Management of Fibrous Hamartoma of Infancy: A Contemporary Series.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is a rare, benign, soft tissue mass that may be locally infiltrative. Primary excision is the mainstay of treatment; however, given the infiltrative nature, margin negativity can be difficult to achieve. The management of residual disease in the setting of positive margins after primary excision is not well described. METHODS: All patients undergoing FHI excision from 2012 to 2022 were included. Demographics, operative data, margin status, recurrence, and post-operative follow-up data were obtained via retrospective chart review. RESULTS: Nine patients were identified who underwent FHI excision. The median age at time of excision was 9 months (IQR 16). Seven (78%) were male, and the majority (78%) were white. Seven (78%) underwent preoperative imaging via ultrasound or MRI, and 4 (44%) had a preoperative biopsy to confirm diagnosis. Common locations included upper extremity (n = 4, 44%) and lower extremity/inguinal region (n = 4, 44%). Six patients (67%) had positive margins on pathology - 3 (33%) on the upper extremity, 2 (22%) on the lower extremity/inguinal region, and one (11%) on the flank. One patient (11%) had a local recurrence which did not undergo re-excision. CONCLUSIONS: FHI remains a rare diagnosis. There is a high margin positivity rate; however, local clinically significant mass recurrence remains uncommon. With low rates of clinically significant mass development coupled with the benign nature of disease, a "watch and wait" approach may be appropriate for patients with positive histologic margins after complete gross excision to avoid reoperation and need for complex reconstructions. LEVEL OF EVIDENCE: Level 4.

Pharmacokinetic drug evaluation of paliperidone in the treatment of schizoaffective disorder.

INTRODUCTION: This paper reviews the pharmacokinetics, receptor binding, clinical efficacy and safety of paliperidone in the treatment of patients with schizoaffective disorder. Areas covered: We reviewed the literature using keywords 'paliperidone', 'schizoaffective disorder' and 'clinical trials' with a focus on seminal data papers and information that is clinically relevant to the treatment of schizoaffective disorder. The purpose of this paper is to provide a clinically oriented review of the pharmacokinetic and pharmacodynamic properties of paliperidone including receptor binding, clinical efficacy, safety and tolerability. Expert opinion: Paliperidone is currently the only medication FDA approved specifically for the treatment of schizoaffective disorder. Paliperidone is an active metabolite of risperidone, is minimally metabolized in the liver and is primarily known to be cleared through the kidneys. For this reason, paliperidone could be considered for some patients with schizoaffective disorder who also have hepatic impairment. After correcting for the reduced protein binding that is characteristic of hepatically impaired patients, the Cmax was 12% lower than in healthy subjects while the AUC and CL/F were comparable [14]. In addition, the availability of long acting injectable formulations may be useful for patients who are non-adherent with oral medications. The cost of paliperidone may be a disadvantage.

The use of diode array spectroradiometers for dosimetry in phototherapy.

An evaluation of two diode array radiometers, an UV spectroradiometer, Type SC-MP-A, from 4D Controls (Redruth, UK) and an USB2000-UV-VIS spectrometer from Ocean Optics (Duiven, NL), was carried out at the Photobiology Unit, University of Dundee. Three parameters of the instruments' performance were investigated, having been identified as the most likely sources of error in phototherapy dosimetry: (1) calibration, (2) stray light rejection, (3) angular response. An assessment was then made of the reliability of this type of instrument for dosimetry in clinical practice by measurement of a selection of phototherapy sources, in direct comparison with calibrated radiometers. Both instruments were found to have significant stray light levels (SC: 13% and USB: 39%). The use of stray light compensation and a high output calibration source improves accuracy to within acceptable limits. Angular responses were satisfactory: f2 values (+/- 60 degrees) of 5.9% and 7.8% for SC and USB, respectively. The SC spectroradiometer is supplied as a calibrated instrument. Using the supplied calibration resulted in errors in measuring phototherapy sources of up to 44% in UVA. Alternative calibration reduced the error in measuring UVA and UVB sources to within 12%. The USB spectrometer was found to have insufficient responsivity in both UVB and UVA to provide reproducible measurements of most phototherapy sources.

Clustered outbreak of skin and eye complaints among catering staff.

In August 2002, kitchen staff at a hotel in Central Scotland experienced skin and eye problems believed to be related to their working environment. Of a total of 20 staff, eight cooks reported problems with a painful red skin affecting the face, eyelids, side and front of neck as well as burning, gritty eyes. Five of the affected individuals were clinically assessed in April 2003. The overall clinical impression was of conjunctivitis and sunburn-like erythema. Examination of the data sheets of all cleaning agents and sprays used within the kitchen pointed against an environmental phototoxin. The kitchen area was inspected and two electric fly killers positioned on the ceiling and sidewalls were found to be incorrectly fitted with UVC tubes. The output of these tubes was spectroradiometrically assessed. The recommended unprotected skin and eye exposure limit was reached in 14 s at a distance of 30 cm from the tubes. An exposure of about 60 s would be sufficient to induce minimal erythema in someone of skin type I/II. These results demonstrate the importance of exposure to ultraviolet radiation as a possible cause of facial erythema and conjunctivitis, no matter how unlikely this may seem. It is recommended that there should be increased awareness of the need to fit the correct type of lamps to electric fly killers and other devices that incorporate UV lamps.