bluuebunny/crossref_metadata_2025 huggingface dataset:
Probabilistic measures of persistence and extinction in measles (meta)populations
Authors: Gunning Christian E. , Wearing Helen J.
Published: June 2013

Persistence and extinction are fundamental processes in ecological systems that are difficult to accurately measure due to stochasticity and incomplete observation. Moreover, these processes operate on multiple scales, from individual populations to metapopulations. Here, we examine an extensive new data set of measles case reports and associated demographics in pre‐vaccine era US cities, alongside a classic England & Wales data set. We first infer the per‐population quasi‐continuous distribution of log incidence. We then use stochastic, spatially implicit metapopulation models to explore the frequency of rescue events and apparent extinctions. We show that, unlike critical community size, the inferred distributions account for observational processes, allowing direct comparisons between metapopulations. The inferred distributions scale with population size. We use these scalings to estimate extinction boundary probabilities. We compare these predictions with measurements in individual populations and random aggregates of populations, highlighting the importance of medium‐sized populations in metapopulation persistence.
Genetic control of psoriasis is relatively distinct from that of metabolic syndrome and coronary artery disease
Authors: Gupta Yask , Möller Steffen , Zillikens Detlef , Boehncke Wolf‐Henning , Ibrahim Saleh M. , Ludwig Ralf J.
Published: June 2013

Psoriasis is a common chronic inflammatory skin disease, associated with significant comorbidity, for example, metabolic syndrome (MetS) and coronary heart disease (CHD). This association implies that the risk to develop these diseases is commonly controlled or that the presence of one disease favours manifestation of the other. Therefore, we assessed the catalogue of genome‐wide association studies (GWAS) to analyse whether psoriasis, MetS and CHD share susceptibility loci. Interestingly, genetic control of psoriasis is almost completely independent from both MetS and CHD. In contrast, MetS and CHD share 10 common loci. Like by GWAS analysis, psoriasis susceptibility genes showed close clustering in Ingenuity Pathway Analysis, while genes conferring susceptibility to MetS and CHD were interlinked separately. These findings lead to the hypothesis that the clinically observed co‐occurrence of psoriasis with MetS and CHD may be due to a common environmental factor, for example, diet, which is known as a risk factor for all of these diseases.
Pocket‐depths‐related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients
Authors: Derman SHM , Lowden CE , Kaus P , Noack MJ
Published: June 2013

Aim

The aim of this study was to determine the impact of the pocket depth on the effectiveness of an intrapocket anaesthesia gel during SRP in periodontal maintenance patients. Effectiveness was measured by pain levels during SRP via visual analogue scale (VAS) and verbal rating scale (VRS). Secondary endpoint was the evaluation of patients' preferred choice of anaesthesia for SRP.

Methods

A total of 638 patients undergoing the periodontal maintenance programme and with the need for SRP participated in this observational study. After SRP, patients filled in questionnaires to record pain levels experienced and anaesthesia preference for future use. Mann–Whitney U‐test was used to analyse intergroup difference in pain perception and anaesthesia choice.

Results

Overall, increasing pocket depths were accompanied by higher pain levels, irrespective of maximum or commonest pocket depths (P < 0.05). For SRP procedures, patients definitely prefer the anaesthesia gel (72.4%).

Conclusions

In this study, an effectiveness of local anaesthesia gel (lidocaine/prilocaine) related to pocket depths was found in periodontal maintenance patients during SRP. Increasing pocket depths were accompanied by increasing procedural pain levels. Nevertheless, the anaesthesia gel is well accepted and in the majority of cases was found to be the preferred option for future SRP treatments.
The friend, the enemy, and the anthropologist: hostility and hospitality among the Parakanã (Amazonia, Brazil)
Authors: FAUSTO CARLOS
Published: June 2013

Here I investigate a special relationship existing among the Tupi‐speaking Parakanã of Amazonia, usually translated as ‘friendship’, and implying expectations of hospitality. Its field of application spans from the closest other (the cross‐cousin) to the most distant (the enemy). I show that this kind of relationship is internally structured around an unstable prey‐predator polarity, meaning that the most intimate other is also the prey closest to hand. This ambivalence in the friendship relation counteracts the possibility of a space of sovereignty at the levels of the person and of collectivities, but it does not imply a ‘hospitality of visitation’ as envisaged by Derrida.

L'auteur étudie ici une relation particulière entre les Parakanã, un peuple amazonien locuteur du tupi, que l'on traduit habituellement par « amitié » et qui implique des attentes d'hospitalité. Le domaine d'application de cette notion va de l'autre le plus proche (le cousin croisé) au plus éloigné (l'ennemi). L'article montre que ce type de relation est intrinsèquement structuré autour d'une polarité proie‐prédateur instable, dans laquelle l'autre le plus intime est aussi la proie la plus à portée de main. Cette ambivalence de la relation d'amitié s'oppose à la possibilité d'un espace de souveraineté au niveau de la personne et des collectivités, mais elle n'implique pas une « hospitalité de visitation » telle que l'envisageait Derrida.
The ‘successful’ return: Caribbean narratives of migration, family, and gender
Authors: Olwig Karen Fog
Published: June 2013

Research on female migrant caregivers has tended to focus upon the emotional and social problems they encounter working abroad, given women's traditional role as caregivers for their own families. This article analyses how Caribbean women who have returned after a period abroad as domestic workers inscribe their migration experiences within the gendered narrative of the good relative who migrates to help the family left behind and therefore deserves social recognition in the community of origin. It argues that this narrative allows the women to both affirm and reinterpret local family and gender roles within the context of migration. This analysis points to the close connection between narrative structures, accounts of migration experiences, and self‐presentations and suggests that narratives about family and gender roles not only reflect people's lives, but are also a malleable resource that can be (re)shaped to validate a variety of life‐courses.
Prolongation of Anesthesia in Mohs Micrographic Surgery with 2% Lidocaine Jelly
Authors: ROBINS PERRY , ASHINOFF ROBIN
Published: June 2013

The authors performed a prospective, randomized trial of topical 2% lidocaine jelly in patients with basal cell or squamous cell carcinomas to test the effectiveness of the jelly in prolonging the time of anesthesia between the multiple stages of Mohs micrographic surgery. There was a 48% increase in the duration of anesthesia achieved by the use of 2% lidocaine jelly in patients given 1% lidocaine with epinephrine. In patients given 1% lidocaine without epinephrine, there was approximately a 2.5 times greater duration of anesthesia achieved by using topical 2% lidocaine jelly.
Diagnostic and Therapeutic Nail Surgery
Authors: MILLER PAMELA K. , ROENIGK RANDALL K.
Published: June 2013

The function of the nail unit is as a protective covering over the dorsal distal end of the digit. Some basic disease processes affecting the nail unit and the surgical techniques used for diagnosis and treatment are reviewed.
A Regional Approach to Reconstruction of the Upper Lip
Authors: ZITELLI JOHN A. , BRODLAND DAVID G.
Published: June 2013

Treatment of upper lip wounds by second intention, full‐thickness skin grafts, and local flaps is discussed. The location, size, depth, and type of closure for each defect in 200 cases involving defects of the upper lip are reviewed. The percentages of wounds treated by each modality were 20, 6, 74% for second intention, grafts, and local flaps, respectively. Of wound treatment by local flaps, 80% used advancement flaps, 10% used transposition flaps, and 10% used island‐pedicle flaps. Advancement flaps, island‐pedicle flaps, possible complications, and post‐operative care are reviewed.
Local Skin Flaps on the Cheeks
Authors: BENNETT RICHARD G.
Published: June 2013

Local skin flap repairs on the cheek are discussed. Anatomic and special considerations are reviewed. Advancement, rotation, and transposition flaps are described.
Angiolymphoid Hyperplasia with Eosinophilia of the Hand
Authors: HAAS ANN F. , PERRIERE ROBERT LA , KING EARL
Published: June 2013

Angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular neoplasm manifested by multiple or solitary subcutaneous nodules, usually on or about the head of young adults. Angiolymphoid hyperplasia with eosinophilia is characterized microscopically by marked proliferation of large endothelial cells with a mixed inflammatory infiltrate consisting of lymphocytes, histiocytes, and eosinophils. This benign skin disorder may resemble an angiosarcoma both clinically and histologically. We wish to report a patient with angiolymphoid hyperplasia with eosinophilia on the palm of the hand and discuss therapeutic recommendations.
Prognosis and Treatment of Advanced Squamous Cell Carcinoma Secondary to Epidermodysplasia Verruciformis: A Worldwide Analysis of 11 Patients
Authors: KASPAR T. ADAM , WAGNER RICHARD F. , JABLONSKA STEPHANIA , NIIMURA MICHIHITO , TYRING STEPHEN K.
Published: June 2013

Data were collected from three medical centers in the USA, Poland, and Japan regarding 11 patients with advanced squamous cell carcinoma (SCC) secondary to epidermodysplasia verruciformis (EV). Analysis was conducted regarding primary tumor location, age at onset of EV, age at diagnosis of SCC, treatment of SCC, history of local tumor recurrence, presence of metastases, and age at death. Three of 11 patients developed both lymph node and visceral metastases and the mean patient age at death was 44 years (N=6) with no patient to date living past 54 years. Mean patient survival time following metastases was 1.7 years (N = 2). Human papilloma virus typing of nine patients was performed. Current controversies regarding the treatment of patients with advanced SCC in the setting of EV are reviewed.
“Pinch Modification” Used to Repair a Large Surgical Defect on the Scalp: Other Proposed Uses
Authors: ABRUSCI VITO , PASQUALI PAOLA
Published: June 2013

Dr Peng's “pinch modification” of the linear advancement flap, a reconstructive technique used to correct surgical wounds on the nose and suggested as a surgical alternative in other non‐hair‐bearing skin, was used successfully to correct a surgical defect of 55 mm in diameter located on the occipital area, on hair‐bearing skin. Other possible uses for this technique are suggested.
Nail Biopsy: Indications and Methods
Authors: RICH PHOEBE
Published: June 2013

Nail biopsy is a safe and useful diagnostic procedure for many nail disorders when routine clinical and laboratory methods fail to produce a diagnosis. Prerequisites for nail biopsy are an understanding of the surgical anatomy of the nail, adequate anesthesia and hemostasis, and a nail abnormality for which histopathology can provide the diagnosis. Indications and methods for nail biopsy vary according to the site and type of pathology in the nail unit. Nail bed and perionychial biopsies can be performed easily and with minimal scarring. They are most commonly used to diagnose tumors as well as infectious and inflammatory disorders of the nail. The most important reason to biopsy the nail matrix is to make or exclude the diagnosis of melanoma in a patient with longitudinal melanonychia. Great care must be taken in nail matrix biopsy to minimize the risk of permanent nail dystrophy.
Focal Mucinosis (Myxoid Cyst): Surgical Therapy
Authors: MILLER PAMELA K. , ROENIGK RANDALL K. , AMADIO PETER C.
Published: June 2013

Myxoid cysts typically arise in association with distal interphalangeal joint arthritis. When myxoid cysts become problematic, surgical excision is a standard treatment with a high cure rate and few complications. The origin, anatomy, and alternative medical and surgical treatment options are discussed.
A New Method for Preabrasion Graft Site Suturing: The Superficial Linear Restraining Stitch
Authors: WEBER PAUL J. , WULC ALLAN E.
Published: June 2013

Since the introduction of wire brush dermabrasion in the 1940s, many ancillary procedures have been developed including preabrasion scar elevation and punch grafting of deep scars. Unfortunately, unsutured punch grafts tend to cobblestone or rise‐up in an unsightly manner. Traditional suturing methods appear to decrease this tendency but are time consuming and tedious. Herein is described a new method for suturing preabrasion punch grafts that is extremely rapid, efficacious, and easy for the patient to remove if desired.
Oculoplastic Surgery
Authors: WULC ALLAN E.
Published: June 2013

background
. The interface between the subspecialties of dermatologic surgery and oculoplastic surgery is broad. However, there are many commonly seen oculoplastic conditions that are not foremost in the mind of the dermatologic surgeon.

objectives
. Common oculoplastic problems are detailed in this article and should provide the reader with a basis for understanding the wide spectrum of oculoplastic problems encountered in practice. J Dermatol Surg Oncol 1992;18:1033–1038.
The Preseptal and the Retroseptal Approaches in Transconjunctival Blepharoplasty
Authors: ASKEN SAUL
Published: June 2013

background
. Although transconjunctival blepharoplasty was first described in the beginning of this century, it did not start to become popular until recently.

objective
. To describe the best approaches to transconjunctival blepharoplasty and their applications.

conclusions
. There are two distinct approaches in this technique: the preseptal and the retroseptal. While not easier in execution, and at times it can be more difficult than the transcutaneous approach, the transconjunctival blepharoplasty has definite advantages. It belongs in the armamentarium of surgical procedures of all physicians performing cosmetic surgery. J Dermatol Surg Oncol 1992;18:1110–1116.
Recurrence Rates of Treated Basal Cell Carcinomas
Authors: SILVERMAN MARK K. , KOPF ALFRED W. , BART ROBERT S. , GRIN CARON M. , LEVENSTEIN MARCIA S.
Published: June 2013

This is the third report in a series that reviews the experience in the Skin and Cancer Unit, from 1955 through 1982, with the treatment of basal cell carcinomas (BCCs). It concerns 588 previously untreated (primary) BCCs removed by surgical excision. The cumulative 5‐year recurrence rate was 4.8%. This is a statistically significant lower recurrence rate (P = .034) than 135 previously treated BCCs that had a re‐recurrence rate of 11.6%. For the primary BCCs, multivariate analysis showed that location on the head (P = .010) and being male (P = .004) were independent risk factors for recurrence. The patient's age, the duration of the BCC, its maximum diameter, or the time span (1955–1963, 1964–1972, 1973–1982) in which it was treated did not significantly affect the recurrence rate. The 5‐year recurrence rate for BCCs excised from various anatomic sites were as follows: 1) neck, trunk, and extremities = 0.7%; 2) head—less than 6 mm in diameter = 3.2%; 3) head—6 to 9 mm in diameter = 8.0% (treated since 1964 = 5.2%); and 4) head—10 mm or more in diameter = 9.0%. Surgical excision is a highly effective method for removal of BCCs, and achieved a good to excellent cosmetic outcome in about 85% of the recurrence‐free treatment sites.
A New Modification for Preparing Tissue Blocks for Cryostat Sectioning
Authors: KOEHN GERARD G.
Published: June 2013

A modification of the Carter method for preparing tissue blocks for cryostat sectioning is presented. One problem with the Carter method is that tissue edges occasionally freeze above the plane of the smooth cryostat disk. My modification avoids this problem by gradual liquid nitrogen cooling of the disk. This enables all tissue edges to be applied to the smooth disk surface until freeze adherence occurs.
Rapid Atraumatic Nail Plate Removal Using the Cordless Cautery Unit
Authors: SNOW STEPHEN N. , ZWEIBEL STUART , LO JACOB S.
Published: June 2013

This article describes the use of a handy, battery‐powered, thermocautery unit to cut through the nail plate when performing dermatologic surgery involving nail tissue. Thermocauterization of keratin is a simple, atraumatic method of removing portions of the nail plate, so that the underlying soft tissue may be biopsied or treated. The units are inexpensive and safe to operate.
Hair Transplantation: A Three‐Stage Approach For Creating The Hairline
Authors: NUSBAUM BERNARD P. , LEWIS LEONARD A.
Published: June 2013

A method for achieving a solidly filled hairline in three punch autograft sessions is described. Hairline micro‐grafts can be done as part of the three sessions or when transplanting another area. This approach achieves optimal results during all stages of the procedure.
Transplantation of Melanocytes by Epidermal Grafting
Authors: MUTALIK SHARAD
Published: June 2013

Melanocyte transplantation by epidermal grafting was performed in 50 patients with localized, long‐standing, stationary patches of vitiligo. Repigmentation was observed in 48 of the 50 patients within 3 to 4 months after transplantation.
Pseudocyst of the Ear
Authors: HARDER MARY K. , ZACHARY C. B.
Published: June 2013

background. Pseudocyst of the auricle is characterized by an asymptomatic swelling caused by an intracartilaginous accumulation of fluid. Treatments include aspiration, steroid injection, and surgical intervention.

objective. To present two cases of pseudocyst of the auricle treated surgically with an open, deroofing technique.

methods. Two cases are presented and the relevant literature is reviewed.

conclusion. Optimal treatment for pseudocyst of the ear involves removal of the anterior cartilaginous leaflet of the pseudocyst with repositioning of the overlying flap of skin. This results in a normal‐appearing auricle with minimal scarring or recurrence of the pseudocyst.
Inflammatory Ulcers
Authors: KERDEL FRANCISCO A.
Published: June 2013

A large number of diseases can eventuate in cutaneous ulceration. This article will review inflammatory disorders which by their nature can directly produce cutaneous breakdown and ulcer formation. Major emphasis is given to those disorders where recent knowledge has improved our understanding of the condition or where new therapeutic agents or maneuvers have become available. This later group consists of vasculitis, disorders caused by small vessel thrombi or embolus and pyoderma gangrenosusm.
Treatment of Facial Telangiectasia with Sclerotherapy, Laser Surgery, and/or Electrodesiccation: A Review
Authors: GOLDMAN MITCHEL P. , WEISS ROBERT A. , BRODY HAROLD J. , COLEMAN WILLIAM P. , FITZPATRICK RICHARD E.
Published: June 2013

BACKGROUND. Facial telangiectasia is extremely common in patients with fair complexion. Electrosurgery has been the primary form of treatment in the past.

OBJECTIVES. The authors retrospectively evaluated over 300 patients treated with sclerotherapy for facial telangiectasias.

METHODS. Retrospective analysis of over 300 patients with facial telangiectasia treated with sclerotherapy and 55 facial spider telangiectasias treated with laser.

RESULTS. Sclerotherapy utilizing hypertonic saline, Sclerodex, polidocanol, and sodium tetradecyl sulfate resulted in‐between 50 and 100% resolution of facial telangiectasia with minimal complications.

CONCLUSION. The treatment of facial telangiectasia should include sclerotherapy and laser treatment modalities, which effect a higher rate of clearance with less adverse sequela.

LEARNING OBJECTIVES. After studying the following article the participants should be able to:

Understand the classification of superficial cutaneous facial vessels and identify their morphology.

Show an awaremenss of the benefits and risks of utilizing microsclerotherapy as a treatment for certain facial telangiectasias.

Recognize the role of laser surgery and electrosurgery as primary or secondary techniques in treating facial telangiectasias.
Two‐Stage Correction of Depressed Glabella and Nasal Root Scar Contracture Utilizing Subcutaneous Tissue Advancement Flaps and a Layered Soft Tissue/Procerus Muscle Transposition Flap
Authors: FIELD LAWRENCE M.
Published: June 2013

BACKGROUND. A postoperative nasal root and glabellar forehead deformity comprised both vertical and horizontal elements, with scar contracture and fixation across the left medial nose base, extending into the adjacent superior canthal region.

METHODS. A two‐stage reconstruction was performed, initially correcting the vertical centrally placed forehead depression by dual subcutaneous flaps advanced centrally and joined. The horizontal nasal root contracture was repaired at a second stage utilizing a procerus muscle transposition flap elevated on the ipsilateral deep contracture side, imbricated in serpentine fashion on itself and sutured into the depression over the scar base.

RESULT. Significant improvement followed.

CONCLUSION. The careful and precise placement of subcutaneous tissue and muscle can serve to assist in filling certain deep defects and in elevating scar lines.
A Comparison of Copper Vapor and Flashlamp Pumped Dye Lasers in the Treatment of Facial Telangiectasia
Authors: WANER MILTON , DINEHART SCOTT M. , WILSON MATTHEW B. , FLOCK STEPHEN T.
Published: June 2013

METHODS. Twelve adult patients with bilateral facial telangiectasias were treated with two yellow light lasers. A section of each involved area was treated with a copper vapor laser and a similar section in the same patient was treated with the flashlamp pumped dye laser.

RESULTS. Both lasers provided satisfactory clearance at 2 and 6 weeks. Treatment was not painless with either laser; however, no patient needed local or general anesthesia. The time taken to treat equivalent areas was similar for both lasers. Postoperative swelling was greater with the flashlamp pumped dye laser than with the copper vapor laser and the time required for healing was longer with the flashlamp pumped dye laser.

CONCLUSION. The larger purpuric macules produced postoperatively by the flashlamp pumped dye laser were less cosmetically acceptable to patients when compared with the thin linear crusting produced by the copper vapor laser. Scarring or textural changes were not seen with either laser.
The Treatment of Advanced Merkel Cell Carcinoma
Authors: FENIG EYAL , LURIE HEDWIG , KLEIN BARUCH , SULKES AARON
Published: June 2013

BACKGROUND. The optimal management of Merkel cell carcinoma has not been clearly defined.

OBJECTIVE. To describe the treatment of eight patients who presented with Merkel cell carcinoma.

METHODS. Eight patients with advanced locoregional Merkel cell carcinoma were seen in our institute over a 7‐year period. Four patients were successfully treated by induction chemotherapy after excisional biopsy, followed by radiotherapy. Three patients died from widespread metastases and one from neutropenic sepsis induced by chemotherapy.

RESULTS. These cases demonstrate the potential lethality and aggressive nature of this rare skin tumor despite its chemosensitive and radioresponsive character. In all four patients who are alive and disease‐free, chemotherapy was given first and radiotherapy was given as consolidation.

CONCLUSION. We suggest that a multimodality treatment approach — chemotherapy followed by radiotherapy — is indicated in patients with advanced Merkel cell carcinoma.
Lateral Rhinotomy Approach for Mohs Micrographic Surgery of the Anterior Septum
Authors: ZILINSKY I. , BORENSTEIN A. , TSUR H.
Published: June 2013

BACKGROUND. Neoplasms of the nasal septum and internal alar surface are very difficult to treat. This is because of the complicated surface, proximity to important anatomic structures, and technical difficulty—both to resection and follow up. Mohs micrographic surgery might be the ideal mode of treatment for such tumors; however, it is very difficult to accomplish through the nostril.

OBJECTIVE. To resect the tumor on the nasal septum and internal alar surface using Mohs micrographic surgery.

METHODS. Lateral rhinotomy was performed as a preparatory stage to Mohs micrographic surgery of the anterior septum and intranasal alar surface.

RESULTS. The ala nasi was detached from the cheek, thus exposing the anterior nasal cavity — enabling direct access to the neoplasms and allowing excellent visualization.

CONCLUSION. Lateral rhinotomy, as described in this article, is a simple office procedure and in most cases heals with no visible scar.
Phase Contrast Microscopy for Identifying Epidermal Margins in Unstained Cryosections for Mohs Micrographic Surgery
Authors: SATO KENZO , KENNARD CHARLES D.
Published: June 2013

BACKGROUND. Mohs fresh tissue micrographic surgery has been accepted as the most reliable therapeutic modality for the eradication of recurrent cutaneous malignancies or those skin cancers that are difficult to treat otherwise.

OBJECTIVE. We have developed a method to ascertain the presence of the epidermis and other edges in the tissue sections before staining the cryosections and microscopically searching them for cancer cells.

METHODS. Our method for screening the cryosections for the epidermis can be done quickly and easily using relatively inexpensive phase contrast optics.

RESULTS. Use of this method allows easy visualization of freshly cut cryosections, especially the presence of the epidermis and other edges of the tissue, in just a matter of seconds instead of a half hour to stain and recut the sections.

CONCLUSIONS. Phase contrast microscopy and/or dark field illumination are instrumental in screening unstained cryosections for the presence of the tissue borders, especially the epidermis, before they are stained with hematoxylin and eosin. This method saves a great deal of time and effort both for the surgeon and the patient.
Role of Tissue Undermining in the Trapdoor Effect of Transposition Flaps
Authors: KAUFMAN ANDREW J. , KIENE KEVIN L. , MOY RONALD L.
Published: June 2013

background. The trapdoor or pincushioning effect is a frequent complication of transposition flaps. Several explanations have been proposed for its occurrence, including lymphatic or venous obstruction, scar hypertrophy, excessive subcutaneous fat or flap tissue, and scar contracture.

objective. To study the effects of tissue undermining and scar contracture using a guinea pig animal model.

methods. Circular wounds on the dorsal surface of guinea pigs were repaired with transposition paps. Half of the recipient beds were undermined widely and half were not undermined. Animals were observed for evidence of the trapdoor phenomenon.

results. Only animals in the group without undermining demonstrated evidence of the trapdoor effect.

conclusion. Tissue undermining may prevent the development of the trapdoor effect in transposition flaps.
Full‐Thickness Mucous Membrane Grafts from the Vestibular (Oral Labial) Mucosa of the Lip
Authors: FIELD LAWRENCE M. , GEISS JOHN K. , CHRISMAN HOLLY
Published: June 2013

background. Full thickness mucous membrane coverage is desired for a variety of reconstructive tasks involving the oral cavity and vermilion area of the lips.

objective. This article will inform the readership that the vestibular (oral labial) mucosal area of the lower lip close to the sulcus may provide adequate full‐thickness mucous membrane graft tissue for such purposes.

method. A series of photographs from a number of representative cases with accompanying commentary will enable the surgeon to easily incorporate this technique into hislher practice.

conclusion. The lips vestibular mucosa will be found to be an invaluable ally in accomplishing non‐deforming coverage of superficial mucosal defects without unnecessary surgical invasion of visible lip/chin structures.
Partial Retransplantation
Authors: Lucas Manfred W.G.
Published: June 2013

background. In hair transplantation, the availability of a limited number of grafts for a conventional transplantation can pose a serious problem. The result can be a so‐called “bunch” or “brush” appearance in the recipient area.

objective. We therefore developed a new method that allows this effect to be minimized. METHOD. 77ns method is based on the use of a punch (1.6–1.7 mm in diameter) that allows small grafts to be extracted from already established standard grafts. We then transplant the resulting minigrafts in between the established standard grafts, which have now decreased in size.

results. The immediate reduction in the size of the standard grafts and the simultaneous generation of minigrafts produce the desired result: the “minigraft exclusively” look.

conclusion. Thus, patients with previously poor results in standard hair transplantation can now benefit from the modern method of mini‐ and micrograft transplantation.
Rapid Cytokeratin Stains Enhance the Sensitivity of Mohs Micrographic Surgery for Squamous Cell Carcinoma
Authors: Zachary Christopher B. , Rest Ellen B. , Furlong Shawn M. , Arcedo Perico N. C. , Mcgeorge Bruce C. L. , Kist David A.
Published: June 2013

background. Recurrence of squamous cell carcinoma (SCC) following Mohs micrographic surgery is uncommon. However, such cases do exist, presumably because of incomplete excision. Identification of single cells or small clumps of SCC tumor may be extremely difficult and can be compromised by inflammatory reaction.

objective. The purpose of this study was to evaluate the benefits of incorporating rapid cytokeratin (CK) stains into Mohs technique.

methods. Simple modification of standard immunoenzyme techniques allows keratin‐specific staining to be achieved in less than 90 minutes on Mohs cryostat sections. We used the rapid labeled streptavidin biotin anticytokeratin method at the stage when no tumor was apparent by hematoxylin and eosin staining in 20 patients with large, aggressive, or recurrent invasive SCCs.

results. In eight cases, single cells or small clumps of SCC tumor were identified utilizing AE‐1 monoclonal antibody. These patients subsequently underwent further surgery, including wider tumor resection, superficial parotidectomy, or postoperative radiation therapy.

conclusion. The rapid CK antibody staining technique enhances the sensitivity of tumor identification in Mohs micrographic surgery, and should reduce tumor recurrence rates.
Ineffective Treatment of Refractory Melasma and Postinflammatory Hyperpigmentation by Q‐switched Ruby Laser
Authors: TAYLOR CHARLES R. , ANDERSON R. ROX
Published: June 2013

background. Melasma and postinflammatory pigmentation are cosmetic problems with limited options for treatment.

objective. To determine whether selective photothermolysis of pigmented cells by Q‐switched ruby laser treatment would produce clinical benefit in these disorders.

methods. Eight subjects with melasma or postinflammatory hyperpigmentation refractory to traditional treatments were treated with Q‐switched ruby laser pulses (694 nm, 40 nanoseconds) at fluences of 15–7.5 J/cm2, and followed. Histology was obtained before and after treatment.

results. Regardless of fluence, no permanent improvement and, in some cases, darkening was seen in each type of lesion. Except for small depression at high fluences in black patients, there were no textural changes after healing. Immediately after treatment, there was epidermal and dermal injury, with extracellular melanin. Several months later, epidermal pigmentation had returned to baseline and dermal macrophages were apparently focally increased.

conclusions. The Q‐switched ruby laser by itself does not provide an effective treatment for refractory melasma or postinflammatory hyperpigmentation.
Utilization of No‐Kor Needles for Slit‐Micrografting
Authors: BRANDY DOMINIC A. , MESHKIN MICHAEL
Published: June 2013

background. This article introduces the No‐Kor vented needle as an excellent tool for micrograft recipient site development.

objective. To show that No‐Kor vented needles are better than conventional hypodermic needles (with and without dilators) and Bard Parker blades for micrograft recipient site development.

method. Comparisons with hypodermic needles (with and without dilators) and Bard Parker blade incisions are made.

results. When compared with hypodermic needles (with and without dilators, the No‐Kor needles show less scarring, allow easier placement, take less surgical time, and are less expensive. When compared with Bard Parker blade incisions, the No‐Kor needles demonstrate less scarring, more precision, and less expense.

conclusion. The No‐Kor vented needle is an excellent tool for the development of micrograft recipient sites. It demonstrates advantages over both hypodermic needles and Bard Parker blades.
Metastatic Malignant Melanoma with Spontaneous and Complete Regression of the Primary Lesion
Authors: SHAI AVI , AVINOACH ILANA , SAGI AMIRAM
Published: June 2013

background. Spontaneous regression of malignant melanoma is characterized by a partial or complete disappearance of the neoplasm. Partial regression of melanoma has been documented in large series, but complete regression is reported as occurring only sporadically.

objective. To describe a case of metastatic malignant melanoma where the primary lesion underwent spontaneous and complete regression and to review the literature pertaining to regression of melanoma.

methods. The patient was examined clinically. Wide excision of the skin with the lesion was preformed as well as left inguinal lymph node dissection.

results. Histologic examination of the lesion revealed complete regression of malignant melanoma. Examination of the lymph node dissected from the adjacent inguinal area revealed matastatic melanoma.

conclusions. Greater attention should be devoted to identification of regression in melanoma, clinically and histologically, evaluating the prognostic implications which regression might indicate.
Photodynamic Therapy for the Treatment of Squamous Cell Carcinoma Using Benzoporphyrin Derivative
Authors: MARCUS JEFFREY , GLASSBERG EDWARD , DIMINO‐EMME LYNN , YAMAMOTO RICHARD , MOY RONALD L. , VARI SANDOR G. , PAPAIOANNOU THANASSIS , PERGADIA VANI R. , SNYDER WENDY J. , GRUNDFEST WARREN S. , LASK GARY P.
Published: June 2013

background
. Photodynamic therapy (PDT) involves laser light excitation of a tumor‐localizing photosensitizer to destroy neoplasms. Benzoporphyrin derivative (BPD) is a new photosensitizer with several favorable characteristics.

objective
. Studies were designed to: 1) assess the efficacy of BPD‐mediated PDT in treating in vivo squamous cell carcinomas (SCC); 2) obtain dosimetry data for BPD and laser parameters; and 3) establish clinical and histologic correlates of BPD‐induced tumor regression.

methods
. Human SCC was implanted into nude mice. One group received BPD followed by laser light of 150 J/cm2 from an argon‐pumped dye laser at 690 nm. Three control groups included laser energy alone, BPD alone, and no treatment.

results
. At day 21 posttreatment only PDT‐treated tumors showed a statistically significant decrease in tumor volume and complete cure rate. Clinical resolution (scar) correlated perfectly with histologic resolution (scar).

conclusions
. Human SCC in a nude mouse model responds to BPD‐mediated PDT.
Flashlamp‐pumped Pulsed Dye Laser Treatment of Port‐Wine Status
Authors: FITZPATRICK RICHARD E. , LOWE NICHOLAS J. , GOLDMAN MITCHEL P. , BORDEN HERMAN , BEHR KATHLEEN L. , RUIZ‐ESPARZA JAVIER
Published: June 2013

background. Port‐wine stains, or capillary malformations, occur in 0.3–0.5% of newborns and have been shown to be very responsive to treatment with a pulsed dye laser (585 nm, 450 microseconds). Lesional characteristics that may help predict the ease of response to therapy have not been delineated. There exists a great range of Variation in response to treatment.

objective. A retrospective study of 233 patients with 140 port‐wine stain malformations being treated with the flashlamp‐pumped pulsed dye laser was undertaken. Lesion characteristics such as color and location, patient age, and skin type were evaluated as to their correlation with clinical response. Adverse sequelae were evaluated as well.

methods. Charts of treated patients were reviewed and results tabulated. Thefive treating physicians were each responsible for reviewing and evaluating their own patients. Patients were treated at 8–12‐week intervals using slightly overlapping pulses with fluences from 5.5 to 7.5 J/cm.2

results. Factors favoring a positive clinical response were pink lesion color, lesion location of the head and neck, patient age less than 10 years, and patient skin types I‐III. Factors having a more negative impact on clinical result include purple lesion color, lesion location on the distal extremities, patient age > 50 years, and skin types IV and V.

conclusion. Examination of various patient and lesional characteristics shows trends that may be useful in a predictive manner regarding ease of treatment with the flashlamp‐pumped pulsed dye laser.
Combining Manual Dermasanding with Low Strength Trichloroacetic Acid to Improve Actinically Injured Skin
Authors: HARRIS DAVID R. , NOODLEMAN F. RICHARD
Published: June 2013

background: Motor‐driven dermabrasion or deeper chemosurgical peeling improves photodamaged facial skin. However, these procedures each pose disadvantages that we felt could be largely ameliorated by combining manual dermasanding with low strength trichloroacetic acid peeling.

objective: To evaluate the effectiveness, safety, and reproducibility of a technique combining manual dermasanding and light peeling in treating actinically injured facial skin.

methods: Manual abrasion with moistened silicone‐carbide sandpaper followed by application of a 25% trichloro‐acetic acid solution was performed on over 300 patients followed as long as 7 years.

results: Improvement was uniformly noted in luster, brightness, dyschromia, and rhytids. The procedure was easily mastered and results were reproducible. Postoperative pigmentary problems and scarring were extremely rare.

conclusions: The technique demands minimal skill and experience, while providing pleasing results. There is no splatter or sharp lines of demarcation, and results suggest distinct advantages over motor‐driven dermabrasion or deep peeling procedures.
Dermabrasion Using Tumescent Anesthesia
Authors: GOODMAN GREG
Published: June 2013

background. Dermabrasion is a very useful and versatile technique. However, it suffers from side effects and difficulties that limit its popularity among operating dermatologic surgeons and the public.

objective. To show that it is possible to eliminate the need for chlorofluorocarbons, improve the Standard dermabrasion technique, decrease the healing time, improve its side effect profile, and reduce risks to the operating surgeon.

methods. Tumescent fluid containing dilute Xylocaine, bicar‐bonate, and epinephrine in saline was infiltrated before coarse wire brush dermabrasion. Eutectic mixture of local anesthetic (EMLA) was also used topically. The first 14 patients derma‐braded by this method are reported on here. Their healing, progress, side effects, and results are described. A patient questionnaire was completed by 22 of the patients who describe the procedure and results from the patient's viewpoint.

results. The procedure was found to be effective in producing anesthesia, eliminating the use of freezing the skin, and limiting the necessity for sedatives, narcotics, and other anesthesia. It gives a firm surface to dermabrade against, makes the procedure more rapid and technically easier, and produces less splatter and therefore less risk for the surgeon. The results subjectively and objectively would appear to be at least as good as Standard techniques. The healing in this small sample would appear to be faster both to reepithelialization and to reestablishment of normal color. There was only one case of transient hyperpigmentation lasting less than 1 week. Otherwise there were no cases of pigmentary or scarring side effects.

conclusion. Tumescent dermabrasion is safe, effective, and has many benefits over traditional methods.
Split Skin Grafting on Severely Damaged Skin
Authors: ZAKI IRSHAD , SCERRI LAWRENCE , MILLARD LESLIE
Published: June 2013

background. Patients with severely damaged skin are more likely to develop skin malignancies. However, suturing following excision of tumors is difficult due to their fragile skin.

objective. To evaluate the effectiveness of a technique using butyl‐2‐cyanoacrylate tissue adhesive in split skin grafts in patients with severely damaged skin.

method. The technique was used in 19 patients with 24 skin tumors. Two patients also had multiple skin biopsies to assess the biodegradability of the adhesive.

results. Split skin grafts were applied successfully in all patients. The adhesive was completely absorbed without a foreign body reaction within 6 months.

conclusion. We recommend the use of butyl‐2‐cyanoacrylate in split skin grafting patients with severely damaged skin.
Blowin' in the Wind
Authors: Hirst Bill , Jonathan Philip , Randell David
Published: June 2013

It is increasingly important to quantify emissions of environmentally sensitive gases into the atmosphere. Bill Hirst, Philip Jonathan, David Randell and colleagues1 show that provided you understand how the atmosphere mixes as it moves, the answer to “who is emitting what, how much and where” is literally blowing in the wind.
A New Method for Low‐Temperature Decomposition of Chromites and Dichromium Trioxide using Bromic Acid Evaluated by Chromium Isotope Measurements
Authors: Chrastný Vladislav , Rohovec Jan , Čadková Eva , Pašava Jan , Farkaš Juraj , Novák Martin
Published: June 2013

In recent years, routine application of the stable isotope determination of chromium (Cr) in environmental and health protection research has led to the search for simpler chromite decomposition techniques. As the range of Cr isotope abundance ratios in nature is very narrow, conventional chromite decomposition techniques are no longer suitable, due to the relatively high risk of contamination during laboratory procedures. We have developed a protocol for the decomposition of chromites based on oxidation by bromic acid at room temperature. The procedure takes 15 d and requires two doses of bromic acid during the reaction period (day 1 and 8), due to the limited stability of the reagent. Chromium extracted by alkaline oxidative fusion and by bromic acid decomposition yielded statistically indistinguishable δ53Cr values, measured by multi‐collector inductively coupled plasma‐mass spectrometry following addition of a 50Cr‐54Cr double‐spike.
The Single Market as an Engine for Employment through External Trade
Authors: Rueda‐Cantuche José Manuel , Sousa Nuno , Andreoni Valeria , Arto Iñaki
Published: June 2013

This article quantifies for the first time the European employment effects of extra‐EU exports and the correct number of jobs generated through the intra‐EU trade (single market) associated with the production of such exports. The literature has neglected very often the latter effects mainly due to the lack of an appropriate methodology and data. The main results of the article show that, between 2000 and 2007, an increasing number of European jobs were dependent on extra‐EU exports and on the strengthening of the trade linkages across the internal market. During the period considered, the EU employment supported by extra‐EU exports grew from 22 to 25 million jobs, out of which 9 million jobs (in 2007) were due to spillover and feedback effects associated with the single market. Between 2000 and 2007 the EU also became a more vertically integrated economy, and reduced the labour intensity of the extra‐EU exports.
Multicenter Experience with Transvenous Lead Extraction in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
Authors: MAYTIN MELANIE , HENRIKSON CHARLES A. , SCHAERF RAY H.M. , EPSTEIN LAURENCE M. , JOHN ROY M.
Published: June 2013

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC.

Methods

We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high‐volume centers. Patient and lead characteristics, indications, outcomes, and extraction sheath (ES) use were analyzed.

Results

Between 1999 and 2012, more than 2,000 lead extractions were performed at the three centers. Of these, 11 patients underwent 14 extractions meeting inclusion criteria. Mean implant duration was 74.5 months (range 6–140). In 11 patients, a total of 22 leads (16 high‐voltage and six pace‐sense leads) were extracted in 14 procedures. The cohort was 50% male with a mean age of 45 years (range, 25–56) and mean ejection fraction 55 ± 13%. The majority (64%) of leads were extracted due to lead malfunction, three patients had an ICD lead removed for exit block, and three patients underwent TLE for infectious complications (two local, one systemic). ES assistance with laser or mechanical cutting sheaths was employed in the vast majority of cases (85.7%). All leads were removed completely. There were no major procedural complications. In five cases, lead reimplantation encountered low‐amplitude R waves requiring multiple attempted lead positions before final successful implant.

Conclusions

This is the first reported series of TLE in ARVC patients. TLE can be performed safely and effectively in patients with ARVC by experienced operators at high‐volume centers with a low complication rate.
Cytogenomics and gene expression in a case of metachronous bilateral renal cell carcinomas with drop metastasis: Resolving a diagnostic dilemma with molecular technologies
Authors: Takei Hidehiro , Barrios Roberto , Monzon Federico A.
Published: June 2013

Metachronous bilateral renal cell carcinomas (RCCs) are rare but well known. We present a case of metachronous bilateral RCCs with a ureter orifice metastasis, for which the pathological diagnosis was confirmed with single nucleotide polymorphism microarray (SNP‐M) and gene expression assay (GEA). A 53‐year‐old man presented with a right ureteral obstruction. A cystoscopy showed a large pedunculated tumor emanating from the right ureteral orifice, consistent with a drop metastasis, which was biopsied. He had a history of a clear cell RCC (ccRCC) 1.5 years prior and a right renal pelvic mass found 8 months later. Histologically, the biopsied right ureteral tumor demonstrated sheets of poorly differentiated cancer cells composed of a mixture of spindled and focal clear cell components. The main differential diagnosis was metastatic RCC versus urothelial carcinoma, but the immunohistochemical profile was not contributory. SNP‐M revealed a genomic profile consistent with a metastatic ccRCC with loss of chromosome 3p. GEA showed a gene expression pattern consistent with kidney origin. The cytogenomic array also identified chromosome copy number patterns that were shared between both kidney tumors. This finding suggests that both tumors had a common origin, and thus, the metachronous ccRCC in the contralateral kidney represents a metastasis.