Clinical problem-solving: refusing HIV testing.
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Confidentiality↗
Biomedical subjects
D R Lambert
Publications and source records attributed to D R Lambert.
Scalpel sculpturing techniques for graft revision and dermatologic surgery.
BACKGROUND: Postoperative scars can be revised by a variety of techniques, including dermabrasion, laser, curettage, razor blade, and scalpel surgery. Most modern methods of scar revision provide good results but at the expense of time and economy. OBJECTIVE: We present our scalpel sculpting technique that uses the #15 scalpel blade to microshave and feather the skin edges to equalize differences in skin elevations caused by uneven healing. The superficial wounds then heal by second intention. METHODS: Sculpting techniques were used to revise side-to-side closures (grafts and flaps), trap-door elevations, standing tricones and hypertrophic scars. In addition, we used the sculpting technique to remove superficial blemishes such as actinic and seborrheic keratoses, skin tags, and other benign lesions. RESULTS: We have used scalpel sculpting techniques to revise scars and remove blemishes for more than 5 years. We have removed thousands of skin imperfections with very gratifying results. CONCLUSION: Scalpel sculpting techniques provide a simple, efficient method of scar revision and removal of superficial skin lesions. The technique reduces operative time and streamlines instrument reprocessing. Because of its simplicity, there is a high degree of patient, nursing, and physician satisfaction.
Aged↗
Brief report: shock and multiple-organ dysfunction after self-administration of Salmonella endotoxin.
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Bacterial Toxins↗
Skin cancer: a review with consideration of treatment options including Mohs micrographic surgery.
A review of basal and squamous cell carcinoma of the skin is presented with emphasis on treatment modalities. A series of 312 cases of skin cancer is presented in which Mohs micrographic surgery was the treatment. This technique is indicated for tumors that are 1) recurrent; 2) on anatomic sites with a high risk for recurrence; 3) of large size; 4) of aggressive histologic type; 5) incompletely excised; or 6) present on important functional or asthetic areas.
Aged↗
Griseofulvin and ketoconazole in the treatment of dermatophyte infections.
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Arthrodermataceae↗
Lichen planus of the nail presenting as a tumor: diagnosis by longitudinal nail bed biopsy.
Our patient presented with a keratotic tumor of the nail bed that simulated a neoplasm. Longitudinal nail bed biopsy showed lichen planus, sparing the patient excisional surgery. We review the differential diagnosis of nail bed tumors, nail biopsy techniques, and the findings of lichen planus of the nail.
Aged↗
Esophageal-atrial fistula.
We report an unusual case of an esophageal-atrial fistula in a patient with CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma. An ulcer in Barrett's esophagus perforated into the left atrium and led to systemic embolization and cerebral abscess. A review of similar reports of esophageal-atrial fistula reveals a symptom complex that includes chronic esophageal pathology, gastrointestinal bleeding, and neurological signs. An antemortem diagnosis has never been made.
Barrett Esophagus↗
Melanoma in children and adolescents.
Melanoma is a life-threatening and rare malignancy in childhood and adolescence. Because it is so uncommon, melanoma may not be recognized readily or considered seriously in a differential diagnosis, resulting in delays in definitive treatment. We review melanoma occurring in 13 patients under 20 years of age who presented to a single tertiary care children's hospital. Five patients had nonmetastatic primary cutaneous melanoma, with Breslow thickness measurement ranging from 0.84 to 7.8 mm. Three patients had metastatic primary cutaneous melanoma, three had metastatic melanoma arising ina congenital giant nevus, and two had primary leptomeningeal melanoma. All of the patients were given definitive surgical treatment; some received adjunctive radiation therapy and chemotherapy. Overall 5-year survival rate was 40.0% for all cutaneous melanomas, which included 100% for clinical stage I disease, and 0% for clinical stage II and III disease. Both patients with primary leptomeningeal melanoma died an average of 6 months following diagnosis. Nonmetastatic primary cutaneous melanoma is a survivable disease if detected early and treated by surgical excision; metastatic and leptomeningeal disease were uniformly fatal. Types of melanoma, risk factors for melanoma, and the role of the dermatologist in primary prevention and detection are discussed.
Adolescent↗