, she had a similar episode on the left side, which was diagnosed at an outside facility as a chalazion with associated preseptal cellulitis. Her symptoms resolved with 4 days of oral cephalexin. One month later, she developed similar symptoms on the right side. She was again diagnosed with preseptal cellulitis in the setting of a chalazion, and her symptoms resolved with 7 days of oral cephalexin. Her review of systems was positive for 3-4 years of intermittent joint swelling and pain. Initially, small joints, but recently also medium joints, were involved. The pain and swelling would occur in 1-2 joints for 1-2 weeks and then shift to another 1-2 joints. In addition, she noticed several enlarged cervical and axillary lymph nodes for the past 2 years. She also had dry mouth in the morning, but no significant dry eye symptoms. She noted no fever, chills, night sweats, or weight loss, but had chronic fatigue for 2 months. She also had mild chronic facial erythema that did not worsen with sun exposure. Her family history was notable for her mother having been affected by an unspecified connective tissue disease. On ophthalmologic examination, her visual acuity was 20/20 in both eyes, with normal color vision. Her pupils were normal, with no relative afferent pupillary defect. Her intraocular pressure was normal. She was orthophoric and had no subjective double vision. Right extraocular movements were full, but her left eye showed mildly limited abduction and supraduction. Her confrontation visual fields

A Rarely Seen Entity: Morbus Morbihan Disease

Morbus Morbihan disease is granulomatous complication characterized with facial edema occuring due to acne or rosacea. It is resistant to treatment; diagnosis could be difficult. 48 years old male patient applied to our polyclinic with complaint of swelling on left side of his face, around his eye and cheeks, persistent for 6 months. He previously applied to dermatology, dental and Otorhinolaryngology departments in various hospitals but no diagnosis could be made. There was no trauma, exposure to sun, drug use history or symptoms like pain and itch. He was complaining about visual swelling. He had edema stretching from left side of his face to orbital area and mild erythema in his dermatological examination. Our pathology department reevaluated biopsy preparations taken by the center he previously went. Rosacea lymphedema was reported. Doxycycline, ornidazole, ketotifen and flutamide were administered by assuming that patient has Morbus Morbihan disease. In the next examination after one month, it has been observed that edema was diminished. In fourth month, edema decreased a lot. Thus treatment was stopped. The patient was applied again in the following 2 months due to increase at edema on his face. That time 0.5 mg/day isotretinoin treatment started and at third month edema regressed. We found this case appropriate to present to emphasize that it is rare and that it should be considered

External Otitis: An Unusual Presentation in Neonates.

Acute otitis externa (AOE) is an infection of the external auditory canal, the auricle, and the outer surface of the tympanic membrane. Although AOE is one of the most common otologic conditions encountered in pediatric population, it is known to primarily affect children older than 2 years. We report a case of AOE caused by Staphylococcus aureus in a 23-day-old neonate. A 23-day-old female infant presented to our neonatology clinic with irritability and discharge from the right ear. There were yellow otorrhea, mild erythema, and edema of right external ear canal. There was no sign of otitis media on otoscopy. The results of laboratory tests were insignificant. The discharge culture grew colonies of methicillin-sensitive Staphylococcus aureus. After 48 hours of treatment with intravenous cloxacillin, significant improvement was observed. The present case highlights an unusual presentation of staphylococcal infection in a neonate. This is the first case of methicillin-sensitive Staphylococcus aureus otitis externa in an immunocompetent newborn.

Pustulovesicular Skin Eruption as Presenting Feature of Incomplete Kawasaki Disease.

A 12-year-old female was referred with a history of fever and abdominal pain for 10 days and swelling all over her body for 4 days. Swelling developed initially over her left leg and arm followed by the right extremities, later involving the entire body. She also gave a history of passage of red-colored urine for 1 day. On general physical examination, she was febrile (temperature −102°F) with mild pallor and erythema over the lips. Her blood pressure was normal and there was no lymphadenopathy. On abdominal examination, mild ascites and tenderness were present

Diarrhoea Caused by Diffuse Metastatic Lobular Breast Cancer.

A 70-year-old woman with a history of lobular breast cancer presented to our Outpatient Clinic with diarrhoea for the past 3 years. Clinical examination and laboratory research were normal. Colonoscopy showed diffuse mild erythema and a decreased vascular pattern. Biopsies from the ascending colon, transverse colon, and descending colon showed metastases of lobular breast carcinoma. Although gastrointestinal metastases are rare in breast cancer, our case emphasizes the need for further diagnostic efforts in patients with gastrointestinal symptoms and a history of breast carcinoma.

A Phase I Study of Light Dose for Photodynamic Therapy Using 2-[1-Hexyloxyethyl]-2 Devinyl Pyropheophorbide-a for the Treatment of Non–Small Cell Carcinoma In Situ or Non–Small Cell Microinvasive Bronchogenic Carcinoma: A Dose Ranging Study

IntroductionWe report a phase I trial of photodynamic therapy (PDT) of carcinoma in situ (CIS) and microinvasive cancer (MIC) of the central airways with the photosensitizer (PS) 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH). HPPH has the advantage of minimal general phototoxicity over the commonly used photosensitizer porfimer sodium (Photofrin; Pinnacle Biologics, Chicago, IL). MethodsThe objectives of this study were (1) to determine the maximally tolerated light dose at a fixed photosensitizer dose and (2) to gain initial insight into the effectiveness of this treatment approach. Seventeen patients with 21 CIS/MIC lesions were treated with HPPH with light dose escalation starting from 75 J/cm2 and increasing to 85, 95,125, and 150 J/cm,2 respectively. Follow-up bronchoscopy for response assessment was performed at 1 and 6 months, respectively. ResultsThe rate of pathological complete response (CR) was 82.4% (14 of 17 evaluable lesions; 14 patients) at 1 month and 72.7% (8/11 evaluable lesions; 8 patients) at 6 months. Only four patients developed mild skin erythema. One of the three patients in the 150 J/cm2 light dose group experienced a serious adverse event. This patient had respiratory distress caused by mucus plugging, which precipitated cardiac ischemia. Two additional patients treated subsequently at this light dose had no adverse events. The sixth patient in this dose group was not recruited and the study was terminated because of delays in HPPH supply. However, given the observed serious adverse event, it is recommended that the light dose does not exceed 125 J/cm2. ConclusionsPDT with HPPH can be safely used for the treatment of CIS/MIC of the airways, with potential effectiveness comparable to that reported for porfimer sodium in earlier studies.

Primary Cutaneous Marginal Zone B-Cell Lymphoma Treated with Intralesional Rituximab: Experience of a Single Center

BACKGROUNDPrimary cutaneous marginal zone B-cell lymphomas (PCMZL) are low-grade lymphomas with an indolent course, but with a high rate of skin relapses. Surgical excision, local radiotherapy, or combinations of both are the first-line treatment in solitary or localized disease. Therapeutic options in cases of multifocal disease or relapse, include steroids or intravenous Rituximab in monotherapy or in combination with intravenous or oral chemotherapy. The effectiveness of intralesional Rituximab (ILR) in primary cutaneous B-cell lymphomas has been described in a small multicenter series of patients.OBJECTIVETo evaluate the effectiveness and safety of ILR in patients with PCMZL.METHODSIn our center ILR is used since 2010 as fist-line treatment for patients with PCMZL with single facial lesions, multifocal disease that cannot be irradiated or in relapsed disease. The treatment regimen consist of a course of three injections of 10 mg ( days 1, 3 and 5) in a single week at monthly intervals. Oral paracetamol and dexclofeniramire were administrated 30 minutes before the procedure. Courses of ILR were monthly repeated until response or in cases of relapse. The primary outcome measure of the study was the rate of remissions (complete and partial remissions).RESULTSEleven patients with PCMZL have been treated so far: 55% as first-line treatment and 45% in the relapse setting. The relapsed-group had previously received a median of 3 previous treatments (range, 1-6) including radiotherapy in 5 cases, surgery in 1 case, intravenous chemotherapy in 2 cases, and topic steroids in 2 cases. Clinical characteristics of the 11 patients are shown in the table below.A total of 40 courses or ILR have been completed. All patients responded, with 73% complete responses, without evidence of progression or relapse in the site of ILR treatment.Four patients experienced transitory mild perilesional erythema that did not require medication and resolved in less than 4 hours. No systemic toxicities or infections were observed; the tolerance was excellent in all cases.CONCLUSIONSIn our preliminary experience, ILR is an effective and safe therapeutic approach for selected PCMZL patients with single facial lesion, multifocal disease than cannot be irradiated or in relapsed cases. Further controlled studies are needed to confirm these findings. [Display omitted] DisclosuresSureda:Takeda: Consultancy, Speakers Bureau.

Érythème palmaire héréditaire (maladie de Lane) : observation chez un enfant

Palmar erythema may be either congenital or acquired, hereditary or non-hereditary. Its diagnosis and management differs according to whether or not it is acquired, hereditary or associated with symptoms. Herein, we report the case of a child with hereditary palmoplantar erythema (Lane's disease). A 2½-year-old girl consulted for palmar erythema, present since birth, predominantly on the thenar and hypothenar eminences and on the palmar aspect of her fingers. She also presented mild diffuse erythema on the soles of her feet. Both her mother and grandmother had similar signs. The girl had neither impairment nor pain linked to this erythema, and she had no associated symptoms. Physical examination was otherwise normal, as were the results of standard laboratory tests. We diagnosed Lane's disease based on the girl's hereditary erythema with autosomal dominant transmission, and the congenital and asymptomatic nature of her palmoplantar erythema. Nine publications have reported cases of Lane's disease, but this condition is probably highly under-reported.

Objective assessment of intensive targeted treatment for solar lentigines using intense pulsed light with wavelengths between 500 and 635 nm.

Background and ObjectivesSolar lentigines are commonly found in sun‐exposed areas of the body including hands, neck, or face. This study evaluates the efficacy of an intense pulsed light (IPL) device, with wavelengths between 500 and 635 nm and delivered with a targeted tip, for the treatment of solar lentigines on Japanese skin.Study Design/Materials and MethodsForty Japanese patients with solar lentigines received one IPL treatment with a targeted treatment tip that emits wavelengths between 500 and 635 nm and contact cooling. Pulses were delivered through a targeted tip to each lentigo until mild swelling and a gray color were observed. Digital photographs and gray level histogram values were taken pre‐ and post‐treatment, and patient assessments were recorded post‐treatment.ResultsSignificant improvement was observed for all patients in digital photographs and mean values of gray level histograms (P < 0.0001). Ninety percent of patients reported satisfaction with the improvement of the treatment area and convenience of the procedure. Complications were minor and transitory, consisting of a slight burning sensation and mild erythema which resolved within 5 hours of treatment. No serious adverse events were observed.ConclusionsA short‐wavelength IPL, delivered with a targeted tip and contact cooling, offers a highly efficacious treatment for solar lentigines in Japanese skin with minimal downtime and complications. Lasers Surg. Med. 48:30–35, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Hypothermia for preventing chemotherapy-induced neuropathy – a pilot study on safety and tolerability in healthy controls

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting side effect of several chemotherapeutic agents, often leading to treatment discontinuation. Up to 20% of patients treated with weekly paclitaxel experience severe CIPN and no effective treatment has been established so far. The mechanisms of CIPN damage are unclear, but are directly dose-related. We had earlier demonstrated, in rats, the influence of hypothermia in reducing nerve blood flow. Here, we hypothesize that continuous flow limb hypothermia during chemotherapy reduces the incidence and severity of CIPN, by limiting deliverance of the neurotoxic drug to the peripheral nerves. In this study, prior to assessing the effect of hypothermia in preventing CIPN in cancer subjects undergoing paclitaxel chemotherapy, we assess the safety and tolerable temperatures for limb hypothermia in healthy human subjects. Material and methods: In 15 healthy human subjects, hypothermia was administered as continuous flow cooling, unilaterally, via a thermoregulator setup covering the digits up to the elbow/knee, along with continuous skin temperature monitoring. Thermoregulator coolant temperatures between 25 °C and 20 °C were tested for tolerability, based on a carefully designed temperature regulation protocol, and maintained for three hours mimicking the duration of chemotherapy. Tolerability was evaluated using various safety and tolerability scores to monitor the subjects. Results: At the end of the cooling session the healthy subjects presented without significant adverse effects, the main being brief mild skin erythema and transient numbness. Coolant temperatures as low as 22 °C were well tolerated continuously over three hours. Conclusion: Our results confirm the safety and tolerability of continuous flow limb hypothermia in healthy subjects. Further studies will use 22 °C thermoregulator temperature to investigate hypothermia in preventing CIPN in breast cancer patients receiving adjuvant weekly paclitaxel. This pilot study may contribute to alleviating chemotherapy dose limitation due to CIPN and increase the likelihood of success of chemotherapy.

Topical tretinoin in the treatment of vulvar lichen sclerosus: an advisable option?

To assess the effectiveness and safety of a 24-week application of tretinoin 0.025% cream, with an alternate-day regimen, in achieving control of VLS signs and symptoms. 17 patients affected with VLS were included. The main efficacy parameters were the response rate, as defined by protocol parameters, the rate of patients achieving an improvement from baseline of ≥75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment. The safety of the treatment was also assessed. By the end of the 24-week treatment, 12 patients (70.6%) experienced a response; 35.3% and 17.6% of patients achieved an improvement of at least 75% in subjective and objective scores, respectively. Mean scores of itching, leukoderma (pallor) and hyperkeratosis decreased significantly in the study patients, and none presented itching-related excoriations. Erythema increased compared with baseline. Six patients (35.29%) experienced some side effects related to tretinoin, mainly mild erythema and burning. None of the subjects discontinued the treatment because of side effects. Tretinoin 0.025% cream applied for 24 weeks may represent a useful alternative option to corticosteroids in the treatment of active VLS, acting particularly on hyperkeratosis and pallor.

Caught on Capsule: Iron-deficiency Anemia Due to Hookworm Infection

PRESENTATION A tiny ingestible camera identified an otherwise elusive source of anemia in a 63-year-old man. The patient presented to an outside hospital with a 2-week history of generalized weakness, malaise, nausea, and loss of appetite. He denied rectal bleeding. His past medical history was significant for a Billroth II gastric bypass and prior gastric angioectasias. Initial laboratory studies showed that his hemoglobin level, at 7.3 g/dL, was lower than it had been 1 week earlier, when it was 9.9 g/dL, and that, in turn, was reduced from a baseline measurement of 13-15 g/dL, which had been obtained several months prior. Results were also remarkable for leukocytosis at 21.4 10 cells/mm. A rectal examination revealed brown stool that proved positive for blood with a Hemoccult test. Push enteroscopy, with intubation of afferent and efferent limbs of the patient’s Billroth reconstruction, showed mild erythema in the gastric remnant but no angioectasias, ulcers, or evidence of bleeding. Colonoscopy subsequently disclosed internal grade I hemorrhoids and melena throughout the colon and distal small bowel. No source of bleeding was evident. Five units of packed red blood cells did not produce an appreciable increase in his hemoglobin. He was then transferred to our hospital for further workup for a presumed source of bleeding in the small bowel. Upon the patient’s presentation, his wife reported that he had been having dark-colored stools for the past 3-4 years. He had undergone upper endoscopy 1 year earlier and been diagnosed with an angioectasia. This was treated with argon plasma coagulation.