Hypertrophic scars after therapy with CO2 laser for treatment of multiple cutaneous neurofibromas

BACKGROUND. CO2 laser surgery is a treatment modality for cutaneous neurofibromas. OBJECTIVE. Hypertrophic and atrophic scars can result from treatment with CO2 laser surgery. We present a case of cutaneous neurofibromatosis that developed hypertrophic scars postoperatively. METHODS. Continuous wave CO2 laser surgery therapy was applied to the patient. RESULTS. Hypertrophic scars developed 2 months after therapy. CONCLUSION. With a preliminary test treatment the patient is able to see the expected result

Venae perforantes: A clinical review

BACKGROUND. Although many articles on perforating veins have been published, much knowledge about these veins is lacking. OBJECTIVE. In this review relevant facts about the clinical importance of perforating veins in venous disease are described. METHODS. A literature search on English, French and German articles has been performed using literature databases like Medline, Embase and Cochrane. RESULTS. Selection criteria are described. CONCLUSION. A few conclusions are drawn: incompetent perforating veins can be of haemodynamic importance, especially in venous ulceration and (recurrent) varicose veins. The current definition of incompetent perforating veins is reflux more than 0,5 seconds (detected by Duplex ultra-sonography). Good anatomical and clinical classifications are published and should be integrated in the CEAP classification. Based on the clinical classification treatment options are described for the different types of incompetent perforating veins. Two different treatment modalities for incompetent perforating veins are surgery (SEPS) and sclerotherapy. SEPS seems to be of benefit in patients with venous ulceration and advanced CVI. Sclerotherapy (especially ultra sound guided sclerotherapy) is promising and worth further evaluation

Duplication of the great saphenous vein: A definition problem and implications for therapy

BACKGROUND: In the literature there is a range from 1% to 20% of duplication (up to 20%) of the great saphenous vein (GSV) reported, because there is a lack of an accurate definition of the GSV and objective parameters for an anatomical identification. OBJECTIVE: To investigate the frequency of true duplications of the GSV. MATERIALS AND METHODS: A systematic review of the literature, a retrospective analysis of duplex examinations, and a prospective study of duplex examinations to investigate the frequency of true duplications of the GSV. RESULTS: In the literature review, a great variety of definitions is used for duplication of the GSV. Before the consensus of the Union International de Phlébologie (UIP) in 2006, Only in a small number of studies, the definition of the GSV in the saphenous compartment between the fascial blades is mentioned. CONCLUSION: Phlebographic studies have been the criterion standard for the identification of venous anatomy. Now, duplex is regarded as the criterion standard for accurate detection of the veins. True duplication of the GSV is less common than the previous literature has suggested, namely 1.6% to 2%. It is recommended that the duplicated GSV should be treated to avoid an important risk of recurrence of venous insufficiency

Incidence, Prevalence and Future Trends of Primary Basal Cell Carcinoma in the Netherlands

Abstract: Basal cell carcinoma (BCC) incidence rates are increasing worldwide. This study’s objective was to estimate the occurrence of BCC in the Netherlands in terms of incidence and prevalence. Data on first primary carcinomas were retrieved from the Eindhoven Cancer Registry and extrapolated to the Dutch population. Extrapolated data showed a total of 444,131, histologically confirmed cases in the Netherlands between 1973 and 2008. During this period, age-adjusted incidence rates (European Standard Population) increased approximately three-fold from 40 to 148 per 100,000 in males and from 34 to 141 in females. Lifetime risk of BCC was 1 in 5–6 for Dutch citizens. Disease prevalence in the Netherlands was 1.4% and almost four times higher than this (5.4%) in the oldest age group (age 65 years or more). Predictions of future trends showed no signs of a plateau in the number of cases. These estimates should urge Dutch policymakers to provide solutions for the growing group of patients with BCC

Optical-thermal mathematical model for endovenous laser ablation of varicose veins

Endovenous laser ablation (EVLA) is successfully used to treat varicose veins. However, the exact working mechanism is still not fully identified and the clinical procedure is not yet standardized. Mathematical modeling of EVLA could strongly improve our understanding of the influence of the various EVLA processes. The aim of this study is to combine Mordon's optical-thermal model with the presence of a strongly absorbing carbonized blood layer on the fiber tip. The model anatomy includes a cylindrically symmetric blood vessel surrounded by an infinite homogenous perivenous tissue. The optical fiber is located in the center of the vessel and is withdrawn with a pullback velocity. The fiber tip includes a small layer of strongly absorbing material, representing the layer of carbonized blood, which absorbs 45 % of the emitted laser power. Heat transfer due to boiling bubbles is taken into account by increasing the heat conduction coefficient by a factor of 200 for temperatures above 95°C. The temperature distribution in the blood, vessel wall, and surrounding medium is calculated from a numerical solution of the bioheat equation. The simulations were performed in MATLAB™ and validated with the aid of an analytical solution. The simulations showed, first, that laser wavelength did virtually not influence the simulated temperature profiles in blood and vessel wall, and, second, that temperatures of the carbonized blood layer varied slightly, from 952 to 1,104°C. Our improved mathematical optical-thermal EVLA model confirmed previous predictions and experimental outcomes that laser wavelength is not an important EVLA parameter and that the fiber tip reaches exceedingly high temperatures

Topical photodynamic therapy using different porphyrin precursors leads to differences in vascular photosensitization and vascular damage in normal mouse skin

Different distributions of hexyl aminolevulinate (HAL), aminolevulinic acid (ALA) and methyl aminolevulinate (MAL) in the superficial vasculature are not well studied but they are hypothesized to play an important role in topical photodynamic therapy (PDT). The colocalization of fluorescent CD31 and protoporphyrin IX (PpIX) was calculated using confocal microscopy of mouse skin sections to investigate the vascular distribution after topical application. Vascular damage leads to disruption of the normal endothelial adherens junction complex, of which CD144 is an integral component. Therefore, normal CD31 combined with loss of normal fluorescent CD144 staining was visually scored to assess vascular damage. Both the vascular PpIX concentration and the vascular damage were highest for HAL, then ALA and then MAL. Vascular damage in MAL was not different from normal contralateral control skin. This pattern is consistent with literature data on vasoconstriction after PDT, and with the hypothesis that the vasculature plays a role in light fractionation that increases efficacy for HAL and ALA-PDT but not for MAL. These findings indicate that endothelial cells of superficial blood vessels synthesize biologically relevant PpIX concentrations, leading to vascular damage. Such vascular effects are expected to influence the oxygenation of tissue after PDT which can be important for treatment efficacy. The ability of the vasculature to synthesize PpIX and be damaged by PDT was compared between HAL, ALA and MAL in mouse skin using confocal microscopy and fluorescent CD31 and CD144 antibodies. Colocalization of CD31 and PpIX (left images) was calculated to measure endothelial PpIX synthesis. Vascular damage was scored as loss of normal CD144 staining (right images). Both PpIX synthesis and vascular damage were highest for HAL, then ALA, then MAL. This illustrates that superficial blood vessels synthesize biologically relevant amounts of PpIX. Vascular responses can limit oxygen supply during or after PDT and are expected to influence outcome

Proposal for a 4-type classification of acne: An evidence-based review of the literature

Background: Proper evidence-based classification and grading of a disease such as acne are important in guiding medical practitioners to properly diagnose diseases and treat patients. Objective: This is a review of the present classification of acne in order to delineate modified approaches of acne treatment. Methods: The available literature was reviewed, including searches from 7 databases based on the terms “classification of acne vulgaris and pathophysiology”, according to evidence-based medicine using the Cochrane risk of bias tool. Results: From a total of 10,121 studies on acne classification, 51 full-text articles were assessed and 13 studies were included after screening for acne classification. Conclusion: The European-evidence-based guideline (EDF) classification fits best. We propose a modified classification in 4 categories to improve the management of each stage of acne

Limitations of Weight Velocity Analysis by Commercial Computer Program Growth Analyser Viewer Edition

Commercial software package “Growth Analyser Viewer Edition” (“GAVE”) aims to document, monitor and analyze growth and development in children and adolescents. Although its clinical and scientific use is widespread, there are no published studies that describe the method and its validation. We were informed that GAVE calculates the weight velocity (kg/year) at age t from the weight difference between t and 448 days earlier or at birth, divided by the time difference. We recently discussed a case of false child abuse diagnosis (Pediatric Condition Falsification), resulting in the separation of the child from its parents, in which GAVE played a negative contributing role. To prevent such inappropriate diagnoses, we analyzed GAVE from a schematic representation of the measured clinical weight curve, with precisely defined weight velocities. In conclusion, the 448 days included for weight velocity predictions by GAVE caused the erroneous outcomes. Until the necessary changes to the software are implemented and validated, we advise against the use of GAVE in infants younger than 1.5 years, if multiple weight changes occur within 448 days, and following a long-lasting weight velocity change. Our analysis suggests to discard all medical software packages that lack public description and proof of validation

Endovenous laser ablation (EVLA): a review of mechanisms, modeling outcomes, and issues for debate

Endovenous laser ablation (EVLA) is a commonly used and very effective minimally invasive therapy to manage leg varicosities. Yet, and despite a clinical history of 16 years, no international consensus on a best treatment protocol has been reached so far. Evidence presented in this paper supports the opinion that insufficient knowledge of the underlying physics amongst frequent users could explain this shortcoming. In this review, we will examine the possible modes of action of EVLA, hoping that better understanding of EVLA-related physics stimulates critical appraisal of claims made concerning the efficacy of EVLA devices, and may advance identifying a best possible treatment protocol. Finally, physical arguments are presented to debate on long-standing, but often unfounded, clinical opinions and habits. This includes issues such as (1) the importance of laser power versus the lack of clinical relevance of laser energy (Joule) as used in Joule per centimeter vein length, i.e., in linear endovenous energy density (LEED), and Joule per square centimeter vein wall area, (2) the predicted effectiveness of a higher power and faster pullback velocity, (3) the irrelevance of whether laser light is absorbed by hemoglobin or water, and (4) the effectiveness of reducing the vein diameter during EVLA therapy