Treatment of Nodular Fasciitis Occurring on the Face

BackgroundSurgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern.ObjectiveTo describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment.MethodsWe performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO₂) laser.ResultsAmong the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90±1.56 vs. 5.61±1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision.ConclusionSurgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.     

Factors influencing quality of chest compression depth in nursing students

The purpose of the study was to identify factors influencing quality of chest compression depth in nursing students. A convenience sample of 102 female nursing students enrolled in a cardiopulmonary resuscitation skills training session. Each student performed 3 min of chest compression skills on a Resusci Anne SkillReporter manikin for measurements of both depth and rate. Nursing students with correct compression depth (50–60 mm) had higher body weight (t = ?2.02, P = 0.046) and body mass index (t = ?2.19, P = 0.031) compared with students in the incorrect depth group. Mean chest compression depth was shallower in underweight nursing students compared with normal weight or overweight students (F = 8.89, P < 0.001). Body weight was a significant factor influencing quality of chest compression depth (F = 4.25, P = 0.003). Educational intervention targeting underweight nursing students might need to enhance the quality of chest compression skills.     

Adverse myocardial effects of B-vitamin therapy in subjects with chronic kidney disease and hyperhomocysteinaemia

Background & aimsHyperhomocysteinaemia (HHCY), a common finding in patients with chronic kidney disease (CKD), has been shown to contribute to adverse cardiac remodelling and failure. We hypothesised that in human subjects with CKD, HHCY would be associated with myocardial dysfunction, and that homocysteine (HCY)-lowering therapy would improve myocardial remodelling and heart-failure (HF) outcomes.Methods and resultsPost hoc analysis of the Homocysteinemia in Kidney and End Stage Renal Disease (HOST) trial (n = 2056) was performed to determine if HCY-lowering therapy with high dose B vitamins affects HF outcomes in patients with CKD. In addition, effects on myocardial remodelling were assessed in a subgroup of 220 trial subjects who had transthoracic echocardiograms done before study randomisation and during the course of the study as part of their routine clinical care. HF outcomes were not significantly affected by treatment compared to the placebo. HCY levels were inversely correlated with diastolic function (R = ?0.21; p = 0.038). Vitamin therapy resulted in a significant increase in left atrial size (+0.15 ± 0.8 cm vs. ?0.13 ± 0.07 cm; p = 0.0095). No other echocardiographic parameters were significantly associated with baseline HCY levels or changes with vitamin therapy.ConclusionHHCY is associated with diastolic dysfunction in patients with CKD. However, B-vitamin therapy did not improve HF outcomes despite lowering of plasma HCY levels, and was associated with an increase in left atrial size, which is a surrogate for worsening left ventricular diastolic dysfunction. These findings suggest that high-dose B vitamin therapy may be harmful in patients with CKD.     

Ancillary techniques on direct‐smear aspirate slides

Numerous cytologic techniques aimed at effectively acquiring patient material for molecular testing have been proposed. Such techniques are becoming ever more important in an age of personalized medicine. In this commentary, the authors explored some more commonly proposed techniques to aid in the molecular testing of cytologic specimens. These techniques include the use of cell blocks, direct cytologic smears, filter paper storage, frozen samples, and enriched cellular techniques such as ThinPrep and cytospin preparations. Direct‐smeared slides demonstrate excellent preservation of DNA, are easy to prepare, and are amenable to immediate adequacy at the time of the fine‐needle aspiration (FNA) procedure as well as effective subsequent tumor purity estimation. Cell block methods cannot be assessed at the time of FNA and often demonstrate insufficiency, whereas filter paper and frozen techniques do not allow for the direct assessment of the presence and purity of tumor cells in the sample. Direct‐smeared slides are emerging as the most effective preparation and storage medium of cytologic material to be used for molecular testing. Their cost‐effectiveness, ease of use, and reliability have cemented them as the optimal solution for cytopathologists to fulfill the role of providing advanced molecular testing on patient samples. Cancer (Cancer Cytopathol) 2013. © 2012 American Cancer Society.     

Risk factors for recurrence in cutaneous squamous cell carcinoma after Mohs micrographic surgery: A retrospective review of 237 Asian patients

Even after complete removal with Mohs micrographic surgery (MMS), cutaneous squamous cell carcinoma (cSCC) may recur; however, information about risk factors for recurrence in Asian patients is limited. This retrospective study reviewed cSCC patients treated with MMS at a single tertiary referral center from 2000 to 2017. Two hundred and thirty-seven patients were included and 36 showed recurrence (20 with local recurrence, 16 with distant metastasis). History of organ transplantation, diabetes, other malignancies and poorly differentiated histology correlated with cSCC recurrence. History of organ transplantation and cryotherapy at the cSCC site were related to higher local recurrence rates, and poor differentiation related to higher distant metastasis in Asian cSCC patients treated with MMS.