bluuebunny/crossref_metadata_2025 huggingface dataset:
A Surgical Approach to Melanonychia Striata
Authors: FLEEGLER EARL J.
Published: June 2013

Longitudinal pigmented streaks—melanonychia striata longitudinalis—are discussed from the perspective of a difficult diagnostic problem. These must be differentiated as early as possible from melonoma. The history of this subject and evaluation of patients in the context of various populations are reviewed. Difficult decisions and technical aspects of the approach are outlined. Case presentations contrast multiple different subungual pigmented lesions that enter into the differential diagnosis of these tumors. A larger number of lesions that make up this differential diagnosis are also discussed in addition to the cases. Appropriate biopsy is reviewed. The potential deformities from the biopsy are contrasted with dangers that are associated with some subungual pigmented tumors.
Subungual Osteochondroma Diagnosis and Management
Authors: ELIEZRI YEHUDA D. , TAYLOR SUSAN C.
Published: June 2013

Osteochondroma, a benign tumor of bone that may penetrate the skin is rarely recognized by the dermatologist. We report two cases of osteochondroma of the distal phalanges with cutaneous penetration, and discuss the clinical, histologic, and radiographic features that allow rapid identification of this lesion. Furthermore, we emphasize the importance of total tumor excision, including adequate treatment of the underlying bone, to prevent recurrence of the lesion.
Zosteriform and Epidermotropic Metastasis
Authors: MANTEAUX AGNES , COHEN PHILIP R. , RAPINI RONALD P.
Published: June 2013

We report two cases of zosteriform metastasis to the skin. One patient had epidermotropic papulovesicular metastases from a presumed cutaneous adnexal neoplasm. The second patient had painful zoster‐like papulovesicles from metastatic breast cancer. Previously reported dermatomal or zosteriform metastases are reviewed.
Use of the Tumescent Technique for Scalp Surgery, Dermabrasion, and Soft Tissue Reconstruction
Authors: COLEMAN WILLIAM P. , KLEIN JEFFREY A.
Published: June 2013

Application of the tumescent anesthetic technique in scalp surgery, dermabrasion, and soft tissue reconstruction is discussed. Vasoconstriction achieved by using tumescent anesthesia reduces bleeding even with dilute (1:320,000) epinephrine. Tumescent anesthesia also offers the advantages of decreased absorption at the site of infiltration, increased anesthetic infiltration, delayed absorption and lower peak blood plasma levels, and a longer lasting anesthetic effect.
A Review of Sutures and Suturing Techniques
Authors: MOY RONALD L. , WALDMAN BARRY , HEIN DARRYL W.
Published: June 2013

The ideal suture is strong, handles easily, and forms secure knots. It causes minimal tissue inflammation and does not promote infection. It stretches and accommodates wound edema. Although no single suture possesses all of these features, proper selection of sutures helps achieve better results in skin surgery. Proper suturing technique is essential for obtaining good cosmetic results and avoiding scarring and poor wound healing. Techniques that must be mastered include good eversion of skin edges, avoiding suture marks, maintaining uniform tensile strength along the skin edges, and precise approximation along skin edges. J Dermatol Surg Oncol 1992;18:785–795.
Analysis of the Carbon Dioxide Laser Plume for Simian Immunodeficiency Virus
Authors: STARR JON C. , KILMER SUZANNE L. , WHEELAND RONALD G.
Published: June 2013

To determine the viability of the immunodeficiency virus in the laser plume after carbon dioxide (CO2) laser irradiation, multiple samples of culture medium containing concentrated simian immunodeficiency virus (SIVmac at 1000 TCID50 cultured from HUT 78 cells) were irradiated with a continuous‐wave CO2 laser at variable irradiances (from 400 W/cm2 for 5 seconds to 1600 W/cm2 for 300 seconds). The resultant plume was collected and cultured for the presence of SIV. A positive control consisted of handling an infected specimen identically to the test specimens, with the exception of CO2 laser irradiation. All test cultures remained negative over an 8 week incubation period, while the control was positive for viable SIV within 7 days. These results suggest that SIV is not viable in the laser plume after CO2 laser irradiation. Further investigation is necessary before extrapolating these results to the human immunodeficiency virus (HIV).
Topical Tretinoin Treatment in Basal Cell Carcinoma
Authors: BRENNER SARAH , WOLF RONNI , DASCALU DANA I.
Published: June 2013

BACKGROUND. The efficiency of topical tretinoin was examined in a patient with basal cell carcinomas (BCC) for which conventional means of removal was inappropriate.

METHODS. Topical tretinoin was used to treat multiple arsenic‐induced superficial BCCs in a 64‐year‐old woman. Topical tretinoin (0.05% twice daily) was administered to four lesions for 3 weeks followed by a 3‐week interruption.

RESULTS. After three cycles of treatment clinical healing of all the lesions was observed. Histopathological examination of the lesional biopsies showed no evidence of a tumor. However, 9 months later all four lesions relapsed and surgical excision disclosed BCC.

CONCLUSION. The data indicate that topical tretinoin treatment of multiple superficial BCCs induces clinical and pathological regression of the lesions with a high rate of relapse. This report suggests that topical tretinoin is not an effective therapy for the cure of arsenic‐induced superficial BCCs.
The Nasolabial Fold Donor Site for Full‐Thickness Skin Grafts of Nasal Tip Defects
Authors: BOOTH SALLY A. , ZALLA MARK J. , ROENIGK RANDALL K. , PHILLIPS PAMELA K.
Published: June 2013

background. The nasal tip has unique skin texture, geographic, and topographic qualities that frequently make repair of defects in this area difficult from the standpoint of function and cosmesis.

objective. To assess seven outcome variables of function and cosmesis in 41 patients who underwent nasolabial graft repair for nasal tip defects.

methods. A retrospective review of photographic and written records as well as person to person and phone interviews with 41 patients who underwent nasolabial graft repair of nasal tip defects after Mohs micrographic surgery was performed. Seven outcome variables were assessed. Follow‐up periods ranged from 3 to 28 months.

results. Patient and doctor evaluators rated overall outcome as good or excellent in 95% and 89% of cases respectively.

conclusion. We consider the nasolabial graft to be an important reconstructive option for nasal tip defects when the underlying cartilage is not involved.
Scalp Extension
Authors: FRECHET PATRICK
Published: June 2013

background. Surgery to correct extensive alopecia requires increasing the surface of hair‐bearing scalp and removing bald scalp. Two commonly used methods, scalp expansion and scalp reduction, have disadvantages.

objective. To describe a new method, scalp extension, that employs a thin sheet of bioplastic (an extender) stretched and attached with hooks to the galea after scalp reduction.

methods. The surgical technique is described and the results compared with those of patients who have undergone scalp reduction and scalp expansion. A study of the first fifteen cases treated is presented.

results. During the few weeks that the extender is implanted, the constant tension it exerts on the galea causes a progressive stretching of the scalp. Data from the first fifteen cases treated reveal eradication of more extensive bald areas than with scalp reduction, making it possible to cut the number of operations necessary in half while considerably shortening total treatment time. The absence of major side effects, along with the absence of any deformation of the scalp (unlike scalp expansion), explains the excellent acceptability of the instrument by patients.

conclusion. Scalp extension appears to be a useful adjunctive technique in hair replacement and reconstructive surgery, and has distinct advantages over standard scalp reduction and tissue expansion techniques.
Basics of Cutaneous Wound Repair
Authors: CLARK RICHARD A. F.
Published: June 2013

background. Cutaneous wound repair consists of multiple integrated networks of cell‐matrix‐cytokine interactions. It is generally believed that a better understanding of these networks will lead to improved care of cutaneous wounds, whether freshly made by the surgeon's scalpel or previously existing and not healing secondary to underlying abnormalities.

objective. This review is intended to update the readership in some of the salient aspects of wound repair networks.

methods. To facilitate the review of multiple integrated networks, cutaneous wound repair was arbitrarily divided into three phases: inflammation, tissue regeneration including re‐epithelialization and granulation tissue formation, and tissue reorganization.

results. Throughout the entire process of wound repair it is clear that cells produce or alter various cytokines and extracellular matrix. The cytokines and matrix in turn alter the behavior of the producer cells (autocrine response) or neighbor cells (paracrine response).

conclusion. The dynamic reciprocity among cells, cytokines, and matrix material helps explain how integrated wound healing networks are sequential as well as tightly controlled.
Growth Factors and Wound Healing
Authors: FALANGA VINCENT
Published: June 2013

background. Over the last decade, there has been an exponential increase in our knowledge of the biology of growth factors. The hope has been and remains that these potent biologic agents will effect a fundamental improvement in the way we treat wounds.

objective. We will discuss the biology of growth factors and the dramatic effects these proteins have on cell proliferation, cell chemotaxis, and on the formation of extracellular matrix molecules.

results. Growth factors are extremely potent biologic agents that show promise in accelerating wound repair in both animal and human studies. They improve granulation tissue, enhance tensile strength, and promote reepithelialization. Cosmetic effects are also to be expected by antagonizing and blocking the action of these peptides.

conclusion. Growth factors are likely to become an important therapeutic tool for the dermatologic surgeon.
Wound Care After Office Procedures
Authors: TELFER NICHOLAS R. , MOY RONALD L.
Published: June 2013

A knowledge of wound healing physiology and how it is influenced by wound dressings is valuable information for all dermatologists. Such knowledge enables the dermatologist to give authoritative advice on postoperative wound care and more importantly, to use wound dressings as a complement to good planning and surgical technique in order to optimize the conditions for rapid healing following office surgical procedures.
Topical Silicone Gel Sheeting in the Treatment of Hypertrophic Scars and Keloids
Authors: GOLD MICHAEL H.
Published: June 2013

BACKGROUND. Topical silicone gel sheeting has been used successfully in the management of hypertrophic and keloid scars resulting from thermal burn wounds.

METHODS. An open‐labelled approach using the silicone gel sheets was performed using hypertrophic and keloid scars secondary to surgical procedures or traumatic insults.

RESULTS. The silicone gel sheets resulted in moderate improvement in scar thickness, scar color and was noted to be effective to some degree in all tested. The material was easy to use and painless.

CONCLUSION. Topical silicone gel sheeting is an effective method for the treatment of hypertrophic and keloid scars and may be considered useful in the treatment of these difficult cutaneous lesions.
Doppler Ultrasound Findings in Reticular Veins of the Thigh Subdermic Lateral Venous System and Implications for Sclerotherapy
Authors: WEISS ROBERT A. , WEISS MARGARET A.
Published: June 2013

BACKGROUND. Treatment of varicose veins is directed towards eliminating sources of reflux causing venous hypertension in the superficial venous system. Doppler ultrasound is routinely used to localize sources of reflux prior to treatment of large varicose veins.

OBJECTIVE. To assess the value of Doppler ultrasound in localizing reflux in subcutaneous reticular veins associated with groups of lateral thigh telangiectases.

METHODS. Seven hundred patient records in which Doppler ultrasound was performed on thigh reticular veins were reviewed. Patients with reflux of the saphenofemoral junction, saphenopopliteal junction, or major saphenous system perforators were excluded.

RESULTS. Audible reflux upon distal calf compression release was noted in thigh subcutaneous reticular veins of 618 out of 700 patients (88%). These incompetent reticular veins were associated with groups or webs of telangiectases and/or venulectases on the lateral thigh in almost all cases. Reflux was loudest just distal to the lateral femoral condyle. In 20 patients Doppler ultrasound was performed on a reticular vein while a telangiectasia associated with the reticular vein was injected with sclerosing solution. In 15 patients a clearly audible flow signal was heard in the reticular vein during injection.

CONCLUSION. These findings indicate an association of telangiectatic veins with reticular veins on the thighs. Furthermore, this study underscores the value of Doppler in determining sources of reflux in smaller veins and implies that sclerotherapy of reticular veins is necessary for treatment of thigh telangiectatic webs.
Inadvertent Intra‐Arterial Injection Complicating Ordinary and Ultrasound‐Guided Sclerotherapy
Authors: BIEGELEISEN K. , NEILSEN R.D. , O'SHAUGHNESSY ANN
Published: June 2013

BACKGROUND. Intra‐arterial injection is the most dreaded complication of sclerotherapy of varicose veins. The medical literature does not contain enough data to enable one to formulate a definitive strategy for either the prevention or treatment of this complication.

OBJECTIVE. Seven cases of intra‐arterial injection are presented. The causes of these accidents, the recognition of the signs that intra‐arterial injection has occurred, and the treatment of these cases are discussed.

METHODS. Intra‐arterial injection occurs in a variety of different settings. The signs that an intra‐arterial injection has taken place are variable, but in some cases there are no signs until irreversible tissue damage has already set in. Treatment protocols are based mainly on anticoagulation with heparin, which is administered both intravenously and subcutaneously.

RESULTS. Heparin, whether administered continuously by the intravenous route or subcutaneously (twice daily), makes affected areas look and feel better, but there is no proof that it alters the final outcome with respect to tissue necrosis. In agreement with previous authors, we believe that there is a beneficial effect. Coumadin, on the other hand, appears to be completely ineffective.

CONCLUSION. Protocols employing heparin should be considered in cases of suspected intra‐arterial injection. The length of time heparin should be continued is uncertain. The best “treatment” is prevention.
The Preparation of Frozen Sections for Micrographic Surgery
Authors: MILLER LORETTA J. , ARGENYI ZSOLT B. , WHITAKER DUANE C.
Published: June 2013

BACKGROUND. Various methods are currently in use for preparing histological slides for micrographic surgery.

OBJECTIVE. Because many variables contribute to the quality preparation of frozen sections, a review of techniques available is useful to the Mohs surgeon.

TECHNICAL METHODS AND RESULTS. Our techniques as well as the published work of others regarding mounting, embedding, freezing, slides, fixation, staining, and clearing are reviewed in detail. By the use of the options selected we were able to produce, in a short turnaround time, frozen sections with excellent quality and minimal artifact.

CONCLUSION. Presently all preparation techniques may introduce some degree of artifact. However, we feel the process described herein is adaptable to all Mohs surgery laboratories and will result in high quality specimens with minimal artifact.
The Running Locked Intradermal Suture: A Cosmetically Elegant Continuous Suture for Wounds Under Light Tension
Authors: WONG NANCY LINSEY
Published: June 2013

A new suture technique, the running locked intraderma1 suture, is introduced. The suture is continuous and buried, and is designed for closing simple elliptical wounds under light tension in which a good cosmetic result is desired. It is used in conjunction with a topical antibiotic and a transparent dressing. This technique reduces the dermal dead space, achieves close approximation of the epidermal wound edges, has a good cosmetic appearance soon after surgey, reduces necessay postoperative wound care, reduces the risk of wound infection in clean surgical wounds, and obviates suture removal. Three examples of its application on the face are presented. It is compared with frequently used standard wound closure methods are discussed.
Injectable Collagen and Autoimmune Disease
Authors: ELSON MELVIN L.
Published: June 2013

background. The media and litigation in the United States have alleged a link between the use of injectable bovine collagen and the development of autoimmune disease, specifically dermatomyositis/polymyositis.

objective. To present the scientific and epidemiologic data with regard to this issue.

methods. Literature was reviewed as well as reports to Collagen Corporation and the litigation.

results. After review of the literature and review of data currently available to Collagen Corporation, no link can be established at this time between collagen injectable material and autoimmune disease, specifically dermatomyositis/polymyositis.

conclusion. There are no epidemiologic or scientific data to support the alleged link in the media and litigation between injectable bovine collagen material and dermatomyositis/lpolymyositis.
Squamous Cell Carcinoma Arising from Chronic Osteomyelitis Treated by Mohs Micrographic Surgery
Authors: Kirsner Robert S. , Garland Larry D.
Published: June 2013

Squamous cell carcinoma is a rare, but well documented complication of chronic osteomyelitis. Many authors have recommended amputation as the treatment of choice for locally invasive disease. Presented is a patient with squamous cell carcinoma arising in the draining sinus tract of chronic osteomyelitis of the lower extremity that was treated successfully with Mohs micrographic surgery (MMS). After ten year follow‐up he remains tumor free and continues to enjoy use of his leg. We propose MMS as a therapeutic option to amputation for control of locally invasive disease.
Manual Punch for Tattooing
Authors: Gharpuray Mohan B. , Mutalik Sharad
Published: June 2013

We have devised and designed a manual instrument for tattooing with two shapes. It has been found to have certain advantages over the routinely used electrically operated machine. This instrument can be sterilized easily.
Mohs Micrographic Surgery Local Recurrences
Authors: HRUZA GEORGE J.
Published: June 2013

background. Even though 5‐year cure rates are as high as 99% for Mohs micrographic surgery (MMS) of cutaneous carcinomas, theoretically 100% cure rates of unifocal carcinomas should be possible.

objective. To determine why cutaneous malignancies recur locally (persist) after MMS.

methods. A retrospective study of all cutaneous malignancies treated with MMS during a 4‐year period at Washington University School of Medicine was made. All lesions that were locally recurrent after previous MMS were analyzed for any possible cause of the recurrence.

results. POf 2,414 cutaneous malignancies treated, 33 (1.4%) were locally recurrent after previous MMS by four different Mohs surgeons and five separate technicians. Technical or interpretation problems that could have accounted for the local recurrence were identified in 77% of the lesions. The mean time to recurrence was 38.5 months, with 20% developing more than 5 years after the initial MMS.

conclusion. MMS local recurrences are rare with procedural errors representing a majority of them. Five‐year cure rates for basal cell carcinoma may somewhat overestimate the ultimate cure rate.
Comparison of Iontophoresis of Lidocaine with a Eutectic Mixture of Lidocaine and Prilocaine (EMLA) for Topically Administered Local Anesthesia
Authors: GREENBAUM STEVEN S. , BERNSTEIN ERIC F.
Published: June 2013

background. Almost all dermatologic surgery is accomplished using local anesthesia. To make our patients more comfortable, there is a constant search for less painful methods of administering anesthetic agents. Topical EMLA as well as iontophoresis are both useful in this regard.

objective. In this study we compared topical EMM with lidocaine delivered by iontophoresis in a double‐blind placebo‐controlled trial. Our goal was to assess the degree of anesthesia obtained as well as the relative rapidity of onset.

methods. A double‐blind controlled study was performed on 10 healthy volunteers between 26 and 37 years of age. Three test sites were placed on each forearm. EMLA or a moisturizer control was placed on two of the three test sites on each arm. Each site was wiped free of cream and tested for sensitivity to pinprick 30 and 60 minutes after cream placement. One iontophoretic unit was placed on each forearm. Both units were saturated with anesthesia with the control unit being turned off. Sensitivity to pinprick was evaluated at the iontophoretic sites and one of the EMLA sites 30 minutes after site placement on the subject. The additional EMLA‐treated site was tested in the same manner 60 minutes after placement.

results. Both EMM cream and the iontophoretic unit delivered topical anesthesia greater than the control. Significantly more anesthesia was acquired 1 hour after application of EMM than was seen 30 minutes earlier. The iontophoretic patch‐treated area provided greater anesthesia than the EMLA‐treated sites evaluated 30 and 60 minutes after placement. Both modalities provided significant anesthesia when left in place for 60 minutes.

conclusion. Both iontophoresis of lidocaine and topical EMM delivered significant, and sometimes complete, local anesthesia. A greater degree of anesthesia is delivered via iontophoresis after 30 minutes as compared with EMLA left on the skin for 30 or 60 minutes. Both modalities have important and unique advantages and disadvantages. Topical EMM and iontophoretically delivered lidocaine are both valuable tools for the dermatologic surgeon.
Acrally Occurring Dermatofibrosarcoma Protuberans in Children and Adults
Authors: RABINOWITZ LINDA G. , LUCHETTI MARY ELLEN , SEGURA ANNETTE D. , ESTERLY NANCY B.
Published: June 2013

background. Dermatofibrosarcoma protuberans (DFSP) arising on the hands and feet is unusual and, at any site, is extremely rare in children.

objective. We report a 5‐year‐old girl who developed DFSP on her hand at 9 months of age. We review the clinical features and treatment of childhood DFSP and of acrally occurring DFSP at all ages.

conclusion. DFSP in children develops most often on the back (22.2%) and at acral sites(14.8%). It occurs on the hands and feet of children more commonly than in adults. This may be related to the increased frequency of trauma at these sites in children. Mohs micrographic surgery is the treatment of choice for DFSP.
The Use of Retention Sutures and Tensed Silastic‐Dacron Strips for the Prevention of Stretch‐Back after Alopecia‐reducing Procedures
Authors: BRANDY DOMINIC A.
Published: June 2013

background. A comparison between using retention sutures (N = 25), a tensed Silastic‐Dacron strip (N = 25), or nothing (N = 25) for the prevention of stretch‐back (after alopecia‐reducing procedures) was performed between 1990 and 1992.

objective. The purpose was to determine if retention sutures or a tensed Silastic‐Dacron strip placed subgaleally from one donor fringe to the other would reduce the amount of stretch‐back after alopecia‐reducing procedures.

method. A prospective study of a total of 75 patients was performed. The width of the bald area was measured immediately after the surgery and at 3 months with each of the three modalities.

results. Retention sutures resulted in some prevention of stretch‐back. Tensed Silastic‐Dacron Strips totally prevented stretch‐back and in some cases made the bald area compressed.

conclusions. Retention sutures placed through subgaleal tunnels reduces stretch‐back after alopecia‐reducing procedures. Tensed Silastic‐Dacron Strips totally prevent stretch‐back and in approximately half the cases compress the area of baldness.
Application of Electrosurgery in Scalp Reduction
Authors: PETERSON JOHN L.
Published: June 2013

An ultrasharp tungsten electrode was used in several hundred scalp reduction procedures from 1988–1992 at Peterson Medical Institute, Santa Monica, California. This unique instrument has proved to be a useful adjunct in facilitating hair restoration surgery.
Radiation‐induced Adiposis of the Parotid Gland
Authors: HARRINGTON ALLAN C. , STASKO THOMAS
Published: June 2013

Radiation‐induced changes to the parotid gland may complicate later surgery for new or recurrent tumors of the area. Radiation commonly causes the replacement of parotid parenchyma by adipose cells as well as fibrosis and glandular atrophy. If the Mohs micrographic surgeon is not prepared for the gross and microscopic changes which may be present in the parotid gland, neighboring structures such as the facial nerve may be inadvertently encountered and tumor depth and extent may be poorly estimated. By discussing and illustrating this situation, we hope to make other surgeons aware of the difficulties which may be present after radiation to the parotid gland.
Squamous Cell Carcinoma Developing within Lichen Planus of the Penis
Authors: LEAL‐KHOURI SUSANA , HRUZA GEORGE J.
Published: June 2013

background. Lichen planus is a common disease, with a low malignant potential. There are several case reports in the literature of squamous cell carcinoma (SCC) developing in cutaneous lichen planuse. However, SCC developing in penile lichen planus is extremely rare.

objective. To report a case of SCC developing within penile lichen planus, to discuss treatment with Mohs micrographic surgery, and to review the literature.

method. The diagnosis of lichen planus and SCC were made by biopsy of the lesion.

results. We present the first case in the English literature of SCC developing within lichen planus of the penis. The lesion was treated with Mohs surgery and the patient's penis is functional and free of tumor 2 years postoperatively.

conclusion. Squamous cell carcinoma may develop within lichen planus. Treatment‐resistant longstanding cases of lichen planus should be biopsied. Mohs micrographic surgery is a precise treatment for penile SCC, it avoids penectomy, and preserves normal function.
Sequential Injection of 3% Sodium Tetradecyl Sulfate and 20% Sodium Chloride in the Treatment of Refractory Varicosity of the Greater Saphenous Vein
Authors: MILLER DENNIS , BIEGELEISEN K.
Published: June 2013

background. American practitioners of sclerotherapy are limited by United States Food and Drug Administration (FDA) restrictions. The strongest FDA‐approved sclerosant is sodium tetradecyl sulfate. In the United States, when a varicose vein is refractory to treatment with this drug, there are no effective FDA‐approved pharmaceutical alternatives.

objective. A method of sequential injection of sodium tetradecyl sulfate followed immediately by sodium chloride is described. We have theorized that this drug combination should be more effective than equivalent doses of either drug alone.

methods. The injections are done under ultrasonic guidance. Sodium tetradecyl sulfate is injected first. After the vessel goes into spasm, a second injection of sodium chloride is made through the same needle.

results. In the majority of varicose veins that had been refractory to repeated large doses of sodium tetradecyl sulfate alone, a single sequential injection treatment has brought about sclerosis and rapid atropy.

conclusion. This method should be considered for any case in which sclerotherapy is indicated, if it is known or anticipated that sodium tetradecyl sulfate alone will be ineffective or inefficient.
Basal Cell Epithelioma Arising from Epidermoid Cyst
Authors: MEHREGAN DAVID A. , AL‐SABAH HUMOUD Y. , MEHREGAN AMIR H.
Published: June 2013

background
. Basal cell epithelioma is a tumor arising from a pluripotential cell found within the basal cell layer of the epidermis or various appendageal structures.

objective
. We report two cases of basal cell epithelioma arising from the wall of an epidermoid cyst.

methods
AND RESULTS. Review of our files produced two cases of basal cell epithelioma arising from a cyst wall.

conclusions
. Basal cell epithelioma arising from the wall of an epidermoid cyst is rare. Examination of all cysts removed surgically is important as not to overlook this possibility and to allow close follow‐up for potential recurrence.
The Modified Buried Vertical Mattress Suture
Authors: SADICK NEIL S. , D'AMELIO DIANA L. , WEINSTEIN CYNTHIA
Published: June 2013

background. Recent modifications of mattress suturing techniques have been reported producing rapid and effective skin eversion and excellent tensile strength while producing cosmetically elegant results.

objective. Presented here is a new modification of the buried vertical mattress suture. Results employing this technique compared with conventional bi‐layered wound closure are presented.

methods. One hundred patients were analyzed in a doubleblind randomized study where excision was carried out on benign pigmented lesions of the upper back. Fifty patients were treated by a conventional bi‐layered closure technique while another 50 patients were treated by the newly described buried vertical mattress suture technique. Parameters of infection, hypertrophic scar/keloid formation, dehiscence, suture reaction, wound spread, and patient satisfaction were examined.

results. The modified buried vertical mattress suture technique produced less hypertrophic scar/keloid formation (2% vs 16%) as well as less wound scar spread (6% vs 24%) compared with conventional bi‐layered suturing techniques. In addition, it was associated with a high degree of patient satisfaction (96%).

conclusion. The modified buried dermal mattress suture technique produces excellent cosmetic results in closing elliptical excisions on thick dermal cutaneous anatomic areas under considerable wound tension. Its decreased requirement for postoperative wound care makes it an excellent alternative for patients living long distances from physician referral centers.
Acral Lentiginous Melanoma
Authors: CASCINELLI NATALE , ZURRIDA STEFANO , GALIMBERTI VIVIANA , BARTOLI CESARE , BUFALINO ROSARIA , DEL PRATO IVAN , MASCHERONI LUIGI , TESTORI ALESSANDRO , CLEMENTE CLAUDIO
Published: June 2013

background. Acral lentiginous melanoma (ALM) is reported to have a poorer prognosis than melanomas of other histotypes.

objective. The purpose of this paper is to verify if ALMs, per se, have a more aggressive behavior or if the poorer prognosis of these patients is due to a later diagnosis.

methods. Clinical Charts of 165 patients with acrally located melanoma were reviewed as well as all histological slides. In all patients, histotype, Clark's level, Breslow thickness, pigmentation, presence of ulceration, and regression were reported. Mitotic index, vascular invasion, and microscopic satellitosis were also determined. Survival of the 64 patients with ALM was compared with survival observed in the remaining 101 acral (nonlentiginous) melanomas.

results. Melanoma localized at acral sites constitute 8.9% of the 1845 patients with melanoma treated at our Institute from 1975 to 1990. All were Caucasian, 57 were males, and 108 females. Out of the 165 patients with this localization, 64 (38.8%) were classified as ALM. Disease‐free and overall survival of the 64 ALM patients were not different at a statistically significant level compared with the areas observed in the other acral nonlentiginous melanoma.

conclusion. The survival difference between ALM and other histological types is due to a later diagnosis and not to a more aggressive behavior of ALM.
Treatment of Pyoderma Gangrenosutn with Cultured Keratinocyte Autografts
Authors: LÍMOVÁ MARKÉTA , MAURO THEODORA
Published: June 2013

background. Pyoderma gangrenosum is an uncommon chronic skin disease characterized by rapidly enlarging cutaneous ulcers. Immunosuppressive agents, such as corticosteroids, are the mainstay of therapy.

objective. We describe a patient with pyoderma gangrenosum treated with cultured keratinocyte autografts for a full‐thickness ulcer located on the dorsal and lateral aspects of the foot.

methods. After stabilizing the ulcer with intralesional and systemic corticosteroids, the ulcer was debrided and cultured keratinocyte autografts were secured with nylon mesh. An outer dressing of gauze and elastic bandage was used.

results. The patient had > 95%“take” of the grafts and the ulcer was fully healed in less than 1 month. The grafted area preserved the clinical phenotype of the palmar skin from which the original biopsy was taken.

conclusion. Cultured keratinocyte autografts can provide permanent wound coverage for patients on high doses of immunosuppressive medications.
Heterogeneity of the Accident Externality from Driving
Authors: Huang Rachel J. , Tzeng Larry Y. , Wang Kili C.
Published: June 2013

This article examines the accident externality from driving in terms of loss probability and severity by using a unique individual‐level data set with more than 3 million observations from Taiwan. Two types of accident externality are, respectively, measured: the average number of kilometers driven per month per vehicle and the total number of speeding tickets per month. For both variables, we find significant evidence to support the existence of the accident externality. Moreover, we find that the accident externality is heterogeneous in terms of the vehicles’ characteristics.
In Tennis, do Smashes Win Matches?
Authors: Budrus Sarah , Plas Susan Vander , Cook Dianne
Published: June 2013

It is summer, and Wimbledon and the French and US Opens are with us. In tennis, does the man with the fastest serve win? And can you make too few unforced errors for success? Sarah Budrus, Susan Vander Plas and Dianne Cook analyse what gets the star players to match point.
Monetary Integration In Eastern And Southern Africa: Choosing A Currency Peg For Comesa
Authors: Vieira Carlos , Vieira Isabel
Published: June 2013

African countries involved in monetary integration projects have been advised to peg their currencies against an external anchor before the definite fixing of exchange rates. In this study, we estimate optimum currency area indices to determine, between four alternatives, which international currency would be the most suitable anchor for Common Market for Eastern and Southern Africa (COMESA) members and for a set of other selected African economies. We conclude that the euro and the British pound prevail over the US dollar or the yen; that the euro would be the best pegging for most, but not all, COMESA members; and that some of these economies display evidence of more intense integration with third countries, with which they share membership in other (overlapping) regional economic communities, than within COMESA.
An Alternative Business Cycle Dating Procedure for South Africa
Authors: Bosch Adél , Ruch Franz
Published: June 2013

This paper applies a factor‐augmented Markov‐switching model to the South African economy to provide an alternative classification of the business cycle and its turning points. In the principal components step, 123 variables are used to establish the aggregate cyclicality in all sectors of the economy with the number of factors chosen using a modified Bai and Ng method. By exploiting the rich nature of the dataset, we provide a model with well‐defined statistical properties that compares favourably with the South African Reserve Bank (SARB) dating points. Combining the results of the parametric approach followed in the Markov‐switching model and the non‐parametric approach followed by the SARB should allow for a robust turning point analysis. A Markov‐switching model of real gross domestic product is also estimated because this variable is commonly used in the literature and provides a benchmark for the factor models.
DNA fragmentation is higher in spermatozoa with chromosomally unbalanced content in men with a structural chromosomal rearrangement
Authors: Perrin A. , Nguyen M. H. , Bujan L. , Vialard F. , Amice V. , Guéganic N. , Douet‐Guilbert N. , De Braekeleer M. , Morel F.
Published: June 2013

It has been previously shown that men with chromosomal structural abnormality had a higher rate of sperm DNA fragmentation. We studied 11 male carriers of a chromosomal structural abnormality (seven with a balanced reciprocal translocation, three with a Robertsonian translocation, one with a pericentric inversion) to determine whether spermatozoa with unbalanced chromosomes were more likely to have fragmented DNA. A sequential method combining analysis of DNA fragmentation using the TUNEL assay followed by analysis of meiotic segregation by fluorescent in situ hybridization was performed on the same spermatozoa. A statistically significant higher number of spermatozoa with unbalanced chromosomal content were found to have fragmented DNA for each man. The rate of spermatozoa with DNA fragmentation was higher than the rate of those without fragmented DNA in particular modes of segregation. Our findings provide a better understanding of the mechanisms involved in male infertility ascribable to chromosomal structural abnormality.
Genome‐wide association study for inhibin, luteinizing hormone, insulin‐like growth factor 1, testicular size and semen traits in bovine species
Authors: Fortes M. R. S. , Reverter A. , Kelly M. , McCulloch R. , Lehnert S. A.
Published: June 2013

The fertility of young bulls impacts on reproduction rates, farm profit and the rate of genetic progress in beef herds. Cattle researchers and industry therefore routinely collect data on the reproductive performance of bulls. Genome‐wide association studies were carried out to identify genomic regions and genes associated with reproductive traits measured during the pubertal development of Tropical Composite bulls, from 4 to 24 months of age. Data from 1 085 bulls were collected for seven traits: blood hormone levels of inhibin at 4 months (IN), luteinizing hormone following a gonadotropin releasing hormone challenge at 4 months (LH), insulin‐like growth factor 1 at 6 months (IGF1), scrotal circumference at 12 months (SC), sperm motility at 18 months (MOT), percentage of normal spermatozoa at 24 months (PNS) and age at a scrotal circumference of 26 cm (AGE26, or pubertal age). Data from 729 068 single‐nucleotide polymorphisms were used in the association analysis. Significant polymorphism associations were discovered for IN, IGF1, SC, AGE26 and PNS. Based on these associations, INHBE, INHBC and HELB are proposed as candidate genes for IN regulation. Polymorphisms associated with IGF1 mapped to the PLAG1 gene region, validating a reported quantitative trait locus on chromosome 14 for IGF1. The X chromosome contained most of the significant associations found for SC, AGE26 and PNS. These findings will contribute to the identification of diagnostic genetic markers and informed genomic selection strategies to assist breeding of cattle with improved fertility. Furthermore, this work provides evidence contributing to gene function annotation in the context of male fertility.
The experience of discrimination by US and Internationally educated nurses in hospital practice in the USA: a qualitative study
Authors: Wheeler Rebecca M. , Foster Jennifer W. , Hepburn Kenneth W.
Published: June 2013

Aim

To document experiences of nurses educated abroad and in the USA in 2 urban hospitals in the southeastern USA.

Background

Nurses are responsible for providing quality patient care. Discrimination against nurses in the workplace may create hostile environments, potentially affecting patient care and leading to higher nurse attrition rates. Structuration theory posits that agents' interactions create structures. Agents' use of resources and rules shapes interactions, potentially changing the structures. In this study, nurses described interactions with patients and their families and other healthcare personnel, their strategies for managing interactions and rationales behind their selected strategy.

Design

This study employed a qualitative, explorative approach using structuration theory.

Methods

In 2011, 42 internationally educated and 40 USA‐educated nurses practising in two urban hospitals in the southeastern USA were interviewed about their experiences in the workplace. Forty‐one nurses were re‐interviewed to explore the issues raised in the preliminary round: 21 internationally educated and 20 USA. Transcripts were analysed using the constant comparative method.

Findings

Although internationally educated nurses experienced more explicit discrimination, all nurses experienced discrimination from their patients, their nurse colleagues and/or other hospital personnel. Internationally educated nurses and USA nurses shared similar coping strategies.

Conclusion

The prevalence of nurses' experiences of discrimination suggests that healthcare institutions need to strengthen policies to effectively address this harmful practice. More research is needed about discrimination against nurses in the workplace because discrimination may have serious psychological effects that impact nurse retention and the quality of patient care.
Greater past disparity and diversity hints at ancient migrations of European honey bee lineages into Africa and Asia
Authors: Kotthoff Ulrich , Wappler Torsten , Engel Michael S.
Published: June 2013

Aim

We re‐evaluated the proposition based on the present‐day distribution of honey bees (genus Apis) that their centre of origin resides in Asia, with subsequent migration and diversification into Europe and Asia. In our research, we considered the so‐far largely ignored fossils distributed through a variety of late Palaeogene (Oligocene) and early Neogene (Miocene) deposits, aiming at a synthesis of both present‐day and past honey bee distribution.

Location

Northern Hemisphere, Africa, Southeast Asia.

Methods

We examined the morphological diversity (also termed ‘disparity’) and affinities of the full living and fossil diversity of honey bees ranging from their earliest origins to the present day. Based on the fossil record and present‐day distribution of species, considering continental drift from the Oligocene until today, we have established an evolution and migration scenario for the genus Apis.

Results

The fossil record of Apis demonstrates a diversity that is predominantly European in origin, particularly among the most basal species of the genus. Honey bees exhibited a greater morphological disparity during the Oligocene and, particularly, the Miocene epochs, a time when the principal lineages were established. Contradicting earlier propositions, the geological models allowed a migration via western Europe to north‐western Africa during the Miocene, and the fossil record corroborates such a migration.

Main conclusions

From the full complement of available data, Apis apparently originated in Europe, spreading from there into Asia, Africa and North America, with subsequent diversification in the former two regions and extinction in the latter. The western honey bee, Apis mellifera, descended from European ancestors that probably migrated from western Europe to Africa during the late Miocene and re‐immigrated into Europe during the Holocene and possibly preceding interglacials.
European Union Lobbying and the Golden Cage of Post‐Socialist Network Capitalism inHungary
Authors: Sallai Dorottya
Published: June 2013

The literature on business lobbying has shown that firms increasingly extend their interest representation activities from the domestic to theEuropean level. Consequently, over the last 20 years, individual firms have become influential political actors inBrussels. Yet, after nine years of full membership, easternEuropean (EE) corporations stay away fromEU‐level policy‐making. This article argues that the institutional structures emerging in post‐socialist countries constitute obstacles to firms developing the necessary capabilities for supranational lobbying. While firms inLondon andBrussels become increasingly professional in their lobbying strategies, large post‐socialist firms handle lobbying exclusively at the highest level of the organizational hierarchy through informal interpersonal networks. It is argued in the article that the confinement of lobbying strategy to the top echelon of corporate management reduces its effectiveness and scope. Consequently,EEcompanies are unable to integrate intoEUlobbying.
Effects of noninvasive electroacupuncture on labour pain and duration
Authors: Mucuk Salime , Baser Muruvvet
Published: June 2013

Aims and objectives

To evaluate the effects of noninvasive electroacupuncture atLI4 orSP6 acupuncture points on labour pain and duration.

Background

The management of labour pain is one of the main goals of obstetrical care. Acupuncture has been reported to be useful for reducing labour length and for pain relief during labour.

Design

This was an experimental study with a control group.

Methods

The study was conducted at theKayseriMaternityHospital inTurkey. The participants were in the active phase of labour and were divided into three groups. In theLI4 group (n = 40), bilateralLI4 acupuncture points were stimulated using transcutaneous electrical nerve stimulation‐acupuncture pen. In theSP6 group (n = 40), the acupuncture points of both legs were stimulated. The same procedure that was performed for theLI4 group was used for theSP6 group. The control group (n = 40) did not receive any stimulation.VisualAnalogScale was used for the assessment of pain.

Results

Duration of labour from initiation of the intervention was 6·2 ± 6·0 hours in theLI4 group, 7·2 ± 6·1 hours in theSP6 group and 8·2 ± 9·9 hours in the control group. Pain scores in theLI4 group were found as 8·0 (4–10) in the 30th minute after the intervention, while they were 9·0 (4–10) in theSP6 group and 10·0 (2–10) in the control group. There was not a statistically significant difference between the groups in terms of labour duration and pain scores measured during contraction and between contractions.

Conclusion

Although they were not statistically significant, labour pain scores and labour duration were lower in the acupuncture groups, especially in theLI4 group.

Relevance to clinical practice

Noninvasive electroacupuncture on theLI4 acupuncture point could be used easily during labour for labour pain relief.