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At least 361 records · Page 20Linked to original sources
PubMed2006

Pacemakers and implantable cardiac defibrillators in dermatologic surgery.

BACKGROUND: Electrosurgery used during dermatologic surgical procedures can cause malfunction of pacemakers and implantable cardiac defibrillators (ICDs), producing problems with rhythm detection, proper function, or alteration of the device. Well-documented safety data on electrosurgery in patients with cardiac devices are limited. At Mayo Clinic in Rochester, Minnesota, the Pacemaker Clinic manages all patients with pacemakers and ICDs undergoing dermatologic surgery. The preoperative and postoperative evaluations provide a unique opportunity to evaluate the safety of dermatologic surgery with electrosurgery in such patients. OBJECTIVES: The objective was to review the evaluation and management, by an experienced cardiology team, of patients with cardiac devices undergoing dermatologic surgery and to characterize perioperative complications. METHODS: A retrospective chart review of all patients identified with pacemakers or ICDs undergoing Mohs micrographic or dermatologic excisional surgery with electrosurgery at Mayo Clinic 2001 through 2004 were identified. Data were abstracted to identify any possible complications. RESULTS: The 173 patients with pacemakers and 13 with ICDs undergoing dermatologic surgery had no documented complications from electrosurgery. CONCLUSION: The lack of complications associated with pacemakers and ICDs with electrosurgery is reassuring. The authors support published recommendations about techniques and precautions to optimize safety during electrosurgery in patients with cardiac devices. The care of patients with ICDs in particular requires special consideration.

Adult↗
PubMed2003

Severe dermatologic reactions at multiple sites after paclitaxel administration.

OBJECTIVE: To report a case of a severe dermatologic reaction at the infusion site, as well as at multiple distant sites, after paclitaxel administration. CASE SUMMARY: A 53-year-old white male with cancer of the base of the tongue was treated with paclitaxel 100 mg/m2 infused over 3 hours and carboplatin dosed at an AUC of 6 mg/mL x min infused over 30 minutes via a peripheral vein on the left arm. After 4 doses of paclitaxel, the patient developed erythematous patches on both forearms and both thighs. The lesions on the left arm worsened into a necrotic ulcer, exposing underlying tissues. All of the lesions healed after paclitaxel was withheld from subsequent cycles. Based on the Naranjo probability scale, it is probable that paclitaxel was the causative agent for these lesions. DISCUSSION: Most of the previously reported paclitaxel-induced dermatologic reactions occurred following extravasation. There are few reports of generalized dermatologic rashes. These rashes are thought to be due to delayed hypersensitivity either to paclitaxel or the solubilizing agents. Our patient had dermatologic toxicity at the infusion site, as well as at multiple other sites, that developed about 6 weeks after the first paclitaxel infusion. CONCLUSIONS: Generalized dermatologic toxicity after paclitaxel administration is uncommon and seems to be immunologically mediated. This toxicity could be secondary to paclitaxel or the additives. The use of paclitaxel is increasing in various malignancies. Newer formulations are under development. Until these formulations are available, clinicians should report any dermatologic reactions in order to identify the cause of toxicity and develop safer administration technique.

Antineoplastic Agents, Phytogenic↗
PubMed2003

Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management.

Psychiatric and psychological factors play an important role in at least 30% of dermatologic disorders. In many cases the impact of the skin disorder upon the quality of life is a stronger predictor of psychiatric morbidity than the clinical severity of the disorder as per physician ratings. Furthermore, in certain disorders such as acne and psoriasis, the psychiatric co-morbidity, which can be associated with psychiatric emergencies such as suicide, is an important measure of the overall disability experienced by the patient. The severity of depression and increased suicide risk are not always directly correlated with the clinical severity of the dermatologic disorder. Consideration of psychiatric and psychosocial factors is important both for the management, and for some aspects of secondary and tertiary prevention of a wide range of dermatologic disorders. It is useful to use a biopsychosocial model which takes into account the psychological (e.g. psychiatric comorbidity such as major depression and the impact of the skin disorder on the psychological aspects of quality of life) and social (e.g. impact upon social and occupational functioning) factors, in addition to the primary dermatologic factors, in the management of the patient. Some dermatology patients are likely to benefit from psychotherapeutic interventions and psychotropic agents for the management of the psychosocial comorbidity, in addition to the standard dermatologic therapies for their skin disorder.

Acne Vulgaris↗
PubMedDate not supplied

The effectiveness of a low-chemical, low-protein medical glove to prevent or reduce dermatological problems.

PURPOSE: This study investigated the effectiveness of a low-chemical, low-protein, powder-free latex medical glove to reduce or prevent hand dermatitis in a group of oral healthcare workers who had a self-reported history of hand irritation from medical glove use. METHODS: Dental hygienists who had previously reported dermatological conditions from routine use of medical gloves were invited to participate in this study to test a new medical glove. All subjects completed baseline information and 85 subjects participated in the study. Subjects wore the gloves routinely for six weeks unless complications developed. Postuse questionnaires were sent to the 85 participants. Dermatological signs and symptoms were measured at both times and subjects' perceptions of change in dermatological conditions were measured postuse. Data were analyzed by frequency distributions, paired t-test, and McNemar's chi-square statistic. RESULTS: For the 85 participants, the reduction in number of dermatological signs and symptoms was statistically significant (t = 3.46; p = 0.001) from a mean of 2.5 (sd = 2.8) to a mean of 1.3 (sd = 2.6) symptoms. A statistically significantly (chi-square = 7/8; p = 0.005) greater proportion of subjects were symptom-free at postuse (61.2%) than at baseline (41.2%). Almost 90% of the oral healthcare workers perceived that the number of dermatological signs and symptoms, the intensity of signs and symptoms, and the area involved stayed the same or decreased. CONCLUSIONS: The medical gloves used in this study were effective in reducing the number of dermatological problems associated with routine medical glove use by oral healthcare workers with self-reported histories of problems with medical gloves.

Allergens↗
PubMed2004

Framework for improved communication: the Dermatology Lexicon Project.

A standardized dermatology vocabulary is central to our collective ability to gather clinical information consistently for patient care, to retrieve information for research or disease management, as well as to conduct outcomes analysis for quality improvement. The deficiencies of current classifications have been recognized by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) in their decision to fund the development of a standard complete reference terminology for dermatology. The Dermatology Lexicon will have a major impact both on clinical care and on dermatologic research. Accuracy in medical records and telemedicine communications will be improved. Reliable terminology will provide for more complete and consistent documentation and data aggregation and reporting. In order to create a useful, sustainable lexicon, involvement of the dermatology community is essential.

Dermatology↗
PubMed1992

Information excess in medicine. Overview, relevance to dermatology, and strategies for coping.

BACKGROUND: The amount of biomedical information contained in scientific journals has grown to the point that complete coverage of this material is impossible. The number of articles and journals being published has been growing at an exponential rate since 1750. Thirty-four thousand references from 4000 journals are added each month to the National Library of Medicine MEDLINE database from among the more than 100,000 scientific journals now published. This increase in scientific literature reflects not greater productivity but simply a larger number of scientists at work. Most articles written are eventually published in the medical literature, but a large number of scientific articles are of less than optimal quality, and most scientific articles that are published are never cited. Articles of higher quality and usefulness cluster in a few journals that enjoy great use in medical libraries and high scores on bibliometric scores such as the Science Citation Index. OBSERVATIONS: To assess the reading habits of dermatologic trainees and evaluate how they cope with this information excess, a survey was distributed to 36 residents in three training programs. The average number of medical journal reading hours per month was 17; the number of hours devoted to reading issues of the Archives of Dermatology, the Journal of the American Academy of Dermatology, and the Journal of Investigative Dermatology were 3.2, 5.0, and 1.4, respectively; and the average resident read seven peer-reviewed journals, two to four dermatologic tabloids, and four peer-reviewed medical journals. CONCLUSIONS: Critically and consistently reading a limited number of high-quality peer-reviewed journals as well as taking advantage of information available through computer networks and bibliographic and full-text databases is the best approach to coping with the volume of medical literature. Translating this information into a change in attitude and modification of physician behavior is best accomplished when local role models incorporate new ideas into their practice and teaching. Modifications that would, in fact, bring about truly useful changes, such as decreasing the number of new publications, melding journals already present into smaller numbers of publications rather than instituting new journals, altering the "publish-or-perish" rules, and writing more comprehensive articles rather than multiple small contributions, all await fundamental alterations in long-accepted policies in medicine.

Dermatology↗
PubMed2000

Safe and effective conscious sedation administered by dermatologic surgeons.

OBJECTIVE: To review the experience with conscious sedation administered by dermatologic surgeons at an academic medical center. DESIGN: Retrospective medical chart review. SETTING: Outpatient dermatologic surgery unit at an academic medical center. PATIENTS: Fifty episodes of conscious sedation in 37 patients undergoing dermatologic surgical procedures. INTERVENTION: Intravenous and inhaled conscious sedation was administered with strict monitoring during procedures. MAIN OUTCOME MEASURES: Efficacy was subjectively recorded by the administering physician and complications were recorded. RESULTS: Administration of conscious sedation by dermatologic surgeons was associated with good to excellent sedation with minimal complications. Extensive preparation and training were necessary, and strict guidelines devised by a conscious sedation task force were followed. Emergency preparedness was high, although it was not used. CONCLUSIONS: Conscious sedation can be safely and effectively administered by dermatologic surgeons in a hospital-based outpatient surgical unit after extensive training. Emergency preparedness is essential, and conservative guidelines should be followed.

Administration, Inhalation↗
PubMed2001

Waiting times to see a dermatologist are perceived as too long by dermatologists: implications for the dermatology workforce.

BACKGROUND: The issue of workforce requirements in dermatology has come to attention in recent years because it affects the delivery of dermatologic care in the United States. OBJECTIVE: To determine the waiting times for appointments with dermatologists in order to assess the adequacy of the current level of dermatology workforce. METHODS: Waiting times were determined for new and return patient appointments by telephone survey of a random sample of American Academy of Dermatology members. Physicians' perception of the adequacy of the number of dermatologists in their area was used as a criterion standard to validate waiting times as a measure of workforce adequacy. Benchmark waiting times of 3 weeks for a new patient appointment and 2 weeks for a return appointment were established. RESULTS: Physicians' estimates of the waiting time for a new patient appointment and their perceptions of the adequacy of the number of practicing dermatologists in their area were closely correlated (r = -0.65; P<.001), validating the use of waiting times as a measure of workforce adequacy. More than 60% of the dermatologists surveyed exceeded the criterion cutoff waiting times, and more than 42% of the US population lives in areas underserved by dermatologists. Dermatologists practicing in areas of higher population density were more likely to have shorter waiting times for new patient appointments and were more likely to include cosmetic dermatology in their practices. CONCLUSION: The long waiting times for appointments suggests that the current supply of dermatologists is not adequate to meet the demand for dermatologists' services.

Attitude of Health Personnel↗
PubMed2004

Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology.

OBJECTIVE: To determine the relative efficacy of store-and-forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes. DESIGN: Prospective study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth. SETTING: Private primary care and dermatology practices and an academic dermatology practice. PATIENTS: Patients requiring dermatology consultation for evaluation of skin growths. Patients were seen by a single primary care physician between July 10, 1998, and August 4, 2000. INTERVENTION: Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist. The patient was then seen face-to-face by a dermatologist. A biopsy was performed if either dermatologist favored biopsy. MAIN OUTCOME MEASURES: Decisions to perform a biopsy. Agreement between the dermatologists was assessed. RESULTS: Of the 49 patients with evaluable photographs, the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients, yielding a sensitivity of the teledermatologist of 1.00 (95% confidence interval [CI], 0.87-1.00) and a specificity of 1.00 (95% CI, 0.85-1.00). The agreement between the dermatologists (kappa) was 1.00 (95% CI, 0.72-1.00). CONCLUSION: Store-and-forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy.

Biopsy↗
PubMed2005

General anesthesia for pediatric dermatologic procedures: risks and complications.

OBJECTIVE: To assess the safety and adverse events associated with the use of general anesthesia in children undergoing elective dermatologic procedures. DESIGN: A multicenter retrospective review. SETTING: Children's Hospital and Health Center, San Diego, Calif, and Northwestern University School of Medicine, Chicago, Ill. PATIENTS: The study population comprised 269 children and adolescents ranging in age from 2 months to 18 years (881 procedures performed by 6 pediatric dermatologic and laser surgeons). MAIN OUTCOME MEASURES: The risk of an adverse event occurring during general anesthesia for pediatric dermatologic procedures. RESULTS: The risk of general anesthesia in elective pediatric dermatologic procedures was low: 90% of patients experienced no clinically relevant complications. The most common clinically relevant adverse effect of general anesthesia was perioperative nausea and emesis, which was noted in 4% of patients. There were no serious life-threatening events noted, and the mortality rate was 0%. CONCLUSION: The use of general anesthesia for dermatologic procedures in a children's hospital setting appears safe, with a low rate of complications.

Adolescent↗
PubMed2006

Uniform resource locator decay in dermatology journals: author attitudes and preservation practices.

OBJECTIVES: To describe dermatology journal uniform resource locator (URL) use and persistence and to better understand the level of control and awareness of authors regarding the availability of the URLs they cite. DESIGN: Software was written to automatically access URLs in articles published between January 1, 1999, and September 30, 2004, in the 3 dermatology journals with the highest scientific impact. Authors of publications with unavailable URLs were surveyed regarding URL content, availability, and preservation. MAIN OUTCOME MEASURES: Uniform resource locator use and persistence and author opinions and practices. RESULTS: The percentage of articles containing at least 1 URL increased from 2.3% in 1999 to 13.5% in 2004. Of the 1113 URLs, 81.7% were available (decreasing with time since publication from 89.1% of 2004 URLs to 65.4% of 1999 URLs) (P<.001). Uniform resource locator unavailability was highest in The Journal of Investigative Dermatology (22.1%) and lowest in the Archives of Dermatology (14.8%) (P=.03). Some content was partially recoverable via the Internet Archive for 120 of the 204 unavailable URLs. Most authors (55.2%) agreed that the unavailable URL content was important to the publication, but few controlled URL availability personally (5%) or with the help of others (employees, colleagues, and friends) (6.7%). CONCLUSIONS: Uniform resource locators are increasingly used and lost in dermatology journals. Loss will continue until better preservation policies are adopted.

Authorship↗
PubMedDate not supplied

Primary care-based dermatology practice: internists need more training.

OBJECTIVE: To evaluate the ability of teachers in an internal medicine clinic to appropriately diagnose, treat, and refer for specific dermatologic disorders. DESIGN: Prospective study. SETTING: Medical school-affiliated primary care clinic. PATIENTS/PARTICIPANTS: Case presentations of 20 patients who had dermatologic problems were prepared in the form of photographs with accompanying histories. All cases were presented to 17 of 21 available faculty internists who answered questions concerning diagnosis and management of the cases on a questionnaire. The responses of three board-certified faculty dermatologists were used as a reference standard. MEASUREMENTS AND MAIN RESULTS: The internists had had an average of three weeks' total formal dermatology training. Overall, 60% of cases were correctly diagnosed by the internists and 89% of these were either treated appropriately or referred to dermatologists. In 40% of incorrectly diagnosed cases, internists failed to refer and the majority of these were treated inappropriately. Of referrals deemed appropriate by dermatologists, only 62% were made. Conversely, 33% of referrals were deemed unnecessary. CONCLUSIONS: Faculty internists were able to diagnose many common skin diseases despite having received little dermatology training. However, errors in diagnosis occurred frequently and when diagnoses were incorrect there was a tendency to mismanage. These data suggest that the current amount of dermatology training is inadequate to prepare future primary care physicians for their increased role in the management of skin disorders.

Adult↗
PubMed2004

[The dermatologic consultation].

BACKGROUND: Dermatology and venereology, as a cross-sectional discipline, plays an important role in the interdisciplinary care of inpatients. Nonetheless, only a few studies on dermatological consultations have been performed. We reviewed the dermatological consulting service at the University Hospital of the Martin-Luther-University, Halle, Germany. PATIENTS AND METHODS: All consultations performed in 2001 and 2002 were retrospectively assessed. In addition, the time spent in consulting activities was prospectively recorded over a period of six months (January-June 2003). RESULTS: A total of 2390 consultations were evaluated. Most of the consultations (42.8%) were made on internal medicine wards, followed by pediatrics (11.7%), neurology (9.9%) and cardiothoracic surgery (5.7%). Infectious skin diseases accounted for the most frequent diagnosis at 24.4%. The time lapse between request and performance of the consultation averaged 1.1 days. Patients older than 40 years needed dermatological consultation more frequently than younger patients. The duration of consultation averaged 23 minutes (time to site, patient examination, documentation). Thus, the man-hours required for the consulting service is 33.6 per month. CONCLUSION: The study emphasizes that dermatological consultation services make an important contribution to the care of inpatients. In light of increasing specialization in medicine, the consulting service guarantees interdisciplinary treatment of the patients and is thus an important quality parameter for inpatient care.

Comorbidity↗
PubMed2004

[Selected emergencies in operative dermatology].

The large number of surgical procedures in many subspecialty areas of dermatology, such as dermatologic oncology, phlebology and aesthetic dermatology, raises the question of possible complications and emergency situations. Along with common complications such as post-operative bleeding, infections or flap necrosis, there are emergency situations which require immediate intervention to avoid significant harm to the patient. One must distinguish between dermatologic situations which require emergency surgery and emergencies that arise during or after dermatological surgery.

Anesthetics, Local↗
PubMed2005

Adolf Jarisch (1850-1902): an important contributor to Austrian dermatology.

Adolf Jarisch was born on the 15th of February 1850 in the city of Vienna, where he also studied medicine. He soon pursued a career in dermatology and venereology and, thus, joined the clinic of von Hebra, one of the founders of the famous new Vienna School of Medicine. After temporarily replacing von Hebra, Jarisch became the chief of the Department of Dermatology at the University of Innsbruck (1887). Although Adolf Jarisch was appointed chief of the dermatologic department at the University of Graz 5 years later (1892), his biggest dream, to become successor of his former teacher Ferdinand von Hebra and head the dermatological department of the Wiener Allgemeines Krankenhaus (Vienna General Hospital) did not come true. Although Adolf Jarisch is mainly known for his observations on skin reactions and a profound worsening of symptoms in syphilitic patients immediately following treatment with mercury (Jarisch-Herxheimer reaction), he authored more than 25 scientific articles and wrote a book, "Hautkrankheiten", which was considered as the most important in German-speaking literature at the beginning of the twentieth century. The purpose of this historical article is to discuss Jarisch's achievements in the field of dermatology based on a detailed analysis of his scientific work.

Austria↗
PubMed2002

Using the internet to assess and teach medical students in dermatology.

BACKGROUND AND OBJECTIVES: We wish to develop and evaluate a user-friendly online interactive teaching and examination model as an adjunct to traditional bedside teaching of medical students during a clinical rotation in dermatology. METHODS: Following completion of an online examination, senior medical students at the University of British Columbia (n = 178) were asked to complete an online survey to evaluate their acceptance of this new method. The online examination model was evaluated through students' responses to the questionnaire-based evaluation they were asked to complete following their examination. Responses were evaluated on a standardized 5-point scale. RESULTS: A high response rate was achieved (98.9%). Overall, 93% of senior medical students felt that the Internet was a useful and effective way to administer a dermatology examination. Most (90%) preferred the online examination to a traditional paper-and-pencil examination and the majority (88%) felt that the quality of digital images presented was sufficient to make an accurate diagnosis. In addition, students strongly supported the further development of teaching resources on the web and would use these resources in learning dermatology (93%). CONCLUSIONS: The development of an online interactive examination tool for dermatology is technically feasible with current technology. Senior medical students are not only accepting of this new technology but also prefer it to more traditional formats and indicate enthusiasm for the development of further online teaching resources in dermatology.

British Columbia↗
PubMed1991

Percutaneous injury during dermatologic surgery.

An anonymous survey was conducted among 100 randomly selected fellows of the American Society for Dermatologic Surgery. Forty-one respondents provided information about their experience with percutaneous injury. Causes of injury during 6278 invasive procedures performed during a 1-month period included suture needlesticks (two injuries), injection needlestick (one), needle recapping (one), scalpel blade (one), skin hook (one), and an injury during the transport of an instrument (one). Dermatologic surgeons were more likely to injure their dominant fingers. Attitudes of dermatologic surgeons were surveyed regarding operating on patients while the physician or assistant was actively infected with human immunodeficiency virus, hepatitis B virus, herpetic whitlow, or paronychia caused by Staphylococcus aureus. Dermatologic surgeons believed that they should be allowed to operate while infected with human immunodeficiency virus (41.5%), hepatitis B virus (40%), herpetic whitlow (25%), and paronychia caused by S. aureus (20%). Few dermatologic surgeons would disclose preoperatively to patients infections present in themselves or in operating team members that were due to human immunodeficiency virus (29.4%), hepatitis B virus (27.8%), herpetic whitlow (28.6%), or paronychia caused by S. aureus (33.3%).

Accidents, Occupational↗
PubMed1994

From Plenck (d. 1807) to Dohi (d. 1931) and today: Austrian influence on Japanese dermatology.

The Vienna surgeon Joseph Plenck first listed individual skin lesions, some of which we consider primary efflorescences today. He wrote many more treatises, relating to different areas of medicine, most of which reached Japan. One century later Keizo Dohi wrote, that Plenck's oeuvre will remain unforgotten in the history of dermatology, for his importance, in general and for the close relation to the development of medicine and dermatology in Japan. A search for Japanese translations of Plenck's books could prove that. Dohi himself wanted to become a surgeon but changed his plans and enrolled in Moriz Kaposi's (1837-1902) department in Vienna as a postgraduate student in 1893. Sifting through Dohi's textbook and papers, the importance of the Hebra-Kaposi School for Japan is again explicitly stated by the Japanese master, who founded the Japanese Dermatological Society in December of 1900 and the disciplines's journal in 1901. The language of publication was German. Dohi's first paper appeared in the Archiv für Dermatologie und Syphilis in 1896, in German. In recent years Austrian dermatology has become influential again in dermatological research after a mid century low. A series of investigators have spent sabbatical years or postgraduate training at the former Hebra-Kaposi Department in Vienna. Their scientific achievements were mainly in the field of immunobiology of the skin. A list of publications and their authors is presented.

Austria↗