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Corticosteroids in rheumatic disease
1463
CURRENT LITERATURE sources such as the sun, electric light, and flash light which are undisciplined. Laser light is monochromatic (one wavelength color), coherent (in phase, spatially, and temporally), and collaminated (nondivergent). Laser energy that strikes an object can be transmitted through it, refracted, or absorbed. Only absorbed energy performs a task. Tissue is nonhomogeneous and contains many absorbers (chromophores). A specific laser wavelength is selected to create peak absorption by a tissue and to minimize competing chromophores. The amount of energy to accomplish a task is the therapeutic or ablation threshold, and occurs during a thermal relaxation time. Selective photothermolysis (SPTL) was originally conceived to meet the treatment needs of port wine-stain birthmarks in young children. It requires a specific wavelength, therapeutic thresholds, and thermal relaxation times. SPTL may also be used to treat pigmented lesions, tattoos, and more recently has been used for skin resurfacing. Laser energy can be aimed and focused similarly to the way in which a nozzle directs water from a garden hose. This concentration of power, or energy, is measured in W/cm2 or J/cm* respectively. Control is through a delivery device and waveguide. While maintaining a constant flow (power), the focus can be changed to alter the concentration (power density), thereby creating a forceful, narrow stream (high power density) or a wide, line gentle spray (low power density). The key to controlling lasertissue interaction in most clinical applications is by predicting, and controlling the thermal effect.-R.H. HAUG Reprint Surgery,
requests to Dr Gregory: Celebration Institute of Aesthetic 400 Celebration Place, A310, Celebration, FL 34747.
Malignant Tumors of the Eyelid. A Population-Based Study of Non-Basal Cell and Non-Squamous Cell Malignant Neoplasms. Margo CE, Mulla ZD. Arch Ophthalmoll16:195, 1998 In a retrospective, population-based study using the Florida Cancer Data System (FCDS), the authors studied the types and distribution of malignant tumors, other than basal cell and squamous cell carcinoma, of the eyelid. Epidemiological information such as relative frequencies, average annual incidences, and patient’s characteristics of nonbasal cell and nonsquamous cell malignant neoplasms of the eyelid were determined. From 1981 through 1994, two hundred and six primary malignant neoplasms of the eyelids were recorded in the FCDS registry. The three most common malignant eyelid tumors were malignant melanoma (72 cases), sebaceous carcinoma (59 cases) and lymphoma (27 cases). The median age at diagnosis was 68 years, 75 years and 77 years respectively. Additionally, there were 25 cases of sarcoma reported, 19 of which were Kaposi sarcoma. Of the 27 reported lymphoma cases, 11 different histological types were found. Only three (1.5%) of 206 eyelid tumors in the FCDS were in blacks, the remaining in whites. The annual incidence for all nonbasal cell and nonsquamous cell tumors of the eyelid was 1.8 per million of the white population older than 20 years and 0.3 per million in blacks. The rates for melanoma and sebaceous carcinoma of the eyelid for whites older than 20 years were 0.6 and 0.5 per million, respectively. Results from this study show that most nonbasal cell and nonsquamous cell malignant neoplasms of the eyelid occur in elderly white patients. The hypothesis that increased skin pigmentation has a protective effect against malignant eyelid tumors is supported by the significantly lower incidence of these tumors in blacks.-AJ. LIBUNAO
Reprint requests to Dr Margo: Department of Ophthalmology, 12901 Bruce Downs Blvd, MDC Box 21, Tampa, FL 33612.
Corticosteroids in Rheumatic Disease. RF. Postgrad Med 103:137, 1998
van Vollenhoven
Corticosteroids have unparalleled efficacy in the treatment of many diseases, but pose a quandry for clinicians because of their multiple potential side effects, which can involve virtually all organ systems. The authors review the systemic and pharmacological effects of corticosteroids, and the side effects. To minimize osteopenia, all patients taking corticosteroids for more than a few days whould receive supplemental calcium (1,500 mg/d) and vitamin D (400 U/d). Steroids are indicated as first-line therapy for most serious rheumatologic diseases, including SLE (systemic lupus erythematosum) and arthritis. Low dose maintainance therapy use in rheumatoid arthritis is controversial. Proponents point out that it decreases progression of cartilage and bone destruction, while opponents argue that the adverse consequences become more apparent after a longer duration of treatment. Avascular necrosis is a particularly troublesome side effect. Treatment goals are the reduction but not the elimination of pain, maintainance of function, and participation in physical activities. Most clinicians use prednisone, but methyl-prednisolone may be used to reduce mineralocorticoid side effects. Adrenal suppression is a greater concern with dexamethasone, because of its long half-life. The author argues that the corticosteroid should be administered in at least two divided dose in severe disease. A single, morning dose is prefered when the disease is more stable. Some researchers have advocated alternate day dosing to reduce side effects, but the author does not believe it is valuable. The author then discusses his treatment regimens of tapering dOSageS.--ROGER E. ALTER Reprint requests to Dr van Vollenhoven: and Rheumatology, Stanford University Stanford, CA 94305.
Division of Immunology School of Medicine, S-02 1,
Papillary Thyroid Carcinoma: Modified Dissection Improves Prognosis. Noguchi Yamashta H, et al. Arch Surg 133:276, 1998
Radical Neck S, Murakami N,
In the surgical management of papillary thyroid cancer, controversy exists not only about thyroidectomy but also about the extent of lymph node excision. In this retrospective study, the authors investigated whether modified radical neck dissection (MRND) offers a survival advantage for some subsets of patients with papillary cancer of the thyroid. There were 2859 patients studied; 72.1% underwent modified radical neck dissection, 8.5% underwent partial node dissection, and 19.4% underwent no node excision. The incidence of nodal metastasis in male and female patients was 92.1% and 85.5% respectively. The loand 20-year survival rates for the group that underwent MRND were 92.4% and 73.2% compared with 80.3% and 56.7% respectively for the group that did not undergo MRND. The significant risk factors were sex, age at the time of the surgery, maximum diameter of the primary tumor, extrathyroidal invasion, and presence of metastasis regardless of the size of the tumor. The authors concluded that MRND improved the outcome in some subsets of patients with papillary thyroid cancer; specifically, those in whom gross nodal metastasis was noticed before or during surgery, those in whom the primary tumor invaded beyond the thyroid capsule, and those who were women older than 60 years.-I. SHA~L~I
CURRENT LITERATURE sources such as the sun, electric light, and flash light which are undisciplined. Laser light is monochromatic (one wavelength color), coherent (in phase, spatially, and temporally), and collaminated (nondivergent). Laser energy that strikes an object can be transmitted through it, refracted, or absorbed. Only absorbed energy performs a task. Tissue is nonhomogeneous and contains many absorbers (chromophores). A specific laser wavelength is selected to create peak absorption by a tissue and to minimize competing chromophores. The amount of energy to accomplish a task is the therapeutic or ablation threshold, and occurs during a thermal relaxation time. Selective photothermolysis (SPTL) was originally conceived to meet the treatment needs of port wine-stain birthmarks in young children. It requires a specific wavelength, therapeutic thresholds, and thermal relaxation times. SPTL may also be used to treat pigmented lesions, tattoos, and more recently has been used for skin resurfacing. Laser energy can be aimed and focused similarly to the way in which a nozzle directs water from a garden hose. This concentration of power, or energy, is measured in W/cm2 or J/cm* respectively. Control is through a delivery device and waveguide. While maintaining a constant flow (power), the focus can be changed to alter the concentration (power density), thereby creating a forceful, narrow stream (high power density) or a wide, line gentle spray (low power density). The key to controlling lasertissue interaction in most clinical applications is by predicting, and controlling the thermal effect.-R.H. HAUG Reprint Surgery,
requests to Dr Gregory: Celebration Institute of Aesthetic 400 Celebration Place, A310, Celebration, FL 34747.
Malignant Tumors of the Eyelid. A Population-Based Study of Non-Basal Cell and Non-Squamous Cell Malignant Neoplasms. Margo CE, Mulla ZD. Arch Ophthalmoll16:195, 1998 In a retrospective, population-based study using the Florida Cancer Data System (FCDS), the authors studied the types and distribution of malignant tumors, other than basal cell and squamous cell carcinoma, of the eyelid. Epidemiological information such as relative frequencies, average annual incidences, and patient’s characteristics of nonbasal cell and nonsquamous cell malignant neoplasms of the eyelid were determined. From 1981 through 1994, two hundred and six primary malignant neoplasms of the eyelids were recorded in the FCDS registry. The three most common malignant eyelid tumors were malignant melanoma (72 cases), sebaceous carcinoma (59 cases) and lymphoma (27 cases). The median age at diagnosis was 68 years, 75 years and 77 years respectively. Additionally, there were 25 cases of sarcoma reported, 19 of which were Kaposi sarcoma. Of the 27 reported lymphoma cases, 11 different histological types were found. Only three (1.5%) of 206 eyelid tumors in the FCDS were in blacks, the remaining in whites. The annual incidence for all nonbasal cell and nonsquamous cell tumors of the eyelid was 1.8 per million of the white population older than 20 years and 0.3 per million in blacks. The rates for melanoma and sebaceous carcinoma of the eyelid for whites older than 20 years were 0.6 and 0.5 per million, respectively. Results from this study show that most nonbasal cell and nonsquamous cell malignant neoplasms of the eyelid occur in elderly white patients. The hypothesis that increased skin pigmentation has a protective effect against malignant eyelid tumors is supported by the significantly lower incidence of these tumors in blacks.-AJ. LIBUNAO
Reprint requests to Dr Margo: Department of Ophthalmology, 12901 Bruce Downs Blvd, MDC Box 21, Tampa, FL 33612.
Corticosteroids in Rheumatic Disease. RF. Postgrad Med 103:137, 1998
van Vollenhoven
Corticosteroids have unparalleled efficacy in the treatment of many diseases, but pose a quandry for clinicians because of their multiple potential side effects, which can involve virtually all organ systems. The authors review the systemic and pharmacological effects of corticosteroids, and the side effects. To minimize osteopenia, all patients taking corticosteroids for more than a few days whould receive supplemental calcium (1,500 mg/d) and vitamin D (400 U/d). Steroids are indicated as first-line therapy for most serious rheumatologic diseases, including SLE (systemic lupus erythematosum) and arthritis. Low dose maintainance therapy use in rheumatoid arthritis is controversial. Proponents point out that it decreases progression of cartilage and bone destruction, while opponents argue that the adverse consequences become more apparent after a longer duration of treatment. Avascular necrosis is a particularly troublesome side effect. Treatment goals are the reduction but not the elimination of pain, maintainance of function, and participation in physical activities. Most clinicians use prednisone, but methyl-prednisolone may be used to reduce mineralocorticoid side effects. Adrenal suppression is a greater concern with dexamethasone, because of its long half-life. The author argues that the corticosteroid should be administered in at least two divided dose in severe disease. A single, morning dose is prefered when the disease is more stable. Some researchers have advocated alternate day dosing to reduce side effects, but the author does not believe it is valuable. The author then discusses his treatment regimens of tapering dOSageS.--ROGER E. ALTER Reprint requests to Dr van Vollenhoven: and Rheumatology, Stanford University Stanford, CA 94305.
Division of Immunology School of Medicine, S-02 1,
Papillary Thyroid Carcinoma: Modified Dissection Improves Prognosis. Noguchi Yamashta H, et al. Arch Surg 133:276, 1998
Radical Neck S, Murakami N,
In the surgical management of papillary thyroid cancer, controversy exists not only about thyroidectomy but also about the extent of lymph node excision. In this retrospective study, the authors investigated whether modified radical neck dissection (MRND) offers a survival advantage for some subsets of patients with papillary cancer of the thyroid. There were 2859 patients studied; 72.1% underwent modified radical neck dissection, 8.5% underwent partial node dissection, and 19.4% underwent no node excision. The incidence of nodal metastasis in male and female patients was 92.1% and 85.5% respectively. The loand 20-year survival rates for the group that underwent MRND were 92.4% and 73.2% compared with 80.3% and 56.7% respectively for the group that did not undergo MRND. The significant risk factors were sex, age at the time of the surgery, maximum diameter of the primary tumor, extrathyroidal invasion, and presence of metastasis regardless of the size of the tumor. The authors concluded that MRND improved the outcome in some subsets of patients with papillary thyroid cancer; specifically, those in whom gross nodal metastasis was noticed before or during surgery, those in whom the primary tumor invaded beyond the thyroid capsule, and those who were women older than 60 years.-I. SHA~L~I