No abstract

Between 1988 and 2000, 378 cases of keloids were treated in the authors' department, and 147 keloids in 129 patients were selected for this study. Keloids that occurred at a different site in the same patient and keloids that recurred later at the same site were deemed to be different keloids. Those keloids were surgically removed, and the patients were treated postoperatively with 15-Gy electron-beam irradiation and followed for more than 18 months. The therapeutic outcomes were evaluated. Statistical analysis was performed using Fisher's exact probability test or chi-square test. Recurrence occurred in two sites on 14 earlobes (14.3 percent), in two sites on 12 necks (16.7 percent), in 22 sites on 51 anterior chest walls (43.1 percent), in 13 sites in 33 scapular regions (39.4 percent), in four sites on 15 upper limbs (26.7 percent), in four sites in 11 suprapubic regions (36.4 percent), and in one site on 11 lower limbs (9.1 percent). The overall recurrence rate was 32.7 percent. Analysis of the therapeutic outcomes showed that the recurrence rates in the sites with high stretch tension, such as the chest wall, and the scapular and suprapubic regions were statistically higher than in sites without high tension, such as the neck, earlobes, and lower limbs (41.1 percent versus 13.5 percent, p = 0.0017). The results suggested that keloid sites with a high risk of recurrence should be treated with escalated radiation doses and posttreatment self-management.

The authors present eight cases of reconstruction of the breasts using bilaterally divided TRAM flaps after removing the injected silicone gel and granulomas. In Japan, we have the opportunity to examine many patients who have had foreign substance injections to the breasts for purposes of augmentation however, most of them are now suffering from delayed complications. Until now we have reconstructed breasts such cases by use of silicone bag prostheses after removal of granulomas; however, now it is difficult to obtain silicone prostheses. Thus, we have decided to reconstruct by the use of autogenous cutaneous and adipose tissue flaps as presented by us in this article.

Between 1988 and 1994, 110 patients with 139 so-called keloids site, which had been treated with conservative therapy were treated with excision, suture, and postoperative irradiation with a 4 MeV electron beam. They were irradiated within one or two days after surgery, for three consecutive days. The total doses were 15 Gy or 18 Gy per fractions for the most part. Control rates of true keloids and hypertrophic scars were 76.0% (57/75) and 93.8% (60/64), respectively, and the overall effectiveness rate was 84.2%. No remarkable side effects were observed. Transient hyperpigmentation was found in 44.6%. No carcinogenesis have been found in our series of patients. Considering the possibility of recurrence, side effects, and carcinogenesis, the indication of our treatment was decided. The result of our treatment using a low-megavolt electron beam was similar to that of published series using a low-energy X-ray. The advantages of the use of electron beam are that the peak of dose is the layer of the occurrence of keloid, and that the depth of penetration of radiation is limited without appreciable effect on the deeper structures. At present, the equipments of low-energy X-ray have been disposed. Our treatment using a electron beam will be an effective treatment.

M ixed tumor of the skin was originally described by Billroth in 1859 1 as an entity histologically similar to the mixed tumor of the salivary glands. 2 In 1961, Hirsch and Helwig 3 introduced the term chondroid syringoma to describe this tumor, which is characterized by the presence of sweat gland elements lying within a cartilage-like stroma. 2 This benign skin adnexal tumor usually develops as a slowly growing intradermal or subcutaneous nodule on the face. This relatively uncommon tumor rarely affects the ocular adnexa. 2 To our knowledge, chondroid syringoma arising from the lower eyelid with severe ectropion is highly unusual. CASE REPORTA 61-year-old woman presented a painless and slowly developing mass (over 25 years) in the left lower eyelid with severe ectropion (Fig. 1). The mass was also exposed on the surface of the palpebral conjunctiva. Visual acuity, intraocular pressure, eye position, and ocular motility were all normal bilaterally. Our original differential diagnosis was dermoid, foreign body granuloma, hordeolum, and chondroid syringoma. The mass, measuring 31 ϫ 22 ϫ 19 mm, was extirpated en bloc, and the lower eyelid and palpebral conjunctiva were sutured to correct the ectropion under general anesthesia (Fig. 2). Histopathologic analysis revealed that the epithelial component had glandular features and a myxoid stromal component (Fig. 3). No atypical cells were visible. These findings were consistent with the diagnosis of chondroid syringoma (mixed tumor of the skin). Postoperative recovery was uneventful, and the tumor has not recurred during the past 5 years (Fig. 4).