A cross-cultural nursing experience on the Rosebud Reservation.

The study of diverse cultures is integral to a liberal arts education. To meet the needs of a changing society, nurse educators must develop strategies to improve nursing students' knowledge of how to provide culturally sensitive care. The author describes the development and implementation of a course with clinical.

Surgical treatment of subcutaneous calcifications of polymyositis or dermatomyositis.

The "tumoral" calcifications seen with polymyositis and dermatomyositis are frequently large and painful. Many surgeons believe such calcifications should not be removed surgically, arguing that the surgical trauma induces further calcification that is probably ever more severe. However, we believe that surgical removal of these large masses is less traumatic than cyclical, spontaneous extrusion of the calcium with secondary healing. We present 2 patients in whom chronically draining and painful dystrophic calcifications were treated surgically without recurrence.

Lymphomatoid papulosis: a proposed treatment plan.

An example is presented of the chronic, nonhealing ulceration that may be present with lymphomatoid papulosis. A treatment plan is outlined, and the importance of long-term follow-up for signs of disseminated malignancy is emphasized.

Giant keratoacanthomas.

A patient with multiple keratoacanthomas association with a well-differentiated squamous cell carcinoma is presented. Incomplete excision of a keratoacanthoma deprives the pathologist of his main criteria in differentiating this lesion from a squamous cell carcinoma. Wide excision appears to be the treatment of choice. Multiple keratoacanthomas can be associated with squamous cell carcinomas, which initially look identical. Persistence with conservative treatment in a growing lesion can fail to deal with an invasive squamous cell carcinoma which will require disfiguring or mutilating operations to cure. Squamous cell carcinoma does develop in keratoacanthomas, but metastases are rare.

Subpectoral augmentation mammaplasty.

We have done subpectoral augmentations on 100 women to enlarge the small or hypomastic breast to a pleasing degree. These operations were performed in a major hospital operating room, under local anesthesia, on an ambulatory basis. No complications were encountered. Our goal, and that of our patients, was to enlarge the small breast to a pleasing degree which would harmonize with the body contour and form, and to maintain the natural consistency of the breast and the normal sensation of the nipple and the breast as a whole. This goal was reached and our patients have been appreciative and pleaded. There was no postoperative weakness of the pectoralis muscle, and we have seen no evidence of capsule contracture. The group represents about one percent of our overall experience with augmentation mammaplasty.

Dermal cylindroma (turban tumor). Case report.

We present an unusual case of massive dermal cylindroma (turban tumor), occupying the entire scalpand forehead. It was treated by a total scalping procedure and skin grafting in two stages. Additional tumors of the face, neck, chest, shoulders, and back were excised and closed. The nose was treated by shoving and dermabrasion, similar to a rhinophyma. The lip was treated by dermabrasion. There has been no evidence of recurrence in the scalp which was treated by excision and grafting. There is now a papular quality of the skin over the nose and on the uppler lip, indicating that regrowth may occur. The etiology, pathology, and a review of the literature are presented.

Congenital giant nevi: clinical and pathological considerations.

A clinical and pathological review of 67 cases of congenital giant nevi and of 5 cases of malignant transformation in congenital giant nevi brings out the following. 1. The lesions should be regarded as premalignant. 2. An aggressive approach is advocated to remove the lesion before school age. 3. Staged excisions, combined with skin grafting and/or local rotation flaps, are advocated. 4. Any nodularity or ulceration developing within a congenital giant nevus should be regarded as an ominous sign. 5. A long-term follow-up is necessary in those patients having subtotal excisions.

Dynamic correction of unilateral paralysis of the lower lip.

We present a simple operation, performed under local anesthesia, to restore essential movement to the side of a lower lip paralyzed by injury to the mandibular branch of the facial nerve. The operation consists of a limited lateral resection of the paralyzed lower lip, plus transposition of the segment of orbicularis muscle from the paralyzed lower lip to the normal upper lip, through a subcutaneous tunnel.

Intralesional BCG, intravenous immune lymphocytes, and immunization with neuraminidase-treated tumor cells to manage melanoma; A clinical assessment.

An attempt was made to produce tumor immunity in 193 patients who had melanoma, 160 of whom had metastases and 33 of whom did not. Four stages of treatment are outlined. The patients whose disease was confined to the skin, subcutaneous tissues, and lymph nodes seemed to benefit most. The treatment was of no benefit to patients whose disease had progressed to the visceral, skeletal, or central nervous systems.