Biomedical subjects
Publications and source records attributed to Carl Vinciullo.
The key to obtaining excellent scars is perfect wound edge apposition with little or no tension across the sutured wound. Unsightly 'dog ear' protrusions at the ends of the wound should be avoided as they can detract from the cosmetic result. A simple, practical and efficient surgical technique is described, which can provide the optimal conditions for a perfect scar.
BACKGROUND: Actinic keratoses are the most common actinic lesions on Caucasian skin. Cryosurgery with liquid nitrogen is commonly used to treat actinic keratoses, but there have been few studies examining the true rate of cure in everyday dermatologic practice. AIM: To determine prospectively the true efficacy of cryosurgery as a treatment for actinic keratoses in everyday dermatologic practice. METHODS: A prospective, multicentered study (a subsidiary study of a photodynamic therapy trial) was performed. Patients with untreated actinic keratoses greater than 5 mm in diameter on the face and scalp were recruited. Eligible lesions received a single freeze-thaw cycle with liquid nitrogen given via a spray device and were reviewed 3 months thereafter. Each center used their preferred freeze time. The only treatment criterion was complete freezing of actinic keratoses and a 1-mm rim of normal skin. Treated lesions were assessed as complete response or noncomplete response. The influence of the duration of freeze, cosmetic outcomes, and adverse events were examined. RESULTS: Ninety adult patients from the community with 421 eligible actinic keratoses were recruited. The overall individual complete response rate was 67.2%[SEM = +/-3.5%; 95% confidence interval (CI) = 60.4-74.1%]. Complete response was 39% for freeze times of less than 5 s, 69% for freeze times greater than 5 s, and 83% for freeze times greater than 20 s. Cosmetic outcomes were good to excellent in 94% of complete response lesions. The main adverse events were pain, stinging, and burning during treatment, and hypopigmentation after healing. CONCLUSIONS: Cryosurgery is an effective treatment for actinic keratoses. The true complete response rate is significantly lower than that previously reported. The freeze duration influences successful treatment. Adverse events are mild and well tolerated.
BACKGROUND: There is considerable interpatient variability in pain tolerance during and after treatment of skin cancer with photodynamic therapy (PDT). Additionally, erythema and edema are common, with mild crusting and healing over 1 to 2 weeks. OBJECTIVE: To determine whether concurrent cold air analgesia improves the tolerability of PDT. METHOD: Twenty-six patients with two similar superficial skin cancers were treated with PDT. One lesion was treated with cold air analgesia and the other without. Patients rated their pain during treatment using the Wong Baker Faces Pain Scale and detailed duration of posttreatment pain. At week 2, the inflammatory response was assessed. RESULT: A statistically significant difference in the analgesia group was shown with respect to the mean duration of pain and the level of erythema after the first treatment as well as pain scores during the second treatment. CONCLUSION: Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field.
BACKGROUND: Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained. OBJECTIVE: The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion. METHODS: The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion. RESULTS: Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images. CONCLUSION: Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.
OBJECTIVE: To describe our use of cheek-based 2-stage transposition flaps for repairing Mohs surgery defects of the lower third of the nose. DESIGN: Retrospective case series. SETTING: Private dermatologic day surgery facility. Patients Twenty-eight patients with defects of the lower third of the nose after Mohs surgery. Intervention Ten alar and 18 nasal tip defects repaired using cheek-based 2-stage transposition flaps. MAIN OUTCOME MEASURES: Acceptability of procedure to patient, complications, and appearance from photographic records. RESULTS: The procedures were well tolerated and achieved good cosmetic results without major complications. CONCLUSIONS: These flaps allow repair of extensive defects of the nasal tip and ala with the patient under local anesthesia. This approach provides an alternative to the median forehead flap for nasal tip repairs.
A 38-year-old man presented with numerous dermal nodules, similar to xanthoma disseminatum, that were histologically consistent with his diagnosis of Erdheim-Chester disease, a non-Langerhans cell histiocytosis. Other cutaneous manifestations of this disease include eyelid xanthelasma, pretibial dermopathy and pigmented lesions of the lips and buccal mucosa. The histological diagnosis of Erdheim-Chester disease was originally made on the patient's retroperitoneal tissue, obtained at a laparotomy for surgical treatment of a presumed phaeochromocytoma, and confirmed by the pathognomonic long bone X-ray findings of this disease.