Arash Taheri

Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial

Background  Aphthous stomatitis is a painful, recurrent disease of the oral mucous membrane. Silver nitrate sticks have been used for a long time to provide pain relief for the duration of an aphthous ulceration, with only one application. Silver nitrate causes chemical cauterization and increases the depth of injury.

Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial

Background  Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes. Many different treatments have been used, with variable success rates.

Electrosurgery: Part I. Basics and principles

The term electrosurgery (also called radiofrequency surgery) refers to the passage of high-frequency alternating electrical current through the tissue in order to achieve a specific surgical effect. Although the mechanism behind electrosurgery is not completely understood, heat production and thermal tissue damage is responsible for at least the majority--if not all--of the tissue effects in electrosurgery. Adjacent to the active electrode, tissue resistance to the passage of current converts electrical energy to heat. The only variable that determines the final tissue effects of a current is the depth and the rate at which heat is produced. Electrocoagulation occurs when tissue is heated below the boiling point and undergoes thermal denaturation. An additional slow increase in temperature leads to vaporization of the water content in the coagulated tissue and tissue drying, a process called desiccation. A sudden increase in tissue temperature above the boiling point causes rapid explosive vaporization of the water content in the tissue adjacent to the electrode, which leads to tissue fragmentation and cutting.

Computer-aided dermoscopy for diagnosis of melanoma

BackgroundComputer-aided dermoscopy using artificial neural networks has been reported to be an accurate tool for the evaluation of pigmented skin lesions. We set out to determine the sensitivity and specificity of a computer-aided dermoscopy system for diagnosis of melanoma in Iranian patients.MethodsWe studied 122 pigmented skin lesions which were referred for diagnostic evaluation or cosmetic reasons. Each lesion was examined by two clinicians with naked eyes and all of their clinical diagnostic considerations were recorded. The lesions were analyzed using a microDERM® dermoscopy unit. The output value of the software for each lesion was a score between 0 and 10. All of the lesions were excised and examined histologically.ResultsHistopathological examination revealed melanoma in six lesions. Considering only the most likely clinical diagnosis, sensitivity and specificity of clinical examination for diagnosis of melanoma were 83% and 96%, respectively. Considering all clinical diagnostic considerations, the sensitivity and specificity were 100% and 89%. Choosing a cut-off point of 7.88 for dermoscopy score, the sensitivity and specificity of the score for diagnosis of melanoma were 83% and 96%, respectively. Setting the cut-off point at 7.34, the sensitivity and specificity were 100% and 90%.ConclusionThe diagnostic accuracy of the dermoscopy system was at the level of clinical examination by dermatologists with naked eyes. This system may represent a useful tool for screening of melanoma, particularly at centers not experienced in the field of pigmented skin lesions.

Acrokeratosis paraneoplastica (Bazex syndrome) associated with breast cancer

particularly in the acute phase, stanozolol. Our patient’s condition improved rapidly, with the introduction of compression and exercise. LDS is usually associated with chronic venous insufficiency and the people commonly affected are middle-aged to elderly, predominantly women. We have been unable to find any previous report of LDS occurring in a 15-year-old. However, the clinical features presented in this case do suggest this diagnosis. What is the underlying cause of the patient’s LDS? It is unusual in this age group to find an underlying venous insufficiency and this was supported by our investigations: the duplex-Doppler showed a functioning deep venous system and no venous abnormalities. However, this does not exclude the possibility of a subtle abnormality in either the venous or the fibrinolytic systems. One possible cause for acute LDS in this age group could be chronic lymphoedema. Lymphoedema does remain a possible explanation even in the presence of normal lymphoscintigraphy, since the false negative rate is > 10% in lymphoedema. Lymphoedema can be primary or secondary. Our patient had tender hyperpigmented induration of the lower legs, an onset of oedema at the age of 12 years, and no history of trauma or lymphangitis. She could belong to the Meige type of hereditary lymphoedema although her marked improvement with conventional compression renders this diagnosis unlikely. Acute panniculitis resembling LDS was also considered in our differential diagnosis, but there were no features to support this and the condition had been present for 3 years at presentation. The clinical findings were not those of erythema induratum or erythema nodosum. Her prompt response to compression, elevation and exercise was further supportive evidence of a problem of underlying venous insufficiency.

Intravitreal triamcinolone acetonide injection at the end of vitrectomy for diabetic vitreous hemorrhage: a randomized, clinical trial.

Purpose: To evaluate the clinical outcome and complications of intravitreal injections of triamcinolone acetonide in patients undergoing pars plana vitrectomy for treatment of diabetic nonclearing vitreous hemorrhage. Patients and Methods: This prospective, randomized clinical trial study included 72 consecutive patients (72 eyes) who underwent pars plana vitrectomy for treatment of diabetic nonclearing vitreous hemorrhage. 38 patients received an intravitreal injection of 4 mg (0.1 cc) of triamcinolone acetonide at the end of surgery. Main outcome measures were rate of recurrent early vitreous hemorrhage, reoperation, intraocular pressure, visual acuity, and incidence of cataract formation. Mean follow-up time was 6 months. Results: Rate of early rebleeding and reoperation were lower in patients taking intravitreal triamcinolone (P = 0.003 and 0.03, respectively). Visual acuity 6 months after operation was better in study group (P < 0.001). Mean intraocular pressure was higher 1 day and 1 week after procedure in study group compared with control group (P < 0.001 and 0.002, respectively); however, in other times its differences were not significant. No significant difference in rate of nuclear sclerosis and cortical cataract formation and other complication was noted between the two groups. However, there was a significantly increased rate of posterior subcapsular progression in a dose dependent manner in the study group versus control (P = 0.011). Conclusion: The present clinical study suggests that intravitreal injection of triamcinolone acetonide is effective in the prevention of rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.

Value of direct immunofluorescence in predicting remission in pemphigus vulgaris

Background  Pemphigus vulgaris is characterized by the presence of autoantibodies to desmogleins. Multiple relapses and remission may occur during the course of the disease. The goal of this study was to determine whether direct immunofluorescence study has any value in detecting immunological remission of pemphigus vulgaris.

Entrance and propagation pattern of high-frequency electrical currents in biological tissues as applied to fractional skin rejuvenation using penetrating electrodes.

Fractional resurfacing of the skin using radiofrequency devices has been used for collagen remodeling and rejuvenation.

Electrosurgery: part II. Technology, applications, and safety of electrosurgical devices.

Electrosurgical currents can be delivered to tissue in monopolar or bipolar and monoterminal or biterminal modes, with the primary difference between these modes being their safety profiles. A monopolar electrosurgical circuit includes an active electrode and a dispersive (return) electrode, while there are 2 active electrodes in bipolar mode. In monoterminal mode, there is an active electrode, but there is no dispersive electrode connected to the patients body and instead the earth acts as the return electrode. Biterminal mode uses a dispersive electrode connected to the patients body, has a higher maximum power, and can be safer than monoterminal mode in certain situations. Electrosurgical units have different technologies for controlling the output power and for providing safety. A thorough understanding of these technologies helps with a better selection of the appropriate surgical generator and modes.

The association between nuchal nevus flammeus and alopecia areata: a case-control study.

Background: The association of alopecia areata (AA) with nuchal nevus flammeus (NNF) has been demonstrated by previous studies. Objectives: The aim of this study was to investigate whether AA is associated with NNF. Methods: 199 AA patients and 215 controls without AA were examined for the presence of NNF. Results: 35 patients (17.6%) in the AA group had NNF. In the control group, 20 patients (9.3%) had NNF (odds ratio = 2.08, 95% confidence interval 1.43–2.73; p = 0.013). A statistically significant association was found between the presence of NNF and duration of the AA (p < 0.001). The presence of NNF was associated with severity of AA (p < 0.001). Conclusions: The results of our study suggest a link between NNF and AA especially in severer and more chronic forms.