Padraic J. Regan

Parsonage-Turner syndrome-case report and literature review.

Parsonage–Turner syndrome is the term used to describe a neuritis involving the brachial plexus. It may present with symptoms of an isolated peripheral nerve lesion, although the pathology is thought to lie more proximally. A case describing an isolated anterior interosseus nerve palsy due to an acute brachial neuritis is presented where the electromyographic findings confirmed the diagnosis, but also demonstrated the coexistence of a dual pathology in the form of a cervical radiculopathy. The literature is reviewed regarding etiology, treatment, and prognosis.

Pregnancy as an autologous tissue expander for closure of an abdominal-wall defect

We report the reconstruction of a complex abdominal-wall defect using expanded skin from pregnancy. Wound closure was achieved using a vertical abdominoplasty.

An Assessment of Histological Margins and Recurrence of Melanoma In Situ

Background: Melanoma in situ (MIS) accounts for up to 27% of all melanomas. MIS has no metastatic potential and the aim should be to excise the lesion completely with a clear histological margin, although margin clearance remains undefined. We aimed to assess the relation of histological excision margins of MIS to recurrence and progression to invasive disease. Methods: We analyzed all patients with MIS excised by wide local excision or staged excision in our institution over a 5-year period from December 2008 to January 2014 using a prospectively maintained database. Clinicopathologic details included patient demographics, anatomical site of lesion, melanoma subtype, histological excision margin, and recurrence. Results: A total of 410 patients had MIS excised during this time, the majority of which were lentigo maligna subtype (79%). The average histological excision margin was 3.7 mm. The rate of recurrence was 2.2% (9/410), with a median follow-up of 23 months. Lentigo maligna had a similar rate of recurrence to non-lentigo MIS (2.3% vs 1.2%) (P = 0.69). The mean excision margin of those that recurred was 1.9 mm compared with an average of 3.8 mm in those that did not. The rate of recurrence of MIS with histological excision margin ⩽3.00 mm was 3.8% compared with 0.5% in those with a histological margin >3.00 mm (P = 0.03). One case of MIS recurred as invasive disease. Conclusion: At institutions using wide local excision or staged excision for MIS, a histological margin of >3.0 mm is required to achieve a low recurrence rate.

The trap door flap for reconstructing defects of the concha

We report six cases of conchal neoplasms where the defect was reconstructed with a Trap Door Flap based on the post auricular vessels. The flap was reliable and gave good cosmetic results.

Silver nitrate masquerading as a radiopaque foreign body.

Silver nitrate is commonly used as a method of chemical cauterization to areas of hypergranulation. We report two cases wherein silver nitrate in the hand was misinterpreted radiologically as foreign bodies.

100 citation classics in the melanoma literature: a bibliometric analysis.

BACKGROUND Modern immunologic therapies targeting genetic mutations have created a renewed interest in melanoma research, and this is reflected in the increasing number of published works. OBJECTIVE The purpose of this study was to identify the top 100 most cited articles in melanoma and to examine the characteristics of each individual article. METHODS Using an electronic database through the Web of Science, we were able to determine the 22 journals that contributed to the 100 most cited articles in melanoma. RESULTS Each article was examined individually looking at characteristics such as subject matter, article type, country of origin, institution, authorship, and year of publication. The New England Journal of Medicine contributed the most articles to the top 100 with 20 articles, whereas the most cited article originated from the Archives of Surgery and has been cited 2,384 times. The United States produced 74% of the top 100 articles, and the most prolific institution was the National Cancer Institute in Maryland with 18 articles. CONCLUSION This study has identified the most significant contributions to melanoma research over the past 63 years and identifies many important scientific breakthroughs and landmarks that have occurred during this time.

Button holes: novel deepithelialization technique in reduction mammaplasty.

Reduction mammaplasty procedures are straightforward operations that generally result in high levels of patient satisfaction, but they can also prove to be time-intensive and tedious for the surgeon.1 Although several pedicle techniques have been described in the literature, the inferior pedicle technique is still the most commonly employed, particularly when larger volumes of breast tissue are being removed.2 Deepithelialization has been a constant component in reduction mammaplasty procedures since originally being introduced by Schwarzmann et al in 1937.3 It was initially described as an effort to preserve blood supply to the nipple-areola complex (NAC). The principal blood supply to the NAC is derived from the internal mammary artery and intercostal perforator arteries via the breast …

Skin cancer risk and the use of UV nail lamps

1. Teulings HE, Overkamp M, Ceylan E et al. Decreased risk of melanoma and nonmelanoma skin cancer in patient with vitiligo: a survey among 1307 patients and their partners. Br. J. Dermatol. 2013; 168: 162–71. 2. Schallreuter KU, Tobin DJ, Panske A. Decreased photodamage and low incidence of non-melanoma skin cancer in 136 sun-exposed Caucasian patients with vitiligo.Dermatology 2002; 204: 194–201. 3. Schallreuter KU, Behrens-Williams S, Khaliq TP et al. Increased epidermal functioning wild-type p53 expression in vitiligo. Exp. Dermatol. 2003; 12: 268–77. 4. Centre for Epidemiology and Evidence. 2010 Reports on Adult Health From the New South Wales Population Health Survey. Sydney, NSW: NSW Department of Health, 2011. 5. Taieb A, Picardo M. Vitiligo. N. Engl. J. Med. 2009; 360: 160–9. 6. Mohammed TF, Al-Jamal M, Hamzavi IH et al. The vitiligo working group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J. Am. Acad. Dermatol. 2017; 76: 879–88. 7. Hexsel CL, Eide MJ, Johnson CC et al. Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo. J. Am. Acad. Dermatol. 2009; 60: 929–33. 8. Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: a review of the literature. Int. J. Dermatol. 2005; 44: 355–60. 9. Hearn RM, Kerr AC, Rahim KF et al. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br. J. Dermatol. 2008; 159: 931–5. 10. Paradisi A, Tabolli S, Didona B et al. Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo. J. Am. Acad. Dermatol. 2014; 71: 1110–6. 11. Feily A, Pazyar N. Why vitiligo is associated with fewer risk of skin cancer?: providing a molecular mechanism. Arch. Dermatol. Res. 2011; 303: 623–4. 12. Shen C, Gao J, Sheng Y et al. Genetic susceptibility to vitiligo: GWAS approaches for identifying vitiligo susceptibility genes and loci. Front. Genet. 2016; 7: 3. 13. Naveh HP, Rao UNM, Butterfield LH. Melanoma-associated leukoderma–immunology in black and white? Pigment Cell Melanoma Res. 2013; 26: 796–804. 14. Byrne KT, Turk MJ. New perspective on the role of vitiligo in immune response to melanoma. Oncotarget 2011; 2: 684–94.

High-risk squamous cell carcinoma of the ear - A potential role for sentinel node biopsy: High risk SCCS of the ear and sentinel node biopsy

Background Squamous cell carcinomas (SCCs) of the external ear have a significant rate of metastasis. The purpose of this study was to present analyzed factors associated with auricular SCC metastasis in order to identify a group that may benefit from sentinel lymph node biopsy (SLNB). Methods We performed a retrospective review of all operable SCCs between 2009 and 2014. The association between high-risk features and metastasis were analyzed. Results One hundred eighty-nine auricular SCCs were excised. Local recurrence was noted in 11% and 9.5% developed metastases. Cartilage, perineural, and lymphovascular invasion were significantly associated with metastasis, as were increased tumor depth and diameter (P < .001). All patients with metastasis developed nodal disease. Conclusion Factors, including poor differentiation, perineural, cartilage, and lymphovascular invasion, are associated with auricular SCC metastasis. Patients with 2 or more high-risk features may benefit from SLNB in order to identify and treat early nodal disease and possibly reduce the risk of further spread.Squamous cell carcinomas (SCCs) of the external ear have a significant rate of metastasis. The purpose of this study was to present analyzed factors associated with auricular SCC metastasis in order to identify a group that may benefit from sentinel lymph node biopsy (SLNB).

Second to Fourth Digit Ratios in Plastic Surgery.

The second to fourth digit ratio (2D:4D) is the ratio of the length of the index finger (2D) to the length of the ring finger (4D), and it is the most powerful human dimorphic digital ratio combination.1 The 2D:4D is a well-recognized physical marker of intrauterine androgenic steroid exposure with the index finger length being a measure of the amount of intrauterine estrogen exposure and the ring finger length acting as a measure of intrauterine androgen exposure. Low digit ratios have been shown to be associated with increased assertiveness and risk taking,2 aggression, sporting prowess,3 and improved visuospatial ability. Good visuospatial awareness has been explicitly linked to surgical performance, and it is now utilized as an essential criterion in the selection process for surgical training.