Argon–Helium Cryoablation for Cutaneous Squamous Cell Carcinoma in the Elderly

Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant neoplasm in non-melanoma skin cancer (NMSC). Most cases of simple cSCC are considered curable by surgical removal of the lesion. However, clinical treatments for cSCC with medium- or large-sized lesions are difficult. Meanwhile, the effectiveness of the treatments is not guaranteed, especially for elderly patients, because of an intolerance to surgical resection or other adjuvant modalities. In such cases, safe and effective treatments with excellent aesthetic outcomes are urgently needed. In this study, we reported 6 elderly cSCC patients with medium- or large-sized lesions treated with argon–helium cryoablation. The average age of all 6 patients was 78 years (range 72–85 years). They were all diagnosed with cSCC with a median tumor size of 5.8 cm (range 2.5–15.5 cm) and dermal invasion. Complete ablation was achieved in all cases after a single ablation session (2 freeze–thaw cycles). Patients experienced mild pain and hemorrhage after ablation, but the symptoms were manageable. One patient developed infection and fever because of extensive necrosis of the tumor, which was eventually cured after treatment. All patients obtained good cosmetic outcomes, and their quality of life improved significantly. In the 5-year follow-up study, 4 patients were alive while 2 patients died of unrelated diseases 3 years after cryotherapy. None of the 6 patients had a recurrence. These results suggested the feasibility of argon–helium cryoablation as a novel therapeutic strategy for elderly cSCC with medium- or large-sized lesions.

Modified three-step procedure to treat buried penis in children without previous surgery: experience in 150 cases

[Background] The buried penis has an abnormally smaller and shorter appearance. We performed a modified three-step procedure to correct the buried penis with satisfactory cosmetic results. [Methods] From May 2014 to December 2020, 150 boys, ranging in age from 2 to 7 years old (median age: 3.3 years), underwent this three-step procedure. The chief complaint was a smaller and shorter appearance of the penis. The surgical procedure consisted of three steps: complete degloving through a diamond-shaped penoscrotal incision, circumcision to remove the majority of the inner plate, and anchoring of the penopubic skin to the base of albuginea penis at the 4 and 8 o’clock positions with unabsorbable sutures. [Results] The mean operative time was 50 minutes (range from 40 to 60 minutes). The mean follow-up time was 2.8 years (range from 10 months to 6 years). There were no complications or recurrences. Good cosmetic results were achieved in all boys. [Conclusions] Our modified three-step procedure had good cosmetic results without complications. We recommend this effective surgical procedure for boys with buried penis who have no history of previous surgery.

МОДИФИЦИРОВАННАЯ МАЛОИНВАЗИВНАЯ МЕТОДИКА ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПО ПОВОДУ ДОБРОКАЧЕСТВЕННЫХ ЗАБОЛЕВАНИЙ ПРИДАТКОВ МАТКИ

The article substantiates the feasibility of developing minimally invasive operations on the adnexa and minimizing surgical trauma. The technique of the modified laparoscopic surgery method proposed by the authors for benign diseases of the adnexa is described in details. The results of treatment of 37 patients operated on by the presented method are considered. The selection criteria for patients for the application of this method of surgical treatment are determined. It is shown that the presented method corresponds to the current trend of minimizing surgical trauma, has a good cosmetic effect, helps to reduce postoperative pain, and is also economically feasible, because it does not require the use of additional endoscopic instruments.

Dramatic radiotherapy response of a giant T4 cutaneous squamous cell carcinoma of the scalp with extensive bone destruction: a case report

Background Patients with large cutaneous squamous cell carcinoma of the scalp are a treatment challenge. We report a case of dramatic radiotherapy response of a patient with a giant cutaneous squamous cell carcinoma of the scalp with extensive skull destruction and suspected infiltration of the dura mater and superior sagittal sinus. This case is the first report of this kind in the literature that shows that large bone defects can heal with the resolution of tumor and inflammation by secondary intention without surgical reconstruction. We want to put an end to concerns about radiocurability of tumors with extensive bone involvement, and show sustained complete response after definitive radiotherapy and programmed cell death protein-1 inhibiting antibody therapy. Case presentation A 74-year-old White man presented with a 7.2 × 6.8 × 5.5 cm painless tumor on the right parietal region of the scalp. Medical imaging revealed widespread destruction of the skull and suspected infiltration of the dura mater and superior sagittal sinus. Biopsies showed cutaneous squamous cell carcinoma (cT4a cN0 cM0, stage IVA). The patient was treated with a total dose of 60 Gy, at 2 Gy per daily fraction with volumetric modulated arc therapy using 6 megavoltage photons. The biologically effective dose (alpha/beta 10 Gy) was 72 Gy. The tumor response correlated with dose received. The patient had a massive tumor necrosis secondary to tumor shrinkage after 18 fractions (36 Gy, biologically effective dose 43.2 Gy). Leakage of cerebrospinal fluid did not occur. Radiotherapy did not hamper the patient’s quality of life. The patient had a clear regression of the initial tumor on the final day of radiotherapy. The bone defect healed by secondary intention without surgical interventions. The patient achieved a complete response with a good cosmetic result after 82 days follow-up. He started a programmed cell death protein-1 inhibiting antibody therapy with cemiplimab 2 months after radiotherapy, and is now at 10 months follow-up without evidence of recurrence. Conclusion Definitive radiotherapy is a safe and highly effective therapy for giant tumors of the scalp with extensive bone destruction. We report a sustained complete response with a good cosmetic result after secondary wound healing.

Minimally Invasive Non-Endoscopic Correction for Sagittal Craniosynostosis in Children Aged Below 6 Months

AIM: Object of this study is to determine effectiveness of this procedure used in this study which is minimally invasive non endoscopic correction for sagittal craniosynostosis in children below 6 months. METHODS: A prospective study was done in Neurosurgery children unit, Abu Elreash Japanese children hospital, Cairo university, Egypt, for patients with non syndromatic sagittal craniosynostosis. The variables analyzed; OFD, BPD, CI pre. & postoperative, age of patients at time of surgery, sex, duration of surgery and length of hospital stay. RESULTS: Our results shows statistically significant difference between pre-operative with post-operative after 2 days, post-operative follow-up, and follow-up after 1 year for OFD, BPD and CI. CONCLUSIONS: Internal helmet technique used in correction of sagittal synostosis in children below 6 months old giving good cosmetic results with the following advantages, (1) short surgery time, (2) small wound, (3) no much blood loss, (4) immediate good cosmetic result, (5) no need to use external devices which reduces the cost, family load, and child suffering, and (6) no need for long-term follow-up.

Cryodestruction of recurrent malignant skin tumors of different localizations in polyclinics

Introduction. Skin cancer is one of the most common types of malignant neoplasms in Russia. Radiation therapy, surgical intervention, and combined treatment are usually used for skin cancer. Unfortunately, the above methods are not always successful. The reason for the incomplete effect of surgical treatment may be insufficient radicalism of the intervention due to the doctor's desire to cause the least trauma to the surrounding healthy tissues in order to obtain a good cosmetic result. Selective destruction of tumor tissue in cryogenic exposure with minimal damage to surrounding healthy tissues is accompanied by a hemostatic effect, which is especially important in the treatment of both primary and recurrent decaying tumor ulcers. Aim — to evaluate the effectiveness of cryodestruction as the method of choice in the outpatient treatment of recurrent skin cancer. Materials and methods. The study was controlled, non-randomized. The criterion for inclusion in the study was the establishment of the diagnosis of recurrent skin cancer at the application and subsequent treatment in the outpatient clinic of the State Budgetary Institution "Oncologic Dispensary" in Novocherkassk from 2016 to 2020. A total of 532 patients were studied. Patients were planned to undergo tumor cryodestruction with several freeze-thaw cycles, lasting 2-5 minutes. Results. The results of the study indicate high efficiency of cryodestruction. Complete recovery in the treatment of recurrent skin cancer was observed in 446 (83.4%) patients. Repeated cryodestruction was performed in 86 (16.6%) patients, who experienced continued growth and recurrence after cryodestruction within 1 to 18 months. Subsequently, 38 of 86 patients (7.2%) did not experience continuation of growth and new recurrences. Discussion. Based on the literature data and our treatment results it was determined that cryodestruction is the most acceptable and simple method of treatment for this category of patients. Conclusion. In the presence of limited recurrences of skin cancer of various localizations, cryogenic exposure is effective (in 90.6% of the outcome — recovery) in patients of different sex and age, regardless of the location and prevalence of the tumor process and is the method of choice of treatment in an outpatient setting.

Urethral mobilization and advancement technique in distal types of hypospadias: short-term local experience

Background A prospective study was conducted on 65 cases with distal hypospadias operated using the urethral mobilization technique between July 2017 and December 2019. Patients with proximal hypospadias and those with distal hypospadias, but with a hypoplastic urethra, were excluded from the study. In this technique, the urethral tube was mobilized proximally in a ratio of 3–4:1 (the ratio of mobilized urethral length to the initial distance between the native meatus and the tip of the glans) then positioned distally after creating wide glans wings. The aim of this study was to assess the outcome of the urethral mobilization technique in distal hypospadias in our center. Results The age of patients was ranged 9 months to 7 years old (mean 37.5 months); 17 (26%) cases were already circumcised. During the postoperative follow-up, 62 (95.4%) patients had a good caliber neomeatus with a good and straight urinary stream; the remaining 3 (4.6%) cases developed meatal stenosis which responded well to urethral dilatation. One (1.5%) patient had a minor retraction of neomeatus but remained within the glans and not requiring further intervention. Four (6%) cases developed minor hematoma which was resolved on conservative measures. Six (9.2%) patients developed minor wound infection which was treated with daily dressing and antibiotic coverage. Conclusion The urethral mobilization technique is a good choice for repairing distal hypospadias especially for boys who are previously circumcised as the preputial flap is not required in this technique. It provides good cosmetic and functional results, with a fewer complication rate.

Karapandzic Flap for Functional & Cosmetic Reconstruction of Lower Lip Cancer with Review of Literature

The incidence and prevalence of lip and oral cavity cancer has increased over the last decade, worldwide and in India. It ranks at 1st position in males in india, all ages, in 2020. Lips are essential organ of the body which carries dynamic role in facial expression, speech, sensuality, deglutition. Resection of central, large, lower lip cancer creates a more than 2/3rd large defect. Covering of this defect with maintenance of oral competency is a difficult task for a treating surgeon. Number of techniques are described for covering of large lower lip defects. Out of these techniques, karapandzic flap is a successful, accepted, simple, easy to learn reconstructive procedure with good cosmetic results. It is a modification of Gillie’s fan flap and it involves unilateral or bilateral full-thickness circumoral advancement-rotation flaps. The feature which distinguishes it from other techniques is preservation of neuro-vascular integrity, symmetry and oral competency. We are reporting a case of an elderly gentleman with large, central, lower lip cancer who underwent oncological resection with reconstruction by karapandzic flap technique.

Axillary uniportal video-assisted thoracoscopic surgery for bullae is a cosmetically superior approach to primary spontaneous pneumothorax: a case report

Background Bulla is a common cause of primary spontaneous pneumothorax. Video-assisted thoracoscopic surgery (VATS) through the lateral chest wall is a common surgical approach and an effective treatment for this condition, but postoperative incision scars affect the aesthetic outcome. VATS via axillary approach can hide the scar in the axilla, and the wound in its natural state is invisible; this greatly improves the cosmetic appearance. To our knowledge, this is the first report of VATS-based bullectomy via the axillary approach in a patient with spontaneous pneumothorax. Case presentation A 20-year-old female patient was admitted to the hospital with a 2-day history of chest tightness and chest pain. Plain chest computed tomography showed right spontaneous pneumothorax, lung compression of 75%, and right pulmonary bulla. After complete preoperative examination, VATS bullectomy via right axillary approach was performed. During the operation, a bulla measuring about 4 × 4 cm was found at the apex of the right lung and resected. The incision healed well, and the patient was discharged after surgery. Conclusions VATS bullectomy via axillary approach is safe and feasible, with the incision hidden in the axilla and not visible in the natural state. This method leaves no scar on the chest wall and has good cosmetic outcome.

Limbal conjunctival approaches to extraocular muscles in the surgical treatment of previously operated strabismus

Purpose. Тo analyze clinical efficacy of the surgical treatment of previously operated strabismus using limbal incisions which are lengthening the conjunctiva and Tenon's capsule. Material and methods. The study included 440 patients (440 eyes) with previously operated strabismus at the age of 4 to 68 years old. The main group included 240 patients (240 eyes) who underwent strabismus surgery by limbal approach; the control group included 200 patients (200 eyes) who underwent surgery by paralimbal conjunctival approach. Horizontal strabismus occurred in 146 patients (60,8%) in the main group and in 158 (79%) in the control group. Horizontal strabismus in combination with vertical strabismus was found in 94 patients (39.2%) in the main group and in 42 patients (21%) in the control group respectively. The following approaches were applied: Y-shaped limbal approach, T-shaped incision of the conjunctiva, lower limbal peritomy, circular limbal approach with an additional horizontal incision towards the muscle being strengthened. Results. Good cosmetic result in the main group was achieved in 94.7% of cases, in the control group in 87% of cases, р<0.001. Re-surgery in the long term period was required for 39 patients (19.5%) in the control group and 14 patients (7%) in the main group, р<0.001. Conclusion. Limbal approaches performed to lengthening the conjunctiva and Tenon's capsule on the side of the weakened muscle and shortening on the side of the muscle being strengthened, are enhancing the effect of recession and resection, thereby contributing to the achievement of the state of orthotropy in 83% and have a good cosmetic result in 94.67% of cases. Key words: limbal conjunctival approaches, limbal conjunctival incisions, strabismus, children.