RESUMO
BACKGROUND: Patients awake during staged cutaneous surgery procedures may experience procedure-related pain. OBJECTIVE: To determine whether the level of pain associated with local anesthetic injections prior to each Mohs stage increases with subsequent Mohs stages. METHODS: Multicenter longitudinal cohort study. Patients rated pain (visual analog scale: 1-10) after anesthetic injection preceding each Mohs stage. RESULTS: Two hundred fifty-nine adult patients presenting for Mohs who required multiple Mohs stages at 2 academic medical centers were enrolled; 330 stages were excluded due to complete anesthesia from prior stages, and 511 stages were analyzed. Mean visual analog scale pain ratings were nominally but not significantly different for subsequent stages of Mohs surgery (stage 1: 2.5; stage 2: 2.5; stage 3: 2.7: stage 4:2.8: stage 5: 3.2; P = .770). Between 37% and 44% experienced moderate pain, and 9.5% and 12.5% severe pain, during first as versus subsequent stages (P > .05) LIMITATIONS: Both academic centers were in urban areas. Pain rating is inherently subjective. CONCLUSIONS: Patients did not report significantly increased anesthetic injection pain level during subsequent stages of Mohs.
Assuntos
Anestésicos Locais , Lidocaína , Adulto , Humanos , Anestésicos Locais/efeitos adversos , Lidocaína/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Cirurgia de Mohs/métodos , Estudos Prospectivos , Estudos Longitudinais , Dor/etiologiaRESUMO
Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/educação , Procedimentos Cirúrgicos Dermatológicos/educação , Treinamento por Simulação/métodos , Técnicas de Sutura/educação , Procedimentos Cirúrgicos Ambulatórios/métodos , Animais , Competência Clínica , Procedimentos Cirúrgicos Dermatológicos/métodos , Dermatologia/educação , Dermatologia/métodos , Humanos , Internato e Residência , Pele , Pele Artificial , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , SuínosRESUMO
While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to systemic reactions, high energy systems, and trauma are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of surgical emergencies can mitigate any associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue.
Assuntos
Anafilaxia/etiologia , Anestésicos Locais/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Traumatismos Oculares/etiologia , Terapia a Laser/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Anafilaxia/diagnóstico , Anafilaxia/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Emergências , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/terapia , Incêndios , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/terapia , Humanos , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/terapia , Fatores de RiscoRESUMO
While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to vascular occlusion, hypertension, and hypotension are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of these emergencies can mitigate or forestall associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue.
Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/terapia , Emergências , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Hipotensão/etiologia , Hipotensão/terapia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapiaRESUMO
Acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome is a rare form of autosomal dominant ectodermal dysplasia due to mutations in the TP63 gene, a locus that has also been implicated in other syndromic forms of ectodermal dysplasia. It shares many phenotypic characteristics with other TP63 gene mutation syndromes, often making an accurate diagnosis difficult. Long-term management and follow-up of the various sequelae of ectodermal dysplasia require an accurate diagnosis. We report a familial case of ADULT syndrome in a daughter, mother, and son and provide a brief review of the clinical characteristics of this syndrome.
Assuntos
Anodontia/diagnóstico , Mama/anormalidades , Displasia Ectodérmica/diagnóstico , Predisposição Genética para Doença , Obstrução dos Ductos Lacrimais/diagnóstico , Deformidades Congênitas dos Membros/diagnóstico , Unhas Malformadas/diagnóstico , Linhagem , Transtornos da Pigmentação/diagnóstico , Fatores de Transcrição/genética , Proteínas Supressoras de Tumor/genética , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/epidemiologia , Adolescente , Adulto , Anodontia/epidemiologia , Anodontia/genética , Criança , Diagnóstico Diferencial , Displasia Ectodérmica/epidemiologia , Displasia Ectodérmica/genética , Feminino , Humanos , Obstrução dos Ductos Lacrimais/epidemiologia , Obstrução dos Ductos Lacrimais/genética , Deformidades Congênitas dos Membros/epidemiologia , Deformidades Congênitas dos Membros/genética , Mães , Mutação , Unhas Malformadas/epidemiologia , Unhas Malformadas/genética , Transtornos da Pigmentação/epidemiologia , Transtornos da Pigmentação/genética , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , IrmãosRESUMO
OBJECTIVE: To determine the motivating factor for why men seek urologic care and determine persistence of these symptoms and any factors that influence resolution. METHODS: Men presenting to an outpatient urology clinic with lower urinary tract symptoms (LUTSs) were prospectively evaluated. At each of 2 visits, surveys were administered including the American Urological Association Symptom Index and a chief LUTS complaint (CLC) identification form. On the CLC identification form, symptoms were considered "transient" if only seen at V1 and "persistent" if they were selected at both visits. RESULTS: Sixty-five percent of the 1240 participants were able to specify a CLC. Among these, nocturia was by far the most common and was found to be persistent in 49% of cases. When comparing the groups of patients who presented with transient verses persistent nocturia, older age (P <.001), diabetes (P = .006), hypertension (P = .033), alpha-blocker use (P = .018), 5-alpha-reductase inhibitor use (P = .008), higher nocturia severity (P <.001), and more severe American Urological Association Symptom Index scores at initial visit (P = .047) were found to be predictors of persistent nocturia. CONCLUSION: Most men with LUTS can identify a predominant CLC. Of these, nocturia is the primary CLC of most men and does not improve in almost 50% of those studied. By improving our identification of a predominant CLC and the patient factors that influence both the development and persistence of urinary symptoms, we may start to better evaluate and hopefully focus treatment on the most bothersome urinary symptom.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Seguimentos , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Noctúria/epidemiologia , Noctúria/fisiopatologia , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos , UrodinâmicaRESUMO
A 7-week-old boy presented to the pediatric dermatology clinic for evaluation of diffuse blue lesions on the skin. The mother first noticed a bluish lesion on the left thigh at 6 to 7 weeks of age. The child quickly developed several similar lesions and deeper nodules on the head, arms, and trunk. He had a history of ankyloglossia and subsequent uncomplicated repair, as well as a sister with neonatal anemia. He was otherwise well and thriving. Review of systems was unremarkable. His birth involved an uncomplicated delivery, with negative maternal serology. There was no history of maternal infection or recent exposure to infection. Physical exam revealed a well-appearing, non-dysmorphic, vigorous infant. Skin exam was notable for numerous dusky erythematous and violaceous-blue patches and nodules on the anterior scalp, bilateral arms, legs, face, and trunk - including the diaper area. Lesions ranged in size from 1 to 3 cm. The nodules were firm and non-tender. The remainder of his physical examination was normal without abnormal lymphadenopathy or hepatosplenomegaly noted. No mucosal lesions were noted. A biopsy was performed on a thigh lesion.
Assuntos
Leucemia Mieloide Aguda/patologia , Infiltração Leucêmica , Pele/patologia , Humanos , Lactente , MasculinoRESUMO
Ganglioside GM3 mediates adipocyte insulin resistance, but the role of GM3 in diabetic wound healing, a major cause of morbidity, is unclear. The purpose of this study was to determine whether GM3 depletion promotes diabetic wound healing and directly activates keratinocyte (KC) insulin pathway signaling. GM3 synthase (GM3S) expression is increased in human diabetic foot skin, ob/ob and diet-induced obese diabetic mouse skin, and in mouse KCs exposed to increased glucose. GM3S knockout in diet-induced obese mice prevents the diabetic wound-healing defect. KC proliferation, migration, and activation of insulin receptor (IR) and insulin growth factor-1 receptor (IGF-1R) are suppressed by excess glucose in wild-type cells, but increased in GM3S (-/-) KCs with supplemental glucose. Co-immunoprecipitation of IR, IR substrate 1 (IRS-1), and IGF-1R, and increased IRS-1 and Akt phosphorylation accompany receptor activation. GM3 supplementation or inhibition of IGF-1R or PI3K reverses the increased migration of GM3S(-/-) KCs, whereas IR knockdown only partially suppresses migration.