Biomedical subjects

P Kim Phillips

Publications and source records attributed to P Kim Phillips.

7 recordsLinked to original sources

PubMed2006

Educational outcomes regarding skin cancer in organ transplant recipients: Randomized intervention of intensive vs standard education.

OBJECTIVE: To determine whether an intensive educational program focused on the risk of skin cancer in organ transplant recipients, a population at high risk for development of skin cancer because of immunosuppression, produced measurable improvement in patient knowledge and sun-protective behavior. DESIGN: Patients were randomly assigned to receive standard episode-of-care-based education or intensive repetitive written education about skin cancer after organ transplantation. Preintervention knowledge was assessed and documented through a self-administered educational assessment tool. Retention of knowledge and the effect on sun-protective behavior were assessed with a follow-up questionnaire at 3 and 10 months. SETTING: Transplant center of an academic medical center. PATIENTS: Two hundred two patients presenting for transplant dermatologic consultation. Intervention Randomized intensive, repetitive written educational reinforcement. MAIN OUTCOME MEASURES: Retention of knowledge and the effect on sun-protective behavior were assessed with a follow-up questionnaire at 3 and 10 months. RESULTS: Both intervention groups had similarly high baseline and 3- and 10-month scores on the knowledge portion of the surveys, and they had similar scores on the behavioral assessment portion of the surveys at baseline. Subjects receiving intensive education scored significantly better on the behavioral assessment at 3 and 10 months, although an improvement in knowledge was not documented. CONCLUSIONS: This cohort of transplant recipients was well educated about skin cancer prevention before educational intervention and retained this knowledge. Patients who received the intensive educational intervention were significantly more compliant with recommendations for sun-protective behavior than those who received standard education, although differences in knowledge were not apparent. Lack of time and hassle were the most commonly cited barriers to behavioral compliance with sun protection.

Adolescent↗

PubMed2005

Primary closure vs second-intention treatment of skin punch biopsy sites: a randomized trial.

OBJECTIVE: To determine if healing of punch biopsy wounds by second intention is equivalent to healing with primary closure. DESIGN: Prospective, randomized, method comparison equivalence study. SETTING: Tertiary academic medical center. PARTICIPANTS: Study volunteers were recruited from the general population and enrolled between January 7, 2002, and August 20, 2002. Patients with immunodeficiency, peripheral vascular disease, or history of keloid formation and those receiving anticoagulation therapy or systemic corticosteroids were excluded. Intervention Study volunteers had two 4-mm or two 8-mm punch biopsies performed on the upper outer arms, midlateral aspect of the thighs, or upper back. One biopsy site was closed with interrupted 4-0 nylon suture, and the contralateral biopsy site was allowed to heal by second intention. MAIN OUTCOME MEASURES: At 9 months, scar appearance was evaluated blindly and independently by 3 physicians using a visual analog scale (0 indicating poor and 100 indicating best). RESULTS: Seventy-seven of 82 enrolled volunteers completed the study. Mean (SD) visual analog scale score was 57.1 (19.5) for biopsy sites allowed to heal by second intention and 58.9 (19.7) for biopsy sites that healed with primary closure. The median surface area of the biopsy scars at 9 months was 32 mm(2) for second intention and 33 mm(2) for primary closure. For the 8-mm biopsies, the volunteers preferred the appearance of the sites that healed with primary closure; however, for the 4-mm biopsies, volunteers had no significant preference for either biopsy method. Costs were lower for second intention, and complications were equivalent. CONCLUSIONS: Punch biopsy sites allowed to heal by second intention appear at least as good as biopsy sites closed primarily with suture. Although volunteers preferred suturing at larger biopsy sites, elimination of suturing of punch biopsy wounds would result in personnel efficiency and economic savings for both patients and medical institutions.

Adult↗

PubMed2005

Antibiotic prophylaxis in dermatologic surgery: updated guidelines.

BACKGROUND: Antibiotic prophylaxis in dermatologic surgery is poorly understood, and data on its use are lacking. Prophylaxis is indicated for the prevention of endocarditis and prosthesis infection, as well as surgical site infection. OBJECTIVE: We review essential considerations for the use of antibiotic prophylaxis in dermatologic surgery and provide clear guidelines for practical implementation. METHODS: Guidelines were developed after review of the literature and consultation with infectious disease specialists and subspecialists in the areas of cardiac, orthopedic, and neurosurgical infectious disease at Mayo Clinic. RESULTS: Three factors affect the decision to use prophylactic antibiotics in dermatologic surgery: (1) the underlying indication for prophylaxis (patient risk stratification), (2) the condition of the skin, and (3) the specific procedure planned. Thorough preoperative evaluation and surgical planning are critical in identifying and optimizing patient and environmental risk factors that may increase the risk of infection. Appropriate antibiotic selections with site-specific consideration and appropriate timing of antibiotic administration are key factors in providing effective prophylaxis. CONCLUSIONS: Low rates of infection associated with dermatologic surgical procedures warrant selective use of antibiotic prophylaxis. The proposed guidelines reflect current standards of practice.

Antibiotic Prophylaxis↗

PubMed2005

Role of multiple scouting biopsies before Mohs micrographic surgery for extramammary Paget's disease.

BACKGROUND: Extramammary Paget's disease (EMPD) frequently extends subclinically, resulting in high recurrence rates after surgical excision. Mohs micrographic surgery (MMS) improves cure rates but may require time-consuming reexcision of subclinical extension. A mechanism to estimate the location and extent of subclinical extension would be helpful. OBJECTIVE: To describe and evaluate a technique for multiple scouting biopsies before MMS for EMPD. METHOD: A retrospective review of patients at Mayo Clinic who had multiple scouting biopsies before MMS for EMPD without dermal invasion. TECHNIQUE: The clinical extent of EMPD is identified. The scouting biopsy sites are determined and documented with photographs. The scouting biopsy specimens are sent for permanent sections. The results of the scouting biopsies help guide the extent of the initial Mohs layer. The tumor is cleared with MMS. An additional 1 mm peripheral margin of tissue is usually submitted for permanent sections. RESULTS: Multiple scouting biopsies were done in five patients. Four of the five patients had at least one true-positive result. At least one true-negative result was obtained in all five patients. Two patients had at least one false-negative result. CONCLUSION: Multiple scouting biopsies before MMS for EMPD without dermal invasion can be a beneficial adjuvant technique.

Aged↗

PubMed2003

Lymphocytic infiltrates and subclinical epithelial tumor extension in patients with chronic leukemia and solid-organ transplantation.

BACKGROUND: Dense infiltrates in association with squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) in patients with underlying chronic lymphocytic leukemia (CLL) may complicate pathologic interpretation of histologic margins. OBJECTIVE: The study was conducted to determine the frequency of identifying dense inflammatory infiltrates in frozen histologic sections during Mohs operation for BCC or SCC in patients with CLL and organ-transplant recipients, to characterize the infiltrate (reactive versus leukemic) in CLL, and to estimate the subclinical tumor extension in patients with CLL, transplant recipients, and control subjects undergoing Mohs procedure. METHODS: Frozen sections of head and neck BCC and SCC obtained during Mohs procedures in patients with CLL, organ transplant recipients, and a control group were reviewed retrospectively. Biopsy specimens of CLL with dense infiltrates were assessed with immunohistochemical stains. Subclinical tumor extension (postoperative defect size minus preoperative tumor size) was evaluated in each group. RESULTS: Dense infiltrates were found in tumors of 20 of 55 patients with CLL (36%), 1 of 8 transplant recipients (13%), and 1 of 105 controls (1%). In patients with CLL, 75% of the dense infiltrates were B-cell leukemic. Compared with controls, the mean subclinical tumor extension was larger in patients with CLL (P=0.029) and in transplant recipients (P=0.55). CONCLUSION: Dense leukemic infiltrates associated with BCC or SCC in CLL may complicate pathologic interpretation of Mohs surgical histologic margins and may be associated with larger postoperative defects relative to preoperative clinical tumor appearance. In patients with CLL, as in transplant recipients, SCC seems more likely to develop than BCC.

Basal Cell Carcinoma↗

PubMed2002

A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma is an aggressive cutaneous neoplasm with a high propensity to metastasize to lymph nodes. OBJECTIVE: The objective of this study was to determine the prognostic significance of sentinel lymph node status in patients with Merkel cell carcinoma. METHODS: A meta-analysis of case series of patients with Merkel cell carcinoma managed with sentinel lymph node biopsy was performed. RESULTS: Forty of 60 patients (67%) had a biopsy-negative sentinel lymph node; 97% of this group had no recurrence at 7.3 months median follow-up. Twenty patients (33%) had a biopsy-positive sentinel lymph node; 33% of this group experienced local, regional, or systemic recurrence at 12 months median follow-up. Risk of recurrence or metastasis was 19-fold greater in biopsy-positive patients (odds ratio, 18.9; p = 0.005). None of 15 biopsy-positive patients who underwent therapeutic lymph node dissection experienced a regional recurrence; 3 of 4 who did not receive therapeutic lymphadenectomy experienced regional recurrence. CONCLUSION: Sentinel lymph node positivity is strongly predictive of a high short-term risk of recurrence or metastasis in patients with Merkel cell carcinoma. Therapeutic lymph node dissection appears effective in preventing short-term regional nodal recurrence. Aggressive adjuvant treatment should be considered for patients with positive sentinel lymph nodes.

Carcinoma, Merkel Cell↗

PubMed2002

Cutaneous surgeons cannot predict blood-thinner status by intraoperative visual inspection.

Cutaneous surgeons cannot predict blood-thinner status by intraoperative visual inspection. Many surgeons believe they can discern whether a patient is taking an anticoagulant or a platelet inhibitor (blood thinner) by visual inspection of intraoperative oozing. However, there is little objective evidence to support this strongly held belief. The authors' objective was to determine whether visual inspection of intraoperative oozing during cutaneous surgery is accurate in identifying use of blood thinners. Blinded physician evaluators observed intraoperative oozing in 110 patients having cutaneous excisional surgery, rated the amount of oozing, and judged the likelihood that the patient was taking a blood-thinning agent. On the basis of the impressions of the most senior evaluator, 43 patients having used aspirin in the past 14 days or warfarin or vitamin E in the past 2 days, seven were judged as definitely or probably taking blood-thinning agents (sensitivity, 16.3 percent; 95 percent confidence interval, 6.8 to 30.7 percent). Of 67 patients who did not report recent use of a blood-thinning agent, just 11 were judged as definitely or probably taking blood-thinning agents (false-positive rate, 16.4 percent; 95 percent confidence interval, 8.5 to 27.5 percent). The level of training of the physicians doing the judging did not affect diagnostic sensitivity. Only 10 of the 110 patients (9.1 percent) were assessed as exhibiting excessive oozing, and of those, only four (40 percent) were actually taking a blood thinner. Results were similar when only patients who were taking aspirin or warfarin were analyzed. Thus, contrary to a commonly and strongly held belief, visual inspection of intraoperative oozing during cutaneous excisional surgery correlates poorly with blood-thinner use by patients. The data add further evidence that use of blood thinners does not have an objectively measurable adverse effect during cutaneous surgery.

Adult↗