Muba Taher

Insights into the contemporary epidemiology and outpatient management of congestive heart failure.

OBJECTIVES To evaluate the epidemiology, prognosis, and patterns of practice in patients with chronic congestive heart failure (CHF) treated and followed at a specialized clinic. METHODS Prospective cohort study of consecutive patients referred to and followed up in a specialized heart failure clinic between September 1989 and March 1996. RESULTS Of the 628 patients referred, 566 were confirmed to have CHF. Mean duration of follow-up was 518 +/- 490 days (range 1 to 2192 days). Vital status was available for 99.3% of patients. Mean age at enrollment was 66 years, 68% were men, 67% had an ischemic cause of heart disease, and 78% had systolic dysfunction. Patients with preserved systolic function were older, more often female, had higher mean systolic blood pressures, and a lower prevalence of ischemic heart disease, ventricular arrhythmias, or impaired renal function when compared with those with systolic dysfunction (all P </=.001). Although there was a significant negative trend in survival with decreasing ejection fraction (P =. 03), the survival experience of those with CHF and preserved systolic function did not significantly differ from those with systolic failure (P =.25). Multiple logistic regression analysis showed increased mortality risk was associated with increasing age, New York Heart Association class IV, ischemic cause of disease, elevated serum creatinine level, use of diuretics, and systolic dysfunction, whereas use of beta-blockers was associated with reduced risk. CONCLUSIONS Our data suggest that a specialized outpatient clinic can improve practice patterns in patients with CHF. The high mortality risk in CHF with preserved systolic function suggests the need to find efficacious (and effective) therapies for this condition.

Squamous Cell Carcinoma Arising in a Nevus Sebaceous of Jadassohn in a 9‐Year‐Old Girl: Treatment Using Mohs Micrographic Surgery with Literature Review

Jadassohn first described nevus sebaceous of Jadassohn (NSJ), a localized skin malformation, in 1895. Mehregan and Pinkus outlined three clinical stages of NSJ development. During the first stage, in infancy and childhood, the NSJ usually appears as a smooth, alopecic, orange-yellowish skin thickening. A second stage occurs in puberty, when the NSJ thickens and contains verrucous papules, plaques, or both. A third stage may occur in adulthood characterized by development of benign and malignant tumors in the original nevus.

Acrokeratosis paraneoplastica (Bazex syndrome) presenting in a patient with metastatic breast carcinoma: possible etiologic role of zinc.

Background: Bazex syndrome (acrokeratosis paraneoplastica) is a rare paraneoplastic syndrome that usually occurs in males over 40 years old and is particularly associated with squamous cell carcinoma of the upper aerodigestive tract and adenopathy above the diaphragm. Objective: The objectives of our article are (1) to describe a unique case of acrokeratosis paraneoplastica and (2) to review the current literature regarding skin findings, commonly associated neoplasms, and treatment options relative to this condition. Patient: We describe a 68-year-old female with lobular breast carcinoma, complicated by local and distant recurrences, who presented with a 1-year history of prominent acral skin and nail changes. Results: Our patients clinical skin findings improved significantly following treatment and partial remission of her underlying malignancy. Conclusions: Our patient represents one of few females described with this syndrome, which is especially rare in association with lobular breast carcinoma. Further, the patients presentation is unique as she was discovered to demonstrate laboratory findings consistent with coexistent porphyria cutanea tarda and relative zinc deficiency.

Staged margin-controlled excision (SMEX) for lentigo maligna melanoma in situ

No consensus exists regarding the best surgical strategy to achieve clear surgical margins while minimizing tissue excision when definitely excising lentigo maligna melanoma in situ (LM). The staged margin controlled excision (SMEX) technique is a modification of the spaghetti technique that allows surgeons to minimize margins and ensure complete excision of LM.

Sun-Smart Practices Amongst School Students (Grades 5, 7, and 9) in Alberta, Canada:

Objectives: The aim of this study was to assess the current knowledge children possess on melanoma and sun-protective behaviour. Methods: A one-page survey was administered to students in grades 5, 7, and 9. Results: Three hundred ninety-two students from 11 schools in Edmonton were surveyed. Seventy-one percent of students knew that sun exposure can cause skin cancers. Sixty-nine percent were taught by their parents about sun protection, but only 44% of students received similar instructions from teachers. Twenty percent of students indicated that they never or rarely wore sunscreen. Twenty-five percent of students had experienced painful sunburns, and only 46% were willing to use sunscreen if it were available at school. More Caucasian students reported painful or peeling sunburns in each grade level than their non-Caucasian peers (for grade 5, P = .003; for grade 7, P < .0001; for grade 9, P = .001). For all grade levels, the percentage of Caucasian students who indicated that they would not wear sunscreen when going out in the sun was greater than among their non-Caucasian peers (for grade 5, P < .001; for grade 7, P = .003; for grade 9, P = .015). Conclusions: A comprehensive and focused approach to sun-smart education is recommended for students.