Long-term extracorporeal photochemotherapy in a pediatric patient with refractory sclerodermatous chronic graft-versus-host disease.

Sclerodermatous chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT) in children is difficult to treat and life-threatening. Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy that involves the infusion of autologous peripheral blood leukocytes after ex vivo exposure to the photoactive agent 8-methoxypsoralen and ultraviolet A radiation, is an effective treatment for steroid-refractory cGVHD. After undergoing allogeneic HSCT for pre-B-cell acute lymphoblastic leukemia, a 14-year-old boy developed extensive sclerodermatous cGVHD that was refractory to prednisone, tacrolimus, and sirolimus.

Midface lift using a minimally invasive technique and a novel absorbable suture.

Background: Midface rejuvenation is a minimally invasive procedure designed to correct early ptosis of the cheeks and deepening nasolabial folds. Implementation of this technique requires a detailed understanding of the anatomy of this region in addition to recognizing the vectors of change that occur over time as one matures. Finally, aesthetic competence and requisite surgical skills are required to restore the midface in a minimally invasive fashion.

A novel specialized suture and inserting device for the resuspension of ptotic facial tissues: early results.

Background: In the past decade, the popularity of minimally invasive procedures for facial rejuvenation has increased.

Objective: To describe a new specialized suture, and its associated technique, used to elevate sagging tissues of the face and neck.

Methods: A detailed description of the technique and the results obtained in 20 patients in whom we have used this novel approach.

Extracorporeal photopheresis for the treatment of refractory Crohn's disease: results of an open-label pilot study.

Background: Extracorporeal photopheresis (ECP) is effective in immune-mediated disorders. A prospective, uncontrolled pilot study was conducted to evaluate the safety and efficacy of ECP in patients with active Crohn's disease (CD) who were refractory to or intolerant of immunosuppressants and/or anti-TNF therapies.

Methods: Patients with moderate-to-severely active CD (Crohn's Disease Activity Index [CDAI] 220-450 points) underwent 12 weeks of ECP treatment (Weeks 1-4: twice weekly, every week; Weeks 5-12: twice weekly, every other week).

Extracorporeal photochemotherapy for the treatment of refractory Crohn's disease.

Crohn's disease is an idiopathic, relapsing inflammatory disorder of the gastrointestinal tract. We prospectively evaluated the use of extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy, to treat moderate or severe Crohn's disease (Crohn's Disease Activity Index [CDAI] score > or = 220 points) in 2 patients who failed multiple treatments, including immunosuppressants and anti-tumor necrosis factor agents. After at least 24 weeks of ECP with stable concomitant therapy, the patient with moderate disease achieved a clinical response (a decrease in CDAI score from baseline of > or = 100 points and an endpoint CDAI score of < or = 150 points), whereas the other patient with severe disease demonstrated limited improvement.

Persistent inflammatory reaction to hyaluronic acid gel: a case report.

Soft tissue augmentation is widely used to enhance or improve a patient's appearance. Hyaluronic acid is considered to be one of the best fillers for cosmetic procedures, mainly because of its lack of immunogenicity. We report a case of a persistent inflammatory reaction to injectable hyaluronic acid gel used for the correction of melolabial folds.

A randomized, double-blind, placebo-controlled trial of photopheresis in systemic sclerosis.

Background: Systemic sclerosis is a multisystemic connective tissue disease with marked involvement of the skin and joints for which few effective evidence based therapies are available. To further investigate the efficacy of extracorporeal photochemotherapy on early aggressive cutaneous disease, a randomized, double-blind, placebo-controlled trial was performed.

Objective: Our aim was to evaluate the efficacy of photopheresis in the treatment of patients with systemic sclerosis (scleroderma).

Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy.

Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy developed for cutaneous T-cell lymphoma, has shown promise in treating chronic graft-versus-host disease (cGvHD) in uncontrolled studies. The purpose of this study was to further examine the effects of ECP on cGvHD. ECP (administered initially 3 times weekly on alternating days) was retrospectively evaluated in 14 patients with extensive cGvHD following allogeneic hematopoietic stem cell transplantation.

Anterior face-lift for correction of middle face aging utilizing a minimally invasive technique.

Objective: A minimally invasive face-lifting approach aimed at rejuvenation of the midface was examined, for patients with concerns limited to midfacial aging.

Methods: An incision in the preauricular area and then minor undermining to lift superfical musculo apponeurotic system (SMAS), followed by SMAS plication and removal of skin laxity in the midface, results in excellent superolateral reversal of inferomedial displacement of the aging vector.

Results And Conclusion: A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

Experience with more than 5,000 cases in which monitored anesthesia care was used for liposuction surgery.

Background: Conscious sedation using monitored anesthesia care can provide a clinical spectrum from relaxation to moderate anesthesia. This middle ground between general anesthesia and "pure" tumescent liposuction can help facilitate patient comfort and surgical proficiency during the procedure.

Objective: To describe a method of liposuction surgery with monitored anesthesia care in which a designated licensed and qualified individual is responsible for administration of supplemental intravenous conscious sedation as well as continuous monitoring of the patient.

Photopheresis. Therapeutic potential in preventing restenosis after percutaneous transluminal coronary angioplasty.

Photopheresis (extracorporeal photochemotherapy) is an immunomodulatory therapy that entails the reinfusion of peripheral blood mononuclear cells after exposure to the photoreactive agent methoxsalen and ultraviolet A (UVA) radiation. Currently available at approximately 150 treatment centers worldwide, photopheresis is approved by the US FDA for advanced-stage cutaneous T-cell lymphoma (CTCL) and has also shown promise in treating nonmalignant immune-related conditions such as organ transplant rejection, acute and chronic graft-versus-host disease, and autoimmune disorders. The precise mechanism by which photopheresis evokes clinical responses is unknown, although this modality seems capable of modulating T-cell and monocyte activity.

Herpes simplex virus prophylaxis with famciclovir in patients undergoing aesthetic facial CO2 laser resurfacing.

Herpes simplex virus 1 (HSV-1) reactivation may occur in patients undergoing facial carbon dioxide (CO2) laser resurfacing and can delay healing and result in severe scarring. Prophylactic oral antiviral agents are administered routinely to patients undergoing laser resurfacing to prevent postoperative HSV-1 eruptions; however, dosage and duration of treatment vary in the literature. Famciclovir is a highly effective nucleoside analog used in the treatment of HSV infections.

Giant congenital melanocytic nevus with a large ulceration at birth: a 5-year follow-up.

Giant congenital melanocytic nevus (GCMN) is a rare birthmark that places patients at an increased lifetime risk of malignant melanoma. Herein, we describe an unusual case of GCMN that was followed up from birth until 5 years of age. A white girl was born, after an uncomplicated gestation, with a large cutaneous ulceration that extended over her entire back and laterally toward the anterior aspect of her trunk to involve the chest symmetrically.

Resuspension of mild to moderate jawline laxity using a minimally invasive technique.

Background: A practical approach for superficial musculoapponeurotic system plication and neck lift is indicated for early aging changes of jawline.

Methods: A single or series of small punches or single incisions at the earlobe and then minor undermining to lift the superficial musculoapponeurotic system followed by removal of skin laxity in neck and jowl result in a seamless scar via a simple V to Y closure.

Results And Conclusion: A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

Management of large surgical defects of the forehead and scalp by imbrication of deep tissues.

Background: When facing surgical defects, the dermatologic surgeon follows certain basic principles that help reduce the inherent tension to allow for a better cosmetic outcome. These commonly include the use of undermining, releasing technique such as galeotomy if applicable, selection of suture material of appropriate tensile strength, and closure along relaxed skin tension lines.

Objective: To review the imbrication of deep tissues, another surgical principle aimed at wound tension reduction and widely utilized by cosmetic surgeons in forehead lifts and scalp reductions, as it applies to dermatologic surgeons in the repair of large surgical defects of the upper face and scalp.

Reduction of conchal enlargement and/or anterolateral rotation: otoplasty by the cosmetic dermatologic surgeon.

Background: Otoplasty is the correction of protuberant ears. One of the most common malformations responsible for prominauris is conchal enlargement and/or anterolateral rotation. The surgical technique we utilize for the correction of this type of auricular malformation is not unlike the removal of auricular skin and cartilage frequently performed by dermatologic surgeons in the treatment of cutaneous malignancies of the ear.

Auricular reconstruction of helical rim defects: wedge resection revisited.

Auricular reconstruction of an acquired helical rim defect is a clinical situation commonly encountered by dermatologic surgeons. Wedge resection is a simple but effective method for repairing such helical rim defects. This is a review of the wedge resection, outlining its indications, limitations, surgical technique, postoperative care, and pitfalls.