Leonard M. Dzubow

Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: Detection and protection

Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator safety. We therefore have studied a group of human and bovine warts to define further the potential risk of wart therapy and to test whether a surgical mask could reduce exposure. Half of each wart was treated with carbon dioxide laser and the other half with electrocoagulation. The vapor produced by each form of therapy was collected with a dry filter vacuum apparatus and analyzed for the presence of papillomavirus. Vapor from human plantar warts was analyzed for the presence of human papillomavirus DNA, because there is no infectivity assay for human papillomavirus. Of plantar warts treated, five of eight laser-derived vapors and four of seven electrocoagulation-derived vapors were positive for human papillomavirus DNA. Greater amounts of papillomavirus DNA were usually recovered in the laser vapor than in the electrocoagulation vapor from the same wart. Bioassay readily detected infectious bovine papillomavirus in the vapor from bovine warts treated with either modality; more virus was present in laser-derived material. A surgical mask was found capable of removing virtually all laser- or electrocoagulation-derived virus, strongly suggesting that such masks can protect operators from potential inhalation exposure to papillomavirus.

The incidence of bacteremia in skin surgery of the head and neck

The normal microflora of skin vary significantly between sebaceous rich, wet, and dry areas. This would be expected to influence the likelihood of developing transient bacteremia while undergoing skin surgery on these different areas, thereby affecting the risk of infective endocarditis from such procedures. We evaluated the incidence of transient bacteremia in 45 patients undergoing skin surgery on the sebaceous rich areas of the head and neck. After surveillance skin cultures, aerobic and anaerobic blood culture samples were taken at 0, 1, 5, and 15 minutes after the start of the procedure. All baseline blood culture results were negative. Three of the 45 patients developed transient bacteremia within the first 15 minutes after the start of the procedures. Samples from two patients grew pure cultures of Propionibacterium acnes and that from one patient grew a pure culture of Staphylococcus hominis, yielding a 7% incidence of bacteremia in the 45 patients studied. These data support the use of perioperative prophylactic antibiotics for surgery involving clinically uninfected skin of the head and neck only in patients with prosthetic heart valves. This is in keeping with the current recommendations of the American Heart Association against the need for antibiotic prophylaxis for nonprosthetic valve endocarditis in patients undergoing cutaneous surgery on clinically uninfected skin.

Conchal bowl skin grafting in nasal tip reconstruction: Clinical and histologic evaluation

BACKGROUND It is often difficult to achieve an esthetically pleasing cosmetic match when full-thickness skin grafts from periclavicular, preauricular, or postauricular donor sites are used to repair distal nasal defects. This, in large part, is due to the highly sebaceous nature of the skin on the distal aspect of the nose. OBJECTIVE Our purpose was to describe the benefits of using donor skin from the conchal bowl to repair defects of the nasal tip. METHODS The technique of conchal bowl grafting is described. RESULTS The conchal grafts give an excellent cosmetic result with respect to color and texture match and are time efficient because the donor site can be allowed to heal by secondary intention. CONCLUSION The conchal bowl offers an esthetically reliable source of donor skin for full-thickness and perichondrial cutaneous grafts to repair defects of the nasal tip.

The interaction between propranolol and epinephrine as observed in patients undergoing Mohs' surgery

The blood pressure response to the administration of epinephrine-containing local anesthetics was studied prospectively in ten patients taking propranolol and in ten control patients. While no significant alteration in blood pressure was documented for the patients taking propranolol, the blood pressures of the control group tended to decrease following injection of anesthetic. The variation in blood pressure response between the two groups was statistically significant and represents a mild manifestation of the blockade of beta-2 receptors of the vascular beds from the propranolol. The uncommon occurrence of a malignant hypertensive response from a propranolol-epinephrine reaction is probably a dose-related, somewhat idiosyncratic sensitivity of the peripheral vasculature to the alpha pressor effect of epinephrine unmasked by the blockade of beta receptors. The risk of this catastrophic event must be weighed against the risk of precipitating a myocardial ischemic event from too rapid an alteration in propranolol dosage. Malignant hypertension is probably uncommon in patients receiving low doses of epinephrine during most dermatologic procedures.

Gene expression profiling of porokeratosis demonstrates similarities with psoriasis

Background:  Porokeratosis (PK) is a clinically heterogeneous entity associated with sharply demarcated, annular, or serpiginous lesions with a hyperkeratotic ridge. This disorder is associated with aberrant keratinocyte differentiation that histologically manifests as a stack of parakeratin termed the cornoid lamella; this structure represents the peripheral hyperkeratotic ridge of clinical lesions. Histologically, the keratinocytes forming the cornoid lamella demonstrate an altered differentiation program. However, the molecular basis of PK remains incompletely understood.

Eccrine syringofibroadenoma (Mascaro): an ultrastructural study

To confirm the eccrine acrosyringeal differentiation of eccrine syringofibroadenoma (ESFA) and to elucidate the histogenesis of its angiofibrotic stroma, a case of ESFA from a 45‐year‐old man was examined by light and electron microscopy. Histologically, the parenchyma featured anastomosing, slender epithelial cords containing small cuboidal cells and occasional duct‐like structures. The stroma had increased numbers of mast cells, increased capillaries with swollen endothelial cells, and prominent fibrosis. Ultrastructurally, the following findings were characteristic of ESFA: a) abundant glycogen particles in epithelial cells, b) numerous intracytoplasmic and extracellular spaces lined with microvilli, c) intraepithelial duct formation, consisting of microvilli, vesicles, rod‐shaped dense bodies, multivesicular dense bodies, and peripheral network of tonofilaments, and d) large numbers of mast cells, closely associated with fibroblasts, surrounding increased numbers of capillaries containing swollen endothelial cells. These ultrastructural features support the acrosyringeal differentiation of ESFA. We hypothesize that mast cell hyperplasia and degranulation may play an important role in the formation of the angiofibrolic stroma.

The fasciae of the face: An anatomic and histologic analysis

The face has two distinct fascial components--a superficial layer and a deep layer. The anatomy of the fasciae in relation to surgically significant vessels, nerves, and muscles is examined with anatomic and histologic specimens.

The isolated frontal forelock

BACKGROUND The progression and extent of male pattern baldness is statistically unpredictable. OBJECTIVE An approach to the patient with male pattern baldness is suggested, which results in a product that changes appearance in a positive way, is natural, requires no maintenance, and does not deconstruct with progression of alopecia. METHODS AND RESULTS A technique is described for transplantation of the frontal forelock allowing creation of a soft anterior zone and a dense posterior component. CONCLUSION The utilization of donor hair to create a transplanted forelock will eventuate in a product that maintains naturalness regardless of the progression or extent of future hair loss.

Comparison of preoperative skin preparations for the face.

Antiseptic preparation of the skin before dermatologic surgical procedures should provide maximal reduction of cutaneous microflora for the duration of the operation. No data currently exist concerning the efficacy of topical antimicrobials on the most common site of cutaneous surgery, the face. In this study the potency and temporal characteristics of three antimicrobials were tested on the faces of 14 volunteers. A 10-second wipe of 70% isopropyl alcohol was as effective in reducing aerobic microflora at the 5-minute postoperative period as a 60-second alcohol wipe or a 60-second povidone-iodine or chlorhexidine tincture application. At 60 minutes after the application, aerobic bacterial reduction possibly was better maintained by the povidone than by the 10- or 60-second alcohol preparation. None of the antiseptics tested were capable of a profound reduction of the anaerobic flora present on the sebaceous facial regions.

Computer simulation of the metabolism of guinea pig brain slices, and how they differ from the intact brain

A computer model of the metabolism of glutamate, glutamine, gamma-aminobutyrate and the Krebs cycle in guinea pig cortex slices has been constructed in terms of 98 reactions among 38 unlabeled species. Fitting the data from slices required the addition of a third small compartment to previous 2-compartment models based on whole brain experiments. This third compartment corresponds to the tissue damaged during the slicing process, and dominates the metabolism of 14C-labeled substrates at early times. The times required for equilibration between this additional compartment and the bulk of the slice are no longer than expected. Interpretation of short-term slice experiments may be subject to appreciable error owing to the presence of this additional compartment.