bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient perception of skin-cancer prevention and risk after liver transplantation
Authors: Thomas B. R. , Barnabas A. , Agarwal K. , Aluvihare V. , Suddle A. R. , Higgins E. M. , O'Grady J. G. , Heaton N. D. , Heneghan M. A.
Published: June 2013

Introduction

Sun exposure is a major risk factor for the development of skin cancer. This is particularly relevant in immunosuppressed liver-transplant recipients (LTRs). Preventative strategies may help minimize the skin-cancer risk in this patient group.

Methods

We assessed 670 patients in our post-transplant clinic, using questionnaires. Patient data were collected, and we assessed whether patients had received education (such as formal talks or information from transplant coordinators or from hepatologists) on skin, sun exposure and skin cancer. In a subset of 280 of the LTRs who responded, we recorded their recall of sun-protection advice and assessed the level of patient adherence to such advice.

Results

The response rate was 57.5% (349/607), with a mean responder age of 51.1 years (range 19–84) and an average post-transplant time of 7.1 years (range 0–27). In the recall assessment, 37.2% reported that they were given advice about their skin, while 18.1% were seen by a dermatologist, and education on sun exposure and the risks of skin cancer was given to 65.6% and 47.9%, respectively. Over three-quarters (78%; 185/280) of the patients used mechanical sun protection (i.e. hats/clothing), while 66% reported using sunscreen; 31.8% of these used a sunscreen of the recommended sun protection factor (SPF) of > 30. Twelve patients had developed squamous cell carcinoma after a mean of 10.9 years (1–23) post-transplant; half of these had used either no sunscreen or one with an SPF of < 15.

Conclusions

Despite the fact that LTRs are given information on sun-exposure and SC before and after transplantation, recall of such advice and use of sun-protection methods was only moderate, indicating that regular reinforcement of SC education is needed.
A family with two female siblings with compound heterozygous FMR1 premutation alleles
Authors: Basuta K. , Lozano R. , Schneider A. , Yrigollen C.M. , Hessl D. , Hagerman R.J. , Tassone F.
Published: June 2013

Premutation alleles (55–200 CGG repeats) of the fragile X mental retardation (FMR1) gene have been linked to various types of clinical involvement ranging from mood and anxiety disorders to immunological disorders and executive function deficits. Carrier females typically have a premutation allele and a normal allele (<55 CGG repeats). Although rare, seven cases of females that carry two expanded alleles (compound heterozygous premutation) have been reported. Here, we report on four members of a family including two compound heterozygous premutation sisters with similar CGG allele sizes, affected with different levels of clinical severity.
The impact of minimum wages on employment of low‐wage workers
Authors: Nguyen Cuong Viet
Published: June 2013

This study provides empirical evidence on the impact of a minimum wage increase on employment of workers in the formal sector who have wages below the minimum level in Vietnam. Using the difference‐in‐differences with propensity score matching and the Vietnam Household Living Standard Surveys of 2004 and 2006, the article finds that the minimum wage increase in 2005 reduced the proportion of workers having a formal sector job among low‐wage workers. Most workers who lost formal sector jobs became self‐employed.
Ambrosia beetles (Curculionidae:Scolytinae andPlatypodinae) onFagus crenata Blume: community structure, seasonal population trends and resource utilization patterns
Authors: Iidzuka Hiroaki , Goto Hideaki , Yamasaki Michimasa , Osawa Naoya
Published: June 2013

Ambrosia beetles (manyScolytinae and allPlatypodinae) are one of the most important insect pests for forestry worldwide, but little is known about the community structure of ambrosia beetles in terms of their vertical variations and resource utilization. We clarified the community structure and seasonal population trends of ambrosia beetles on 11 living and three newly deadFagus crenata Blume trees using individual tube traps placed up to 10 m high fromMay toNovember in 2007 and 2008. We captured seven scolytine species (Ambrosiodmus lewisi(Blandford),Euwallacea validus(Eichhoff),Trypodendron proximum(Niisima),Xyleborinus saxeseni(Ratzeburg),Xyleborus atratus Eichhoff,Xylosandrus brevis(Eichhoff) andXylosandrus germanus(Blandford)) and three platypodine species (Crossotarsus niponicus Blandford,Platypus hamatus Blandford andPlatypus severini Blandford). The ambrosia beetles were suggested to breed at species‐specific height ranges, with the equal host resource use per individual among the species. Of the three major species,C. niponicus,P. hamatusandP. severini, two (C. niponicusand P.hamatus) had male‐biased sex ratios, which is considered a reproductive strategy to increase maternal fitness. Morphological characteristics of the mandibles may play an important role in the difference of sex roles on reproduction in the three major species.
Blue light irradiation suppresses dendritic cells activation in vitro
Authors: Fischer Michael R. , Abel Manuela , Lopez Kostka Susanna , Rudolph Berenice , Becker Detlef , von Stebut Esther
Published: June 2013

Blue light is a UV‐free irradiation suitable for treating chronic skin inflammation, for example, atopic dermatitis, psoriasis, and hand‐ and foot eczema. However, a better understanding of the mode of action is still missing. For this reason, we investigated whether dendritic cells (DC) are directly affected by blue light irradiation in vitro. Here, we report that irradiation neither induced apoptosis nor maturation of monocyte‐derived and myeloid DC. However, subsequent DC maturation upon LPS/IFNγ stimulation was impaired in a dose‐dependent manner as assessed by maturation markers and cytokine release. Moreover, the potential of this DC to induce cytokine secretion from allogeneic CD4 T cells was reduced. In conclusion, unlike UV irradiation, blue light irradiation at high and low doses only resulted in impaired DC maturation upon activation and a reduced subsequent stimulatory capacity in allogeneic MLRs with strongest effects at higher doses.
Clear, crashing, turbid and back – long‐term changes in macrophyte assemblages in a shallow lake
Authors: Hilt Sabine , Köhler Jan , Adrian Rita , Monaghan Michael T. , Sayer Carl D.
Published: June 2013

During eutrophication, submerged macrophytes in temperate European shallow lakes are thought to undergo a sequence from seasonally ‘stable’ conditions characterised by high water clarity in spring and summer, through ‘crashing’ conditions where the water is clear in spring but dominated by phytoplankton in late summer, to ‘turbid’ conditions with year‐round phytoplankton dominance. However, it is not known whether this sequence is reversed during re‐oligotrophication and whether this contributes to the often observed delay in macrophyte recovery during lake restoration.

We analysed long‐term (100 years) data on macrophyte species presence, maximum colonisation depth, Secchi depth and seston concentration in shallow Lake Müggelsee during eutrophication from around 1900 and during re‐oligotrophication that started in 1990. The current clonal diversity of the dominant species (Potamogeton pectinatus) was investigated to determine whether vegetative dispersal was predominant during its re‐establishment.

During eutrophication, Lake Müggelsee went through a crashing phase for c. 70 years with a gradual decline in macrophyte species diversity from c. 24 to 5 species. From around 1970, the lake became turbid and was dominated by phytoplankton for the next 20 years. Following a reduction in external nutrient loading by 50% from 1990, spring clear‐water conditions immediately re‐appeared, and P. pectinatus started to re‐establish from a few stands that had survived in very shallow areas. By 2011, species diversity had increased to 25 species and maximum colonisation depth had reached 3.2 m. Despite a continuing dominance of P. pectinatus, seasonally persistent (Ceratophyllum demersum) and late‐season associated (Najas marina) species re‐appeared suggesting potential for seasonally stable macrophyte conditions in future.

Based on microsatellite analyses, more recently established P. pectinatus stands had lower genotype diversity and were comprised of only a small subset of genotypes from shallower areas, suggesting that vegetative dispersal was more important than seed dispersal for plant re‐establishment. We argue that this prevailing reproduction by tubers in combination with negative effects of herbivory and periphyton shading, shown for P. pectinatus in earlier studies in this lake, contributed to the long duration of macrophyte re‐establishment.
Trinity, Simplicity and the Status of God's Personal Relations
Authors: Dolezal James E.
Published: June 2013

It is commonly argued by Christian philosophers and theologians that the traditional doctrine of divine simplicity is incompatible with the orthodox doctrine of the Trinity. First, it would seem that the presence of relations in God suggests a composition of substance and accidents in him. Second, if all that is in God is God, as simplicity claims, then it would seem that one could not maintain the real distinctions between the divine persons, as the Trinity requires. In answer to these challenges this article seeks to recover Thomas Aquinas' and the Reformed scholastics' emphasis upon the subsistence and pure actuality of the personal relations in God. The article concludes that while God's personal relations are really distinct from each other, there is no real distinction between the personal relations and the divine substance and that the Trinity and the doctrine of divine simplicity are thus agreeable.
Arresting hospitality: the case of the ‘handshake in space’
Authors: BATTAGLIA DEBBORA
Published: June 2013

The diplomatic event which symbolically terminated the Space Race was a high‐risk mission on low Earth orbit which came to be known as the Apollo‐Soyuz ‘handshake in space’. Designed as an act of détente to literally and figuratively transcend national borders and technocultural differences, the mission in the end transcended itself in denying any but space nature –‘space‐as‐itself’– the sovereignty of hosting. Humorous exchanges between astronauts and cosmonauts illustrate how the ‘risk exchange economy’ of the human space flight programme performed what might be termed an extra‐territorial ethics of hospitality, with far‐reaching implications for mapping possible worlds of nature‐culture accountability.

L'événement diplomatique qui mit fin symboliquement à la course à l'espace fut une mission à haut risque en orbite terrestre basse, la « rencontre dans l'espace » entre Apollo et Soyouz. Qualifiée d'acte de détente, transcendant au sens propre comme au sens figuré les frontières nationales et les différences technoculturelles, la mission a fini par se transcender elle‐même en déniant à tout ce qui n'était pas la nature de l'espace, l'espace « en lui‐même », la souveraineté de l'accueil. Les échanges de plaisanteries entre astronautes et cosmonautes illustrent la manière dont « l'économie d'échange des risques » du programme de vols spatiaux habités réalisait ce que l'on pourrait appeler une éthique extraterritoriale de l'hospitalité, dont les implications vont très loin dans l'élaboration de mondes possibles de responsabilité envers la nature‐culture.
The experimental hut: hosting vectors
Authors: KELLY ANN H.
Published: June 2013

In southeast Tanzania, ten canvas huts raised on wooden foundations occupy a plot of cleared rice field. Designed to simulate malaria transmission on the domestic scale, the experimental hut is constructed in the fashion of indigenous homes (complete with villagers, paid to spend the night), but is structurally modified to render mosquito behaviours visible. The experiment's domestic camouflage provides the setting for multiple, and reciprocal, hostings: between parasite, mosquito, and human, and between villagers, volunteers, and scientists. This paper explores the valences of hospitality when the ‘home’ becomes a site of experimentation, and the cosmopolitan encounters these experiments entail.

Dans le sud‐est de la Tanzanie, dix cases en toile dressées sur des fondations en bois occupent une parcelle de rizière dégagée. Conçue pour simuler la transmission du paludisme à l'échelle domestique, la case expérimentale est construite à la manière des maisons indigènes (avec même des villageois, payés pour y passer la nuit), mais sa structure est modifiée de façon à rendre le comportement des moustiques visible. Le camouflage domestique de l'expérience crée le cadre de multiples hébergements réciproques : entre le parasite, le moustique et l'homme, entre villageois, bénévoles et scientifiques. Le présent article explore les valences de l'hospitalité quand « la maison » devient un lieu d'expérimentation, ainsi que les rencontres cosmopolites qu'impliquent ces expériences.
The Determinants of Risk Premia on the Italian Stock Market: Empirical Evidence on Common Factors in Asset Pricing Models
Authors: BRIGHI PAOLA , d'ADDONA STEFANO , DELLA BINA ANTONIO CARLO FRANCESCO
Published: June 2013

We study the pricing factor structure of Italian equity returns using 25 years of data. A two‐step empirical analysis is provided where first we estimate an unrestricted multifactor model to test if there is any evidence of misspecification. Then, we estimate the restricted model through the Generalized Methods of Moments. We find that the market premium and the size premium are confirmed for a domestic Italian investor. On the contrary, weak evidence is found for the value premium. Finally, we highlight, that augmenting the model with a momentum factor may at least partially improve its performance. As a robustness check we control if the above results also hold for three shorter sub‐periods taking into account the macroeconomic and financial conditions that characterized the Italian economy. The results are generally confirmed in the case of the size and value factors while the momentum effect shows an irregular trend playing any role in the first sub‐period but becoming more important in the subsequent two.
Excision of Exposed Cartilage for Management of Mohs Surgery Defects of the Ear
Authors: LARSON PAUL O. , RAGI GANGARAM , MOHS FREDERIC E. , SNOW STEPHEN N.
Published: June 2013

Cartilage of the ear is often exposed during Mohs surgical procedures. Fenestration of the cartilage with a skin punch has been recommended to stimulate granulation tissue where the perichondrium has been destroyed. This article describes an alternative method—the excision of a window through the exposed cartilage, fully exposing the perichondrium on the other side of the cartilage. This promotes the rapid healing by second intention or provides a vascular bed for immediate skin grafting. Also, aggressive excision of nonviable cartilage helps prevent chondritis or perichondritis.
Cryomold: A Device for Tissue Embedding in Mohs Micrographic Surgery
Authors: LESHIN BARRY , COOK SUSAN R. , FRYE DEBBIE W.
Published: June 2013

We describe the use of a cryomold as a technique for tissue embedding in Mohs Micrographic Surgery. This technique regularly affords many advantages over other methods of tissue embedding, such as: 1) regularly and expeditiously yields complete margins for microscopic review; 2) facilitates flattening of large, thick, and irregularly shaped specimens; and 3) avoids crush artifact and tissue distortion that may be seen with forcible compression.
A Modified Rhombic Transposition Flap and Its Application in Dermatology
Authors: HOLT PETER J. A. , MOTLEY RICHARD J.
Published: June 2013

A modified, rhombic transposition flap based around a circular primary defect is described. We have found it to be a versatile design that produces good cosmetic results with a low incidence of postoperative complications. It has become the most frequently used transposition flap in our dermatologic practice.
Reconstruction of the Lower Lip and Chin Using Local and Random‐Pattern Flaps
Authors: WHEELAND RONALD G.
Published: June 2013

Unlike the reconstruction of wounds found on more predictable and less variable anatomic subunits of the face, reconstruction of defects on the chin and lower lip often present special difficulties for the surgeon in accurately assessing and selecting the lines of incision that will provide the patient with the best cosmetic result. The author discusses the many factors which must be considered as part of that selection process and describes the uses of the most common local flaps for reconstructing wounds found in this anatomic location.
Stability of Buffered Lidocaine and Epinephrine Used for Local Anesthesia
Authors: LARSON PAUL O. , RAGI GANGARAM , SWANDBY MARY , DARCEY BARBARA , POLZIN GREG , CAREY PATRICK
Published: June 2013

Buffered lidocaine has been recently recommended for local anesthesia, as there is less pain on injection of the buffered solution. Reduced pain on injection of lidocaine and epinephrine buffered to a neutral pH was confirmed in 20 subjects (P < .01). Concentrations of buffered lidocaine and epinephrine were performed in order to evaluate their stability. Buffered lidocaine dropped to 66.1% of initial concentrations after 4 weeks when stored at 25°C. Buffered epinephrine fell to 1.34% of its initial concentration under similar conditions. Buffered lidocaine and epinephrine maintained 94.54% and 82.04%, respectively, of their initial concentrations after 4 weeks when refrigerated at 0–4°C. Both lidocaine and epinephrine maintained greater than 90% concentration 2 weeks after buffering when stored at 0–4°C. This permits batch buffering of lidocaine with epinephrine and storage for periods up to 2 weeks when properly refrigerated.
Applications of the Crescentic Advancement Flap
Authors: MELLETTE J. RAMSEY , HARRINGTON ALLAN C.
Published: June 2013

Repair of defects of the lateral nose, perialar, and nasolabial region are often challenging. Maintaining the normal anatomic boundary lines and if possible placing the sutures within these lines are important considerations when designing a closure. The crescentic advancement flap has proved to be a versatile closure for skin cancer defects in these regions. A brief historic perspective on this flap along with important concepts in its utilization for defects of the lateral nose, perialar region, and nasolabial fold are discussed.
A Technique to Accurately Construct a Contact Dressing
Authors: GOLDMINZ DAVID , BENNETT RICHARD G.
Published: June 2013

We describe a technique to rapidly and accurately construct the contact layer of a composite dressing. This technique is simple to perform and is suitable for any open wound. It is especially useful for moderately sized wounds created during extirpation of tumors by Mohs micrographic surgery.
Specific Indications for Cryosurgery of the Nail Unit: Myxoid Cysts and Periungual Verrucae
Authors: KUFLIK EMANUEL G.
Published: June 2013

Myxoid cysts and periungual warts are easily diagnosable yet management can be difficult and disappointing. A large series of myxoid cysts of the fingers were treated with cryosurgery using the open‐spray and cryoprobe techniques. Another group of patients with periungual warts were treated with the dip‐stick technique. The cure rates were high and the cosmetic results were excellent.
Recalcitrant Ingrowing Nails Surgical Approaches
Authors: SIEGLE RONALD J. , STEWART RICHARD
Published: June 2013

Ingrowing toenails are a very common condition that has a significant associated morbidity. Although treated by practitioners of many specialties, most doctors have minimal training in this area. In this overview, an algorithm will be used to direct in an efficient and pain minimizing way the management of recalcitrant ingrowing nails.
The Suture Tension Adjustment Reel: A New Device for the Management of Skin Closure
Authors: COHEN BERNARD H. , COSMETTO A. JOHN
Published: June 2013

The initial clinical experience with a new device, called the Suture Tension Adjustment Reel (STAR), is described. The historical precedence and rationale underlying linear tissue expansion is presented. Case reports illustrate the use of the STAR for preoperative tissue stretching, for intraoperative tissue stretching, and for tissue mobilization as applied to scalp reduction surgery. The multipurpose device is a safe, simple, and reliable adjunct to sutured surgery. It is of value in the general management of tensioned and nontensioned skin closures.
Modified Electrosurgical Adapters
Authors: WEBER PAUL J. , WEBER ROBERT G.
Published: June 2013

background
: Allegedly because of concerns over worker safety in removing spent needles from the Bernsco adapter a new, modified Luer‐lok adapter has been introduced by the manufacturer. However, the new adapter frequently holds needles too loosely.

objective
: To introduce a modification of the original adapter design.

methods
: The end to be inserted into the needle hub was hollowed and trisected to allow flexibility of the phalanges. A small hole is drilled in the distal shaft to allow the placement of a spiral wire, allowing a snug fit even in older, well used electrosurgical handles.

conclusion
: The modified electrosurgical adapter may facilitate needle removal and increase surety of fit with most electrosurgical handles. J Dermatol Surg Oncol 1992;18:991–992.
Benign Eyelid Lesions
Authors: CAHILL KENNETH V. , BURNS JOHN A.
Published: June 2013

background
. Benign eyelid lesions include a diverse group of tumors, infections, and degenerative lesions that require specialized care for identification and treatment.

objective
. Diagnosis of benign eyelid lesions based on their clinical characteristics with pathological confirmation by biopsy where indicated.

methods
. Clinical evaluation, biopsy, and treatment with medication, surgery, and laser surgery are utilized.

results
. Improvement or complete resolution of these eyelid lesions is possible.

conclusion
. Special care is necessary to avoid ocular complications that could compromise vision, comfort, and cosmesis. J Dermatol Surg Oncol 1992;18:1051–1055.
Closure of Eyelid Defects
Authors: ROSS JOSEPH J. , PHAM RANDALL
Published: June 2013

background
. Repair of eyelid defects can be achieved by an array of procedures.

objective
. To provide a basic approach to repairing eyelid defects.

methods
. Defects are categorized by size. The method of repair for each defect is described.

conclusion
. By selecting the proper method of closure, with due consideration of the size, location, and configuration of the defect, the cutaneous surgeon can repair eyelid defects whilst maintaining the best possible function and cosmetic appearance. J Dermatol Surg Oncol 1992;18:1061–1064.
Considerations in Aesthetic Eyelid Surgery
Authors: SHORR NORMAN , ENZER YOASH R.
Published: June 2013

background
. Successful aesthetic eyelid surgery is based upon multiple complex factors that, when put together, yield a pleasing result. Beauty is inherently related to normal eyelid function and symmetry.

objective
. To review the critical issues facing the aesthetic surgeon, and to propose a systematic method of assessing the patient preoperatively.

methods
. This article first examines the general considerations for aesthetic eyelid surgery, followed by specific concerns within each anatomic area.

results
and
conclusion
. The critical task in aesthetic eyelid surgery is to reconstitute or preserve the normal structure and function of the eyelids. This is especially true in the multicontoured areas. It is essential for the surgeon to define the problems in a hierarchal fashion, and plan the surgery accordingly. Thus, not all patients can achieve the desired results in one sitting. The goal of aesthetic surgery is to avoid the telltale signs of surgery and to help the patient attain a youthful and energetic appearance for his or her age bracket. J Dermatol Surg Oncol 1992;18:1081–1095.
Upper Eyelid Blepharoplasty
Authors: PERMAN KEVIN I.
Published: June 2013

background
. The surgical removal of redundant upper eyelid skin along with the excision of prolapsed anterior orbital fat is one of the most popular elective cosmetic surgical procedures performed today.

objective
. To provide a brief overview of patient selection and upper eyelid blepharoplasty technique.

conclusion
. Through careful patient selection and preoperative evaluation in addition to a thorough knowledge of eyelid and orbital anatomy, good outcomes from upper eyelid blepharoplasty can be obtained. J Dermatol Surg Oncol 1992;18:1096–1099.
Clinical Predictors of Malignant Pigmented Lesions
Authors: McGOVERN THOMAS W. , LITAKER MARK S.
Published: June 2013

Reducing morbidity and mortality from malignant melanoma is the greatest challenge facing dermatology today. We present a comparison of the Glasgow seven‐point checklist and the American Cancer Society's ABCDs of pigmented lesions for detecting early melanomas. Logistic regression analysis showed that the Glasgow checklist (N = 205 lesions) contained two significant variables (irregular outline, P =.001, relative odds= 20.9; diameter greater than 1 cm, P = .005, relative odds = 6.7) for differentiating benign from malignant pigmented lesions whereas a three‐point version of the ABCDs (N =192 lesions) had three significant variables (irregular outline, P =.001, relative odds = 9.3; diameter greater than 6 mm, P =.008, relative odds=5.5; variegation, P =.05, relative odds = 3.7). All six melanomas scored 3 out of 3 on the ABCD scale for a sensitivity of 1.00 and specificity of 0.98 at a threshold of 3 out of 3. Patients rarely sought dermatologic consultation because of these predictors but often sought help for nonsignificant reasons such as inflammation (P = .93), color change (P =.84), itch (P =.72), and increasing size (P = .38). The simpler three‐point scale at a threshold of two had equal specificity (0.88 versus 0.94) and better sensitivity (0.73 versus 0.44) than the Glasgow seven‐point checklist at the recommended threshold of three out of seven. We therefore recommend that the American public be better educated about the ABCDs to help increase self‐referral so that early melanomas can be found and eradicated.
Microsurgical Treatment of Nasolabial and Glabellar Wrinkles
Authors: KOBAYASHI TOSHIO
Published: June 2013

Nasolabial and glabellar wrinkles have been treated using a new microsurgical technique. This technique consists of two steps, both performed under a microscope: 1) microsurgical peeling of tissue surrounding the wrinkle, and 2) direct excision of the wrinkle. This procedure was performed on approximately 30 patients. All results showed effective diminishing of the treated wrinkle with almost no conspicuous scarring. J Dermatol Surg Oncol 1992;18:31–37.
Office Varicose Vein Surgery Under Local Anesthesia
Authors: RICCI STEFANO , GEORGIEV MIHAEL
Published: June 2013

Varicose veins of any size (except teleangiectasia) and in any site of the lower limb (except the saphenofemoral junction) can be avulsed through multiple 0.5‐mm (or larger) incisions under local infiltration anesthesia (Müller's technique). When necessary, high ligation, division, and stripping of the proximal long saphenous vein can also be performed under local anesthesia. It is thus possible to treat even the most complex varicose cases with outpatient office‐based surgery.
Hair Transplantation in Females
Authors: COTTERILL PAUL C. , UNGER WALTER P.
Published: June 2013

Hair transplantation in females, to thicken discrete areas of thinning, reconstitute a hairline, or cover scars from previous facial surgery, is a viable treatment option. Techniques dealing with hair transplantation in females are discussed.
LASERS: CO2 Laser Blepharoplasty A Comparison with Cold‐Steel Surgery
Authors: MORROW DAVID M. , MORROW LINDA B.
Published: June 2013

This study compares and contrasts the use of the CO2 laser with the conventional cold‐steel scalpel and electrocautery in cosmetic blepharoplasty. Ten patients underwent bilateral, upper, and lower eyelid cosmetic blepharoplasty using the CO2 laser as the exclusive cutting and cauterizing instrument for one eye, and the cold‐steel scalpel and electrocautery as the exclusive cutting instrument and cauterizing tool for the remaining eye. This comparison evaluated administrative factors, procedural ease, and long‐ and short‐term results.

The benefits of using the CO2 laser rather than the cold‐steel scalpel in blepharoplasty are reduced operative time, less bleeding, superior intraoperative visibility, less bruising and swelling, no pain or discomfort, and a shorter recuperation period.

There were no complications with either the scalpel or the laser. Using the laser with standard safety protocols presents no greater risk to the patients undergoing blepharoplasty than does using the cold steel scalpel with an electrocautery device.

The disadvantages of using the laser compared with the steel scalpel include the cost of purchasing and maintaining the laser equipment, the need for additional and extensive laser training for surgeons and assistants, and the need for two assistants rather than the one needed for scalpel surgery.
Mucoepidermoid Carcinoma Metastatic to the Skin: An Histologic Mimic of a Primary Sweat Gland Carcinoma
Authors: SMOLLER BRUCE R. , NARURKAR VIC
Published: June 2013

Mucoepidermoid carcinomas are tumors that usually arise from salivary glands and have a characteristic histologic pattern of atypical squamous cells showing focal mucin production. Mucoepidermoid carcinomas are uncommon neoplasms that metastasize most commonly via lymphatic and hematogenous channels. We report what we believe to be the first case of a mucoepidermoid carcinoma arising from a sublingual salivary gland with metastasis to a distant site on the skin. The patient is a 58‐year‐old black woman who was initially diagnosed with a high grade mucoepidermoid carcinoma of the salivary glands of the tongue. Approximately 18 months after presentation, and 6 months following surgery, chemotherapy, and radiation therapy, the patient noted a firm nodule on her flank. Biopsy showed malignant squamous epithelium. Periodic acid‐Schiff and alcian blue stains revealed focal mucin production. The histologic differential diagnosis included an eccrine carcinoma, mucin‐producing adenocarcinoma with squamous differentiation, a primary cutaneous adenosquamous (mucoepidermoid) carcinoma and a malignant mixed tumor of the skin. Clinical correlation was essential in making the correct diagnosis. While mucoepidermoid carcinomas only uncommonly show distant metastasis, and even less frequently involve the skin, this entity should be included in the differential diagnosis of mucin‐producing neoplasms in the skin.
Neuroendocrine Carcinoma of the Skin (Merkel Cell Carcinoma) in a Black
Authors: ANDERSON LAWRENCE L. , PHIPPS TERRI J. , McCOLLOUGH MARTHA L.
Published: June 2013

Neuroendocrine carcinoma of the skin is an uncommon, small‐cell neoplasm most commonly found on white, sun‐exposed skin. Diagnosis by clinical and histologic means may be difficult. Immunohistochemical and ultrastructural analysis are often required. Because of the aggressive nature of neuroendocrine carcinoma of the skin, prompt diagnosis and treatment are essential. We present the rare occurrence of a neuroendocrine carcinoma of the skin on sun protected skin in a black. Clinical, histologic, immunohistochemical, and ultrastructural features are reviewed, and therapeutic options are discussed. J Dermatol Surg Oncol 1992; 18:375–380.
Light Reflection Rheography: A Non‐Invasive Diagnostic Tool for Screening for Venous Disease
Authors: NEUMANN H.A. MARTINO , BOERSMA IDS
Published: June 2013

Light reflection rheography has been increasingly used in the last few years to screen for chronic venous insufficiency. It is non‐invasive, easy to perform, and well‐suited for repetition and standardization. Light reflection rheography is appropriate for the global assessment of calf‐pump insufficiency regardless of whether it is caused by varicosis, the postphlebitic syndrome, or deep venous thrombosis. For this reason, it is a good method to use as a pretreatment selection test, especially for varicose veins. With the application of tourniquets, it can help to predict treatment results. When it is used in combination with ultrasound venous Doppler, a simple decision can be made for the treatment of nearly all venous patients. J Dermatol Surg Oncol 1992;18:425–430.
Hemangioma‐Associated Rhinophyma
Authors: MARSILI MARK , COCKERELL CLAY J. , LYDE CAROLYN B.
Published: June 2013

BACKGROUND. Rosacea is a disorder characterized by erythematous papules, pustules, and telangiectases involving the nose, chin, cheeks, and forehead that may progress to rhinophyma. Although the etiology of rosacea remains unclear, a common theme in pathogenesis is vasodilation. Rosacea has been associated with both idiopathic flushing as well as that induced secondarily.

OBJECTIVE. To report clinical and histologic features of rhinophyma that developed in association with a longstanding cavernous hemangioma.

RESULT. The patient is a 57‐year‐old Hispanic man with a congenital port‐wine stain that had developed into a nodular, cavernous hemangioma over the course of years. Clinically, in the site of the angioma there was marked soft‐tissue overgrowth with sebaceous hyperplasia. These changes were confined to the angiomatosis areas and were sharply demarcated from the surrounding normal skin. Histologically, there was marked fibroplasia; numerous small cysts, some with focal rupture and inflammation; dilated follicular ostia; and prominent sebaceous gland hyperplasia in addition to numerous ectatic blood vessels, which were a component of the hemangioma. In contrast, normal‐appearing skin adjacent to this site revealed only normal sebaceous glands and no fibroplasia. Treatment consisted of CO2 laser excision of the nodular components of the hemangioma with a tightly focused beam, followed by resculpting of the natural facial contour with laser abrasion of hypertrophic soft tissues with a broad, unfocused beam. The treated area healed well, with a skin tone of a more natural color than the original hemangioma.

CONCLUSION. Our findings suggest that rhinophyma may develop secondary to the vasodilation seen in large hemangiomas and that the CO2 laser offers excellent treatment for both the vascular and stromal components of the lesion.

We describe a patient with a large port‐wine stain with cavernous components and associated rhinophyma. We suggest that the long‐standing vasodilation secondary to the hemangioma was responsible for its development. Treatment with CO2 laser proved effective for both the hemangiomatous elements and the rhinophyma and is a valuable therapeutic option for lesions such as these.
Less Painful Alternatives for Local Anesthesia
Authors: LUGO‐JANER GERARDO , PADIAL MICHAEL , SÁNCHEZ JORGE L.
Published: June 2013

BACKGROUND. Infiltration of commonly used local anesthetics is painful. It has been speculated that the pain on infiltration is a direct consequence of the acidity of the anesthetic solution.

OBJECTIVE. To compare the degree of pain of intradermal infiltration and the duration of anesthesia for 1% lidocaine with epinephrine 1:100,000, 1% lidocaine with epinephrine 1:100,000 with 80 meq/L sodium bicarbonate, bacteriostatic saline solution with 1% lidocaine with epinephrine 1:300,000, and bacteriostatic saline solution with 1% lidocaine with epinephrine 1:100,000.

METHODS. The study was performed in three phases: 1) double‐blind comparison study, 2 and 3) open clinical trials.

RESULTS. Bacteriostatic saline solution with epinephrine 1:300,000 is significantly less painful on intradermal infiltration than lidocaine with epinephrine 1:100,000 with sodium bicarbonate 80 meq/mL. The saline preparation is an effective anesthetic alternative for superficial surgical procedures such as shave and scissors excision, light curettage and electrodesiccation, and superficial CO2 laser vaporization.

CONCLUSION. The pH values of bacteriostatic saline solution with epinephrine 1:300,000 and lidocaine with epinephrine diluted with bacteriostatic saline solution are 5.3 and 4.2, respectively. Both were found to be less painful than 1% lidocaine with epinephrine with sodium bicarbonate 84 meq/mL, which had a pH of 7.4. It is unlikely that the pain of infiltration is a simple function of the pH of the anesthetic solution.
Histologic Preparation for Mohs Micrographic Surgery
Authors: RANDLE HENRY W. , ZITELLI JOHN , BRODLAND DAVID G. , ROENIGK RANDALL K.
Published: June 2013

background. Tissue processed by Mohs micrographic surgery is usually cut into several sections before it is processed.

object and methods. We describe a single section method, in which the tissue is not subdivided, for preparing a tissue specimen for histologic examination in Mohs micrographic surgery.

results. This technique saves time for both technicians, who prepare fewer specimens, and physicians, who have fewer histologic specimens to interpret. It may minimize false‐positive margins and technical errors.

conclusions. Small specimens are handled best by this technique; however, the size of the specimen is limited only by the size of the cryostat chuck and histologic slide. The single section method is technically more difficult for preparing specimens that contain cartilage or ones that are extremely concave or convex, such as specimens from the conch of the ear.
Primary Mucinous Carcinoma of the Skin
Authors: FUKAMIZU HIDEKAZU , TOMITA KOICHI , INOUE KUNIO , TAKIGAWA MASAHIRO
Published: June 2013

background. Primary mucinous carcinoma is a rare primary adnexal neoplasm of the skin with a high recurrence rate.

objective. To improve the recognition of this clinical entity and aid in establishing the origin of this tumor.

methods. Two cases of this tumor were reported and investigated histopathologically and histochemically. Furthermore, some mucinous carcinomas arising from the breast or gastrointestinal tract were compared with this tumor.

results. Both cases showed no evidence of primary neoplasms as a source of metastasis and had characteristic findings of primary mucinous carcinoma of elongated cords and small lobules of epithelial cells floating in lakes of sialomucin. The origin of this tumor seemed to be an eccrine sweat gland.

conclusion. This tumor should be resected widely and, at least, the breasts and gastrointestinal tract should be investigated for primary lesions.
Occlusive Dressings
Authors: EAGLSTEIN WILLIAM H.
Published: June 2013

background. Although occlusive dressings speed epithelization, reduce inflammation and tenderness, reduce the chance of infection, stimulate healing of chronic wounds, and produce less scarring, they are still underutilized by physicians and nurses. The principal reasons for their underutilization are fear of infection, the time needed for instructing patients in their use, a lack of knowledge about occlusive dressings, and the general unavailability and high cost of the dressings.

methods. This chapter describes the principles which help in selection of the proper dressing, discusses the mechanisms of action of occlusive dressings, lists some novel new occlusive dressings, and emphasizes some of the drawbacks of occlusive dressings for chronic wounds.

conclusion. While occlusive dressings have become an important treatment protocol, their role in opening the minds of clinicians to the possibility of controlling the repair process may be their greatest contribution to medical science.
Biologic Skin Substitutes
Authors: PHILLIPS TANIA J.
Published: June 2013

background. The ideal skin substitute should closely approximate the skin in function. The substitute should be readily available, easily sterilized and stored, and relatively inexpensive.

objective. To describe recent developments in the area of biologic skin substitutes.

results. Considerable advances have been made in keratinocyte and fibroblast culturing when used in conjunction with a biodegradable material as a substrate.

conclusion. There is no skin substitute that perfectly mimics autologous skin. However, recent developments show promise.
Recurrent Basal Cell Carcinoma of the Back Infiltrating the Spine
Authors: MORSELLI PAOLO , TOSTI ANTONELLA , GUERRA LILIANA , FANTI PIER ALESSANDRO , FEDELI FRANCO , PISTORALE TONINO , CAVINA CARLO , VAROTTI CLAUDIO
Published: June 2013

BACKGROUND. Risk of basal cell carcinoma (BCC) recurrence appears to be related to tumor location, tumor size, treatment modality, radicalness of excision, and histologic type. Recurrences of BCC on the trunk and extremities are rare, with 97% of all recurrent lesions being located in the head and neck region.

OBJECTIVE. This report concerns a man who had a BCC of the back removed with electrodesiccation and curettage in 1980 at the age of 36. In the following 10 years the patient experienced five recurrences and finally developed infiltration of the thoracic spine that precluded further attempts at radical excision of the neoplasm.

METHODS AND RESULTS. The pathology of the BCC in our patient revealed a number of histologic features that have been associated with aggressive behaviour. These include an infiltrative growth pattern characterized by an irregular and acute tapered profile of the tumor cell groups and fibroblast‐rich stroma, infiltrating invading tumour edges, poorly peripheral palisading, nuclear pleomorphism, and perineural invasion.

CONCLUSION. Basal cell carcinomas that occur in sunlight‐protected areas of the trunk of middle‐aged individuals can occasionally exhibit aggressive and highly invasive features as well as a marked tendency for local uncontrollable recurrences. The prognosis for patients with this variety of BCC is poor, especially when progressive infiltration of deep tissues does not permit, as in our case, any possible further radical surgical procedure.
Anatomical Examination of Leg Telangiectases with Duplex Scanning
Authors: SOMJEN GEORGE M. , ZIEGENBEIN ROBERT , JOHNSTON ANDREW H. , ROYLE JOHN P.
Published: June 2013

BACKGROUND. Earlier studies using Doppler ultrasound suggested that thigh telangiectasia might be associated with reflux in the larger subcutaneous veins.

OBJECTIVE. The aim of the study was an accurate description of the anatomy of the venous drainage from thigh telangiectases and evaluation of the extent of venous valvular incompetence using a noninvasive imaging method.

METHOD. High‐definition color duplex ultrasonography was used to achieve the objective.

RESULTS. Thirty‐seven legs with lateral and/or medial thigh telangiectasia were examined. Patients studied were those without saphenofemoral, saphenopopliteal, or deep venous abnormalities on Doppler ultrasound examination. Altogether 53 sites were tested. In 89% reticular vein incompetence was found close to telangiectases. Often reticular vein incompetence was associated with reflux in larger epifascial veins. In 15% incompetent perforating veins were detected between reticular veins and the deep venous system.

CONCLUSION. An accurate, functional reconstruction of the subcutaneous venous drainage was accomplished. It was found that telangiectasia was rarely an isolated condition, but was usually associated with incompetence in other elements in the venous drainage of the subcutaneous tissue.
Mucinous Breast Carcinoma
Authors: NAHASS GEORGE T. , OTRAKJI CHRISTIAN J. , GOULD EDWIN
Published: June 2013

BACKGROUND. Mucinous or colloid carcinoma is an uncommon breast neoplasm which is generally associated with a good prognosis. Metastases tend to occur late in the disease and are found principally in lymph nodes, lungs, and bones. The longest latency period reported for development of a distant metastasis is 30 years after primary resection of the tumor.

OBJECTIVE. To describe a case of cutaneous metastasis from a mucinous breast carcinoma occurring 22 years after initial resection and review the literature.

RESULTS. Comparison of the primary tumor with the metastatic lesion showed identical histology. Review of the literature revealed this case represents the second longest latency for a distant metastasis from mucinous breast carcinoma and the unusual involvement of the skin.

CONCLUSION. This represents the second longest reported latency period for the development of a distant metastasis from mucinous breast carcinoma and its rare occurrence in the skin.
The Influence of Age and Patient Positioning on Skin Tension Lines
Authors: MEIRSON DAN , GOLDBERG LEONARD H.
Published: June 2013

background. The best cosmetic results are obtained if certain “skin lines” are followed. However, which “skin lines” are the correct ones has been controversial.

objective: To review the histo y of skin lines, the physiological basis of skin tension lines, and the factors that govern them.

method: Twenty‐seven individuals were observed, 15 greater than 65 years of age, and 12 less than 30 years of age. Patients were placed at 0″ and 90″ and the shift in skin tension lines was observed.

result: In older patients there was a significant shift in the skin lines with changes in positioning that was not present in the younger patients. In the older group of patients the shift in skin lines appeared to follow the direction of gravity's effect on the skin.

conclusions: Skin tension lines in older patients may become movable with position changes and are not static as previously stated.
Human Saphenous Vein In Vitro Model for Studying the Action of Sclerosing Solutions
Authors: ROTTER STEVEN M. , WEISS ROBERT A.
Published: June 2013

background. Previous studies detailing the clinical and histologic effects of sclerosing solutions in rabbit ear and other animal vein models have provided information comparing the effects of various concentrations of hypertonic saline with and without dextrose (Sclerodex), polidocanol, scleremo (chromated glycerin), and sodium tetradecyl sul‐fate.

objective. To observe short‐term histologic changes of sclerosing solutions in vitro in large diameter human vein.

methods. Human saphenous vein segments were obtained following cardiac bypass procedures. Several types of sclerosing solutions, including 23.4% hypertonic saline, 1 % polidocanol, and 3% sodium tetradecyl sulfate, were allowed continuous contact with the vessel wall for 10 minutes. Test vein segments were immediately fixed and observed for histologic changes compared with normal saline controls.

results. Endothelium was rapidly destroyed by all tested sclerosing solutions. Vessel wall necrosis occurred quickly with the extent determined by the sclerosing solution. Destructive potential of 3% sodium tetradecyl sulfate greatly exceeded that of 23.4% hypertonic saline or 1% polidocanol, in agreement with previous animal studies.

conclusion. Direct toxic effects of sclerosing agents may be compared in a constant, reproducible environment with this in vitro model.
Compression Stockings and Non‐Continuous Use of Polyurethane Foam Dressings for the Treatment of Venous Ulceration: A Pilot Study
Authors: SAMSON RUSSELL H.
Published: June 2013

background. Venous ulceration is usually treated with Unna's boot. Recently another product, Ulcer‐care, has been developed to treat these ulcers.

objective. To evaluate the therapeutic value of Ulcer‐care.

methods. Over 24 months, 20 ambulatory patients with 30 lower extremity stasis ulcers were treated with a product consisting of: 1) a hydrophilic polyurethane sponge covered by a hydrophobic membrane changed daily or evey other day; 2) an inner liner stocking that applies 10 mmHg pressure and is worn 24 hours a day; and 3) a surgical stocking with a posterior zipper that applies 30 mmHg graduated pressure and is removed at night.

results. All ulcers healed after 2 to 30 weeks (mean 8.3 weeks) including 15 previously treated by Unna's boot or hydrocolloid dressings and 3 infected ulcers.

conclusion. The Ulcercare treatment for stasis ulcers is highly successful, easy to use, and well accepted by patients.