Venous lakes are dark blue-to-violaceous compressible papules that are caused by the dilation of the superficial dermal venules; they are usually observed in older individuals. Seventeen elderly patients presenting with venous lakes on the lip were treated with a variable-pulsewidth 595 nm Pulsed-Dye Laser. We used the V-beamTM (Candela, USA) with a Dynamic Cooling Device (DCD)TM. The pulse width of the laser was held constant at 1.5 ms, the output energy was 12–15 J/cm2, and the spot size was 7 mm. The DCD spray duration was 20 or 30 msec, and the DCD delay duration was also 20 or 30 msec. We treated each venous lake 1–4 times (average 3.2 times) until it disappeared entirely. After completing the above treatment, we applied white Vaseline to the treatment site. None of the patients experienced any trouble thereafter. The treatment of venous lakes with a Long Pulsed-Dye Laser is therefore considered to be a safe and effective therapeutic modality.
Background: Foot ulcer is complication of diabetes which significantly deteriorates the quality of life of these patients, especially at times of lower extremity amputation. The objective of this study is to consider preventive measures to avoid amputation by analyzing the risk factors. Methods: Sixty patients with diabetic foot ulcers (49 male, 11 female) who were seen at the Dermatology Department of the St. Luke’s International Hospital from 2000–2007 were analyzed using retrospective cohort study design. Results: Both amputated and non-amputated diabetic patients with foot ulcers had long histories of diabetes, and most were accompanied with other complications. Especially among the amputated, histories of acute myocardial infarction and dialysis were significantly associated (p=0.02, p=0.05). HbA1c levels were high; serum albumin and hemoglobin were low in both groups at onset. Those who improved their serum albumin and hemoglobin levels by 0.2±1.2 g/dl (p=0.005) and 0.2±0.5 g/dl (p=0.003), respectively, were able to avoid amputation. Those with poor control of diabetes tended to undergo amputation. Complications of osteomyelitis and access to dermatology clinic both influenced the prognoses of these ulcers. Conclusion: The risk factors leading to amputation found in this study are measurable and reversible, and thus, can be helpful for early intervention.
The objective of our study was to examine aromatase activity in human skin fibroblasts in relation to age and sex. In the cultured skin fibroblasts derived from 79 subjects (39 men and 40 women, age 2–92) undergoing surgery in Department of Dermatology, Dokkyo Medical University Hospital, we measured aromatase activity, but found no significant difference in the mean values between sexes. The correlations between aromatase activity and age were more positive in patients older than 30 years and became stronger with age. This result is consistent with another experiment in which aromatase activities of human fibroblast strains increased with in vitro age (passage number). When the correlation between aromatase activity and age was analyzed separately for each sex, a significant positive correlation was found only in women older than 30 years. This finding, and the fact that the levels of circulating estrogens rise to a peak in women around their 30 s and then begin a decline, suggest the possibility that estrogens are synthesized locally in response to the changes in circulating levels of estrogens. Interestingly, this significant correlation was lost in those fibroblasts obtained from chronically sun-exposed skins. Thus, exposure to the sun may disturb the increase of local aromatase activity.
In this report, we present two cases of gastric antral vascular ectasia (GAVE) or watermelon stomach associated with systemic sclerosis (SSc). Case 1 was a 68-year-old man who had been suffering from SSc for 5 months and complained of general fatigue. Blood laboratory examination showed anemia (hemoglobin: 7.1 g/dl). Case 2 was a 75-year-old woman who had been treated for SSc for 8 years and also presented with anemia (hemoglobin: 5.0 g/dl). At their endoscopic examinations, parallel, longitudinal vascular ectasia of gastric mucosa were seen from the pylorus to the antrum, resembling the stripes on a watermelon. Both patients received endoscopic therapy using argon plasma coagulation, which resulted in arrest of the bleeding and recovery of their hemoglobin levels. Watermelon stomach is a rare syndrome, which is recognized as a cause of gastric bleeding. This syndrome should be considered when unexplained anemia occurs in SSc patients.