Incidence of vasovagal syncope in Mohs surgery.

Although vasovagal syncopal episodes (VSE) are a well-known complication of dermatologic surgery, there are currently no studies that report an incidence of VSE in Mohs surgery specifically. This study aims to provide data on the incidence of VSE in Mohs surgery by reviewing VSE incident reports from a private, community-based, outpatient Mohs surgery clinic. We report an incidence of VSE of 0.09% in Mohs surgery. This study offers the first data on the incidence of VSE during Mohs surgery and suggests that the incidence of VSE in Mohs surgery may be lower than what has been quoted as the reference standard for dermatologic surgery.

Metastatic Adenocarcinoma of the Scrotal Skin from an Unknown Primary.

A 67-year-old white man presented with a 3-year history of progressively worsening redness and irritation on the suprapubic area, scrotum, and penis. His primary care physician had been treating him unsuccessfully with topical antifungals and corticosteroids during this time. The patient had no significant pain, fever, chills, dysuria, gastrointestinal signs, or a history of sexually transmitted diseases. There was no previous history of malignancy, and his past medical history was not significant beyond an 8 pack-year history of tobacco use that was discontinued 40 years prior.

Cyclosporine-induced infantile nodulocystic acne.

BACKGROUND: In adult organ transplant recipients, nodulocystic acne induced by the use of cyclosporine can be treated successfully with isotretinoin. Cyclosporine's acnegenic effects in children and the pediatric response to treatment are less clear. OBSERVATIONS: A 9-month-old boy presented with cysts and nodules on his face after he began cyclosporine therapy after a heart transplantation. We describe successful treatment with cessation of cyclosporine therapy and administration of isotretinoin. CONCLUSIONS: Nodulocystic acne may be induced by the use of cyclosporine in children as well as adults. When it occurs, it can be managed with cessation of cyclosporine therapy and treatment with isotretinoin. Because this management approach may influence other outcomes in children with transplants, it is best to treat these patients using a multidisciplinary approach.

Isotretinoin and the controversy of psychiatric adverse effects.

Isotretinoin is a synthetic oral retinoid that has great efficacy against severe, recalcitrant, nodulocystic acne. Since its introduction to the market, it has been associated with a variety of adverse psychiatric effects, including depression, psychosis, mood swings, violent behavior, suicide, and suicide attempts. A MEDLINE review was performed to compile all case reports, case series, adverse drug event reportings, and prospective and retrospective studies relating psychiatric adverse events to isotretinoin. In addition, literature linking a biological mechanism for psychiatric adverse events to retinoid signaling pathways was also reviewed. Although a variety of anecdotal and epidemiologic studies are available, the overall lack of concrete scientific data limits any conclusion that can be drawn about a causal relationship between istotretinoin and psychiatric adverse events. Several lines of evidence link retinoid signaling to theorized psychiatric pathogenesis, but are limited in their applicability to adult neurophysiology.

Ethnic and gender patterns for the five congenital disorders in Texas from 1992 through 1998.

The Texas Department of Health's Newborn Screening Program screens for five inherited disorders: phenylketonuria (PKU), congenital adrenal hyperplasia (CAH), congenital hypothyroidism (CH), galactosemia (GAL), and sickle cell disease (SCD). The objective of this study was to determine the prevalence of these disorders and to describe ethnic and gender patterns in their distribution. Cases were identified from blood specimens collected at birth from live births in Texas from 1992 through 1998. During this time, the overall prevalence of these disorders per 10,000 live births was 0.70 for PKU, 0.21 for GAL, 4.18 for CH, 1.03 for CAH, and 3.92 for SCD. Ethnic and gender disparities were observed among PKU, CH, CAH, and SCD prevalence. Results suggest that unidentified mutations and environmental factors may exist that contribute to these patterns. This warrants further investigation to determine possible modifiable risk factors for populations with higher prevalence.