Background: Various conservative methods for treatment of labial swelling in patients with cheilitis granulomatosa have been attempted, often with only moderate success and sometimes with persistent disfiguring lip sw...Background: Various conservative methods for treatment of labial swelling in patients with cheilitis granulomatosa have been attempted, often with only moderate success and sometimes with persistent disfiguring lip swelling. Severe macrocheilia can produce an unaesthetic facial deformity associated with functional disturbances. In patients with persistent macrocheilia, reduction cheiloplasty with excision of excess tissue may be indicated when conservative treatment has proven ineffective in reducing swelling but may have been successful in stabilizing disease. Objective: To evaluate long- term results after reduction cheiloplasty in patients with macrocheilia caused by Melkersson- Rosenthal syndrome or cheilitis granulomatosa. Design: Follow- up study in 7 patients with severe persisting macrocheilia, including 3 patients with Melkersson- Rosenthal syndrome and 4 patients with cheilitis granulomatosa in a stable state of disease, treated by reduction cheiloplasty at our hospital between January 1, 1987, and December 31, 2002. Preoperative and postoperative medical histories were obtained, and criteria for the success of surgical treatment were evaluated by clinical examination. Different techniques of reduction cheiloplasty are described and demonstrated in representative cases of severe macrocheilia. Results: Surgical treatment in all 7 patients showed satisfying aesthetic and functional outcomes that persisted throughout follow- up (median follow- up, 6.5 years). Conclusions: Reduction cheiloplasty is an effective method to correct persistent macrocheilia and improve lip aesthetics in patients with Melkersson- Rosenthal syndrome or granulomatous cheilitis in the persistent state of disease. With careful planning, proper sequencing of treatment, and proficiency in the various surgical techniques, optimal results can be achieved.展开更多
Background and Objectives.The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with o pioid receptor antagonists. The aim of this investigation ...Background and Objectives.The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with o pioid receptor antagonists. The aim of this investigation was to describe the ef ficacy and safety of naltrexone, an orally active opiate antagonist, in the trea tment of severe, otherwise intractable pruritus of varying origins. Patients. A total of 133 patients with pruritus caused by inflammatory skin diseases (asteat otic dermatitis, atopic dermatitis, prurigo, and psoriasis vulgaris), liver-and renal diseases, cutaneous lymphoma, as well as with pruritus of unknown origin were treated with naltrexone (Nemexin.)50 to 150 mg daily. Results. A therapeuti c response was achieved in 86 of the 133 (64.6%) patients. Naltrexone was most effective in prurigo nodularis, cutaneous lymphoma and pruritus of unknown origi n. Tachyphylaxis occurred in 13%of the patients, but appeared late, and could b e counterbalanced by raising the dosage. Adverse drug effects were restricted to the first two weeks of treatment and included mainly neurological (dizziness, h eadache, fatigue) and gastrointestinal (nausea, vomiting, diarrhea) symptoms. Co nclusions. The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.展开更多
文摘Background: Various conservative methods for treatment of labial swelling in patients with cheilitis granulomatosa have been attempted, often with only moderate success and sometimes with persistent disfiguring lip swelling. Severe macrocheilia can produce an unaesthetic facial deformity associated with functional disturbances. In patients with persistent macrocheilia, reduction cheiloplasty with excision of excess tissue may be indicated when conservative treatment has proven ineffective in reducing swelling but may have been successful in stabilizing disease. Objective: To evaluate long- term results after reduction cheiloplasty in patients with macrocheilia caused by Melkersson- Rosenthal syndrome or cheilitis granulomatosa. Design: Follow- up study in 7 patients with severe persisting macrocheilia, including 3 patients with Melkersson- Rosenthal syndrome and 4 patients with cheilitis granulomatosa in a stable state of disease, treated by reduction cheiloplasty at our hospital between January 1, 1987, and December 31, 2002. Preoperative and postoperative medical histories were obtained, and criteria for the success of surgical treatment were evaluated by clinical examination. Different techniques of reduction cheiloplasty are described and demonstrated in representative cases of severe macrocheilia. Results: Surgical treatment in all 7 patients showed satisfying aesthetic and functional outcomes that persisted throughout follow- up (median follow- up, 6.5 years). Conclusions: Reduction cheiloplasty is an effective method to correct persistent macrocheilia and improve lip aesthetics in patients with Melkersson- Rosenthal syndrome or granulomatous cheilitis in the persistent state of disease. With careful planning, proper sequencing of treatment, and proficiency in the various surgical techniques, optimal results can be achieved.
文摘Background and Objectives.The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with o pioid receptor antagonists. The aim of this investigation was to describe the ef ficacy and safety of naltrexone, an orally active opiate antagonist, in the trea tment of severe, otherwise intractable pruritus of varying origins. Patients. A total of 133 patients with pruritus caused by inflammatory skin diseases (asteat otic dermatitis, atopic dermatitis, prurigo, and psoriasis vulgaris), liver-and renal diseases, cutaneous lymphoma, as well as with pruritus of unknown origin were treated with naltrexone (Nemexin.)50 to 150 mg daily. Results. A therapeuti c response was achieved in 86 of the 133 (64.6%) patients. Naltrexone was most effective in prurigo nodularis, cutaneous lymphoma and pruritus of unknown origi n. Tachyphylaxis occurred in 13%of the patients, but appeared late, and could b e counterbalanced by raising the dosage. Adverse drug effects were restricted to the first two weeks of treatment and included mainly neurological (dizziness, h eadache, fatigue) and gastrointestinal (nausea, vomiting, diarrhea) symptoms. Co nclusions. The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.
