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Biomedical subjects

Raymond G Dufresne

Publications and source records attributed to Raymond G Dufresne.

10 recordsLinked to original sources
PubMed2006

Tanning in body dysmorphic disorder.

Tanning in body dysmorphic disorder (BDD) has not previously been studied. In this study, 200 subjects with BDD were evaluated with measures to examine the prevalence of BDD-related tanning--i.e., darkening one's skin color by direct exposure to sunlight or artificial light which is motivated by a desire to improve a perceived appearance defect (i.e., a BDD concern). We also examined clinical characteristics of individuals who engaged in BDD-related tanning. 25% (95% CI, 19.0%-31.0%) of subjects reported BDD-related tanning. Among tanners, the skin was the most common body area of concern (84.0%). All tanners experienced functional impairment due to BDD, 26% had attempted suicide, and quality of life was markedly poor. 52% of tanners had received dermatologic treatment, which was usually ineffective for BDD symptoms. Tanners were more likely than non-tanners to compulsively pick their skin. In conclusion, tanning--a behavior with well-known health risks--is a relatively frequent BDD-related behavior.

Adolescent↗
PubMed2006

Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons.

BACKGROUND: Despite rising medical malpractice costs, little is known about the factors associated with claims filed against Mohs surgeons. OBJECTIVE: We sought to define the scope of medical malpractice claims filed against Mohs surgeons and to identify salient factors associated with the filing and disposition of those claims. METHODS: A comprehensive survey was mailed to 599 physicians with US addresses listed in the 2003 directory of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. RESULTS: Of the 300 completed surveys returned, 33 (11%) reported ever having been sued. Physicians who practiced Mohs surgery for a longer period of time were more likely to have been sued for malpractice. Physicians reported the wrong site and functional outcome as the most frequent causes of malpractice lawsuits.

Dermatology↗
PubMed2005

Meningiomas after medulloblastoma irradiation treatment in a patient with basal cell nevus syndrome.

A 23-year-old woman with basal cell nevus syndrome (BCNS), or Gorlin's syndrome, was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiation. Multiple basal cell carcinomas developed at the craniospinal irradiation port site 8 years later. She subsequently developed multiple meningiomas within the area of irradiation at age 20 years. This case reviews early presentation of BCNS, newly described differences between medulloblastomas in patients with BCNS and nonsyndromic medulloblastomas, and global assessment of patients by the treating dermatologist of this patient population. This is the first report in the dermatologic literature, to our knowledge, of radiation-induced meningiomas in a patient with BCNS.

Adult↗
PubMed2005

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin).

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.

Adult↗
PubMed2005

Post-Mohs micrographic surgical margin tissue evaluation with permanent histopathologic sections.

BACKGROUND: Incomplete resection of nonmelanoma skin cancer is associated with a relatively high rate of recurrent tumors. Mohs micrographic surgery provides microscopic evaluation of tumor margins to ensure complete excision of nonmelanoma skin cancers at high risk of recurrence. OBJECTIVE: This purpose of this study is to confirm the histologic accuracy of Mohs excision of facial skin cancers by evaluating an additional layer of tissue with permanent histopathologic sections after Mohs excision. METHODS: Two hundred ninety-six Mohs cases were identified, which, after excision, were sent to a single plastic surgeon for reconstruction. This plastic surgeon routinely takes an additional layer and sends for permanent histopathologic evaluation at the time of reconstruction. A review of the pathology reports and tissue specimens on these patients provides valuable data on tumor margins and the effectiveness of the Mohs technique for tumor excision. RESULTS: Two excisions of nodular basal cell cancer were determined by the pathologist to have positive tumor involvement on post-Mohs permanent tissue. On additional review, one specimen was interpreted to be more consistent with follicular epithelium, and the second was verified as a focus of nodular basal cell cancer. CONCLUSION: These data support the high reliability of Mohs surgery for margin control.

Basal Cell Carcinoma↗
PubMed2004

Body dysmorphic disorder and cosmetic dermatology: more than skin deep.

Body dysmorphic disorder (BDD) is relatively common in cosmetic practise, yet it remains under-recognized. BDD patients are unnaturally concerned with minimal or non-existent flaws, most commonly in the skin (e.g. facial acne or scarring) and hair (e.g. hair loss). Many patients develop social avoidance and suffer occupational or academic impairment. More severely ill patients may become housebound or even attempt suicide. Despite the minimal or non-existent nature of the perceived appearance flaws, patients with BDD may request dermatological treatments such as isotretinoin or dermabrasion. Although treatment outcome has received little investigation, it appears that most patients are dissatisfied with dermatological treatment and, even if the outcome is objectively acceptable, they do not worry any the less about their appearance afterwards. In contrast, a majority of patients respond to serotonin reuptake inhibitors or cognitive behavioural therapy. Treatment of these patients is best given by an experienced health professional. This may be a mental health professional or a dermatologist with an interest in psychological medicine.

Journal Article↗
PubMed2002

Body dysmorphic disorder: a guide for primary care physicians.

Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, is a relatively common psychiatric disorder that often presents to nonpsychiatric physicians. Body dysmorphic disorder is associated with marked impairment in functioning, notably poor quality of life, and a high suicide attempt rate. Most patients seek and receive surgery or nonpsychiatric medical or dermatologic treatment, often with a perceived poor outcome despite an objectively acceptable result. In contrast, psychiatric treatment, serotonin-reuptake inhibitors and cognitive-behavioral therapy, often are effective. This clinically focused review describes the clinical features and prevalence of BDD, the disorder's treatment response, how to recognize and diagnose BDD, and practical suggestions for primary care physicians who encounter these often difficult-to-treat patients.

Adult↗
PubMed2002

Dietary supplements in the setting of mohs surgery.

BACKGROUND: The use of dietary supplements has become increasingly popular. While many are safe in small doses, others may have potentially harmful effects, particularly in surgical patients. OBJECTIVE: To study the incidence of dietary supplement use in patients presenting for Mohs surgery. METHODS: One hundred consecutive patients presenting for Mohs surgery completed a questionnaire providing all current medications. During the consultation, the patients were then asked specifically about their current use of any dietary supplements. Responses differing from those on the questionnaire were recorded. RESULTS: Forty-nine of 100 patients (49%) were currently taking dietary supplements. Of this group, 17 patients (35%) self-reported the use of supplements; 32 patients (65%) did not. Thirty women (59%) were currently using dietary supplements regularly compared to 19 men (39%). Women were also more likely to self-report the use of supplements compared to men: 14 women (47%) versus three men (15%). Forty-eight of the 100 study patients (48%) were currently taking anticoagulant medications such as aspirin, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), or clopidogrel bisulfate. Fifty instances were noted where patients were taking one or more dietary supplements that have demonstrated anticoagulant properties. Of this group, 21 instances (42%) where patients took a combination of prescription and over-the-counter (OTC) anticoagulants and one or more dietary supplements shown to have effects on coagulation were recorded. CONCLUSION: Of the almost 50% of patients taking dietary supplements, one-third reported usage, while two-thirds did not. Women used dietary supplements more frequently than men and were more than three times more likely to offer this information. Furthermore, many supplements have been shown to have effects on coagulation, including vitamin E, garlic, ginkgo, feverfew, and fish oils. Use of these substances alone or in combination may potentiate the anticoagulant effects of each other or prescribed medications. It is therefore important for the dermatologic surgeon to communicate openly with patients regarding dietary supplements to avoid potential complications during or following surgery.

Adult↗