bluuebunny/crossref_metadata_2025 huggingface dataset:
Not intending but somewhat willing: The influence of visual primes on risky sex decisions
Authors: Roberts Megan E. , Gibbons Frederick X. , Kingsbury John H. , Gerrard Meg
Published: June 2013

Objectives

This article investigates a potential mechanism underlying the ‘sexually conservative puzzle’ (the scenario where people reporting little to no casual sex intentions nevertheless go on to engage in casual sex).

Methods

In two experiments, we tested whether people reporting no behavioural intentions (BI) for casual sex were nevertheless more responsive to risk‐conducive cues, when compared to those with some BI. Responsiveness to cues was assessed in terms of increases in behavioural willingness (BW) for casual sex.

Results

In Study 1, subliminal priming of sexual images (vs. control images) increased the casual sex BW of male undergraduates, but only among those who had previously reported no BI for casual sex in a baseline survey. In Study 2, these results were replicated using supraliminal priming with a more diverse online sample; effects were not moderated by age, education, or relationship status.

Conclusions

Overall, these findings suggest that although sexually conservative people often do not plan on having sex (i.e., they have no BI), for some, their reactive, context‐sensitive decision‐making (i.e., their BW) can be swayed in the presence of risk‐conducive cues.

Statement of contribution

What is already known on this subject?

The sexually conservative puzzle occurs when those with low casual sex intentions go on to have casual sex.

When experience for a health‐risk behaviour is low, behavioural willingness (BW) tends to predict better than behavioural intentions (BI).

Risk‐inductive cues can increase risk cognitions and behaviour, but there are important individual differences.

What does this study add?

Among men with low BI for casual sex at baseline, sexual primes increased casual sex BW.

It appears that more sexually conservative men are more swayed by sexual cues.

Results highlight an interesting and rather unsuspected group of at‐risk individuals.
Welfare Effects of Food Safety Recalls
Authors: Richards Timothy J. , Nganje William
Published: June 2013

Estimates of the welfare losses associated with food recalls typically assume the announcement causes demand to shift, or the willingness‐to‐pay (WTP) falls for all quantity levels. Several researchers, however, have observed evidence of a rotation as well, where WTP rises for some consumers and falls for others. Preference heterogeneity theory implies that this observation results from an increase in the dispersion of demand. We test this theory using Centers for Disease Control and Prevention announcement data and Nielsen Homescan panel data for the fresh produce category. We find that the rotation effect cannot be disregarded, but is still dominated in welfare calculations by the shift effect of a recall announcement.
Using quantitative wastewater analysis to measure daily usage of conventional and emerging illicit drugs at an annual music festival
Authors: Lai Foon Yin , Thai Phong K. , O'Brien Jake , Gartner Coral , Bruno Raimondo , Kele Benjamin , Ort Christoph , Prichard Jeremy , Kirkbride Paul , Hall Wayne , Carter Steve , Mueller Jochen F.
Published: June 2013

Introduction and Aims

Wastewater analysis provides a non‐intrusive way of measuring drug use within a population. We used this approach to determine daily use of conventional illicit drugs [cannabis, cocaine, methamphetamine and 3,4‐methylenedioxymethamphetamine (MDMA)] and emerging illicit psychostimulants (benzylpiperazine, mephedrone and methylone) in two consecutive years (2010 and 2011) at an annual music festival.

Design and Methods

Daily composite wastewater samples, representative of the festival, were collected from the on‐site wastewater treatment plant and analysed for drug metabolites. Data over 2 years were compared using Wilcoxon matched‐pair test. Data from 2010 festival were compared with data collected at the same time from a nearby urban community using equivalent methods.

Results

Conventional illicit drugs were detected in all samples whereas emerging illicit psychostimulants were found only on specific days. The estimated per capita consumption ofMDMA, cocaine and cannabis was similar between the two festival years. Statistically significant (P < 0.05;Z = −2.0–2.2) decreases were observed in use of methamphetamine and one emerging illicit psychostimulant (benzyl piperazine). Only consumption ofMDMAwas elevated at the festival compared with the nearby urban community.

Discussion and Conclusions

Rates of substance use at this festival remained relatively consistent over two monitoring years. Compared with the urban community, drug use among festival goers was only elevated forMDMA, confirming its popularity in music settings. Our study demonstrated that wastewater analysis can objectively capture changes in substance use at a music setting without raising major ethical issues. It would potentially allow effective assessments of drug prevention strategies in such settings in the future.[Lai FY, Thai PK, O'Brien J, Gartner C, Bruno R, Kele B, Ort C, Prichard J, Kirkbride P, Hall W, Carter S, Mueller JF. Using quantitative wastewater analysis to measure daily usage of conventional and emerging illicit drugs at an annual music festival. Drug Alcohol Rev2013;32:594–602]
Effect of phytic acid used as etchant on bond strength, smear layer, and pulpal cells
Authors: Nassar Mohannad , Hiraishi Noriko , Islam Md. Sofiqul , Aizawa Mamoru , Tamura Yukihiko , Otsuki Masayuki , Kasugai Shohei , Ohya Keiichi , Tagami Junji
Published: June 2013

This study aimed to evaluate the effect of phytic acid (IP6), used as etchant, on resin–dentin bond strength, smear layer removal, and the viability of pulpal cells. Flat dentin surfaces with smear layer were etched with 1% IP6 for 60, 30, or 15 s; in the control group 37% phosphoric acid (PA) was used. Dentin surfaces were rinsed, blot‐dried, and bonded with an etch‐and‐rinse adhesive, followed by composite build‐ups. The specimens were subjected to tensile testing after 24 h of water storage at 37°C, and failure modes were determined using scanning electron microscopy. The effectiveness of IP6 to remove the smear layer was observed using scanning electron microscopy. To evaluate the effect on pulpal cells, solutions of 0.1 and 0.01% IP6 and of 3.7 and 0.37% PA were prepared and rat pulpal cells were treated with these solutions for 6 and 24 h. Cell viability was measured using the 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay. The results demonstrated that all application times of IP6 produced bond‐strength values that were significantly higher than that of the control. Phytic acid effectively removed the smear layer and plugs, thus exposing the collagen network. Phytic acid had a minimal effect on pulpal cells, whereas PA resulted in a marked decrease in their viability.
Effect of notch on fatigue behaviour of a directionally solidified superalloy at high temperature
Authors: Shi D. Q. , Hu X. A. , Wang J. K. , Yu H. C. , Yang X. G. , Huang J.
Published: June 2013

The effect of notch types and stress concentration factors (Kt) on low cycle fatigue life and cracking of the DZ125 directionally solidified superalloy has been experimentally investigated. Single‐edge notched specimens with V and U type geometries were tested at 850 °C with stress ratio R = 0.1. High temperature in situ optical method was used to observe crack initiation and short crack propagation. Scanning electron microscope observation of fracture was used to analyse the failure mechanism. The results reveal that fatigue resistance decreases with Kt increasing from 1.76 to 4.35. The ratcheting is found to be affected by both Kt and the nominal stress from the displacement–force curve. In situ observations indicate that the cracking does not occur at the notch apex but at the location where the max principal stress or Hill's stress is the highest. According to the scanning electron microscope observations, the failure of the notched specimens strongly depends on the anisotropy microstructures.
Distance, dams and drift: what structures populations of an endangered, benthic stream fish?
Authors: Roberts James H. , Angermeier Paul L. , Hallerman Eric M.
Published: June 2013

Spatial population structure plays an important role in species persistence, evolution and conservation. Benthic stream fishes are diverse and frequently imperilled, yet the determinants and spatial scaling of their population structure are understudied.

We investigated the range‐wide population genetic structure of Roanoke logperch (Percina rex), an endangered, benthic stream fish of the eastern United States. Fish were sampled from 35 sites and analysed at 11 microsatellite DNA loci. Clustering models were used to sort individuals into genetically cohesive groups and thereby estimate the spatial scaling of population structure. We then used Bayesian generalized linear mixed models (BGLMMs) to test alternative hypotheses about the environmental factors most responsible for generating structure, as measured by the differentiation statistic FST.

Clustering models delineated seven discrete populations, whose boundaries coincided with agents of fragmentation, including hydroelectric dams and tailwaters. In the absence of hydrological barriers, gene flow was extensive throughout catchments, whereas there was no evidence for contemporary dispersal between catchments across barriers.

In the best‐supported BGLMM, FST was positively related to the spatial distance and degree of hydrological alteration between sites and negatively related to genetic diversity within sites. Whereas the effect of tailwaters was equivocal, dams strongly influenced differentiation: the effect of a dam on FST was comparable to that of a between‐site distance of over 1200 km of unimpounded river. Overall, the effect of distance‐mediated dispersal was negligible compared to the combined effects of fragmentation and genetic drift.

The contemporary population structure of P. rex comprises a few geographically extensive ‘islands’ that are fragmented by hydroelectric projects. This information clarifies the importance of a catchment‐scale perspective on conserving the species and suggests that its recovery may require genetic and/or demographic reconnection of presently isolated populations.
Consumers' perception of the environmental performance in retail stores: an analysis of the German and the Spanish consumer
Authors: Stolz Johannes , Molina Horacio , Ramírez Jesús , Mohr Nikolaus
Published: June 2013

The purpose of our research is to find out about the consumer's perception of environmental retailing performance. Furthermore, consumer motives leading to sustainable consumption are measured by how they influence the consumer perception. Our study is divided into two parts and based on an international survey (n = 989) comparing German and Spanish consumers. First, we measure the perceiving availability and visibility of sustainable products in retail stores. Second, the impact of personal motives on sustainable consumption is evaluated, considering culture to be a moderating factor. Our study suggests that Spanish consumers tend to exhibit a weaker perception of sustainable products at their market places due to a weaker environmental awareness. Finally, we have identified the high importance of the social impact on both consumer groups regarding personal motives. The egoistic motive, however, has stronger effects on sustainable consumption among the Spanish consumers.
Immigrants in the Old‐Age Pension System: The Case of Sweden
Authors: Ekberg Jan , Lindh Thomas
Published: June 2013

The article investigates incomes and especially state pensions 2008 among elderly immigrants who arrived in Sweden before 1970. At age 70 and above, the level of state old‐age pension for immigrant men was nearly the same and for immigrant women somewhat higher than for natives with similar characteristics. At age 65–66 the state pension was lower for immigrants than for their native counterparts. The differences in pensions for immigrants of different ages are probably due to changed rules in the Swedish state old‐age pension system from 2003. The new rules have hit different age groups in different ways. The gaps are partially levelled out when other incomes are included. The extent to which levelling occurs varies greatly between different immigrant groups. For immigrants who have arrived during the last decades, the future state old‐age pension outcomes are expected to be worse.

Policy Implications

The Swedish Pensions Agency should set up a register of pensions from abroad. This will tell us to what extent old‐age pensions from the home country compensate for low old‐age pensions from the Swedish system.

Better integration on the labour market is a powerful measure for reducing the risk of future low pensions among immigrants. This is a challenge for Swedish integration policy.

To what extent can other parts of the Swedish welfare system in the future compensate individuals with low old‐age pensions?
Periorbital Reconstruction
Authors: MOY RONALD L. , ASHJIAN AMARA A.
Published: June 2013

Reconstructions of the lower lid, the upper lid, the medial canthus, the infraorbital area, and the eyebrow area are reviewed. Various flap procedures are described.
A New Hydrophilic Copolymer Membrane for Dermabrasion
Authors: RAAB BENJAMIN
Published: June 2013

Omiderm, a hydrophilic copolymer membrane, is a new dressing for the postoperative care of the dermabrasion patient. The unique physical properties of this dressing will be examined. Based on the clinical experiences presented, suggestions will be outlined that facilitate the best results from its use following dermabrasion.
Heterogeneity in Oxygen Diffusion Around Venous Ulcers
Authors: FALANGA VINCENT , McKENZIE ALDIN , EAGLSTEIN WILLIAM H.
Published: June 2013

The pathogenesis of venous ulceration is thought to involve the formation of fibrin cuffs around dermal capillaries. Consistent with a barrier effect of fibrin, it has been shown that the dermal diffusion of oxygen, as measured by transcutaneous oxygen pressure (TcPO2), is decreased in limbs affected by venous ulcer. However, it is unknown whether oxygen diffusion around the perimeter of venous ulcers is uniformly affected. In this study, we investigated TcPO2 values at four different quadrants around the ulcers of 14 patients, the contralateral leg of five patients with unilateral ulcers, and the leg of six normal individuals. These values were also compared to TcPO2 measurements at the chest. Our results indicate that, whereas TcPO2 values in limbs affected by venous ulcers are much lower than normal, there is a great deal of variability in oxygen diffusion around individual ulcers. These findings may represent a heterogeneity in the disease process affecting the leg.
The Depth of Thermal Necrosis Using the CO2 Laser: A Comparison of the Superpulsed Mode and Conventional Mode
Authors: FITZPATRICK RICHARD E. , RUIZ‐ESPARZA JAVIER , GOLDMAN MITCHEL P.
Published: June 2013

In order to compare the depth of thermal necrosis on human skin using the superpulse CO2 laser to the conventional CO2 laser, single impacts of various laser settings were fired at both ends of fusiform excisions done for other clinical purposes. These laser impacts were then examined histologically and the superpulse mode was found to limit the depth of thermal necrosis by approximately a factor of two.
Sclerotherapy for Multiple Glomangiomata
Authors: GOULD EDWARD P.
Published: June 2013

Multiple glomangiomata have always been treated by surgical resection. However, sclerotherapy can be used obliterate the majority of these tumors.
Sunscreens
Authors: LUFTMAN DEBRA B. , LOWE NICHOLAS J. , MOY RONALD L. , PROTECTION SUN
Published: June 2013

The awareness of sun‐induced skin damage has increased in both the lay public and physician.Coincidentally, there has been progress in the development of new ultraviolet‐(UV) radiation protecting sunscreens. In this review and update on sunscreens, sunscreen classification, UVB and UVA protection, sunscreen vehicle, and substantivity will be addressed.
Slit Grafting: The Use of Serrated Island Grafts in Male and Female‐Pattern Alopecia
Authors: SWINEHART JAMES M. , GRIFFIN EDMOND I.
Published: June 2013

Successful aesthetic treatment of earlier thinning of scalp hair in men and women has necessitated the development of alternatives to traditional punch grafting. The hair‐bearing “serrated island” remaining between two parallel rows of round donor sites can be removed and dissected to yield a large number of “serrated island grafts” and single‐hair grafts. These miniature grafts, along with half grafts from bisected plugs, can be placed, in one or several sessions, into dozens to hundreds of small “slits” between the remaining hairs in patients with early or advanced thinning on the crown, vertex, or anterior scalp — hence the name “slit grafting.” The versatility of this technique is demonstrated by its value for patients with dark hair and light skin, in repair work, in patients necessitating extensive vertex coverage, or in combination with alopecia reduction and traditional punch grafting. The finely tufted progressive growth from hundreds of these carefully placed slit grafts can thus counteract further hair loss in a variety of different situations.
The Carmalt Straight Splinter Forceps: A Versatile Economical Instrument
Authors: FISH FREDERICK S. , PEREZ MANUEL , GREENWAY HUBERT T.
Published: June 2013

The inexpensive Carmalt straight splinter forceps has many uses including removal and placement of wound closure adhesive strips, suture removal, isolating small blood vessels for electrosurgical destruction, and holding suture ends prior to cutting. It can also be used to assist in suturing.
Unresectable Primary Facial Cutaneous Carcinoma
Authors: WHITAKER DUANE C.
Published: June 2013

Over 500,000 nonmelanoma skin cancers are diagnosed and treated in this country each year. All treatment modalities quote a 90% or greater cure rate. Even with high cure rates, thousands of patients will require secondary treatment. Some nonmelanoma skin cancers are very aggressive and may not be resectable following single treatment failure. Recurrent tumors in critical anatomic locations require a multidisciplined approach. Combined tumor board evaluation and management are advocated.
The Importance of Bicarbonate in Large Volume Anesthetic Preparations
Authors: SMITH SHARON L. , HODGE JULIE A. , LAWRENCE NAOMI , BADAME ANTHONY J. , COLEMAN WILLIAM P.
Published: June 2013

background
: The tumescent local anesthetic approach is now being used more widely in dermatologic surgery. Although the original formula contains 12.5 mEq sodium bicarbonate per 50 mL of lidocaine, traditionally buffered solutions contain 1 mEq per 10 mL.

objective
: This study examines the effects of changing the concentrations of sodium bicarbonate in the tumescent formula.

methods
: Various concentrations of sodium bicarbonate in tumescent anesthetic preparations were measured for pH.

results
: Tumescent anesthetic preparations containing 5 mEq/L have a more physiologic pH (7.41) than the classic formula of 12.5 mEq/L (7.73). Clinical use of this reduced sodium bicarbonate solution showed no difference from the original formula.
CONCLUSIONS: Sodium bicarbonate can be used in a 1 mEq per 10 mL of lidocaine ratio similar to other buffered anesthetic solutions. This solution is physiologic in pH. However, some thought should also be given to the pKa of lidocaine, which is at pH 7.9. To achieve this even higher concentration (20 mEq/L) bicarbonate must be added to the tumescent solution. Thought must be given to these concepts when tumescent solutions are used in large volumes. J Dermatol Surg Oncol 1992;18:973 ‐975.
Alginates: A “New” Dressing Alternative
Authors: PIACQUADIO DANIEL , NELSON DONETTE B.
Published: June 2013

background
: Currently, a wide variety of bio‐occlusive dressing materials are available. In general, these dressing materials provide a moist wound healing environment that has been shown to promote healing in both human and animal studies. To effectively use these dressings the clinician must have a full understanding of the properties of the materials as well as the pathophysiology of the particular wound. Most recently, a “new” biosynthetic dressing material, the alginates, has become available.

objective
: To highlight proper use of alginate dressings for the management of acute and chronic wounds.

methods
: Case study and literature review.

results
: Alginates were shown to be effective in a wide variety of acute and chronic wounds.

conclusion
: Alginates possess several unique properties that should prove useful to the dermatologic surgeon as well as the dermatologist. Proper patient selection and use of this “new” dressing material, as well as a review of the literature is presented. J Dermatol Surg Oncol 1992;18:992–995.
Periocular Flaps
Authors: WIGGS EUGENE O.
Published: June 2013

background
. Most flaps used in periocular reconstruction are random pattern flaps.

objective
. To discuss the principles of periocular flaps as they relate to oculoplastic surgery, with an emphasis on reconstruction of the eyelids and ocular adnexa.

methods
. The advantages, disadvantages, and techniques of reconstruction are reviewed.

conclusion
. The ability to conceptualize and utilize flaps in periocular surgery enormously extends the surgeon's capabilities to produce optimal results for the patient. J Dermatol Surg Oncol 1992;18:1069–1073.
Lower Eyelid Blepharoplasty
Authors: NEUHAUS RUSSELL W.
Published: June 2013

background
. Lower eyelid blepharoplasty is a frequently performed procedure to reverse partially gravitational aging effects on eyelid tissues. Careful planning, proper execution, and appropriate management of potential postoperative complications will generally result in a happy and satisfied patient. However, in any surgical procedure that is primarily aesthetic in nature, the surgeon needs to be constantly aware of factors that may compromise the functional integrity of the eyelid. A patient with altered visual function or ocular discomfort is no longer primarily concerned about the final aesthetic appearance of even the most perfectly executed, technically correct blepharoplasty procedure.

objective
. To describe the preoperative evaluation, surgical technique, and postoperative complications of lower eyelid blepharoplasty. Specific attention will be given to lower eyelid retraction and ectropion following blepharoplasty.

conclusion
. Successful lower eyelid blepharoplasty surgery can be a source of both patient and physician satisfaction. As long as patient expectations are consistent with realistic surgical goals, lower eyelid blepharoplasty is an important aspect of overall facial aesthetic surgery. J Dermatol Surg Oncol 1992;18:1100–1109.
Nuances in Ophthalmic Plastic Surgery
Authors: WEBER PAUL J.
Published: June 2013

background
. Presented several nuances in the performance of cosmetic upper, lower, and lateral eyelid surgery.

objective
. To provide slight modifications in the performance of cosmetic upper and lower eyelid surgery that may be timesaving and outcome‐enhancing. Lateral eyelid tightening is discussed. The expected outcomes and best candidates for surgery are also described.

methods
. Methods vary with the individual procedure. However, expertise in the traditional methods of cosmetic eyelid surgery is integral to success with the modified techniques.

results
. Results vary with the individual procedure, the surgeon's expectations, and the surgeon's interpretation of the patient's expectations, as well as other factors.

conclusion
. Modifications of traditional cosmetic eyelid surgical procedures may benefit the patient following careful planning and technique execution. J Dermatol Surg Oncol 1992;18:1117–1121.
Complications of Blepharoplasty and Their Management
Authors: POPP JEFFREY C.
Published: June 2013

background
. Blepharoplasty is the most frequently performed cosmetic procedure on the face. Although complications are rare, their consequences can be devastating both the for patient and the surgeon.

objective
. The complications of blepharoplasty and their management are reviewed. J Dermatol Surg Oncol 1992;18:1122–1126.
Salicylic Acid Ointment Peeling of the Hands and Forearms: Effective Nonsurgical Removal of Pigmented Lesions and Actinic Damage
Authors: SWINEHART JAMES M.
Published: June 2013

A methyl salicylate‐buffered, croton oil‐containing 50% salicylic acid ointment peel, following pretreatment with topical tretinoin and localized 20% trichloroacetic acid, is extremely effective for removal of lentigines, pigmented keratoses, and actinically damaged skin from the dorsum of the hands and forearms. The ease of application, uniform results, decreased risk of scarring, and one‐time application of this peel, in comparison with other methods used for treatment of these aging‐skin changes, warrants consideration by the dermatologic surgeon.
Iontophoresis of Lidocaine for Anesthesia during Pulsed Dye Laser Treatment of Port‐Wine Stains
Authors: KENNARD CHARLES D. , WHITAKER DUANE C.
Published: June 2013

Port‐wine stains may be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm. However, the discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions. Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use. We performed a prospective double‐blind, placebo‐controlled evaluation of the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port‐wine stains. Eleven patients with port‐wine stains completed the initial phase of the study. Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 (P < .0001), with no significant difference between these treatments. Follow‐up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port‐wine stains, despite significant decreases in perfusion, as measured by laser Doppler velocimetry, of port‐wine stain areas receiving iontophoresis of lidocaine with epinephrine. Iontophoresis of lidocaine HCl 4% with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy.
Squamous Cell Carcinoma Secondary to Recessive Dystrophic Epidermolysis Bullosa: A Report of 4 Patients with 17 Primary Cutaneous Malignancies
Authors: NEWMAN CATHY , WAGNER RICHARD F. , TYRING STEPHEN K. , SPIGEL G. THOMAS
Published: June 2013

Four patients with recessive dystrophic epidermolysis bullosa and 17 invasive primary cutaneous squamous cell carcinomas (SCCs) are presented. All skin cancers arose at the site of scarring due to recessive dystrophic epidermolysis bullosa. Three of 17(18%) primary cutaneous SCCs recurred locally following initial treatment with either surgical excision or wide surgical excision. Patients with recessive dystrophic epidermolysis bullosa are more likely to develop SCCs of the extremities than nonimmunocompromised patients or patients with epidermodysplasia verruciformis. Like patients with epidermodysplasia verruciformis, patients with recessive dystrophic epidermolysis bullosa are likely to suffer from invasive and metastatic SCCs at a much younger age than nonimmunocompromised patients.
Mohs Surgery Update: Intraoperative Presuturing
Authors: WEBER PAUL J. , WEBER ROBERT G.
Published: June 2013

During the course of Mohs surgery, the surgeon may be able to predict that the final closure may require tissue expansion or some other extraordinary measure to close a defect on a particular location. Presuturing, the use of stitches to preoperatively stretch donor tissue peripheral to the wound, has been previously advocated to aid in the primary closure of nonMohs tumor removal defects and scalp reduction defects. We describe the anticipatory need for and the use of button bolstered nonabsorbable sutures to stretch or expand the perioperative tissues for final closure. Previously unreported in the literature, we also employ this technique prior to flap closure. This quick and easy manouever following the intermediate and final stages of Mohs surgery has seen great use in the care of some relatively large tumors.
Antibacterial Activity of Lidocaine in Combination with a Bicarbonate Buffer
Authors: THOMPSON KENNETH D. , WELYKYJ SOPHIA , MASSA MARY C.
Published: June 2013

BACKGROUND. The antibacterial properties of lidocaine have been previously described. Recent reports indicated that the addition of NaHCO3 to lidocaine reduces the pain associated with the injection. This study was conducted to determine the antibacterial activity of lidocaine buffered with NaHCO3.

METHODS. Rates of killing of six species of bacteria were determined in the presence of buffered and unbuffered lidocaine. When bacteria were incubated with lidocaine buffered with NaHCO3 at either 25, 50, or 100 mEq/L, there was a decrease of>99% of all bacteria tested over the 6 hours of the assay. This dramatic rate of killing was not observed in the unbuffered control preparations.

RESULTS. The results of this study indicate that NaHCO3 enhances the killing effect that has been described for lidocaine alone. The inability to recover common pathogenic bacteria from biopsy specimens could be the result of exposure to local anesthetic agents such as lidocaine that are buffered with NaHCO3.
Painful Tumors of the Skin
Authors: HERZBERG ARLENE J. , MURPHY GEORGE F.
Published: June 2013

BACKGROUND. Several cutaneous tumors are characteristically associated with considerable and sometimes incapacitating pain.

OBJECTIVE. A review of the histologic features of these tumors, subjective characteristics of the pain, hypotheses proposed to explain the mechanism of pain production by the tumor, and treatments that have been effective in abolishing or relieving the patient's perception of the stimulus.

METHODS. Review of case reports as well as studies that have proposed mechanisms of pain production based on histologic, electron microscopic, and pharmacologic studies.

RESULTS. Several hypotheses may be equally valid in explaining the cause of pain of a single tumor type, while no apparent cause is found in other types of tumors. There is variability in the success of a treatment between patients.

CONCLUSION. Our understanding of the mechanism of pain production by cutaneous tumors is limited by the small number of studies (and sample size) addressing the issue as well as by our incomplete general understanding of pain production.
Management of Patients Taking Anticoagulants and Platelet Inhibitors Prior to Dermatologic Surgery
Authors: GOLDSMITH STUART MARTIN , LESHIN BARRY , OWEN JOHN
Published: June 2013

background. The use of anticoagulants and platelet inhibitors can increase the risk of intraoperative and postoperative hemorrhagic complications in cutaneous surgery. Currently there are no general guidelines and no consensus among dermatologic surgeons on how to manage patients taking these medicines.

objective. To address many of the issues involved in the management of these patients.

conclusion. General recommendations are made for managing patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.
Duplex Scanning and Light Reflection Rheography in the Assessment of the Severity of Short Saphenous Vein Incompetence
Authors: SOMJEN GEORGE M. , ROYLE JOHN P. , TONG YISHA , MacLELLAN DONALD G.
Published: June 2013

background. Duplex ultrasound assessment of veins in the popliteal fossa is an accepted alternative to venography. Light reflection rheography provides additional quantitative information on venous reflux in chronic venous insufficiency.

objective. To use duplex ultrasound and light reflection rheography to study the venous reflux patterns in the popliteal fossa in a group of patients.

methods. Duplex ultrasound examination and light reflection rheography were used in the assessment of the severity of short saphenous vein incompetence.

results. The study revealed that any associated deep venous reflux which was detectable beyond the saphenopopliteal junction represented a more advanced stage of superficial venous insufficiency.

conclusions. Light reflection rheography, as a semiquantitative test, provided useful additional information to duplex scan findings in assessing venous reflux of the popliteal fossa. Short saphenous vein reflux with functional deep venous incompetence was associated with shorter venous refilling times and clinically represented a more advanced stage of primary varicose vein disease.
Techniques of Split‐Thickness Skin Grafting for Lower Extremity Ulcerations
Authors: KIRSNER ROBERT S. , FALANGA VINCENT
Published: June 2013

objective. To discuss the role of skin grafts in the functional repair of lower extremity ulcerations.

methods. The indications, types of skin grafts, and the methods of harvesting grafts are described.

results. Detailed description of our method of bedside split‐thickness skin grafting with both pinch and mesh grafts in hospitalized patients is given. We also discuss post‐operative care and complications seen with skin grafting.

conclusion. Split‐thickness skin grafting offers an important therapeutic option in the treatment of lower extremity ulcerations.
Review of Continuous Sutures in Dermatologic Surgery
Authors: WONG NANCY L.
Published: June 2013

BACKGROUND. Continuous sutures have been developed to close surgical defects to save time, to distribute tension evenly, or to improve the cosmetic result. The choice of suture technique can significantly affect the speed of closure and the eventual appearance of the scar.

OBJECTIVE. To review the different types of continuous sutures, their advantages, and disadvantages.

CONCLUSION. Recommendations are made regarding the appropriate use of continuous sutures in wounds depending on the amount of tension in the wound, and requirement of a good cosmetic result.
Indications for the Sclerosing Agent Polidocanol
Authors: GUEX JEAN‐JÉRÔME
Published: June 2013

BACKGROUND. Polidocanol is a widely used sclerosing agent that was first developed as a local anesthetic. In France it is used in varicose veins as well as in telangiectases.

OBJECTIVE. To improve the knowledge of the effects of polidocanol and provide recommendations for better use.

METHODS. Based on 12 years of experience in treating nearly 11,000 patients with polidocanol, the author reviews his observations. A theoretical model of dilution of sclerosing agents in injected veins is provided.

RESULTS. The author observed: seven cases of minor urticaria, occurrence ofgrey veil when used under the air‐block technique, one case of cutaneous necrosis (5 cm3), and some small epidermic necrosis (1‐mm diameter) and neither shock nor severe adverse reaction.

CONCLUSION. Polidocanol is characterized by its spasmogenic action on veins, excellent local tolerance, and a very low incidence of general reactions. Low concentrations (0.3 to 0.600) can be used for the treatment of quite large varicose veins if an adequate volume is injected.
A History of Tissue Expansion
Authors: BENNETT RICHARD G. , HIRT MICHAEL
Published: June 2013

BACKGROUND. Tissue expansion has become a widely used adjunct in reconstruction of the skin.

OBJECTIVE. To trace the history of the concept of tissue expansion from the ancient to the latest medical literature.

METHODS. We reviewed the technologic developments in the materials and methods of tissue expansion.

RESULTS. Tissue expansion is of clinical importance and can be understood by the biochemical, biomechanical, and histologic features of expanded skin.

CONCLUSION. Tissue expansion is becoming widely used and accepted and its continued use under many circumstances is justified by the experimental and clinical results.
Bowenoid Changes in Kaposi's Sarcoma
Authors: COHEN PHILIP R. , ADLER‐STORTHZ KAREN , RAPINI RONALD P.
Published: June 2013

background: Previous reports have documented the coexistence of multiple infectious organisms or Kaposi's sarcoma within the same biopsy specimens of mucocutaneous lesions in human immunodeficiency virus‐(HIV) infected patients.

objective: A 31‐year‐old black man with the acquired immunodeficiency syndrome (AIDS) who had Bowenoid changes and Kaposi's sarcoma within the same cutaneous lesion is described.

methods: Microbiologic cultures, microscopic examination, and polymerase chain reaction were performed on a lesional skin biopsy specimen to evaluate for infectious organisms, histopathology, and the presence of human papil‐lomavirus (HPV) deoxyribonucleic acid (DNA), respectively.

results: Bacteria, fungi, and mycobacteria were not detected with special stains and cultures. The histologic findings were consistent with Bowen's disease in the epidermis and patch stage Kaposi's sarcoma in the dermis. There was no polymerase chain reaction product generated from the HPV‐specific primers in two individual polymerase chain reaction assays.

conclusion: The possibility that coexisting infectious or neoplastic disorders, or both, may be present within a single mucocutaneous lesion should always be considered when evaluating a lesion from an HIV seropositive individual.
Effectiveness of the Health Campaign for the Early Diagnosis of Cutaneous Melanoma in Trentino, Italy
Authors: CRISTOFOLINI MARIO , BIANCHI RAFFAELLA , BOI SEBASTIANA , DECARLI ADRIANO , MICCIOLO ROCCO , CRISTOFOLINI PAOLO , ZUMIANI GIUSEPPE
Published: June 2013

background. To reduce the mortality rate from cutaneous melanoma in Trentino, a health campaign for early diagnosis aimed at the general public was organized.

objective. The mortality rate from cutaneous melanoma in Trentino before and after our health campaign was analyzed and compared with the mortality rates in three neighboring regions where no campaigns were carried out.

methods. The mortality for cutaneous melanoma was analyzed using data from the death certificates provided by ISTAT for the pre‐ and postcampaign periods. The two Summary methods: cumulative rate and the standard mortality ratio were used.

results. The cumulative mortality rates in the neighboring regions show a tendency to increase over the three periods whereas the increase in Trentino is less evident. The standard mortality ratios confirmed this result.

conclusion. We feel that this type of campaign is to be recommended in the reduction of mortality from cutaneous melanoma.
Basal Cell Carcinoma of the Male Nipple Case Report and Review of the Literature
Authors: BENHARROCH DANIEL , GEFFEN DAVID B. , PEISER JOHANAN , ROSENBERG LIOR
Published: June 2013

background. Basal cell carcinoma (BCC) of the nipple is a very unusual occurence, often mistaken for Paget's disease.

objective. By reporting a further case of BCC of the nipple in a 57‐year‐old man and by reviewing the sixteen previously reported cases, we mean to characterize further a common lesion arising at an unusual site. We also wish to stress the lack of aggreement regarding the treatment of BCC of the nipple.

methods. Review of the literature was based on a search in Medline.

conclusions. We appeal to compile all cases of BCC arising at unusual locations in order to gain a better understanding of these lesions.
Recurrent Malignant Melanoma Following a 35‐Year Disease‐Free Interval
Authors: TAHERY DAN P. , MOY RONALD L.
Published: June 2013

A case is presented of recurrent melanoma following a 35‐year disease‐free interval after treatment for stage 1 disease. Although the case seems to indicate a recurrence of melanoma, the possibility that the “recurrent 1esions” may have been a new primary lesion should be considered. Regardless of disease‐free interval following initial treatment, a complete cure of the disease can never be assumed.
Scalpel Sculpturing Techniques for Graft Revision and Dermatologic Surgery
Authors: Snow Stephen N. , Stiff Mark A. , Lambert David R.
Published: June 2013

background. Postoperative scars can be revised by a variety of techniques, including dermabrasion, laser, curettage, razor blade, and scalpel surgery. Most modern methods of scar revision provide good results but at the expense of time and economy.

objective. We present our scalpel sculpting technique that uses the #15 scalpel blade to microshave and feather the skin edges to equalize differences in skin elevations caused by uneven healing. The superficial wounds then heal by second intention.

methods. Sculpting techniques were used to revise side‐to‐side closures (grafts and flaps), trap‐door elevations, standing tricones and hypertrophic scars. In addition, we used the sculpting technique to remove superficial blemishes such as actinic and seborrheic keratoses, skin tags, and other benign lesions.

results. We have used scalpel sculpting techniques to revise scars and remove blemishes for more than 5 years. We have removed thousands of skin imperfections with very gratifying results.

conclusion. Scalpel sculpting techniques provide a simple, efficient method of scar revision and removal of superficial skin lesions. The technique reduces operative time and streamlines instrument reprocessing. Because of its simplicity, there is a high degree of patient, nursing, and physician satisfaction.
Reconstruction of Midfacial Defects Following Surgical Management of Skin Cancer
Authors: Baker Shan R. , Swanson Neil A.
Published: June 2013

Compared with other locations on the face, skin cancer of the midface has a higher risk of recurrence owing, in part, to the mode of spread and the high frequency of subclinical extension. Skin cancers occurring in the region of the melolabial crease, nasal columella and medial canthus should be resected by Mohs surgery. Because tumors of the midface are sometimes recalcitrant, there are times when surgical ablation results in extensive defects. Reconstruction may be difficult owing to lack of available donor tissue, or because of previous surgery in the area of the proposed donor region. In these circumstances, tissue expansion in the form of controlled prolonged expansion or rapid intraoperative expansion, may, on occasion, provide the optimal reconstruction of form and function.
Mohs Micrographic Excision of Sebaceous Carcinoma of the Eyelids
Authors: Yount Avis B. , Bylund David , Pratt Steven G. , Greenway Hubert T.
Published: June 2013

background. Sebaceous carcinoma of the eyelid is a difficult tumor to manage because of diagnostic difficulties and pagetoid‐type spread in the conjunctivae.

objective. We report our experience with eight patients using the Mohs technique of excision with reconstruction.

methods. Six cases were managed with paraffin‐embedded hematoxylin and eosin sections. One case was managed by frozen histologic sections and one was managed with frozen section processing followed by paraffin‐embedded section review.

results. The correct pathologic diagnosis was made initially in only 50% of the cases. Eighty‐eight percent of the cases revealed intraepithelial neoplasm. There has been one recurrence with metastatic disease. The average follow‐up period has been 56.8 months.

conclusions. We advocate early recognition and excision with the Mohs technique with paraffin‐embedded sections followed by reconstruction. The use of paraffin‐embedded histologic sections helps with interpretation of intraepithelial and pagetoid tumor spread.
Uterine Adenocarcinoma Metastatic to the Skin Responsive to Megestrol Acetate
Authors: Spencer David M. , Bigler Lane R. , Wilkin Jonathan K. , Gams Richard A.
Published: June 2013

background. Although endometrial carcinoma is the most common gynecological cancer, it only rarely metastasizes to the skin, with a reported prevalence of 0.8%. We report a case of an elderly lady who recently developed cutaneous metastases from an endometrial primary diagnosed 7 years earlier.

objective. Our purpose was to determine if the oral administration of megestrol acetate would be effective in the treatment of uterine adenocarcinoma metastatic to the skin.

methods. The index case was given oral megestrol acetate over a period of 9 months. Pre‐ and posttreatment skin biopsies were performed and analyzed.

results. During treatment with megestrol acetate, the cutaneous metastases in the abdominal skin decreased in area to less than 10% of the pretreatment surface area correlating with a marked histopathologic decrease in adenocarcinomatous glandular structures.

conclusion. Megestrol acetate can be successfully utilized in the treatment of endometrial adenocarcinoma metastatic to the skin as well as ostensibly in the treatment of other progesterone‐sensitive metastatic cutaneous carcinomas.
Follow‐Up Recommendations for Patients with Stage I Malignant Melanoma
Authors: ROMERO JUDITH B. , STEFANATO CATHERINE M. , KOPF ALFRED W. , BART ROBERT S.
Published: June 2013

The objective of follow‐up examinations of patients who have had Stage 1 invasive malignant melanoma is the early detection of local recurrences, metastases, and new primary melanomas.

Model schedules for follow‐up intervals were developed based on a survey of eight physicians. These melanoma experts agree that regular follow‐up examinations are indicated and that the time intervals between examination vary according to the thicknesses of the melanomas.

The patient follow‐up schedule derived is: for melanomas up to 0.75‐mm thick, every 6 months for years 1 and 2, and annually for years 3, 4, and 5; for melanomas 0.76–1.50 mm thick, every 3 months for years 1 and 2, semiannually for years 3, 4, and 5; and for melanomas > 1.50 mm thick, every 3 months for years 1, 2, and 3, and semiannually for years 4 and 5. After the fifth year, the recommendation is to examine all patients annually for life because of the continued risk for recurrences and new primary melanomas. For those individuals at especially high risk for developing multiple primary melanomas more frequent examinations may be appropriate.
Usefulness of the Dissecting Microscope in the Surgical Management of Skin Cancers
Authors: SHUM DAVID T. , GUENTHER LYN C. , VISWANATHA DAVID
Published: June 2013

Dermatopathological examination of excised skin cancers serves the dual purposes of defining the nature of the malignancies and evaluating the resection margins for evidence of tumor involvement. Conventional histological techniques, including horizontal frozen sections as prescribed in Mohs micrographic surgery to evaluate resection margins, can often be tedious and not without many pitfalls. In this study, the use of a stereoscopic dissecting microscope is compared with routine microscopy in the examination of 54 skin specimens resected with the clinical diagnosis of cancer. Our results show that the dissecting microscope is more efficient and as accurate in diagnosing basal and squamous cell carcinomas, and in detecting tumor involvement of resection margins. The ability to visualize marginal surfaces in three dimensions allows for a thorough examination and quick localization and mapping of the involved sites. Tissue artifacts due to fixation, freezing, or sectioning are nonexistent. With the lower cost and ease of operation, we suggest that the dissecting microscope is a more superior instrument. Its usefulness in the surgical management of skin cancers should be emphasized and further validated.