Interaction between transient metabolically mediated dilatation and pressure induced constriction in the canine coronary artery.

This study explored the interaction between metabolically mediated vasodilatation (ventricular extra-activation) and pressure induced vasoconstriction (transient augmentation of aortic diastolic pressure). Eight dogs having formalin-induced heart block were chronically instrumented with aortic and left ventricular catheters and an electromagnetic flow probe on the left circumflex coronary artery. At a heart rate of 60 beats/min a single ventricular extra-activation introduced at 200 ms after the normal paced beat resulted in a 13 +/- 1% decrease in diastolic coronary vascular resistance index (DCVRI) in the first response beat (D1) and a persistent vasodilatation lasting for five beats (D1-D5).

Estrogen and progesterone receptors: their role in postsclerotherapy angiogenesis telangiectatic matting (TM).

Background: Postsclerotherapy neoangiogenesis telangiectatic matting (TM) occurs in up to 24% of individuals treated by sclerotherapy. Although the etiology is unknown, obstructive flow factors, angiogenic factors, estrogen, inflammatory, and endogenous factors have all been postulated to play a role in its pathogenesis.

Objective: The aim of the study was to ascertain the presence or absence of estrogen and progesterone receptors in postsclerotherapy TM lesions and thus substantiate their possible role in the pathogenesis of TM.

The role of lasers and light sources in the treatment of leg veins.

Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment.

High-intensity flashlamp photoepilation: a clinical, histological, and mechanistic study in human skin.

Objective: To examine the clinical, histological, and immunohistological effects of flashlamp photoepilation.

Design: Nonrandomized control trial with blinded histological study and follow-up of 1 to 20 months.

Setting: Private academic practice.

Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome.

Background: Although much has been published on the effects of compression on the venous system, relatively few studies address the duration of compression following sclerotherapy of telangiectatic webs associated with reticular veins.

Objective: To perform a controlled study comparing the effects of different durations of compression following sclerotherapy of reticular veins and telangiectasias in similar locations.

Method: This study consisted of a total of 40 patients, 30 patients who received compression therapy and 10 control patients who did not receive compression therapy.

Quantitative immunohistochemical differences in Langerhans cells in dermatitis due to internal versus external antigen sources.

Cutaneous hypersensitivity reactions can develop against antigens delivered through the epidermis (contact dermatitis) or through the blood vessels (e.g., drug eruptions).

Combined high ligation and stab avulsion for varicose veins in an outpatient setting.

Background: In recent years, the transition from radical surgery for the treatment of primary varicose veins has been modified from the previously described high ligation with complete stripping of the greater or lesser saphenous vein.

Objective: The purpose of the herewith-described technique is to present a less invasive technique that incorporates saphenofemoral ligation with hook avulsion of branch varicosities.

Methods: Sapheno-femoral ligation with hook avulsion of branch varicosities is carried out under local anesthesia utilizing the tumescent technique with dissection, ligation, and division of the greater saphenous vein and its tributaries.

Antimicrobial agents for the dermatologist. II. Macrolides, fluoroquinolones, rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

This article is the second of a two-part series reviewing antimicrobial agents that are used by the dermatologist. In part I we reviewed beta-lactam antibiotics and related compounds. In this section we again emphasize some newer agents (macrolides, fluoroquinolones) as well as some of the more commonly employed older agents (rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds.

We review the newer antimicrobial agents that are being employed by dermatologists with increased frequency as well as some of the more commonly used older agents. Particular emphasis is based on selection factors such as causative pathogens and their resistance profiles, routes of administration, toxicity, drug interactions, and dosing requirements. Emphasis in this review is on the newer classes of antimicrobials such as third- and fourth-generation cephalosporins; beta-lactam, beta-lactamase inhibitor combination agents; monobactams; carbapenems; macrolides; and fluoroquinolones.

The development of a Marjolin's cancer in a human immunodeficiency virus-positive hemophilic man and review of the literature.

Background: The malignant potential of chronic ulcers and scars secondary to a variety of injuries is well characterized in the medical literature. Furthermore, it has been reported that human immunodeficiency virus (HIV)-positive patients have a higher incidence of basal cell carcinoma (BCC) than the general population.

Objective: To describe a case of an unusually aggressive morpheaform BCC that developed in a 28-year-old HIV-positive patient.

Current aspects of bacterial infections of the skin.

The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.

The intrinsic antimicrobial activity of selected sclerosing agents in sclerotherapy.

Background: Detergent sclerosing agents may have intrinsic antimicrobial properties. In addition, they may have synergistic effects with other antibiotics such as penicillin. They may induce suppression of intrinsic resistance to penicillin in Staphylococcus aureus.

Congenital erosive and vesicular dermatosis with reticulated, supple scarring: a neutrophilic dermatosis.

Congenital erosive and vesicular dermatosis with reticulated, supple scarring is a rare disease seen at birth with blisters that become eroded and crusted and then heal with characteristic scars. We report the seventh case in the American literature, and the first description of biopsy specimens of early lesions. The acute skin lesions were characterized by sterile, neutrophilic infiltrates in the dermis.

Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment.

Background: Telangiectatic matting and hyperpigmentation are some of the most commonly observed side effects of sclerotherapy. Cutaneous necrosis is relatively rare and often of limited sequelae but most commonly related to extravasation of sclerosant. Physicians treating varicosities and telangiectasia by sclerotherapy must be familiar with causes and means for minimization of all three side effects.

The modified buried vertical mattress suture. A new technique of buried absorbable wound closure associated with excellent cosmesis for wounds under tension.

Background: Recent modifications of mattress suturing techniques have been reported producing rapid and effective skin eversion and excellent tensile strength while producing cosmetically elegant results.

Objective: Presented here is a new modification of the buried vertical mattress suture. Results employing this technique compared with conventional bi-layered wound closure are presented.

The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness.

The effects of the 5 alpha-reductase inhibitor, finasteride, on scalp skin testosterone (T) and dihydrotestosterone (DHT) levels were studied in patients with male pattern baldness. In a double blind study, male patients undergoing hair transplantation were treated with oral finasteride (5 mg/day) or placebo for 28 days. Scalp skin biopsies were obtained before and after treatment for measurement of T and DHT by high pressure liquid chromatography-RIA.

Can the electrophysiologic study predict treatment outcome in patients with sustained ventricular tachyarrhythmias unrelated to coronary artery disease?

Unlabelled: Sustained ventricular tachyarrhythmias unrelated to coronary artery disease are uncommon. Currently there are no clear guidelines to aid selection of the most appropriate treatment strategy. Therefore, factors potentially predictive of arrhythmia recurrence and death and the ability of the electrophysiologic study to predict treatment outcome in patients with spontaneous sustained ventricular tachyarrhythmias unrelated to coronary artery disease were examined in 41 medically treated patients followed for a median of 25 (range 1-76) months.

Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration.

Background: Sclerosing agents produce local endothelial destruction extending to the adventitia of the vessel wall while producing minimal thrombosis formation. They are rapidly inactivated in order to prevent damage far beyond the injection site. It has been stated that detergent sclerosants may have more distal sclerosing capabilities than hyperosmolar sclerosants.

Use of nitrous oxide in hair transplantation surgery.

A study of 400 hair transplants carried out in 200 patients using nitrous oxide as an inducing agent before instillation of lidocaine 1%/epinephrine 100,000 parts anesthesia is presented. Clinical efficacy, side effect profile, and toxicity profile are presented. Nitrous oxide is an excellent agent used for the preanesthetic induction phase of hair transplantation surgery.

Acquired ichthyosis in concomitant HIV-1 and HTLV-II infection: a new association with intravenous drug abuse.

Background: Papulosquamous eruptions are common in HIV-1-infected patients. Acquired ichthyosis may occur after profound T-cell depletion. Intravenous drug users infected with HIV-1 can be coinfected with human lymphotropic virus II (HTLV-II).