scholarly journals A case report of a patient presented with skin ulcer after treatment of lenvatinib

2021 ◽  
Vol 21 (2) ◽  
pp. 194-198
Author(s):  
Serin Cha ◽  
Dong Woo Kim ◽  
Jung Wan Choe ◽  
Tae Hyung Kim ◽  
Seung Young Kim ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Stage Iv ◽  
Skin Ulcer ◽  
Small Bowel Mesentery ◽  
Tissue Necrosis ◽  
Skin Ulceration ◽  
Thickness Skin ◽  
Skin Loss ◽  
Perineal Region ◽  
Grade 3

A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.

scholarly journals Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang
Keyword(s):  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Salvage Procedure ◽  
Primary Defect ◽  
Scalp Defects ◽  
Thickness Skin ◽  
Scalp Defect ◽  
Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

scholarly journals Patients presenting with metastases: stage IV uveal melanoma, an international study

2021 ◽  
pp. bjophthalmol-2020-317949
Author(s):  
Gaurav Garg ◽  
Paul T Finger ◽  
Tero T Kivelä ◽  
E Rand Simpson ◽  
Brenda L Gallie ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Ciliary Body ◽  
Regional Lymph Node ◽  
Subcutaneous Tissue ◽  
Primary Tumour ◽  
Stage Iv ◽  
International Study ◽  
Whole Body ◽  
Retrospective Data Analysis ◽  
Synchronous Metastases

ObjectiveTo analyse ocular and systemic findings of patients presenting with systemic metastasis.Methods and analysisIt is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.ResultsOf 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1–T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.ConclusionsThough higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.

First-line nivolumab (NIVO) plus ipilimumab (IPI) plus two cycles of chemotherapy (chemo) versus chemo alone (4 cycles) in patients with advanced non-small cell lung cancer (NSCLC): Two-year update from CheckMate 9LA.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9000-9000
Author(s):  
Martin Reck ◽  
Tudor-Eliade Ciuleanu ◽  
Manuel Cobo ◽  
Michael Schenker ◽  
Bogdan Zurawski ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Performance Status ◽  
Objective Response ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Expression Level ◽  
First Line ◽  
Ecog Performance Status ◽  
Grade 3

9000 Background: In the randomized phase 3 CheckMate 9LA trial (NCT03215706), first-line NIVO + IPI combined with 2 cycles of chemo significantly improved overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) vs chemo alone (4 cycles). Clinical benefit was observed regardless of programmed death ligand 1 (PD-L1) expression level and histology. Here we report data with 2 years’ minimum follow-up from this study. Methods: Adult patients (pts) with stage IV / recurrent NSCLC, ECOG performance status ≤ 1, and no known sensitizing EGFR/ALK alterations were stratified by PD-L1 (< 1% vs ≥ 1%), sex, and histology (squamous vs non-squamous) and were randomized 1:1 to NIVO 360 mg Q3W + IPI 1 mg/kg Q6W + chemo (2 cycles; n = 361) or chemo alone (4 cycles; n = 358). Pts with non-squamous NSCLC in the chemo-alone arm could receive pemetrexed maintenance. The primary endpoint was OS. Secondary endpoints included PFS and ORR by blinded independent central review, and efficacy by different PD-L1 levels. Safety was exploratory. Results: At a minimum follow-up of 24.4 months for OS (database lock: Feb 18, 2021), pts treated with NIVO + IPI + chemo continued to derive OS benefit vs chemo, with a median OS of 15.8 months vs 11.0 months, respectively (HR, 0.72 [95% CI, 0.61–0.86]); 2-year OS rates were 38% vs 26%. Median PFS with NIVO + IPI + chemo vs chemo was 6.7 months vs 5.3 months (HR, 0.67 [95% CI, 0.56–0.79]); 8% and 37% of pts who had disease progression received subsequent immunotherapy, respectively. ORR was 38% with NIVO + IPI + chemo vs 25% with chemo. Similar clinical benefit with NIVO + IPI + chemo vs chemo was observed in all randomized pts and across the majority of subgroups, including by PD-L1 expression level (Table) or histology. Any grade and grade 3–4 treatment-related adverse events were reported in 92% and 48% of pts in the NIVO + IPI + chemo arm vs 88% and 38% in the chemo arm, respectively. Conclusion: With 2 years’ minimum follow-up, first-line NIVO + IPI + chemo demonstrated durable survival and benefit versus chemo in pts with advanced NSCLC; no new safety signals were identified. Clinical trial information: NCT03215706. [Table: see text]

Fournier gangrene: what’s new in treatment?

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (3) ◽  
Author(s):  
Zbigniew Tański ◽  
Zbigniew Jarząbek ◽  
Bartosz Konowalski ◽  
Maciej Truszkowski ◽  
Jakub Biedrzycki ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Medical Literature ◽  
Abdominal Cavity ◽  
Tissue Necrosis ◽  
Improve Treatment ◽  
Fournier Gangrene ◽  
Soft Tissue Necrosis ◽  
Life Threatening ◽  
Perineal Region ◽  
Balanced Crystalloid

Fournier gangrene is necrotic, life-threatening fasciitis occurring in the perineal region and within external sexual organs and anus. It may extend to the abdominal cavity, leading to soft tissue necrosis and sepsis. The article presents current methods of diagnosis and treatment of necrotising fasciitis (Fournier gangrene being a part of this disease) based on the medical literature and experience of two urological wards. The following methods are discussed: isotonic salt and balanced crystalloid fluids, antibiotics, steroids, immunoglobulin, hyperbaric oxygen therapy, surgical debridement and split-thickness mesh grafting. At the beginning broad spectrum antibiotics were administrated for the patients, according with local guidelines therapeutic committee and results of specimens for Gram’s staining and culture and laboratory tests. After receiving antibiogram prompt antibiotic treatment was continued. Cystostomy was done for everyone. Active dressing was applied rarely. Mortality was not observed in this group of patients. Fournier gangrene frequently ends with death due to sepsis, ARDS, or insufficiency of the kidneys, liver or other organs. Early diagnosis, careful debridement and application of a proper antibiotic are the basic factors that reduce mortality and improve treatment outcomes.

Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

2012 ◽  
Vol 25 (01) ◽  
pp. 42-48 ◽  
Author(s):  
S. C. Ralphs ◽  
G Coronado ◽  
D. C. Sweet ◽  
J. Ward ◽  
C. P. Bloch ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skin Graft ◽  
Clinical Case ◽  
Subcutaneous Tissue ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preparation Methods ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Significant Difference

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

scholarly journals Management of Chronic Non-Healing Wound using Ayurvedic drugs - A Case Study

2020 ◽  
Vol 11 (2) ◽  
pp. 337-341
Author(s):  
Hemanta Kumar Panigrahi
Keyword(s):  
Wound Healing ◽  
Subcutaneous Tissue ◽  
Oral Intake ◽  
Central Research Institute ◽  
Central Research ◽  
Ayurvedic Drugs ◽  
Superficial Wound ◽  
Healing Wound ◽  
Skin Loss ◽  
External Wound

Sushruta in 1st part of his compendium described about wound healing its types etc. as Vranitopasaniya adhyaya. Ayurveda described so many compound medicines and oil for oral administration and topical application to accelerate the wound healing. But this is not scientifically validated. So there is always a search for finding a newer and better medicine for wound healing. I am presenting a case of 42 year old married male with complain of superficial external wound with mild pain,  mal odour  and not healing  since 45 days in spite of taking allopathic conventional treatment in his lower limb. The study was done in my outpatient department of Central Research institute for cardiovascular disease, Punjabi Bagh, New Delhi. On examination it was found that surface area of superficial wound is 22.5 sq. cm. having full thickness, skin loss involving necrosis of subcutaneous tissue extended down to underlying fascia. Necessary laboratory investigations were done prior to initiate the treatment. The wound was irrigated with Panchvalkala kasaya and dressing with Jatyadi Tail was done daily followed by oral intake of Triphala guggulu 500mg twice in a day and Amalaki churna 6gm twice in a day was administered orally for 28th days. Periodic follow up was done on 0, 7, 14, and in 28 days. This regimen was found to be effective in faster wound epithelialization, and reducing wound exudates. There was no evidence of any allergic reaction as well as no evidence showing any adverse event on the wound.

Crossover and rechallenge with pembrolizumab in recurrent patients from the EORTC 1325-MG/Keynote-054 phase 3 trial, pembrolizumab versus placebo after complete resection of high-risk stage III melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9500-9500
Author(s):  
Alexander M. Eggermont ◽  
Andrey Meshcheryakov ◽  
Victoria Atkinson ◽  
Christian U. Blank ◽  
Mario Mandalà ◽  
...  
Keyword(s):  
Disease Progression ◽  
Objective Response ◽  
Stage Iv ◽  
Median Number ◽  
Complete Resection ◽  
Stage Iii ◽  
Phase 3 ◽  
Double Blind ◽  
Grade 3 ◽  
To Receive

9500 Background: The phase 3 double-blind EORTC 1325/KEYNOTE-054 trial evaluated pembrolizumab (pembro) vs placebo in stage III cutaneous melanoma patients (pts) with complete resection of lymph nodes. Pembro improved RFS (hazard ratio [HR] 0.57) and DMFS (HR 0.60) (Eggermont, NEJM 2018, TLO 2021). In the pembro group, the incidence of immune related AE (irAE) grade 1-5 was 37%, and of grade 3-5 was 7%. We present the safety profile, response rate and PFS for the subset of pts who had a recurrence and crossed over or were rechallenged with pembrolizumab, within protocol. Methods: Pts were randomized to receive iv. pembro 200 mg (N=514) or placebo (N=505) every 3 weeks for a total of 18 doses (~1 year). Upon recurrence with no brain metastases, pts with an ECOG PS 0-2 were eligible to enter part 2 of the study, i.e. to receive pembro 200 mg iv. every 3 weeks for a maximum of 2 years, for crossover (those who received placebo) or rechallenge (those who recurred ≥6 months after completing one year of pembro therapy). Treatment was stopped in case of disease progression (RECIST 1.1) or unacceptable toxicity. Results: At the clinical cut-off (16-Oct-2020), 298 (59%) pts had a disease recurrence in the placebo group; 155 pts participated in the crossover part 2 of the trial. A total of 297 (58%) pts completed the 1-yr pembro adjuvant treatment, of whom 47 had a recurrence ≥6 mths from the stop of treatment and 20 entered in the rechallenge part of the trial. Among 175 pts who started pembro in Part 2, 160 discontinued due to completion of therapy (N=24), disease progression (N=88), toxicity (N=20), investigator's decision (N=21), or other reason (N=7); 15 pts were still on-treatment. Results for the 2 groups are provided in the table. The median number of doses was 12 and 5.5, respectively (resp), and the median follow-up was 41 and 19 mts, resp. Among the 175 pts, 51 (29%) had a grade 1-4 irAE (by group: 47 [30%] and 4 [20%] resp) and 11 (6%) a grade 3-4 irAE. Conclusions: Pembrolizumab treatment after crossover yielded a 39% ORR in evaluable pts and an overall 3-yr PFS of ̃32%, but after rechallenge the efficacy was lower. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA The median PFS (95% CI) from start of Part 2 was 14 (5-27) and 8 (5-15) mts for stage III-resected and III/IV various, resp. Among the 80 stage IV crossover pts with evaluable disease, 31 (39%) had an objective response: 14 (18%) CR, 17 (21%) PR. The 2-yr PFS rate from response was 69% (95% CI 48-83%). For these 80 pts, the median PFS was 6.1 mts and the 3-yr PFS rate was 31% (95% CI 21-41%). Among 9 stage IV rechallenged pts with an evaluable disease, 1 (11%) reached CR, 3 had SD and 5 PD. Clinical trial information: NCT02362594. [Table: see text]

scholarly journals The effectiveness of local surgical technique in treatment of axillary bromhidrosis

2019 ◽  
Vol 7 (2) ◽  
pp. 187-191
Author(s):  
Thuong Nguyen Van ◽  
Tan Nguyen Manh ◽  
Phuong Pham Thi Minh ◽  
Trang Trinh Minh ◽  
Nghi Dinh Huu ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skin Necrosis ◽  
Subcutaneous Tissue ◽  
Skin Flap ◽  
Life Quality ◽  
Arm Movement ◽  
Surgical Excision ◽  
Heart Valve Disease ◽  
Apocrine Glands ◽  
Thickness Skin

BACKGROUND: Up to now, surgical excision of apocrine glands still has been a method that yields high treatment results and low rate of odour recurrent for patients, but many people worry about some serious complications that have been observed postoperatively, such as hematoma and skin necrosis. These prolong wound healing, leading to unsightly scars in the axillary fossae. AIM: We conducted this research to investigate the effects and complications of our surgical technique for axillary bromhidrosis. METHODS: Forty-three patients with axillary bromhidrosis were treated. An elliptical incision was made at a central portion of the area marked, with both tips of the ellipse along the axillary crease. The elliptical skin with the subcutaneous tissue was removed en lock. The adjacent skin was undermined to the periphery of the hair-bearing area with straight scissors. The undermined subcutaneous tissue was removed with curved scissors, and the skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Appropriate drains were placed, and the treated area was covered with thick gauze to each axilla. Arm movement was strictly controlled in the first 3 days post-operatively. RESULTS: Thirty-one patients have been followed up and evaluated for 6 months. 56 out of 62 axillae (90.3%) showed good to excellent results for malodor elimination. All patients reported a reduction in axillary sweating. There were two axillae of skin necrosis and three axillae of hematoma, with one patient receiving an anticoagulant from a cardiologist after the first day of surgery, to treat heart valve disease. The Dermatology Life Quality Index (DLQI) score decreased significantly, and the quality of life improved after the operation. CONCLUSION: Our technique is a simple surgical procedure and easy to perform helping to achieve results for high malodor elimination, with almost no serious complications. Patient’s life quality improved significantly after the operation.

Subcutaneous tissue infiltration as an adjunct to split-thickness skin grafting

1972 ◽  
Vol 123 (5) ◽  
pp. 624-625 ◽  
Author(s):  
Paul Silverstein ◽  
William F. McManus ◽  
Basil A. Pruitt
Keyword(s):  
Subcutaneous Tissue ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Treatment of advanced carcinoma of the vulva with chemoradiotherapy — can exenterative surgery be avoided?

1994 ◽  
Vol 4 (3) ◽  
pp. 150-155 ◽  
Author(s):  
D. J. Sebag-Montefiore ◽  
C. Mclean ◽  
S. J. Arnott ◽  
P. Blake ◽  
P. Van Dam ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Stage Iv ◽  
Complete Response ◽  
Figo Stage ◽  
Who Grade ◽  
Low Toxicity ◽  
Venous Infusion ◽  
Grade 3 ◽  
Extent Of Disease ◽  
Disease Free

Thirty-seven patients with advanced FIGO stage (17 stage III, 20 stage IV) carcinoma of the vulva whose extent of disease would have required extenterative surgery were treated with chemoradiotherapy (CRT). Radiotherapy was given as a split course (2500 cGy mid-plane dose in 10 daily fractions, repeated 1 month later) to the first seven patients. Subsequently radiotherapy was given as a continuous course (4500 cGy mid-plane dose in 20–25 daily fractions). Chemotherapy included mitomycin c as an intravenous bolus and 5 fluorouracil as a continuous intra-venous infusion over 4–5 days, with variations in timing and dose according to the type of radiotherapy course. Fifteen (47%) complete and 11 (34%) partial responses were seen at 3 months after completion of treatment. Of the 15 patients with complete response, 10 remained disease-free for a median of 24 months (range 6–36 months). The median sur-vival for complete and partial responding patients was 15 and 11 months, respectively (range 2–37 months). Acute toxicity included moist perineal desquamation, diarrhea and myelosupression. One death secondary to neutropaenic sepsis occurred in the split course group. WHO grade 3 radiation enteritis occurred in one patient (14%) in the split course and two patients (6%) in the continuous CRT groups. Using CRT, very high response rates have been obtained with relatively low toxicity. There is a useful role for CRT in the treatment of patients with locally advanced recurrent disease although its place in the management of extensive primary disease requires further evaluation.

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