Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy

BACKGROUND: Keloids are common benign tumors of the dermis, typically arising after insult to the skin. While typically only impinging on cosmesis, large or recurrent keloids may require therapeutic intervention. While no single standardized treatment course has been established, several series report excellent outcomes for keloids with post-surgery radiation therapy. CASE PRESENTATION: We present a patient with a history of recurrent keloids arising in the absence of an ascribed trauma and a maternal familial history of keloid formation, whose physical examination several large perineal keloids of 6-20 cm in the largest dimension. The patient was treated with surgical extirpation and adjuvant radiation therapy. Radiotherapy was delivered to the scar bed to a total dose of 22 Gy over 11 daily fractions. Acute radiotherapy toxicity necessitated a treatment break due to RTOG Grade III acute toxicity (moderate ulceration and skin breakdown) which resolved rapidly during a 3-day treatment break. The patient demonstrated local control and has remained free of local recurrence for more than 2 years. CONCLUSION: Radiotherapy for keloids represents a safe and effective option for post-surgical keloid therapy, especially for patients with bulky or recurrent disease

Diseases of Renal Microcirculation: Diabetic Nephropathy

The prevalence of diabetes mellitus and its long-term vascular complications are increasing worldwide. Diabetic nephropathy is one of the main microvascular complications of diabetes and is characterized by the development of persistent macroalbuminuria (i.e., a urinary albumin excretion [UAE] >300 mg/24 h) or proteinuria (i.e., a urinary protein excretion >0.5 g/24 h). Characteristic glomerular changes of diabetic nephropathy include thickening of the glomerular basement membrane (GBM), mesangial expansion, and podocyte injury. Since type 1 and type 2 diabetic nephropathies share similar histologic characteristics as well as structural-functional relationships, one common classification is used to describe the pathologic classification of diabetic nephropathy for both type 1 and 2 diabetes. Although UAE should rather be considered as a continuous variable rather than using specific cutoff values, we describe the clinical course of diabetic nephropathy based on the classic approach using three stages based on urinary albumin excretion (i.e., normoalbuminuria, microalbuminuria, and macroalbuminuria). Diabetic nephropathy is a major independent risk factor for diabetes-related morbidity and mortality. However, a number of interventions are available that can reduce the risk of developing diabetic nephropathy and slow the progression hereof. Key treatment strategies that could reduce the incidence and progression of diabetic nephropathy include blood glucose control, blood pressure control, lipid-lowering therapy, and lifestyle interventions