The ugly truth about summer allergies

As if a runny nose and red eyes weren’t enough to ruin your warm weather look, summer allergies can gift you with even more than you’ve bargained for this year. In fact, some unusual symptoms can leave you looking like you lost a round in a boxing ring.”Summer allergies can cause severe symptoms for some sufferers, and can be just as bad as the spring and fall seasons,” said allergist Michael Foggs, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI). “Symptoms aren’t always limited to the hallmark sneezing, runny nose and watery eyes. Black eyes, lines across the nose and other cosmetic symptoms can occur.”Even if you’ve never before had allergies, they can suddenly strike at any age and time of year. You might want to consider visiting your board-certified allergist if these undesirable signs accompany your sniffle and sneeze.Allergic Shiner: Dark circles under the eyes which are due to swelling and discoloration from congestion of small blood vessels beneath the skin in the delicate eye area. Allergic (adenoidal) Face: Nasal allergies may promote swelling of the adenoids (lymph tissue that lines the back of the throat and extends behind the nose). This results in a tired and droopy appearance. Nasal Crease: This is a line which can appear across the bridge of the nose usually the result of rubbing the nose upward to relieve nasal congestion and itching. Mouth Breathing: Cases of allergic rhinitis in which severe nasal congestion occurs can result in chronic mouth breathing, associated with the development of a high, arched palate, an elevated upper lip, and an overbite. Teens with allergic rhinitis might need braces to correct dental issues. …

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Soccer-related facial fractures examined

Fractures of the nose and other facial bones are a relatively common and potentially serious injury in soccer players, reports a Brazilian study in Plastic and Reconstructive Surgery — Global Open , the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).On the eve of the 2014 World Cup, a group of Brazilian plastic surgeons review their experience with soccer-related facial fractures requiring surgery. Dr. Dov Charles Goldenberg, MD, PhD, of University of So Paulo and colleagues write, “Due to exposure and the lack of protection for the face, the occasional maxillofacial trauma sustained during soccer games often entails serious facial injuries requiring hospital admissions and invasive procedures.”Soccer Players at Risk of Nasal and Other Facial FracturesThe researchers assembled data on 45 patients undergoing surgical treatment for soccer-related facial fractures at two large university hospital centers in So Paulo between 2000 and 2013. The 45 soccer injuries accounted for two percent of surgically treated facial fractures during that time. Forty-four of the patients were male; the average age was 28 years. All of the injured players were amateurs.The nose and upper jaw (maxilla) accounted for 35 percent of fractures and the cheekbone (zygomatic bone) for another 35 percent. Most of the remaining fractures were of the lower jaw (mandible) and eye socket (orbit). Eighty-seven percent of the injuries were caused by collision with another player; the rest occurred when the player was struck by the ball.Nasal fractures were treated by repositioning (reducing) the fractured bones to their proper place and splinting until they healed. Other types of facial fractures required open surgery and internal fixation (plates, screws) to reposition the bones. The patients remained in the hospital for about five days on average, and were told they could return to play after six to eight weeks of healing.Emphasis on Awareness and Examination to Detect Soccer-Related FracturesThe results are consistent with previous studies of soccer-related facial injuries. …

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Breakthrough drug-eluting patch stops scar growth, reduces scar tissues

Scars — in particular keloid scars that result from overgrowth of skin tissue after injuries or surgeries — are unsightly and can even lead to disfigurement and psychological problems of affected patients. Individuals with darker pigmentation — in particular people with African, Hispanic or South-Asian genetic background — are more likely to develop this skin tissue disorder. Current therapy options, including surgery and injections of corticosteroids into scar tissues, are often ineffective, require clinical supervision and can be costly.A new invention by researchers from Nanyang Technological University in Singapore (reported in the current issue of TECHNOLOGY) provides a simple, affordable and — most importantly — highly effective way for patients to self-treat keloid scars. The team of scientists and engineers from NTU’s School of Chemical and Biomedical Engineering, in collaboration with clinicians from Singapore’s National Skin Centre, have developed a special patch made from polymers fabricated into microneedles, which are loaded with the US food and drug administration (FDA)-approved scar-reducing drug, 5-fluorouracil. Self-administered by patients, the microneedles attach the patch to scar tissue and allow sustained drug-release (one patch per night). The drug as well as the physical contact of the microneedles with the scar tissue contributes to the efficacy of the device, leading to the cessation of scar tissue growth and a considerable reduction of keloids as demonstrated in laboratory cultures and experiments with animals. “Most patients seek treatment due to disfigurement and/or pain or itch of scars,” says Assistant Professor Xu Chenjie from NTU who leads the study. “We wanted to develop a simple, convenient, and cost-effective device able to inhibit keloid growth in skin tissue and reduce the size of disfiguring scars,” adds Yuejun Kang, another key investigator in the study from NTU.”Self-administered treatment for keloid scars can reduce the economic burden on the healthcare system and provide a treatment option for patients who have limited access to medical care,” comments Professor Jeffrey Karp from Brigham and Women’s Hospital at Harvard Medical School, US, an expert on medical device design who was not involved in this study.Story Source:The above story is based on materials provided by World Scientific. Note: Materials may be edited for content and length.

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Burn victims avoid hypothermia with practice developed by nurses

Loyola University Health System has established new guidelines to protect burn victims at risk for hypothermia during surgery.The skin regulates body temperature and when a large portion of skin is burned, the body loses heat. Loyola nurses recognized this threat and established a warming process for burn victims at risk for dangerously low body temperatures.”Burn victims are in an extreme amount of pain and are at risk for severe complications from their injuries,” said Sharon L. Valtman, RN, BSN, CNOR, the Loyola nurse who initiated the warming process for patients. “It is our job as nurses to listen to our patients and identify ways to ease their discomfort and prevent further health issues.”The warming process Valtman established involves using Bair Hugger technology to elevate the patients’ body temperature. The device carries warm air through a hose to a blanket that is draped over the patient. Nurses initiate this process in a patient’s hospital room one hour before surgery and continue it during the procedure. Studies have shown that keeping a patient warm during surgery results in less bleeding and faster recovery.The success of this program led Loyola’s Burn Center and operating room doctors, nurses and staff to adopt this process as hospital protocol for burn patients.Story Source:The above story is based on materials provided by Loyola University Health System. Note: Materials may be edited for content and length.

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Olfactory receptors in the skin: Sandalwood scent facilitates wound healing, skin regeneration

Skin cells possess an olfactory receptor for sandalwood scent, as researchers at the Ruhr-Universitt Bochum have discovered. Their data indicate that the cell proliferation increases and wound healing improves if those receptors are activated. This mechanism constitutes a possible starting point for new drugs and cosmetics. The team headed by Dr Daniela Busse and Prof Dr Dr Dr med habil Hanns Hatt from the Department for Cellphysiology published their report in the Journal of Investigative Dermatology.The nose is not the only place where olfactory receptors occurHumans have approximately 350 different types of olfactory receptors in the nose. The function of those receptors has also been shown to exist in, for example spermatozoa, the prostate, the intestine and the kidneys. The team from Bochum has now discovered them in keratinocytes — cells that form the outermost layer of the skin.Experiments with cultures of human skin cellsThe RUB researchers studied the olfactory receptor that occurs in the skin, namely OR2AT4, and discovered that it is activated by a synthetic sandalwood scent, so-called Sandalore. Sandalwood aroma is frequently used in incense sticks and is a popular component in perfumes. The activated OR2AT4 receptor triggers a calcium-dependent signal pathway. That pathway ensures an increased proliferation and a quicker migration of skin cells — processes which typically facilitate wound healing. In collaboration with the Dermatology Department at the University of Mnster, the cell physiologists from Bochum demonstrated that effect in skin cell cultures and skin explants.Additional olfactory receptors in skin detectedIn addition to OR2AT4, the RUB scientists have also found a variety of other olfactory receptors in the skin, the function of which they are planning to characterise more precisely. …

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Alternative to surgery for Graves’ eye disease: Low-carb, gluten-free diet may help

Don Parker was facing a second surgery to treat the bulging eyes and double vision he was experiencing due to Graves’ eye disease.But then ophthalmologist James McDonnell, MD, of Loyola University Medical Center recommended an alternative therapy that did not involve surgery or medication.McDonnell told Parker to change his diet, lose weight and take a nutraceutical (natural food product) that’s designed to restore proper immune and digestive function.Parker followed McDonnell’s regimen. He lost more than 35 pounds by giving up soda pop and eating a low-carb, gluten-free diet with lots of vegetables. Each day, he takes 12 capsules of the nutraceutical.“My double vision is almost gone and there is so little bulging in my eyes that they look almost completely normal,” he said.Graves’ eye disease, also known as Graves’ ophthalmopathy, is present in about half of people who have Graves’ disease, an autoimmune disorder. In Graves’ eye disease, the immune system attacks muscles and other tissues around the eye. This can cause the eyes to bulge out and become misaligned.Bulging eyes can be treated with orbital decompression surgery. The surgeon removes bone and/or fat from behind the eye, allowing the eye to move back into its socket. Double vision can be treated with a different surgery, which straightens the eyes by adjusting the eye muscles.When Parker came to see McDonnell, he already had undergone one orbital decompression, and was facing a possible second surgery for his double vision. But rather than recommending surgery, McDonnell suggested a holistic approach.“Once you clear up and balance your body, a whole raft of problems can go away,” McDonnell said.Parker said his doctor’s appointment with McDonnell served as a wake-up call. “I was at a crossroads in my life,” Parker said. “I would have to either change my ways or die. …

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Facial transplantation: Almost a decade out, surgeons prepare for burgeoning demand

Plastic and reconstructive surgeons leading the first retrospective study of all known facial transplants worldwide conclude that the procedure is relatively safe, increasingly feasible, and a clear life-changer that can and should be offered to far more carefully selected patients.Reporting in The Lancet online April 27, NYU Langone plastic and reconstructive surgeon and senior author Eduardo Rodriguez, MD, DDS, says results after nearly a decade of experience with what he calls the “Mount Everest” of medical-surgical treatments are “highly encouraging.”The review team noted that the transplants still pose lifelong risks and complications from infection and sometimes toxic immunosuppressive drugs, but also are highly effective at restoring people to fully functioning lives after physically disfiguring and socially debilitating facial injuries.Surgeons base their claims on the experience of 28 people known to have had full or partial face transplants since 2005, when the first such procedure was performed on a woman in France.Of the 22 men and six women whose surgeries were reported, including seven Americans, none have chronically rejected their new organs and tissues, says Dr. Rodriguez, chair of the Department of Plastic Surgery at NYU Langone Medical Center and director of its Institute of Reconstructive Plastic Surgery. All but three recipients are still living. Four have returned to work or school.Dr. Rodriguez, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery at NYU Langone, in 2012 performed what is widely considered the most extensive facial transplant (when he practiced at the University of Maryland Medical Center in Baltimore). The patient was a Virginia man who had lost the lower half of his face in a gunshot accident 10 years earlier. Dr. Rodriguez is currently readying his new team at NYU Langone to perform its first facial transplantation, expected later this year.In The Lancet article, Dr. Rodriguez and his colleagues point out that although all recipients to date have experienced some complications from infection, and mild to moderate signs of rejection, the few deaths among patients were due to infection and cancer not directly related to their transplants. …

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Scientists report success growing cartilage to reconstruct nostrils and implanting tissue-engineered vaginal organs into humans

Two new articles published in The Lancet report the first ever successful operations in humans to reconstruct the alar wings of the nose (nostrils) (Martin et al), and to implant tissue-engineered vaginal organs in women with a rare syndrome that causes the vagina to be underdeveloped or absent (Atala et al), in both cases using the patients’ own tissue.In one paper, led by Professor Ivan Martin from the University of Basel in Switzerland, scientists report having engineered a human cartilage graft from patients’ own nasal septum cartilage cells to successfully rebuild the nostrils (alar lobule) of five individuals whose noses were damaged by skin cancer. One year after reconstruction, all five recipients were satisfied with their ability to breathe, as well as the cosmetic appearance of their nose, and did not report any local or systemic adverse events.The nose is the most common site of non-melanoma skin cancer, because of its cumulative exposure to sunlight, with the highest frequency of cancer occurring on the alar lobule. Currently, when removing skin cancers, surgeons often have to cut away parts of cartilage, (for instance from the nasal septum, ear, or rib) as grafts to functionally reconstruct the tumour excision site. However, this painful and invasive procedure involves major additional surgery, and has been associated with complications at the site from which cartilage has been removed.A team from the University of Basel, Switzerland, investigated an alternative approach using engineered cartilage tissue grown from patients’ own cells. They extracted the cartilage cells (chondrocytes) from the nasal septum of each patient, and multiplied the cells by exposing them to growth factors for two weeks. The expanded cells were seeded onto collagen membranes and cultured for two additional weeks, generating cartilage 40 times larger than the original biopsy. When the engineered grafts were ready they were shaped according to the defect and implanted.According to Professor Martin, “The engineered cartilage had clinical results comparable to the gold standard cartilage graft surgery. This new technique could help the body accept the new tissue more easily, and improve the stability and functionality of the nostril. Our success is based on the long-standing, effective integration in Basel between our experimental group at the Department of Biomedicine and the surgical disciplines. It opens the way to using this engineered cartilage for more challenging reconstructions in facial surgery such as the complete nose, eyelid, or ear. …

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Scientists grow cartilage to reconstruct nose

Scientists at the University of Basel report first ever successful nose reconstruction surgery using cartilage grown in the laboratory. Cartilage cells were extracted from the patient’s nasal septum, multiplied and expanded onto a collagen membrane. The so-called engineered cartilage was then shaped according to the defect and implanted. The results will be published in the current edition of the academic journal The Lancet.A research team from the University of Basel in Switzerland has reported that nasal reconstruction using engineered cartilage is possible. They used a method called tissue engineering where cartilage is grown from patients’ own cells. This new technique was applied on five patients, aged 76 to 88 years, with severe defects on their nose after skin cancer surgery. One year after the reconstruction, all five patients were satisfied with their ability to breathe as well as with the cosmetic appearance of their nose. None of them reported any side effects.Cells from the nasal septumThe type of non-melanoma skin cancer investigated in this study is most common on the nose, specifically the alar wing of the nose, because of its cumulative exposure to sunlight. To remove the tumor completely, surgeons often have to cut away parts of cartilage as well. Usually, grafts for reconstruction are taken from the nasal septum, the ear or the ribs and used to functionally reconstruct the nose. …

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Growth of breast lifts outpacing implants 2-to-1, stats show

New statistics released today by the American Society of Plastic Surgeons (ASPS) show that breast lift procedures are growing at twice the rate of breast implant surgeries. Since 2000, breast lifts have grown by 70 percent, outpacing implants two-to-one. Breast implants are still by far the most performed cosmetic surgery in women, but lifts are steadily gaining. In 2013, more than 90,000 breast lift procedures were performed by ASPS member surgeons.”Many women are looking for a youthful breast by using the tissue they already have,” said ASPS President Robert X. Murphy, Jr., MD.According to the new statistics, women between the ages of 30-54 made up nearly 70 percent of the breast lift procedures performed in 2013. “The breast lift procedure is way up in my practice,” said Anne Taylor, MD, an ASPS-member plastic surgeon in Columbus, Ohio. “More women are coming to us who’ve had children, whose breast volume has decreased and who are experiencing considerable sagging,” she said. “For many of them, we are able to get rid of excess skin and lift the breasts back up where they’re supposed to be.”Kim Beckman of Casstown, Ohio is one of the women who went to Dr. Taylor. “Childbirth, breastfeeding and aging takes a toll on the body,” she said. …

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New and improved laser and light treatments take aim at cellulite, fat, tattoos, wrinkles and sagging skin

As more people look for ways to turn back the clock or improve their appearance, dermatologists are pioneering many of the newest aesthetic laser technologies — from tattoo removal to erasing fine lines and wrinkles to reducing fat or cellulite. Before considering any cosmetic procedure, dermatologists recommend that consumers do their homework to better understand the best technologies available for their specific needs.Information was provided by board-certified dermatologist M. Christine Lee, MD, FAAD, assistant clinical professor of dermatologic surgery at the University of California, San Francisco and director of a private practice in Walnut Creek, Calif.Treatments for Cellulite, Excess Fat Now Produce Long-Lasting ResultsCellulite and excess fat are two of the biggest hurdles that many women face in their quest to improve their appearance. While diet and exercise can help reduce body fat, cellulite is resistant to these types of lifestyle changes. Unique to women, Dr. Lee estimates that cellulite affects 80 percent of women regardless of their body weight. Until now, no cellulite treatment could dramatically change the appearance of cellulite, and any results were temporary.1440 Nanometer Laser• First minimally invasive laser treatment to treat cellulite approved by the Food and Drug Administration (FDA) in 2012 and provides long-lasting, dramatic results.• Surgical procedure involves inserting a tiny fiber optic beneath the skin to break the fiber bands responsible for cellulite in women. The laser releases the skin and allows the depressions (or dimpling that gives cellulite its appearance) to rise to the surface of the skin. Once the laser beam severs the fiber bands, the blood supply to this area is cut off so the bands do not regrow, and collagen production is stimulated.• Multiple areas can be treated with only one session, and the most common treatment areas are the buttocks, hips and thighs.• Some downtime is required after the procedure, due to bruising and swelling that can take one to two weeks to resolve.Cryolipolysis• Non-invasive procedure approved by the FDA to remove localized areas of fat in the lower abdomen and along the sides of the body.• Works by freezing the lipids in fat cells, which then slowly dissolve without injuring surrounding tissues.• Typically, three treatments are needed to dissolve an inch of fat.• Results are not immediate, as it takes three to four months to see a noticeable improvement.Ultrasound• Non-invasive procedure approved by the FDA uses high-intensity, focused ultrasound energy to destroy or melt targeted fat without harming surrounding skin.• Used to reduce fat bulges in the abdomen, with the average reduction of about an inch per treatment session. Can also be used on the thighs or other large areas of fat.• Results are not immediate, requiring two to three months.• An added benefit is noticeable improvement in the appearance of cellulite in the months following the procedure.These newer treatments provide alternatives to liposuction, which has been used to remove pockets of fat for decades but is more invasive and requires more downtime. …

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Military dermatologists making strides in applying treatments for wounded warriors to injured civilians

For the millions of men and women serving in the U.S. military, injuries are a job hazard that can be nearly impossible to avoid in the line of duty. As a result, many in the military suffer from scars and wounds that, in some cases, last a lifetime and pose considerable challenges by restricting motion in affected limbs when performing common, everyday activities.To aid in the function and appearance of battlefield scars, military dermatologists began experimenting with ablative fractional laser surgery — known to improve the appearance of acne scars. Results over the last seven years have been impressive, and dermatologists now are treating civilians injured from car accidents, fires and job and household accidents with this laser therapy to enhance scar and wound healing.Information was provided by board-certified dermatologist Chad M. Hivnor, MD, LtCol, USAF, MC, FS, staff dermatologist (Chief Research, Chief Lasers) for the San Antonio Military Health System.Dr. Hivnor recently received the Paul W. Myers Award from the Air Force Association for his work using fractional lasers to treat scars and improve range of motion for wounded service members. The Paul W. Myers Award honors the Air Force medical corps officer who has made the largest contribution to the overall health and well-being of men and women in the branch.Physical and Cosmetic Aspects of Scars Improve With LaserAblative fractional lasers work by delivering very tiny columns of heat quickly to the top and deeper layers of skin, which produces a wound that heals with the help of the surrounding healthy skin tissue. When Dr. …

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Cosmetic treatment can open door to bacteria

Many people have ‘fillers’ injected into their facial tissue to give them ‘bee-stung lips’ or to smooth out their wrinkles. Unfortunately, a lot of cosmetic treatment customers experience unpleasant side effects in the form of tender subcutaneous lumps that are difficult to treat and which — in isolated cases — have led to lesions that simply will not heal. Research recently published by the University of Copenhagen now supports that, despite the highest levels of hygiene, this unwanted side effect is caused by bacterial infection.Injections of fillers were previously reserved exclusively for trauma treatment — when rebuilding a face disfigured in a traffic accident, for example. However, the jelly-like substances are increasingly being used in beauty treatments with the intention of making lips swell up and to erase the effects of ageing from the skin. Side effects in the form of stubborn, tender lumps or even lesions are becoming an increasing problem:”Previously, most experts believed that the side effects were caused by an auto-immune or allergic reaction to the gel injected. Research involving tissue from patients and mouse models has now shown that the disfiguring lesions are actually due to bacteria injected in connection with the cosmetic procedure. What is more, we have demonstrated that the fillers themselves act as incubators for infection, and all it takes is as few as ten bacteria to create an ugly lesion and a tough film of bacterial material — known as biofilm — which is impossible to treat with antibiotics,” says Morten Alhede, a postdoc at the Department of International Health, Immunology and Microbiology, University of Copenhagen.The results have just been published in the journal Pathogens and Disease.Biofilm is resistant to antibioticsTreatment with fillers is very common. According to the American Society for Aesthetic Plastic Surgery (ASAPS), treatment with products based on hyaluronic acid — such as Restylane — constitutes the second-most popular non-surgical cosmetic procedure in the United States. The precise figures for Denmark are not known, but there can be no doubt that the numbers are rising rapidly — and a rise in the number of treatments will inevitably make the side effects more evident.”Because a lot of cosmetic practitioners refuse to accept that side effects from filler procedures are caused by bacteria, claiming that such problems are caused by allergic reactions, the usual procedure has been to treat with steroids. This is actually the worst possible treatment because steroid injections exacerbate the condition and give the bacteria free rein. …

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Anesthetic technique improves quality of recovery for women having breast cancer surgery

Anesthesiologists using a technique similar to a dental freeze can improve the quality of recovery and decrease recovery time for breast cancer surgery patients, according to a new study.The study, from researchers at St. Michael’s Hospital and Women’s College Hospital, was published in the March edition of Anesthesiology. It is the world’s first randomized control trial for breast cancer surgery that compares the use of ultrasound-guided paravertebral blocks – a local anesthetic freezing that blocks breast nerves – to general anesthetic. The findings reveal that breast cancer patients who received local anesthetic had superior pain relief, spent less time in recovery rooms after surgery, and were discharged an hour earlier than patients who were put under general anesthesia.”Real time, image-guided ultrasound nerve blocks have revolutionized the practice of regional anesthesia,” said Dr. Faraj Abdallah, an anesthesiologist at St. Michael’s Hospital and lead author of the study. “This is the first study to show how effective these ultrasound-guided blocks can now be for breast cancer surgery. Even more importantly, we’ve been able to demonstrate that blocks help patients feel better and return to their normal levels of mental and physical functionality sooner after surgery.”Dr. Abdallah conducted this randomized controlled trial of 64 women at Women’s College Hospital, the first Canadian site to complete a study where this image-guided technique was used in breast cancer surgery. Because of its demonstrated benefits and the addition of Dr. …

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Indications for prevention of sun damage associated with skin aging, non-melanoma skin cancer found

Date:March 4, 2014Source:Journal of Drugs in DermatologySummary:A clinical study highlighting the efficacy of Triple Protection Factor Broad Spectrum Sunscreen, TPF 50, to prevent skin sun damage and Non-Melanoma Skin Cancer (NMSC) has been released. In this head-to-head comparison study, investigators found that TPF50 was more effective than both the main DNA repair and AO existing products.Journal of Drugs in Dermatology (JDD) released a clinical study highlighting the efficacy of Triple Protection Factor Broad Spectrum Sunscreen, TPF 50, to prevent skin sun damage and Non-Melanoma Skin Cancer (NMSC). In this head-to-head comparison study, investigators Enzo Emanuele MD, PhD, James M. Spencer MD, MS and Martin Braun MD found that TPF50 was more effective than both the main DNA repair and AO existing products.Continued exposure to ultraviolet radiation (UVR) is one of the major risk factors for photo-aging and the development of non-melanoma skin cancer (NMSC). Mainstream sunscreens cannot ensure a complete protection against all molecular lesions associated with UVR exposure, making the emergence of TPF 50 a significant advance in preventive science.”JDD offers one of the fastest routes for disseminating dermatologic information. The JDD is pleased to publish this relevant, timely breakthrough research for dermatologists. This new information is important, very beneficial and is another treatment in the dermatologist’s armamentarium in preventing skin cancers,” said Dr. Robins, Editor-in-Chief and Professor Emeritus of Dermatology at New York University School of Medicine.The study’s abstract can be accessed at: http://jddonline.com/articles/dermatology/S1545961614P0274X/1Story Source:The above story is based on materials provided by Journal of Drugs in Dermatology. Note: Materials may be edited for content and length.Journal Reference:Enzo Emanuele MD PhD, James M. Spencer MD MS, and Martin Braun MD. …

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New approach to breast reconstruction surgery reduces opioid painkiller use, hospital stays

A new approach to breast reconstruction surgery aimed at helping patients’ bodies get back to normal more quickly cut their postoperative opioid painkiller use in half and meant a day less in the hospital on average, a Mayo Clinic study found. The method includes new pain control techniques, preventive anti-nausea treatment and getting women eating and walking soon after free flap breast reconstruction surgery. It has proved so effective, it is now being used across plastic surgery at Mayo Clinic. The findings were being presented at the Plastic Surgery Research Council annual meeting March 7-9 in New York.Breast reconstruction surgery is common after breast tissue is removed to prevent or treat breast cancer; in free flap breast reconstruction, the plastic surgeon transfers a section of tissue from one part of the body to the chest. Using traditional care, the hospital stay averaged roughly four and a half days after that procedure. Using a new approach known as an “enhanced recovery pathway,” patients spent an average of three days in the hospital, the researchers found.Opioid painkiller use by patients in the hospital after surgery also declined with the new method, and those patients reported less pain at 24 hours after surgery than those who received the traditional approach. Calculated in oral morphine equivalents, opioid use averaged 142.3 milligrams over the first three days in the hospital, compared with an average of 321.3 milligrams over the same period with traditional care.Patients are giving the changes positive reviews, says senior author Michel Saint-Cyr, M.D., a plastic surgeon in the Breast Diagnostic Clinic at Mayo Clinic in Rochester, Minn.”I think it minimizes their apprehension and anxiety preoperatively and they go into surgery with a better mindset. The majority do not think it was as painful as they thought it would be after surgery,” Dr. Saint-Cyr says. “We’re seeing pain scales ranging from 0 to 4 out of 10, compared to 6 to 8 out of 10 before the pathway. …

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