Assessing the outcomes, risks, and costs of local versus general anesthesia: A review with implications for cutaneous surgery.

BACKGROUND: There is a paucity of data providing direct comparison of outcomes, complications, and costs between general and local anesthesia in cutaneous surgery. OBJECTIVE: Analyze the literature from dermatologic and other specialties to compare outcomes, risks, and costs of general and local anesthesia. METHODS: A retrospective analysis of case comparison studies from other specialties comparing outcomes, risks, and/or costs in local versus general anesthesia was performed. A review of the literature from dermatology and other specialties was included. RESULTS: A total of 51 studies were selected; 41 of them directly examined outcomes in procedures performed under local and general anesthesia, and none found a significant difference in outcomes. A total of 41 studies measured adverse effects. Of these, 15 studies (36.6%) report significantly better outcomes between the 2 techniques. Only 2 studies (4.9%) report significantly improved outcomes with use of general anesthesia; 15 of 36 studies (41.7%) report fewer adverse events in local anesthesia. Of the 13 studies that examined costs, all (100%) found significantly decreased costs with use of local anesthesia. LIMITATIONS: These data cannot be seamlessly applied to all cases of cutaneous surgery. CONCLUSION: Local anesthesia techniques provide outcomes equal to or better than general anesthesia and with significantly lower costs.

Calcinospherules: A Unique Morphology of Dystrophic Calcification That Mimics Deep Fungal Infection.

Dystrophic calcification may occur in association with cutaneous neoplasms. We report the case of a 50-year-old woman with unusual appearing dystrophic calcification that was mistaken for coccidiomycosis during Mohs micrographic surgery for an invasive squamous cell carcinoma on the lower lip. The term "calcinospherule" is suggested as a term to describe the round calcified bodies found within the lesion that mimicked spherules with endospores characteristic of Coccidioides imitis infection. Both the dermatopathologist and Mohs micrographic surgeon should be aware of this entity as well as other calcified bodies that may be encountered in Mohs micrographic surgery frozen sections. Literature regarding these calcified bodies is briefly reviewed.

Multiple linear leiomyomas of the forehead as the presenting sign of Reed syndrome.

A 62-year-old female presented with a linear arrangement of multiple asymptomatic, discrete, dome-shaped, smooth, skin-colored papules and nodules involving the left forehead. Histopathology showed a poorly circumscribed nodule of haphazardly arranged fascicles of smooth muscle cells involving the papillary and superficial reticular dermis. Genetic testing revealed the patient to be heterozygous for the R233H mutation in the fumarate hydratase gene. Clinical, microscopic, and genetic findings were consistent with a diagnosis of Reed syndrome. Reed syndrome is a rare disorder defined by cutaneous and uterine leiomyomas and, uncommonly, renal cell carcinoma.

Amiodarone induced liver cirrhosis. Report of two cases.

Amiodarone is used commonly in patients with cardiac diseases. Common side effects include thyroid dysfunction and hepatic abnormalities. However, recently there has been concern for developing liver cirrhosis secondary to amiodarone therapy. We present two cases of liver cirrhosis in patients taking amiodarone. Their clinical presentation as well as histological features are discussed in detail.