Biomedical subjects
Publications and source records attributed to R J Siegle.
Ingrowing toenails are a very common condition that has a significant associated morbidity. Although treated by practitioners of many specialties, most doctors have minimal training in this area. In this overview, an algorithm will be used to direct in an efficient and pain minimizing way the management of recalcitrant ingrowing nails.
BACKGROUND: Xeroderma pigmentosum (XP) is a hereditary disorder characterized by recessive inheritance and elevated rates of skin carcinogenesis. There are seven complementation groups (A through G) for which the genetic defect results in a failure to repair DNA damage from UV light and sunlight; one group, the variant, fails to replicate UV-damaged DNA correctly. Patients in XP groups A, B, D, and G have associated neurologic problems, the most severe being known as the DeSanctis-Cacchione syndrome. OBSERVATIONS: We describe a patient with XP from consanguineous parents who has severe multisystem involvement similar to that of the DeSanctis-Cacchione syndrome. Extensive laboratory investigation showed that cells from this patient exhibit DNA replication after irradiation with UV light that is characteristic of the XP variant. The cells also show normal sensitivity to UV light and normal excision repair, consistent with XP variant classification. The presence of the neurologic symptoms is quite unusual in an XP variant. CONCLUSION: Our patient clearly fits into the XP variant category based on normal survival, caffeine toxic reaction, photoproduct excision and repair, and the deficient replication of UV-damaged DNA. This patient seems to be rare, however, among XP variants in displaying severe neurologic symptoms. Because of the consanguineous parents, the possibility that some of this patient's findings are from non-XP-related abnormalities must also be entertained. However, other consanguineous patients with XP variant, eg, XPIOCA, have been described who do not show neurologic abnormalities. In view of the difficulty of defining an XP group from clinical symptoms alone, we urge the term xeroderma pigmentosum variant be used only in the context of the laboratory studies of patients with XP that contain normal repair but deficient semiconservative replication of UV-damaged DNA.
Guidelines for forehead reconstruction include maintaining or re-establishing normal boundaries, preserving nerve function, and maximizing scar camouflage. The interrelationships of anatomy, function, and principles of tissue movement which are critical to optimal reconstructive planning will be presented.
This study used microbiologic counts to evaluate bacterial contamination during cutaneous surgeries of the head and neck. Aerobic bacterial counts of the surgical field in cases with immediate closure (group A, n = 10 patients) and prolonged procedures such as Mohs micrographic surgery (group B, n = 15 patients) were performed three times during the operation. Cultures were taken before antiseptic application, 30 seconds after application, and before closure. Each group showed a statistically significant reduction in aerobic bacteria both 30 seconds after antiseptic application and before closure. All aerobic bacterial counts at both intervals were less than 100,000 colony-forming units/cm2 in each group. The consistent reduction in aerobic bacteria suggests that a clean technique for the two classes of office operating room surgeries provides low-risk conditions for infection in relatively healthy patients.
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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.
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Cutaneous bullae secondary to lymphatic fluid reflux are rare. We report the case of a patient with lymphatic bullae without lymphedema following second-intention wound healing.
A subgroup of midfacial basal and squamous cell carcinomas invade extensively into the surrounding soft tissues and at times into bone, cartilage, and the nearby cavities. Their management can be optimized by using the combined skills of the Mohs micrographic surgeon and the head and neck surgeon. Relevant tumor biology and anatomy of this area are presented as a background for the discussion of the mechanics involved in tumor extirpation. Reconstructive philosophies and alternatives are reviewed.
Verrucous carcinoma is a low-grade squamous cell carcinoma. Chronic inflammation is an important factor in its pathogenesis. This is the first case of plantar verrucous carcinoma arising in a lesion of ulcerative lichen planus. This paper also lends further support to the successful use of Mohs micrographic surgical technique as the treatment of choice for verrucous carcinoma.
The purpose of this study was to evaluate the transplantation of BCC to the C57/BALB/C bgJ/bgJ-nu/nu (beige-nude) mouse. This animal has two gene defects which are expressed as impairment of natural killer cells (NK cells) as well as the absence of a thymus. The results demonstrate that human BCC can be successfully transplanted to the C57 beige-nude mouse without the need for supplemental immunosuppression. It may be that the impairment of NK cell activity in the beige-nude mouse model plays a significant role in tumor transplantation.
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.
Bovine collagen implants are in widespread use for the correction of soft tissue deficiencies. A small portion of the population responds adversely to these implants, evidenced by either positive skin tests or treatment site reactions. Antibodies against bovine collagen implants have been detected in the sera of virtually all patients with adverse treatment reactions and in small percentages of untreated individuals and treated individuals without adverse reactions. In this study we examined the levels of anti-bovine collagen implant antibodies in 150 individuals prior to bovine collagen implant therapy and then monitored these patients for adverse reactions to skin tests and bovine collagen implant treatments. Statistical analyses were performed to determine the value of pretreatment serology in predicting positive skin tests or adverse reactions. It was determined that individuals with greatly elevated levels (greater than 2 standard deviations [SDs] above the mean reactivity of pretreatment sera) of anti-bovine collagen implant antibodies prior to treatment were approximately sixfold more likely to suffer adverse reactions than patients with no elevation of antibodies prior to treatment.
A 45-year-old man with multiple myeloma developed iododerma after oral cholecystography with iopanoic acid. The lesions appeared two days after two exposures to iopanoic acid given within one week. To our knowledge, this is the first reported case of iododerma in association with multiple myeloma and orally ingested radiocontrast dye.
Thirty-two patients with acne completed a randomized, double-blind study using topical 1% clindamycin phosphate or its vehicle applied twice daily for 8 weeks for a study of its effects on the intestinal microflora. Two clindamycin patients and one vehicle patient had Clostridium difficile in stools prior to therapy. Of the remaining twenty-nine patients, four of nineteen patients who used clindamycin and none of ten patients who used vehicle had C. difficile detected during treatment; the difference was not statistically significant. There was no diarrhea in the clindamycin group, even though clostridial cytotoxin was found transiently in two patients. Self-limited diarrhea occurred in one vehicle-treated patient, whose stool culture was negative but whose stool specimen showed a positive reaction for C. difficile cytotoxin. With the use of a bioassay, clindamycin was not detected in urine or stool of any patient. No significant changes in Bacteroides fragilis counts in stools were observed in either group.
This paper will review some of the present information on the biology of basal cell carcinoma. Recent developments include a better understanding of the basement membrane components surrounding the tumor nodules, as well as identifying the most actively dividing cells in solid basal cell carcinoma by autoradiographic techniques. The implications of a recently developed animal model will also be discussed.
Infiltrative basal cell carcinoma is a distinct histologic subtype of basal cell carcinoma (BCC). Criteria for its diagnosis are presented and its nonsclerotic nature emphasized. Analysis of 174 consecutive BCCs referred for Mohs micrographic surgery showed the infiltrative subtype (29 tumors) to be significantly more destructive and difficult to treat than the more common nodular BCC.
The successful employment of a carbon dioxide (CO2) laser in the eradication of localized chromomycosis is described. A review of alternative medical and surgical modalities used in treating this disorder is presented. The potential benefits of CO2 laser vs. cold steel surgery are discussed.