Search PubMed⌕ Search

Biomedical subjects

D C Whitaker

Publications and source records attributed to D C Whitaker.

At least 37 records · Page 2Linked to original sources
PubMed1994

Primary cutaneous meningioma associated with von Recklinghausen's disease.

Cutaneous meningeal tumors are rare and can pose a diagnostic problem. We present a case of a 12-year-old girl with a family history of von Recklinghausen's disease. The patient was asymptomatic until the age of 11, when she developed two lesions on the head, both diagnosed as plexiform neurofibroma. Subsequently, she presented with a subcutaneous nodule on the left posterior occipital scalp which was excised. On histology, the tumor was composed of spindle-shaped cells with diffuse and nested patterns. A whorled configuration of the cells, with occasional giant cells and psammoma bodies, was present. There was no evidence of connection between the tumor and the underlying tissues. Immunohistochemical studies were positive for epithelial membrane antigen, vimentin, and weakly for neuron-specific enolase. Cytokeratin, S-100 protein, and muscle markers were negative. Based on these features, the diagnosis of cutaneous meningioma was made. An MRI examination failed to detect any communication between the tumor site and the meninges; however, asymptomatic bilateral acoustic neuromas were identified. This case, besides being of interest as a primary cutaneous meningioma, also documents a unique combination of findings, i.e., plexiform neurofibroma, meningioma, and cerebellopontine acoustic neuromas, which should alert the clinician to a forme fruste presentation of von Recklinghausen's disease.

Child↗
PubMed1994

Complications of cutaneous surgery.

There are many complications that may develop when surgical procedures are performed. With adequate preoperative preparation and careful technique, however, they can be kept to a minimum. Foreknowledge of the possible difficulties will enable the physician to recognize them when they are encountered and to provide appropriate treatment.

Cicatrix↗
PubMed1993

The preparation of frozen sections for micrographic surgery. A review of current methodology.

BACKGROUND: Various methods are currently in use for preparing histological slides for micrographic surgery. OBJECTIVE: Because many variables contribute to the quality preparation of frozen sections, a review of techniques available is useful to the Mohs surgeon. TECHNICAL METHODS AND RESULTS: Our techniques as well as the published work of others regarding mounting, embedding, freezing, slides, fixation, staining, and clearing are reviewed in detail. By the use of the options selected we were able to produce, in a short turn-around time, frozen sections with excellent quality and minimal artifact. CONCLUSION: Presently all preparation techniques may introduce some degree of artifact. However, we feel the process described herein is adaptable to all Mohs surgery laboratories and will result in high quality specimens with minimal artifact.

Fixatives↗
PubMed1993

Primary reconstruction of congenital facial lesion defects with tissue expansion.

BACKGROUND: Congenital facial lesions may require surgical intervention to correct deformity or to decrease the potential for malignant degeneration. OBJECTIVE: Hemangiomata and melanocytic and sebaceous nevi are among the most common congenital facial defects. The techniques and outcome of serial tissue expansion in the management of facial lesions were evaluated. METHODS: Seven pediatric patients had congenital facial defects treated with tissue expansion and subsequent excision and reconstruction. RESULTS: All patients had a satisfactory outcome. Complications are reviewed, and in this patient population were minor. CONCLUSIONS: Tissue expansion has a role in surgical management of congenital facial lesions. Staged excision, skin grafting and nonintervention are also options which must be individualized to the case at hand.

Child↗
PubMed1993

Differentiation of basal cell carcinoma.

Basal cell carcinoma is undoubtedly the most common malignancy in light-skinned people. Because of the high incidence of this type of carcinoma, physicians should be familiar with its many clinical presentations. An understanding of the behavior, multiple histologic variations, and available therapeutic modalities is of great value in the diagnosis and treatment of this tumor.

Basal Cell Carcinoma↗
PubMed1992

Clinical characteristics associated with orbital invasion of cutaneous basal cell and squamous cell tumors of the eyelid.

Over a six-year period, between 1984 and 1990, 622 patients with basal cell and squamous cell carcinoma of the eyelids were examined at our institution. Thirteen patients had orbital invasion at initial examination. The average age of patients at orbital invasion was 75.8 years. Ten patients were men, eight of whom had basal cell carcinoma and two of whom had squamous cell carcinoma. Most patients had an orbital mass and incomitant strabismus at initial examination. Invasive basal cell carcinoma developed in 11 patients, and squamous cell carcinoma developed in two patients. Ten patients were treated for cutaneous carcinoma at the site of invasion before examination at our institution. The average duration between onset of a cutaneous lesion and our examination for orbital invasion was 9.8 years for basal cell carcinoma and one year for squamous cell carcinoma. Radiologic and histopathologic features were reviewed. The clinical characteristics of these patients were reviewed and orbital exenteration was recommended to all 13 patients. Nine patients underwent exenteration and four refused the operation.

Aged↗
PubMed1992

Desmoplastic malignant melanoma: rare and difficult to diagnose.

BACKGROUND: We review our experience with a recent cluster of three cases of rare desmoplastic malignant melanoma (DMM). OBJECTIVE: Our purpose is to alert clinicians to this rare tumor and the difficulty in clinical and histopathologic diagnosis. METHODS: The clinical presentation and steps necessary to establish diagnosis are outlined. A literature review on diagnosis, treatment, and prognosis is presented. RESULTS: Two thirds of DMM are amelanotic and may appear only as a dermal nodule or thickening. Diagnosis can be made with the combination of light microscopy and immunopathology. Treatment consists of surgical excision. Lymph node dissection should be considered only when histologically positive regional nodes are present. CONCLUSION: The diagnosis of DMM may be difficult when based only on clinical expectation of melanoma and light microscopy findings. A strong clinical suspicion of DMM coupled with immunologic studies will establish the diagnosis.

Aged↗
PubMed1992

Malignant eccrine spiradenoma. A clinicopathologic study.

UNLABELLED: Malignant eccrine spiradenomas (MES) are exceedingly rare and their immunohistochemical and ultrastructural features have not been fully characterized. We studied two cases, one of them immunohistochemically and electron microscopically. Patient 1 had a 25-year history of multiple exophytic tumors involving the scalp, the skin of the face, and the torso. Of the lesions removed, ten were spiradenomas, two with malignant changes, and three were cylindromas. The malignant areas showed loss of tubular and nesting patterns, lack of two cell populations, and contained anaplastic cells with high mitotic rate. The immunohistochemical findings were consistent with eccrine differentiation. Patient 2 had a cystlike mass of long duration in the right groin. Histologically, the mass consisted of nodules of benign eccrine spiradenomas adjacent to a ductal-cystic mass lined by anaplastic cells, but areas of squamous and glandular differentiation were also present. CONCLUSIONS: (a) Case 1 is probably the first reported MES associated with multiple spiradenomas and cylindromas. (b) Cytodifferentiation in MES is variable, sometimes with almost complete loss of eccrine differentiation. (c) Identification of adjacent spiradenomas may be required for definite diagnosis of MES. (d) Clinical history of longstanding lesions with recent fast growth warrants tissue diagnosis.

Adenoma, Sweat Gland↗
PubMed1992

Unresectable primary facial cutaneous carcinoma.

Over 500,000 nonmelanoma skin cancers are diagnosed and treated in this country each year. All treatment modalities quote a 90% or greater cure rate. Even with high cure rates, thousands of patients will require secondary treatment. Some nonmelanoma skin cancers are very aggressive and may not be resectable following single treatment failure. Recurrent tumors in critical anatomic locations require a multidisciplined approach. Combined tumor board evaluation and management are advocated.

Basal Cell Carcinoma↗
PubMed1992

Stents for nasal vestibule.

A method employing vinyl polysiloxane and polyethylene chemical tubing to make nasal stents is described. Vinyl polysiloxane stents, when well molded, are comfortable and easily tolerated. The technique has been useful for maintaining patent nares and enhancing graft viability.

Equipment Design↗
PubMed1992

Iontophoresis of lidocaine for anesthesia during pulsed dye laser treatment of port-wine stains.

Port-wine stains may be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm. However, the discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions. Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use. We performed a prospective double-blind, placebo-controlled evaluation of the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port-wine stains. Eleven patients with port-wine stains completed the initial phase of the study. Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 (P less than .0001), with no significant difference between these treatments. Follow-up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port-wine stains, despite significant decreases in perfusion, as measured by laser Doppler velocimetry, of port-wine stain areas receiving iontophoresis of lidocaine with epinephrine. Iontophoresis of lidocaine HCl 4% with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy.

Adolescent↗
PubMed1991

Inverse relation between density of nevi and terminal cutaneous hair. Study of male volunteer subjects and patients enrolled in a dysplastic nevus syndrome registry.

Terminal hair density was graded at seven sites in 19 male patients enrolled in a dysplastic nevus syndrome (DNS) registry and in 22 matched control subjects. An inverse relation between density of nevi and terminal hair for all sites combined was observed for both patients and control subjects (p = 0.0001, regression analysis). In addition, the registry patients had significantly less terminal cutaneous hair overall (p = 0.007, Wilcoxon rank sum test) compared with the controls.

Adult↗