Biomedical subjects
Publications and source records attributed to D J Grande.
A technique is described for treating the alopecia resulting from scalp surgery repaired by split-thickness skin grafts with the method of marsupial minigrafts. This procedure provides an uncomplicated outpatient approach for treating this type of alopecia.
Computed tomography (CT) is a sensitive, noninvasive radiographic technique which can produce detailed cross-sectional images of any anatomic region. The amount and accuracy of the information it provides far exceeds that produced by conventional radiographic techniques. The chemosurgeon can find CT scanning invaluable in his preoperative evaluation of patients with large, invasive head and neck tumors of cutaneous origin.
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The differential diagnosis of pseudoepitheliomatous hyperplasia, atypical pseudoepitheliomatous, and well-differentiated squamous cell carcinoma is discussed. A patient is presented who illustrates the occasional difficulty of this diagnostic question.
An elderly Chinese man with solitary pigmented Bowen's disease of the scrotum is described. This disease must be distinguished from seborrheic keratoses, pigmented basal cell carcinoma, melanocytic nevus, malignant melanoma, and bowenoid papulosis.
The cheek-neck advancement-rotation flap has proved extremely useful for delayed reconstruction of the face following the microscopically controlled surgical excision (MCSE) of skin malignancies. We have recently used these flaps successfully to repair combined defects of the cheek and nose in eight patients, isolated cheek defects in six patients, combined defects of the cheek and lips in two patients, and isolated defects of the nose, temple, and an antral cutaneous fistula in each of three patients. Defects as large as 6.0 X 10.0 cm have been closed in one stage with this flap. This flap is extremely hearty and its scars can be well concealed. It is especially valuable in the elderly patient and should always be considered as one of the options for reconstruction of the face following MCSE of skin malignancies.
We present our experience with the Shaw scalpel in the treatment of a patient with extensive rhinophyma. The heated blade of the scalpel provides rapid maintenance of hemostasis with minimal tissue damage and thus allows for rapid and accurate removal of tissue. After removing the bulk of tissue with the Shaw scalpel, the carbon dioxide laser and dermabrader are used to refine nasal contours.
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The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety.
Health care professionals (medical students, practicing physician's assistants, and residents in the specialties of internal medicine, surgery, and dermatology) were evaluated for their ability to diagnose malignant and benign skin disease. It was found that dermatology residents did significantly better in the diagnosis of malignant and benign skin disease than all other groups, and there was no significant difference among medical students, physician's assistants, and residents in internal medicine or surgery. Findings suggest that the current ability of nondermatologists to correctly diagnose malignant and benign skin disease is not at a comparable level to that of dermatologists and that a 1-month training period in the specialty of clinical dermatology during the primary care residency training period may be inadequate for training nondermatologists to distinguish malignant from benign skin disease. In some specialty areas, such as dermatology, specialization may be preferable to a primary care approach for initially evaluating skin disease.
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Dermatology has entered a new dimension with the introduction of the laser. There are expanding clinical indications for laser excision. The CO2 laser in the cutting mode can incise tissue as sharply as finely honed steel, yet its photocoagulative properties allow rapid sealing of blood vessels and lymphatics. The physician can thereby perform in a relatively bloodless surgical field. Minimal adjacent normal tissue is injured, there is less local postoperative edema, and fewer postoperative analgesics are required. Since there is no need to use epinephrine as a local vasoconstrictive agent and there is no need to use electrocoagulation for control of hemorrhage, CO2 laser excision presents less risk to the medically compromised patient. The CO2 laser may also diminish the risk of seeding or spreading neoplastic cells in the perioperative field.
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Squamous-cell carcinoma involving the upper lip grows more rapidly and is more difficult to control than squamous-cell carcinoma of the lower lip. The lesion usually is histologically more undifferentiated than squamous-cell carcinoma of the lower lip and metastases develop earlier. A case report of a patient with a squamous-cell carcinoma in an upper lip with regional metastases is presented and illustrated.
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A case of recurrent basal-cell carcinoma at the mandibular ramus presented clinically with a subdermal nodule. The patient had previously been treated with aggressive curettage and electrodesiccation which had penetrated through the dermis. The authors postulate that either incomplete extirpation of the neoplasm with the curet or iatrogenic deep implantation of the tumor during the procedure may have led to the presentation of the recurrence as a subdermal nodule.