Biomedical subjects
Publications and source records attributed to S V Pollack.
A case report is used to illustrate the characteristics of Gorlin's syndrome and to emphasize the need for early recognition by the physician and for thorough lifetime follow-up by the patient to prevent severe sequelae.
Selective destruction of connective tissue may be a useful therapeutic tool in conditions associated with abnormal deposition of scar tissue. We have investigated intradermal injections of clostridial collagenase and bovine testicular hyaluronidase alone and in combination in Yucatan miniature hairless pigs. Collagenase in combination with hyaluronidase was quite efficient at destroying the connective tissue matrix, although elastic tissue appeared to be completely spared. Collagenase alone at higher doses degraded collagen, but hyaluronidase had little effect on connective tissue architecture.
Infiltrative basal cell carcinoma is a distinct histologic subtype of basal cell carcinoma (BCC). Criteria for its diagnosis are presented and its nonsclerotic nature emphasized. Analysis of 174 consecutive BCCs referred for Mohs micrographic surgery showed the infiltrative subtype (29 tumors) to be significantly more destructive and difficult to treat than the more common nodular BCC.
1774 basal cell carcinoma lesions treated by Mohs surgery between 1979 and 1986 were evaluated for previous trauma histories. These traumas include burns, sharp trauma, chicken pox scars, blunt trauma, and vaccinations. 129 (7.3%) had a previous history of trauma. Analysis revealed that patients with trauma-related tumors were slightly younger and more likely to be male. Their lesions were larger pre- and post-op, and more often required five or more Mohs surgery stages, indicating these tumors may be especially deceptive clinically. The tumors were not particularly aggressive judging by histologic type. The literature is reviewed and implications for future work suggested.
The past decade has given rise to significant advances in our knowledge of the wound-healing process. Work performed by basic scientific investigators and clinical researchers has resulted in new insights into certain biologic-aspects of wound healing. The thoughtful application of some of these findings has led to the development of modern, physiologically sound wound-healing products and improved patient care.
Cutaneous candidosis is a common skin condition. Facial candidosis is rare. Described herein are three cases of facial candidosis complicating dermabrasion, a previously undescribed condition. Why this may occur, why it is uncommon, and its differential diagnosis and therapy are discussed. The side effects and complications of dermabrasion in general are presented.
Features of basal cell carcinoma are reviewed within the broad categories of growth characteristics, histogenesis, ultrastructural features, biochemical properties, site of origin, metastatic potential, and immunobiology. Biologic features that pertain to host-tumor interactions are emphasized. Perhaps a better understanding of these host-tumor relationships will offer more effective methods of treating and preventing these neoplasms in the future.
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Two patients with small-cell undifferentiated neuroepithelial tumors of skin are reported. The histologic and ultrastructural features of this neoplasm are presented. Characteristic membrane-bound, dense-core neurosecretory granules were seen in the cytoplasm of the tumor cells in both cases. The literature is reviewed in regard to the clinical behavior of these lesions and their possible cell of origin. Dermatologists should be aware of these tumors because they may require electron microscopy for accurate diagnosis. The tumors should be treated aggressively to minimize the chance of local recurrence and nodal or visceral metastases.
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Physicians performing dermatologic surgery should include a thorough drug history in their preoperative assessments of patients. Such information may allow for the discontinuation, if desired, of drugs that negatively influence the wound-healing process. In some instances, the surgeon may find it useful, during the perioperative period, to substitute a drug known to impede wound healing with another possessing no untoward effects. In other situations, as in the treatment of keloids, physicians may wish to introduce drugs known to reduce scar formation into the biologic environment in which wound healing ensues.
Keloids are predominantly fibrous tumors which appear as firm, variably pruritic or tender growths near a site of injury. Usually appearing between the ages of 10 and 30, most keloids are located on the upper back, shoulders, earlobes, and anterior portion of the chest. The etiology remains unknown, but the accumulated fibrous tissue is associated with increased cellularity and increased metabolic activity of keloid fibroblasts. Isolated keloid fibroblasts demonstrate normal growth characteristics along with increased collagen and proteoglycan synthesis. Numerous keloid treatments have been attempted, but variable success has followed either single use or combinations of intralesional corticosteroid injection, surgery, pressure devices, radiation, cryosurgery, and systemic chemotherapy.
Extensive analysis of ten factors in 183 consecutive cases of basal cell carcinoma overlying cartilage of the nose and ear is performed in this prospective study. Duration of tumor and prior treatment rather than one specific modality of previous therapy are significant factors in predicting tumor invasion of cartilage, which necessitates removal of cartilage.
With the introduction of the Mohs fresh-tissue technique, immediate repair of surgical wounds has become feasible in selected cases. In this article several case reports are presented to illustrate the use of primary closures, skin grafts, and flaps in an office facility.
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A variety of factors, both intrinsic and extrinsic, may influence the healing of wounds. Some of these influences are environmental in nature and subject to advantageous manipulation by the practitioner. In this article, the role of humidity, temperature, infection and oxygen tension on the process of wound healing will be discussed.
Wound healing proceeds more efficiently and quickly in well-nourished individuals who are in good general health at the time that they have to undergo surgery. Per contra, individuals who are malnourished and chronically ill heal less well and are in general at greater risk of complications during and after surgery. For the latter, elective surgery may be deferred until nutritional improvement is attained, but for emergency or urgent operations, institution of measures promoting good nutrition has to be concurrent with necessitous surgery and continued postoperatively. In this paper, the importance to wound healing of proteins, carbohydrates, fats, vitamins, and trace elements and minerals is reviewed.