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Biomedical subjects

C C Otley

Publications and source records attributed to C C Otley.

At least 37 records · Page 2Linked to original sources
PubMed1999

Factitious disease of periocular and facial skin.

PURPOSE: To describe the clinical appearance of factitious (or self-inflicted) lesions on periocular skin and face. METHODS: All patients with factitious cutaneous disease who were examined at Mayo Clinic, Rochester, Minnesota, between 1985 and 1997 were identified. For patients with lesions on the face and periocular skin, the demographic features, clinical descriptive characteristics of their lesions, associated psychopathology, and treatments were ascertained. RESULTS: Of 38 patients with factitious dermatitis, 18 (47%) had facial lesions. Of these 18 patients, 15 (83%) were female. The mean age (+/- SD) of the patients with facial lesions was 35.2 +/- 15.7 years (range, 9 to 66 years). Eight patients (44%) had neurotic excoriations, nine (50%) had dermatitis artefacta, and one (6%) had trichotillomania. The working diagnoses of five patients cared for initially in the Department of Ophthalmology were corneal epithelial and facial desquamation associated with severe pain of unknown cause, medial cicatricial ectropion of probable vasculitic cause, basal cell carcinoma of the nasojugal fold, recurrent preseptal cellulitis resistant to medical treatment, and madarosis of the upper eyelids of unknown cause. CONCLUSION: Cutaneous factitious disease may masquerade as numerous clinical entities and should be included in the differential diagnosis of lesions of the periocular skin.

Adolescent↗
PubMed1999

Gabapentin for the treatment of dysesthetic pain after reconstructive surgery.

BACKGROUND: Debilitating, postoperative dysesthetic pain after reconstructive surgery is a rare but problematic complication. Conventional therapy is either marginally effective or fraught with side effects. Gabapentin is a new, novel antiepileptic drug helpful in the management of other pain states. OBJECTIVE: A case of disturbing, postoperative dysesthetic pain after reconstructive surgery is presented. METHODS: A trial of gabapentin in escalating dose was initiated and the results and side effects were recorded. RESULTS: Treatment with gabapentin was associated with a substantial decrease in pain, which relapsed after tapering the medication. Relief was obtained with dose escalation, and a successful taper was eventually accomplished. Side effects were minimal. CONCLUSION: This is the first reported use of gabapentin in the treatment of postoperative dysesthetic pain. Although this type of neuropathic pain is difficult to manage, gabapentin produced substantial relief with few side effects. Further investigation is warranted.

Acetates↗
PubMed1999

Preoperative and postoperative topical tretinoin on high-tension excisional wounds and full-thickness skin grafts in a porcine model: A pilot study.

BACKGROUND: Tretinoin induces neovascularization and the formation of collagen when applied topically. OBJECTIVE: The goal was to determine whether preoperative and postoperative treatment with tretinoin enhances the healing of high-tension, full-thickness excisional wounds and the survival of full-thickness skin grafts. METHODS: A blinded, randomized, placebo-controlled pilot study involved high-tension excisional wounds and full-thickness skin grafts treated perioperatively with tretinoin in a porcine model. RESULTS: Perioperative treatment of high-tension excisional surgery sites with tretinoin appeared to have no consistent beneficial or adverse effects on wound healing or scar spreading. In the full-thickness skin graft model, a trend toward impaired wound healing was noted. CONCLUSION: The collagen-inducing effects of topical tretinoin do not appear to enhance the healing of high-tension excisional surgery wounds in a porcine model. Tretinoin does not appear to improve the survival of full-thickness skin grafts and, in fact, a detrimental effect was apparent in our model.

Administration, Topical↗
PubMed1999

The phlebectomy probe: a new and useful instrument for ambulatory phlebectomy.

BACKGROUND: Tethering of varicose veins by periadventitial connective tissue can limit the length of vein segment that can be avulsed during ambulatory phlebectomy. A thin, malleable blunt probe is described which can dissect connective tissue adhesions surrounding varicose veins. This probe can be used as an endoluminal probe to localize elusive veins. OBJECTIVE: We describe the use of a new type of phlebectomy probe for periadventitial dissection and endoluminal probing during ambulatory phlebectomy. METHODS: The techniques of periadventitial dissection and endoluminal probing are reviewed. RESULTS: The phlebectomy probe seems to permit extraction of longer segments of varicose veins after releasing periadventitial adhesions. Endoluminal probing can assist in difficult localization of venous segments. CONCLUSION: The phlebectomy probe can be helpful for releasing periadventitial adhesions that tether varicose veins. Its application is simple and can result in increased length of avulsed varicose vein segments, thereby reducing the number of incisions needed.

Ambulatory Surgical Procedures↗
PubMed1998

Reinnervation of flaps and grafts of the face.

BACKGROUND: The degree to which disruption of sensory innervation is affected by flaps and grafts on the face has not been explored. The decision to choose a flap or a graft for reconstruction may affect future sensation at the surgical site. OBJECTIVES: To characterize the clinical recovery of sensory innervation after facial reconstructive surgery with flaps and grafts and to offer clinical guidelines on the recovery of sensation in reconstructed sites involving flaps and grafts of the face. METHODS: Seventy patients who underwent Mohs surgery and subsequent repair by either a flap or a graft were evaluated at different postoperative intervals. Fifty patients underwent flap reconstruction and 20 patients underwent graft reconstruction. Three principal modes of sensation were objectively assessed: light touch, temperature, and pinprick. RESULTS: Median time of evaluation after surgery was 11 months. The most common locations tested were the nose (36 patients) and the forehead (9 patients). Postoperative evaluation showed that flap sensation recovery to light touch was present in 10% of patients before 3 months, 41% of patients from 3 to 12 months, 27% of patients from 1 to 2 years, and 75% of patients after 2 years. Graft sensation recovery to light touch was present in no patients evaluated less than 2 years after surgery and in 29% of patients evaluated more than 2 years after surgery. After adjustments for postoperative size and interval, patients with flaps were more likely than those with grafts to have touch sensation at the time of testing (adjusted odds ratio, 8.91; 95% confidence interval, 1.06-74.62; P = .04), to be able to distinguish between warm and cold (adjusted odds ratio, 3.99; 95% confidence interval, 1.05-15.16; P = .04), and to be able to distinguish between sharp and dull (adjusted odds ratio, 27.31; 95% confidence interval, 2.20-339.71; P = .01). CONCLUSIONS: Predictable factors are associated with sensation recovery in patients with flaps and grafts. The recovery of sensory innervation after surgery is earlier with flaps than with grafts. Our data provide clinicians with guidelines for recovery of sensation that ultimately will reassure the patient.

Adult↗
PubMed1998

Comprehensive treatment of the aging face--cutaneous and structural rejuvenation.

As people age, characteristic changes occur in the skin, the soft tissue envelope, and the bony skeleton of the face and result in the aging face syndrome. An understanding of the pertinent biomechanical and histologic changes is necessary for developing an appropriate treatment plan. The advent of many new techniques, including cosmetic exfoliation, laser skin resurfacing, open rhinoplasty, and endoscopic, multiplane plastic surgical procedures, has enhanced therapy for the aging face syndrome. Treatment protocols should be individualized for each patient's needs and desires. Several of these recent treatments for facial rejuvenation are reviewed herein.

Blepharoplasty↗
PubMed1998

Spectrum of cartilage grafting in cutaneous reconstructive surgery.

BACKGROUND: The use of cartilage grafts in cutaneous reconstructive surgery is becoming increasingly common among dermatologic surgeons. OBJECTIVE: Our purpose was to describe the indications, technical application, results, and complications associated with cartilage grafting in cutaneous reconstructive surgery. METHODS: The spectrum of cartilage grafting is reviewed, and illustrative examples are provided. RESULTS: A well-planned application of cartilage grafts in cutaneous reconstructive surgery can provide exceptional results, permitting restoration of impaired anatomic free margins as well as maintenance of the functional patency of key anatomic structures such as the nasal valve. CONCLUSION: Cartilage grafting in cutaneous reconstructive surgery is an important method to ensure optimal reconstructive outcomes. Dermatologists involved in reconstructive surgery will experience improved results through the application of these techniques.

Cartilage↗
PubMed1996

Induction of Darier-White disease with UVB radiation in a clinically photo-insensitive patient.

Combination UVA/UVB radiation and UVB radiation alone have been shown to induce the lesions of Darier-White disease. However, 6% of patients with Darier-White disease claim that sunlight ameliorates their condition. We performed an unblinded, side-by-side controlled trial of UVB, UVA, and combination UVB/UVA phototherapy in a patient with historically photoameliorated Darier-White disease to determine whether phototherapy was beneficial, to determine whether phototherapy-related heat was detrimental, and to confirm, with appropriate controls, the action spectrum of the disease. Phototherapy with radiation in the UVB but not UVA spectrum evoked Darier-White disease in this patient, both clinically and histologically. UVB radiation was capable of inducing Darier-White disease in vivo in spite of a history of photoamelioration, whereas UVA radiation alone and the heat associated with phototherapy in our protocol had no effect on the disease.

Adult↗
PubMed1996

Medium-depth chemical peeling.

Trichloroacetic acid (TCA) alone or in combination with other agents is the mainstay of medium-depth chemical peels. Indications for medium-depth chemical peels include both medical conditions, such as diffuse photodamage with contiguous actinic keratoses, and cosmetic conditions, such as the aging face and solar lentiginosis. Medium-depth chemical peeling with TCA is relatively simple and is associated with a favorable risk/benefit ratio. However, proper patient selection, with attention to both medical and psychological factors, requires significant experience. The histological basis of the rejuvenating effects of TCA peels is well established, with a consistent correlation between wound depth and TCA concentration. The clinical effects of medium-depth chemical peels are generally gratifying for both patient and physician.

Administration, Cutaneous↗
PubMed1996

Complications of cutaneous surgery in patients who are taking warfarin, aspirin, or nonsteroidal anti-inflammatory drugs.

BACKGROUND AND DESIGN: No controlled studies exist with regard to the risks of continuing therapy with warfarin sodium or platelet inhibitors or the benefits of briefly discontinuing therapy with these agents in patients who are undergoing cutaneous surgical procedures. Our objective was to determine the frequency of complications of cutaneous surgery in patients who were receiving warfarin or platelet inhibitors and to evaluate whether preoperative discontinuation reduces complications. A retrospective, controlled study was performed of complications of excisional and Mohs micrographic surgery in 653 patients who were being treated with warfarin or platelet inhibitors or with their medications being briefly withheld. RESULTS: Severe complications of cutaneous surgery in patients who are taking warfarin or platelet inhibitors are uncommon, occur in 1.6% of cases, and are not significantly increased compared with complications in control subjects. Furthermore, there was no statistically significant reduction in the rates of severe complications in patients who had their medications preoperatively held. CONCLUSION: Cutaneous surgery in patients who receive warfarin or platelet inhibitors is associated with a low risk of severe complications, not significantly reduced by brief preoperative discontinuation.

Adolescent↗
PubMed1995

Isotretinoin treatment of human immunodeficiency virus-associated eosinophilic folliculitis. Results of an open, pilot trial.

BACKGROUND: Human immunodeficiency virus-associated eosinophilic folliculitis is a pruritic eruption seen in advanced infection with human immunodeficiency virus. The associated pruritus causes considerable morbidity and is poorly responsive to conventional therapy. We studied whether isotretinoin would prove efficacious in the treatment of human immunodeficiency virus-associated eosinophilic folliculitis. Seven patients with biopsy specimen-proved human immunodeficiency virus-associated eosinophilic folliculitis were treated with a mean of 7.7 weeks of isotretinoin therapy and their responses were monitored. OBSERVATIONS: All patients responded with complete symptomatologic and clinical remission within 1 to 4 weeks of isotretinoin therapy. Four (57%) of seven patients remained in complete remission after just one course of isotretinoin therapy, while three (43%) of seven patients experienced up to three brief relapses, all rapidly responsive to further isotretinoin therapy. Patients remained free of disease for up to 9 months after therapy. CONCLUSIONS: Isotretinoin appears to be a promising treatment for human immunodeficiency virus-associated eosinophilic folliculitis. A double-blind, placebo-controlled trial is indicated.

Adult↗