bluuebunny/crossref_metadata_2025 huggingface dataset:
A Technique for Blepharoplasty Without Incising or “Puncturing” Orbital Septum
Authors: BISACCIA EMIL , SCARBOROUGH DWIGHT A. , SWENSEN RICHARD D.
Published: June 2013

Abstract. A blepharoplasty procedure is described in which the actual dissection and removal of adipose tissue has been replaced simply with unipolar electrodesiccation.
Congenital Melanocytic Nevi with Halo Phenomenon: Report of Two Cases and a Review of the Literature
Authors: LANGER KURT , KONRAD KLAUS
Published: June 2013

Abstract. Verrucous congenital nevocellular nevi surrounded by a depigmented halo occurring in a 7‐year‐old boy and a 13‐year‐old girl were excised and the wounds closed primarily. Histopathologic studies revealed a striking arrangement of the inflammatory infiltrate in these halo nevi. A dense, band‐like, lymphohistiocytic infiltrate was found only around and intermingled with A‐ and B‐type nevomelanocytes in the upper dermis, whereas inflammatory infiltrates were completely absent from type C‐nevomelanocytes in the lower parts of the reticular dermis. The literature is reviewed with particular consideration of congenital halo nevi.
ASDS 20th Anniversary: The History of Dermatologic Surgery
Authors: BENNETT RICHARD G. , KRULL EDWARD A.
Published: June 2013

Abstract. The major developments in dermatologic surgery, including the cutaneous punch, dermabrasion, hair transplantation, cryosurgery, and Mohs micrographic surgery, are chronicled and discussed.
Fire Hazards and Electrosurgery
Authors: SEBBEN JACK E.
Published: June 2013

Abstract. Combustion is a rare hazard of electrosurgery, but every office should be equipped to deal with such emergencies. This article discusses the methods to minimize fire hazard and reviews the choices of fire extinguishing systems.
Single Row Donor Site Harvesting
Authors: NORWOOD O'TAR T.
Published: June 2013

Abstract. Preservation and care of the donor area is as important as designing and planning the recipient area. Conservation of the donor areas is accomplished by cutting grafts in a single row, keeping the rows at least 2.0 cm apart, and by careful, delicate suturing of the donor area.
The Stimulation of Postdermabrasion Wound Healing with Stabilized Aloe Vera Gel‐Polyethylene Oxide Dressing
Authors: FULTON JAMES E.
Published: June 2013

Abstract. Full‐face dermabrasion provided an ideal opportunity to document the effects of dressings on wound healing management. Following the procedure, the abraded face was divided in half. One side was treated with the standard polyethylene oxide gel wound dressings. The other side was treated with a polyethylene oxide gel dressing saturated with stabilized aloe vera. The polyethylene oxide dressing provided an excellent matrix for the release of aloe vera gel during the initial 5 days of wound healing. By 24–48 hours there was dramatic vasoconstriction and accompanying reduction in edema on the aloe‐treated side. By the third to fourth day there was less exudate and crusting at the aloe site, and by the fifth to sixth day the reepithelialization at the aloe site was complete. Overall, wound healing was approximately 72 hours faster at the aloe site. This acceleration in wound healing is important to reduce bacterial contamination, subsequent keloid formation, and/or pigmentary changes. The exact mechanism of acceleration of wound healing by aloe vera is unknown.
Aggressive Keratoacanthoma of the Eyelid: “Malignant” Keratoacanthoma or Squamous Cell Carcinoma?
Authors: REQUENA LUIS , ROMERO EDUARDO , SÁNCHEZ MANUEL , AMBROJO PRUDENCIO , YUS EVARISTO SANCHEZ
Published: June 2013

Abstract. We report an aggressive keratoacanthoma of the upper eyelid that recurred at the site of a previously excised keratoacanthoma. The diagnosis was confirmed by biopsy. Because the surgery required would be extensive, medical therapy was tried first. The tumor was treated with intralesional injections of 5‐fluorouracil and radiotherapy. Despite this therapy, the orbital computed tomogram showed tumor extension into the orbit, and an orbital exenteration was performed. Histopathology of the excised tumor was consistent with squamous cell carcinoma. We discuss the topic of malignant transformation of the keratoacanthoma.
Delayed Grafting of Midline Forehead Flap Donor Defect: Utilization of Residual Flap Tissue
Authors: SALASCHE STUART J. , GRABSKI WILLIAM J. , MULVANEY MICHAEL J.
Published: June 2013

Abstract. The use of a midline forehead flap often creates a secondary defect that is difficult to close primarily. When the pedicle is detached, the residual flap tissue can be utilized as a delayed full‐thickness skin graft. This technique combines two surgical principles: delayed grafting and the use of adjacent residual flap pedicle skin that would normally be discarded.
A New Method for Correction of the Vertical Scar Observed Following Scalp Reduction for Extensive Alopecia
Authors: FRECHET PATRICK
Published: June 2013

Abstract. The serious cosmetic problem posed by the vertical “strip” following scalp reduction may be eliminated. A technique combining scalp reduction with a small random flap is proposed. If necessary, the treatment can be completed with an advancement flap.
Fat Transfer for Aging Skin: Technique for Rhytids
Authors: SCARBOROUGH DWIGHT A. , SCHUEN WENDY , BISACCIA EMIL
Published: June 2013

Abstract. Dermatologic surgeons are familiar with many surgical and nonsurgical techniques for the reduction of facial rhytids. Injectable collagen, silicone, and fibril are commonly employed as injectable filler materials. Properly done, fat transfer is another valuable tool for use in facial restoration. Fat transfer is an excellent technique for intervention in the aging process, and is easily managed as an office procedure. We will review the near‐century‐old history of fat grafting and outline the structural dynamics in the process of facial aging. Our experience from the last 50 fat transfer procedures performed will be reviewed with specific attention to patient selection, extraction and injection technique, complications, and overall results.
Zinc Chloride Paste for the Debridement of Chronic Leg Ulcers
Authors: FALANGA VINCENT , IRIONDO MANUEL
Published: June 2013

Abstract. Chronic leg ulcers present a difficult therapeutic problem, and their management requires frequent debridement. Thorough debridement of painful or extensive ulcerations is not always possible. Frequently, it must be done in the operating room, a situation accompanied by the potential complications of general anesthesia and by considerable expense. We present evidence for the effectiveness of zinc chloride paste as a relatively painless debriding agent in the management of chronic leg ulcers. When applied to the wound bed, zinc chloride paste fixes the tissue and leads to the formation of an eschar that falls off within a few days, leaving a granulating ulcer suitable for grafting.
The Bilateral Dog‐Ear Transposition Flap
Authors: ARNOLD ALAN J. , BENNETT RICHARD G.
Published: June 2013

Abstract. An original technique is presented for the closure of circular defects that cannot be closed primarily without undue tension. The technique involves the creation of dog‐ear tissue, which is then fully utilized in the closure. The technique involves no sacrifice of normal tissue and results in a relatively short, cosmetically acceptable scar.
Practical Advice to the Beginner in Hair Transplantation
Authors: POUTEAUX PIERRE
Published: June 2013

Abstract. Daily practice of hair transplantation enables one to develop certain personal techniques that help to facilitate operations. Such techniques, acquired during 22 years of daily practice, are presented.
Congenital Midline Nasal Masses: Diagnosis and Management
Authors: KENNARD CHARLES D. , RASMUSSEN JAMES E.
Published: June 2013

Abstract Congenital midline nasal masses (CMNMs) are rare lesions most commonly caused by dermoids, hemangiomas, nasal gliomas or encephaloceles. We report a case of nasal glioma and discuss the embryologic development, evaluation, and management of such CMNMs.
The Aging Face: A Psychocutaneous Perspective
Authors: GUPTA MADHULIKA A. , GUPTA ADITYA K. , SCHORK NICHOLAS J. , ELLIS CHARLES N. , VOORHEES JOHN J.
Published: June 2013

Abstract. The cutaneous stigmata of aging may affect an individual's mental well‐being, body image, and quality of life. Before proceeding with treatment, the dermatologist should take into consideration the patient's overall life situation and evaluate whether or not there is severe psycho‐pathology and body image distortion
Histologic Changes in Skin Associated with Aging
Authors: KURBAN RAMSAY S. , BHAWAN JAG
Published: June 2013

Abstract. This is a review of histologic changes noted in the skin of elderly individuals. Among the epidermal changes associated with skin aging are a flattened dermal‐epidermal junction, giving the appearance of atrophy and cellular heterogeneity. The melanocyte density declines slowly, and the Langerhans cells decrease in number with advancing age. Among the dermal changes are attenuation in the number and diameter of elastic fibers in the papillary dermis, an increase in number and thickness of the same fibers in the reticular dermis, and a coarsening of collagen fibers with an increase in density of the collagen network. A decrease in the dermal cell population as well as a functional decline in glandular activity are also noted with intrinsic aging. A decline in hair number, rate of growth, and diameter, along with a slowing of the rate of growth of nails, have been well documented with progressive aging.
Cellular and Molecular Mechanisms of Cutaneous Aging
Authors: YAAR MINA , GILCHREST BARBARA A.
Published: June 2013

Abstract. There are two major theories of aging: the programmatic theory states that aging is an inherent genetic process, and the stochastic theory states that aging represents random environmental damage. Processes that are associated with cellular damage and aging are the production of free radicals (a process much enhanced after ultraviolet irradiation) and an increasing number of errors during DNA replication. Cellular manifestations of intrinsic aging include decreased life span of cells, decreased responsiveness of cells to growth signals, which may reflect loss of cellular receptors to growth factors, and increased responsiveness to growth inhibitors. All these findings are more pronounced in cells derived from photodamaged skin. Molecular manifestations of intrinsic aging, studied mainly in fibroblasts, are altered membrane composition, adhesion properties, production of extracellular matrix, and activity of the enzyme catalase. Molecular changes as a result of photoaging are less well characterized; published studies mainly target differences in composition of the extracellular dermal matrix.
Clinical Features of Photodamage and Treatment with Topical Tretinoin
Authors: GARDNER STEPHANIE STEIN , WEISS JONATHAN S.
Published: June 2013

Abstract. Photodamage constitutes a skin disease that merits therapy. Immediate cosmetic improvement of pho‐todamaged skin can be achieved most dramatically by surgical means. Medical intervention has been limited until the recent advent of topical retinoic acid products for pho‐toaging. These medications have been shown to enhance cosmesis and to produce long‐lasting physiologic changes. The clinical features of photodamage and treatment with topical tretinoin are discussed.
The Role of Chemical Peeling in the Treatment of Photodamaged Skin
Authors: MATARASSO SETH L. , SALMAN SALAH M. , GLOGAU RICHARD G. , ROGERS GARY S.
Published: June 2013

Abstract. Management of the aging face involves evaluation of the degree of solar elastosis, rhytidosis, and the structural changes associated with senescent skin. Chemical facial exfoliation is divided into deep, medium, and superficial based upon depth of penetration of the caustic agent used. Knowledge of the appropriate indications and technique are essential in obtaining optimal clinical results.
Microliposuction and Autologous Fat Transplantation for Aesthetic Enhancement of the Aging Face
Authors: ASKEN SAUL
Published: June 2013

Abstract. The accumulation of subcutaneous fat that occurs with age in certain areas of the face, ie, heavy melola‐bial folds, prominent jowl formation, and accumulation of fat under the chin, can make a person look older than he or she is. Removal of fat from these areas by microliposuction can enhance and rejuvenate the aging face. Similarly, fat loss in certain facial areas due to aging can result in hollow cheeks and deep grooves in the face. Its replacement through autologous fat transplantation can also rejuvenate the aging face, giving it a less angular, more rounded appearance.
Know Your Anatomy: Perineural Involvement of Basal and Squamous Cell Carcinoma on the Face
Authors: CARLSON KEITH C. , ROENIGK RANDALL K.
Published: June 2013

Abstract. Knowledge of facial anatomy, particularly innervation, is basic to performing dermatologic surgery. There are clinical implications for cutaneous oncology (tumor spread), anesthesia, and postoperative complications, such as motor or sensory deficits. Perineural invasion of the facial nerves by squamous and basal cell carcinomas (SCCs and BCCs) occurs occasionally. We present three representative cases of both sensory and motor nerve involvement by SCC and BCC. The anatomy of the nerve supply of the face is summarized and the literature on perineural invasion by SCC and BCC is reviewed.
Liposuction Reduction of the Suprapubic Area
Authors: FIELD LAWRENCE M.
Published: June 2013

Abstract. Liposuction reduction of the suprapubic area is simple, safe, and applicable to a large number of individuals with unsightly protuberances in this area.
Rees Lighted Freedom Retractor for Scalp Reduction
Authors: ORENTREICH DAVID S.
Published: June 2013

Abstract. The Rees Lighted Freedom Retractor provides valuable assistance in scalp reduction surgery.
Tumescent Technique for Regional Anesthesia Permits Lidocaine Doses of 35 mg/kg for Liposuction
Authors: KLEIN JEFFREY A.
Published: June 2013

Abstract. The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12–14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.
Skin Ultrasound in Dermatologic Surgical Planning
Authors: NESSI R. , BLANC M. , BOSCO M. , DAMENO S. , VENEGONL A. , BETTI R. , BENCINI P. L. , CROSTL C. , USLENGHL C.
Published: June 2013

High‐resolution ultrasonography was performed on 55 patients with palpable skin lesions, all submitted to surgical excision and to histologic diagnosis. In all the cases, the ultrasound picture was confirmed by the surgical appearance of the lesions. The sonographic structure was characteristic in the case of cysts and angiomas, lymphangiomas inparticular. Ultrasonography is considered a simple and reliable technique for the pre‐operative evaluation of skin nodules, as it gives a clear picture of their size, depth, and outline. However, sonography cannot substitute for the clinical dermatologic approach and the need for an histologic diagnosis.
The Medical Necessity of Evaluation and Treatment of Port‐Wine Stains
Authors: GERONEMUS ROY G. , ASHINOFF ROBIN
Published: June 2013

New lasers and improved laser delivery systems have allowed for the safe and effective treatment of portwine stains in patients of all ages. The satisfactory results obtained by laser treatment have increased the number of patients seeking consultation regarding their birthmarks. It is imperative that physicians recognize the various medical syndromes and problems associated with port‐wine stains. A review of 415 patients with facial port‐wine stains has revealed hypertrophy and/or nodularity in 65% of patients by the fifth decade of life, which increases significantly the morbidity of these lesions. It is believed that laser treatment will minimize the medical and psychologic complications that result from the natural evolution of port‐wine stains.
Hair Transplantation (a New Method for Recipient Site Suturing): The Upper Dermal Running Stitch
Authors: WEBER PAUL J. , GEM SURGICAL
Published: June 2013

Recipient hair transplant plugs may heal into place with palpable, and unfortunately, visible borders. This appearance, called “cobblestoning,” is reminiscent of the bumps in a cobblestone street. The author presents a new, rapid method of suturing transplanted plugs that greatly reduces cobblestoning, virtually eliminates traumatic plug loss, and facilitates row‐by‐row hair transplantation. Additionally, postoperative bandaging is not necessary, shower cleansing may commence within hours, and postoperative activity may be unlimited.
The Effect of Recombinant Human Growth Hormone on Wound Healing in Normal Individuals
Authors: WELSH KATHLEEN M. , LAMIT MARGARET , MORHENN VERA B.
Published: June 2013

Growth hormone therapy has been suggested to speed wound healing in postoperative patients and in patients with severe burns. This study was undertaken to determine the effect of recombinant human growth hormone on the rate of wound healing in normal individuals. Twenty‐three healthy males were evaluated in a randomized, double‐blind placebo‐controlled study. Each subject received a split‐thickness wound (Davol‐Keratome) on one buttock and a full‐thickness wound (3‐mm punch biopsy) on the other. The full‐thickness wound healed significantly more slowly in the recombinant human growth hormone‐treated group as compared with the placebo control group (t‐test, P = .001). No statistically significant difference was noted in the healing of the split‐thickness wounds. It is concluded that recombinant human growth hormone may impede healing in normal patients with full‐thickness wounds as compared with treatment with placebo. We cannot rule out, however, that the recombinant human growth hormone affected the quality of the scab in full‐thickness wounds and thereby only appeared to alter the wound‐healing process.
The Use of Mohs Surgery in Facial Tumors in a Patient with Darier's Disease
Authors: HAMAD ISSAM , GRANDE DONALD J.
Published: June 2013

A case illustrating the need for the Mohs technique for removing basal cell carcinomas (BCC) in skin involved with Darier's disease is presented. Because of the erythema and scaling secondary to Darier's disease, defining the margins of the tumor clinically is impossible. Therefore, we recommend Mohs micrographic surgery for BCCs that occur in Darier's‐involved skin.
LASERS: Pyogenic Granuloma in Children: Treatment with the Flashlamp‐Pumped Pulsed Dye Laser
Authors: GOLDBERG DAVID J. , CHRISTOPHER W. SCIALES MD
Published: June 2013

Pyogenic granuloma, a rapidly developing, benign vascular nodule often arising in children at sites of trauma in the skin or mucous membrane, was treated successfully with flashlamp‐pumped pulsed dye laser in three pediatric patients. Excellent cosmetic results were obtained. The authors suggest that the flashlamp‐pumped pulsed dye laser be considered as yet another effective modality in the treatment of pyogenic granuloma.
Squamous Cell Carcinoma Presenting as Subcutaneous Nodules
Authors: HOWE NATHAN R. , LANG PEARON G.
Published: June 2013

Four patients with squamous cell carcinomas (SCCs) presenting as subcutaneous nodules of the head were referred for Mohs micrographic surgery. In each case initial histologic sections showed no connection between the tumor and epidermis, raising the possibility that each was a metastasis from an occult SCC. Careful searches for occult SCCs were unrevealing. Subsequent step sections through the entire tumors revealed narrow connections to the overlying epidermis in three of the four cases.
Compression Therapy of the Legs
Authors: PARTSCH HUGO
Published: June 2013

Compression therapy is a powerful method for the treatment of all sorts of swollen extremities. Its effects depend on several factors, including: underlying disease, exerted pressure and body position, and compression material.
An Improved Design for Vermilionectomy with a Mucous‐Membrane Advancement Flap
Authors: FIELD LAWRENCE M.
Published: June 2013

The author describes a modified mucous‐membrane advancement flap for the repair of defects following the removal of premalignant actinic cheilitis or squamous cell carcinoma. The advantages of this modification over other techniques include a more broadly resurfaced lip bilaterally, and prevention of punctate scarring at the lateral oral commissures by use of a continuous mucous membrane in and around the commissures themselves.
Rapid Skin Edge Elevation Using the OCT Compound Droplet Technique to Obtain Horizontal Microsections in Mohs Micrographic Surgery
Authors: DOGAN MELEN M. , SNOW STEPHEN N. , LO JACOB
Published: June 2013

We describe a technique to quickly raise the skin edges when mounting flat tissue specimens on cryostat discs used in Mohs micrographic surgery. The technique consists of placing a drop of OCT compound on the superficial surface of the tissue before the specimen is mounted bottom‐side‐up on the cryostat object disc. When the Mohs tissue layer is transferred to the disc, the droplet spreads out underneath the tissue to support the bottom and to prevent the skin edges from dropping below the horizontal plane of the tissue. This technique assures that the skin edge and bottom surface of the tissue are on the same plane so that a complete section of the undersurface of the flat specimen is taken when the tissue is cut with the microtome. The technique is relatively simple to perform, requires no special instrumentation, and provides consistent microsections with complete skin edge
Chondrodermatitis Nodularis Chronica Helicis
Authors: TAYLOR MARK B.
Published: June 2013

Chondrodermatitis nodularis chronica helicis is a painful, persistent, or recurrent inflammatory lesion involving the cartilage and skin of the external ear. These lesions are resistant to many therapautic modalities and often recur even after surgical excision. The CO2 laser was used to vaporize the cutaneous nodules and involved cartilage. The wounds were allowed to heal with only minimal care using hydrogen peroxide cleansing and applications of topical antibiotic ointment. Twelve lesions have been treated with no recurrences after 2 to 15 months. There have been no complications or infections following laser surgery. The pain from these lesions is gone immediately following laser surgery. Healing with excellent cosmetic results is complete usually within 3 to 4 weeks
Cylindroma Treated by Mohs Micrographic Surgery
Authors: LO JACOB S. , SNOW STEPHEN N. , MOHS FREDERIC E.
Published: June 2013

Cylindroma, a rare benign adnexal neoplasm, may occur in areas in which simple excision is either not possible or severely disfiguring. We present a case of cylindroma that was treated by Mohs micrographic surgery. Postsurgical evaluation of the tumor showed that the tumor had invaded a larger area than was initially suspected based on clinical examination alone
Malignant Cylindroma of the Scalp
Authors: LO JACOB S. , PESCHEN MICHAEL , SNOW STEPHEN N. , ORIBA HOWARD A. , MOHS FREDERIC E.
Published: June 2013

Malignant cylindroma may develop via malignant transformation of cylindroma in rare instances or may develop de novo in others. We present a case of malignant cylindroma located on the left parietal‐occipital scalp that was treated twice by Mohs micrographic surgery in an attempt to excise the tumor completely and to minimize the excision of normal tissue. Our case is the sixteenth reported case of malignant cylindroma in the world literature.
The Surgical Management of Chondrodermatitis Nodularis Chronica Helicis
Authors: COLDIRON BRETT M.
Published: June 2013

Surgical management of chondrodermatitis nodularis chronica helicis by curettage is described. The curet directs the dissection. The necrotic cartilage is soft and is removed easily. The endpoint is reached when the curet is repelled by firm, elastic cartilage. Contours remain normal because the skin is tented over the defect supported by the remaining cartilage.
Basal Cell Carcinoma Treated with Mohs Surgery: A Comparison of 54 Younger Patients with 1050 Older Patients
Authors: DINEHART SCOTT M. , DODGE RICHARD , STANLEY WILMA E. , FRANKS HAYDEN H. , POLLACK SHELDON V.
Published: June 2013

The average age of patients with basal cell carcinoma (BCC) is over 60 years, and fewer than 5% of patients with this tumor are under 30 years of age. A comparison of younger (15 to 30 years) and older (56 to 70 years) patients with BCC was conducted to identify specific tumor or host features associated with BCC occurring early in life. According to data collected over an 11‐year period, 54 of 2728 (2%) BCCs occurred “de novo” in younger patients. In contrast to the predominantly male older group, most of the younger patients were female. An increased use of tanning booths and hair‐dyes was associated with the younger patients (P < .001). More overall sunlight exposure and actinic keratoses were associated with the older patients (P < .01). Defect and lesion sizes were smaller (P < .01) in the younger group. Location, histology, and clinical morphology did not differ appreciably between the two groups. De novo BCCs in younger and older patients are similar, although some differences do exist.
Clinical Usefulness of the Hexascan
Authors: MCDANIEL DAVID H.
Published: June 2013

background. The Hexascan is an automated scanning laser handpiece originally developed to treat port‐wine stains. It can be adapted to operate with most continuous wave laser systems delivering a variety of visible wavelengths.

objective. To review the use of Hexascan with 585‐nm yellow dye laser light for cutaneous vascular disorders and 514‐nm green argon light for benign cutaneous melanocytic disorders.

methods. The current clinical results, treatment parameters, indications, limitations, and complications of these procedures are discussed in a review format. In addition, a new clinical study of benign lentigines treated with green laser light is presented.

results. Most benign lentigines showed considerable lightening or complete disappearance after one or two treatments. Other melanocytic disorders may also respond. Deep dermal lesions such as Nevus of Ota may be totally unresponsive. Both vascular malformations such as port‐wine stains and hemangiomas are also treatable.

conclusion. The Hexascan device attached to a continuous wave tunable dye laser can successfully treat a wide variety of cutaneous vascular and melanocytic disorders in both infants and adults.
Clinical Efficacy of the Pulsed Dye Laser in the Treatment of Vascular Lesions
Authors: GARDEN JEROME M. , BAKUS ABNOEAL D.
Published: June 2013

background. Increasing the selectivity of laser‐induced damage is an ongoing goal for the laser treatment of cutaneous lesions. The flashlamp‐pumped pulsed dye laser has significantly participated and advanced this pursuit. This is especially true in its use for the treatment of cutaneous vascular lesions.

objective. A review of the development and current use of this laser for the treatment of cutaneous vascular lesions will be presented.

methods. The laser has been designed to limit laser energy absorption and damage to hemoglobin and the blood vessel. This has been done by setting the wavelength at 577 to 585 nm and the pulse duration at 360 to 450 μseconds.

results. The therapeutic results have been beneficial for almost all types of superficial small vessel vascular lesions regardless of lesional anatomic site or patient age. These lesions include port‐wine stains, telangiectasia, capillary hemangioma, and other angiomata and vascular ectasia. Deeper cutaneous vascular processes and lower extremity telangiectases have proven to be less responsive to therapy. The increased vascular selectivity has allowed for a dramatic decrease in adverse effects when compared to previously used laser systems.

conclusion. Based on many thousands of treatment sessions and follow‐up evaluation, the pulsed dye laser appears to have the greatest margin of safety in the treatment of cutaneous vascular lesions, especially for the pediatric population.
Laser Treatment of Benign Pigmented Epidermal Lesions Using a 300 nsecond Pulse and 510 nm Wavelength
Authors: FITZPATRICK RICHARD E. , GOLDMAN MITCHEL P. , RUIZ‐ESPARZA JAVIER
Published: June 2013

Sixty‐five patients having a total of 492 lesions were treated with the Candela pigmented lesion dye laser (510 nm, 300 ns). Lesions treated included café‐au‐lait macules, lentigines, seborrheic keratoses, and postinflammatory hyperpigmentation. Fluences varied from 2.0 J/cm2 to 3.5 J/cm2, but averaged 2.25 J/cm2. Response was good to excellent after one treatment with 40–50% completely clearing and an additional 33% clearing by 75% or more. Repeated treatments were capable of clearing residual lesions. Histologic examination revealed vacuolization of melanincontaining cells and suprabasilar vesicles. The only adverse sequelae were transient hypopigmentation and hyperpigmentation, which resolved in 4 to 6 months.
510‐nm Pigmented Lesion Dye Laser
Authors: GREKIN ROY C. , SHELTON RON M. , GEISSE JOHN K. , FRIEDEN ILONA
Published: June 2013

background. Benign pigmented lesions are of a cosmetic concern to many individuals. Numerous treatments exist, including several types of lasers. The Candela 510 nm pigmented lesion dye laser has recently been added to this armamentarium. It is designed specifically for the treatment of superficial pigmented lesions while significantly decreasing the risk of scarring and prolonged hypopigmentation.n

objectives. To describe the characteristics of the Candela pigmented lesion dye laser and report on the therapeutic outcome of patients treated for actinic lentigines, café‐aulait macules, melasma and red tattoos by one of the authors (RCG).

methods. The Candela 510 nm pigmented lesion dye laser was used to treat solar lentigines, café‐au‐lait macules, melasma and red tattoo.

results. Excellent outcomes resulted on facial and hand lentigines (89% and 88% of patients had greater than 75% clearing, respectively), but often required more than one treatment. Lentigines located on the upper extremities and trunk improved less dramatically. Immediate greying occurred universally. Bruising was often noted. Treatment failures have been observed especially in treating lentigines located on the lower extremities. Café‐au‐lait macules responded inconsistently, with facial lesions giving the best results. Melasma responded poorly, often with hyperpigmentation. Three red tattoos cleared. Treatment failure may be related to inaccurate clinical assessment of pigment depth or regrowth of the lesion. Several cases are presented to demonstrate clinical and histologic effects of the laser.

conclusion. The Candela 510‐nm pigmented lesion dye laser is an effective treatment for superficial pigmented lesions. Its associated morbidity is minimal.
A Three‐Step Systematic Incisional‐Slit Minigrafting Approach
Authors: BRANDY DOMINIC A.
Published: June 2013

BACKGROUND. Over the past decade, minigrafting has become the cornerstone of effective hair transplantation because the “corn row” appearance commonly seen with larger grafts occurs infrequently with smaller grafts. However, there still has not appeared in the literature a sequential, systematic approach that yields consistently good results. This article offers an organized blueprint that not only has given predictable and excellent results, but has expedited the minigraft procedure.

OBJECTIVE. To present a three‐step incisional‐slit minigrafting approach.

RESULTS. The method described gives excellent aesthetic results and expedites the procedure.
Melanoma Update Second Primary Melanoma
Authors: FRANK WILLIAM , ROGERS GARY S.
Published: June 2013

BACKGROUND. Second primary melanoma is not a rare phenomenon. It occurs in at least 3 to 6% of melanoma patients and up to a third of individuals from melanoma‐prone families.

OBJECTIVE. To review the clinical and histologic features of multiple primary melanoma. A schema for follow‐up of these patients is presented.

CONCLUSIONS. As the incidence of melanoma continues to rise, we will be faced with an ever increasing number of patients who have survived their tumor. These patients are at risk for subsequent melanomas. This article reviews the literature regarding multiple primary melanoma, and discusses patient management.
A Microbiologic Study of Diluted Sclerotherapy Solutions
Authors: SADICK NEIL S. , FARBER BRUCE
Published: June 2013

BACKGROUND. As sclerotherapy has become more of an exact science it has become appropriate to dilute various sclerosing solutions to produce the least concentration of sclerosant producing effective endosclerosis of a given vessel diameter—the minimal sclerosant concentration.

OBJECTIVE. In this setting it has become necessary to take into account various microbiologic considerations. Contamination of infusates is the most common cause of epidemic device‐related bloodstream infections. With these considerations in mind, the following study was undertaken to determine the bacterial and fungal content of varied concentrations of four commonly employed sclerotherapy agents.

METHODS. Dilutions were made of hypertonic saline 23.4% to 11.7% with both bacteriostatic water and 0.9% normal saline, Polidocanol 0.5% to 0.25% with bacteriostatic water, sodium tetradecyl sulfate 1.0% to 0.5% with bacteriostatic water, and polyiodide iodide 2% to 1% with bacteriostatic water under sterile conditions. Each sclerosant was analyzed for bacterial, fungal, and spore content at determined time intervals with standardized utilization indices for up to 3 months.

RESULTS. At each sclerosant concentration for sodium chloride, polidocanol, sodium tetradechol sulfate, and polyiodide iodide at each study design time interval for sampling all bacterial and fungal cultures remained sterile.

CONCLUSIONS. With appropriate aseptic techniques we may dilute sclerosing solutions to desired concentrations that will remain sterile for a period of at least 3 months under daily usage conditions.
Stab Avulsion of the Short Saphenous Vein Technique and Duplex Evaluation
Authors: GEORGIEV MIHAEL , RICCI STEFANO , CARBONE DOMENICO , ANTIGNANI PIERLUIGI , MOLITERNO CLAUDIO
Published: June 2013

BACKGROUND. Stab avulsion, largely employed for removal of superficial collateral varicosities, is generally considered unsuited for surgical removal of the varicose short saphenous vein.

OBJECTIVE. To describe the technique of stab avulsion of the short saphenous vein and objectively validate it by demonstrating the exact site of short saphenous vein division in the popliteal fossa.

METHODS. Postoperative duplex scan of popliteal fossa in 18 limbs, 3.5 months after stab avulsion of the short saphenous vein.

RESULTS. No short saphenous vein stump in 4 limbs (22%). An average 1.7‐cm (range 1 to 4 cm) stump in the remaining 14 limbs.

CONCLUSIONS. High (not flush) ligation of the standard short saphenous vein, considered adequate by experts who practice traditional (open field) surgery, can also be achieved by stab avulsion without a large incision, and dissection in the popliteal fossa. The stab avulsion technique is therefore adequate for removal of the standard short saphenous vein. However, because of the short‐term follow‐up of this study, in which cases high ligation is as efficacious as flush ligation cannot be indicated.
Tawny owl vocal activity is constrained by predation risk
Authors: Lourenço Rui , Goytre Fernando , del Mar Delgado Maria , Thornton Michael , Rabaça João E. , Penteriani Vincenzo
Published: June 2013

The vocal behaviour of birds may be influenced by many factors, including the risk of being detected by a predator. In Doñana Protected Area, the tawny owl co‐exists alongside its intraguild predator, the eagle owl Bubo bubo. We considered four scenarios to study the vocal behaviour of tawny owls at dusk by analysing: A) the calling rate of all males in 29 sites; B) the calling rate at dusk of males living within the home range of the intraguild predator; C) the calling rate of males living within the home range of the intraguild predator between 60 and 90 min after sunset; and D) the duration of male vocal bouts in visits where eagle owls have called. In scenario A we found that only the number of conspecific males affected the calling rate of tawny owls. In scenario B we observed that the presence of an eagle owl calling constrained the calling rate of the intraguild prey. In scenario C we found that this effect seemed mostly associated to a contemporaneous detection of the intraguild predator’s calls. Finally, in scenario D we found no significant effects on bout duration. These results seem to indicate that tawny owls use their intraguild predator’s calls as a cue to assess predation risk, and then adjust their vocal behaviour in order to minimize predation risk by a predator that may locate its prey by its vocalizations.
Pollinators and seed predators generate conflicting selection onDalechampiablossoms
Authors: Pérez‐Barrales Rocío , Bolstad Geir H. , Pélabon Christophe , Hansen Thomas F. , Armbruster W. Scott
Published: June 2013

Plant–pollinator relationships are often mediated by floral traits that advertise the presence or amount of rewards. However, herbivores may also use these traits to find their hosts. InDalechampia scandens, we tested whether floral advertisements that attract pollinators were also used by seed predators, and whether this generated conflicting selection pressures. We studied the influence of natural variation in the size of showy bracts, amount of reward, and two shape traits on pollinator visitation, pollen arrival on stigmas, seed production and seed predation. We then built a multivariate fitness function for these traits to estimate selection generated by pollinators and seed predators. Blossoms with larger bracts were visited by bees more frequently and received more pollen on their stigmas. Seed predators laid more eggs on blossoms with larger bracts and also on blossoms later producing more seeds. Consequently, selection for larger bract size exerted by pollinators was counteracted by the selection exerted by seed predators. As a result, net selection on bract size tended to be stabilizing. Additionally, we found selection on traits that increased the rate of self‐pollination (assuming uniform seed quality). These results illustrate the importance of both mutualists and antagonists in floral evolution, as well as the value of taking an integrative approach to assessing selection on floral traits.
Factors affecting front line staff acceptance of telehealth technologies: a mixed‐method systematic review
Authors: Brewster Liz , Mountain Gail , Wessels Bridgette , Kelly Ciara , Hawley Mark
Published: June 2013

Aim

To synthesize qualitative and quantitative evidence of front‐line staff acceptance of the use of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease and Chronic Heart Failure.

Background

The implementation of telehealth at scale is a governmental priority in countries including the UK, USA and Canada, but little research has been conducted to analyse the impact of implementation on front‐line nursing staff.

Data sources

Six relevant data bases were searched between 2000–2012.

Design

Mixed‐method systematic review including all study designs.

Review methods

Centre for Reviews and Dissemination approach with thematic analysis and narrative synthesis of results.

Results

Fourteen studies met the review inclusion criteria; 2 quantitative surveys, 2 mixed‐method studies and 10 using qualitative methods, including focus groups, interviews, document analysis and observations. Identified factors affecting staff acceptance centred on the negative impact of service change, staff–patient interaction, credibility and autonomy, and technical issues. Studies often contrasted staff and patient perspectives, and data about staff acceptance were collected as part of a wider study, rather than being the focus of data collection, meaning data about staff acceptance were limited.

Conclusion

If telehealth is to be implemented, studies indicate that the lack of acceptance of this new way of working may be a key barrier. However, recommendations have not moved beyond barrier identification to recognizing solutions that might be implemented by front‐line staff. Such solutions are imperative if future roll‐out of telehealth technologies is to be successfully achieved.
Predicting electoral activism among gays and lesbians in the United States
Authors: Swank Eric , Fahs Breanne
Published: June 2013

Although battles over gay and lesbian rights have appeared prominently in political arenas, scholars have created few empirical studies on gay and lesbian activism. To address this absence, this quantitative study identified factors that inspired greater electoral engagement among gays and lesbians in the United States (n = 285). After integrating “resource,” “mobilizing,” and “framing” variables into regressions, this study found that electoral activism was inspired by many sorts of motivators. In sum, activist tendencies were swayed by educational levels, perceptions of political potency, a desire to conceal sexual orientations, surviving hate crimes, and joining certain political groups. Interestingly, this study supported “new social movement” theories that downplay economic factors as predictors of involvement in gay and lesbian rights campaigns.
The hostile‐world scenario among Israeli homosexual adolescents and young adults
Authors: Shenkman Geva , Shmotkin Dov
Published: June 2013

This study identified relevant themes within the hostile‐world scenario (HWS) concept among lesbian and gay adolescents and young adults. The HWS refers to an image of major threats to one's physical and mental integrity, and thus presents a meaningful structure of stressors that may be particularly aggravated among stigmatized minorities. An Israeli sample of 219 homosexuals (136 men, 83 women; mean age 20.9) was compared with 219 matched heterosexuals. Results showed gays and lesbians as more concerned with HWS themes of victimization (by crime and discrimination), lack of social and family support, poor health condition, disrupted relationships, and aging. This study specifies ingredients of vulnerability among homosexuals in face of challenging life conditions.
Time and space in biogeography: response to Parenti & Ebach (2013)
Authors: de Bruyn Mark , Stelbrink Björn , Page Timothy J. , Phillips Matthew J. , Lohman David J. , Albrecht Christian , Hall Robert , von Rintelen Kristina , Ng Peter K.L. , Shih Hsi‐Te , Carvalho Gary R. , von Rintelen Thomas
Published: June 2013

A recent Guest Editorial by Parenti & Ebach (2013, Journal of Biogeography, 40, 813–820) disagrees with the methods or interpretations in two of our recent papers. In addition, the authors open a debate on biogeographical concepts, and present an alternative philosophy for biogeographical research in the context of their recently described biogeographical subregion called ‘Pandora’. We disagree with their approach and conclusions, and comment on several issues related to our differing conceptual approaches for biogeographical research; namely, our use of molecular phylogenetic analyses, including time estimates; and Parenti & Ebach's reliance on taxon/general area cladograms. Finally, we re‐examine their ‘tests’ supporting the existence of ‘Pandora’.
Behavior of Vegetative Cells and Spores of Bacillus cereus in Two Food Systems
Authors: Desai Shivalingsarj Vijaykumar , Varadaraj Mandyam Chakravarthy
Published: June 2013

The survival and growth of vegetative cells and spores of toxigenic Bacillus cereus CFR 1534 was investigated in a dehydrated (dry mix) blend of flour (roasted finger millet and Bengal gram) and chocolate milk. In the case of dry mix, there was a marginal initial increase of 2 logs in 2 days of storage at 20 and 30C, respectively. In chocolate milk, there was an increase of 1 log with certain inoculum levels introduced and storage temperatures. The survival pattern of vegetative cells/spores was primarily influenced by the initial numbers and, to a slight extent, by the water activity of food matrices. Although stored samples were negative for toxigenic trait of phosphatidylinositol phospholipase C in polymerase chain reaction, associated lecithinase activity was detected in plate assay. Response surface plots for vegetative cells and spores of B. cereus CFR 1534 did indicate the potential risk associated with post‐processing contamination of B. cereus.

Practical Applications

The ability of vegetative cells and spores of a toxigenic culture of Bacillus cereus to survive and grow in two food matrices was studied. Often, the bacterial species tend to remain in the product and increase in their numbers in a slow paced manner. The product with no visual changes, but harbors viable population of toxigenic Bacillus cereus can be of serious public health concern. The understanding of product profile would be of help in assessing the probable risk factors that could be associated with opportunistic foodborne pathogen like B. cereus in the food chain establishment.
Micronutrient malnutrition profile of infants in South India
Authors: Amrutha Veena K. , Kowsalya S. , Kothandapani S.
Published: June 2013

Background

The present study aimed to evaluate the nutritional status of infants in Ramanathapuram district of Tamilnadu.

Methods

The present study comprised a community‐based cross‐sectional study conducted in seven taluks of the Ramanathapuram district. A total of 2800 infants (<1 year of age) comprising of 1400 male and 1400 female infants were selected from all the seven taluks of the Ramanathapuram district at random. Anthropometric parameters such as weight, crown heel length, head circumference, arm circumference and chest circumference were measured using standardised procedures. Clinical examinations for the manifestation of micronutrient deficiency signs were performed. Biochemical estimations of serum haemoglobin, vitamin A and urinary iodine were estimated for 5% of the infants.

Results

Low birth weight was obeserved among 33.5% of the infants, with 1.6% weighing <1500 g. Being underweight (35.4%), stunting (29.6%) and wasting (18.9%) were also obeserved among the infants. Different forms of clinical signs and symptoms of micronutrient deficiencies were obeserved among 21.3% and 27.4% of the male and female infants. Subclinical deficiency of haemoglobin, vitamin A and iodine were obeserved among 67.1%, 52.1% and 32.9% of the infants, respectively.

Conclusions

Micronutrient deficiencies pertaining to the ‘Big 3’, namely vitamin A deficiency, iodine deficiency disorders and iron deficiency anaemia are still common among the infants of Ramanathapuram district, leading to the need for effective intervention measures.