Characteristics of Mohs Practices in the United States: A Recall Survey of ACMS Surgeons

OBJECTIVE The purpose of this study is to better characterize the typical Mohs practice in the United States and to generate data that may be useful in future practice models.
METHODS A survey was mailed in 2004 to all 599 members of the American College of Mohs Surgery with United States addresses listed in the 2003 directory.
RESULTS Most respondents were part of a single speciality group, in a suburban or urban setting, performed between 501–1,000 cases per year, and had been in practice from 0–5 years. The vast majority of Mohs excisions are for basal cell cancers and squamous cell cancers, followed by melanoma. Primary closure is the most common method of repair, followed by the use of flaps. Only 6% of cases were referred to other specialties for closure. Many surgeons augment their practice with non-Mohs cosmetic procedures.
CONCLUSION The characteristics of current Mohs surgery practices in the United States provides useful data for training programs, potential trainees, workforce issues, statistical modeling systems, and Mohs surgeons in the evaluation of their own practices.     

Evidence of an in vitro association between human immunodeficiency virus antigen P24 and Epstein-Barr virus DNA

To investigate the association between human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV), simultaneous determinations of HIV antigen (HIV Ag) p24 and EBV DNA were performed in lymphocyte culture supernatants from 63 individuals at risk of HIV infection. In vitro data, together with HIV immune status results, were subjected to a statistical analysis. HIV infection was identified in 49 patients (78 %); of these, in vitro EBV DNA was found in 44 individuals (90 %), while in only 3 of the 14 non-infected ones (21 %). Statistical analysis demonstrated a close relationship between evidence of HIV infection and in vitro detection of EBV DNA (87.3 % concordant with 95 % confidence interval: 76.5 %–94.5 %). Furthermore, a strong dependence was revealed between the presence of EBV DNA and HIV Ag in culture (p<0.00001). These results indicate the existence of in vitro viral interactions, with likely in vivo implications in the pathogenesis and evolution of HIV infection.     

Chronic paroxysmal hemicrania. VII. Mechanical precipitation of attacks: new cases and localization of trigger points

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.     

Multisection-multiecho MR imaging: effect on image quality

An analysis of the effects of multisection-multiecho imaging on signal intensity is presented using a gaussian excitation pulse. The number of sections acquired, size of the intersection gap, and the number of echoes were all varied independently to evaluate their effect on image intensity. The results indicate that one should take a conservative approach in multisection-multiecho imaging, leaving at least a 2-mm-intersection gap and approximately a 20-msec delay between section excitations to avoid image signal loss owing to partial saturation effects.     

Somatosensory functioning in children with attention deficit hyperactivity disorder

In older to test the hypothesis that attention deficit hyperactivity disorder (ADHD) is related to deficits in somatosensory processing, 49 ADHD male children and 49 matched controls were tested on a wide range of tactile tasks, and somatosensory evoked potentials (SEP) were also recorded. In addition, parents' and teachers' ratings on the children's typical responses to tactile stimuli were obtained. The results show that the ADHD children were less skilled on suprathreshold, but not on threshold tasks than were the controls. Further, a larger percentage of ADHD children were 'tactile defensive'. Finally, the ADHD children showed Iarger-than-normal amplitudes of late, but not early components of the SEP. These data suggest that some aspects of somatosensory processing by ADHD children are deficient.     

Amplification techniques for detection of herpes simplex virus in neonatal and maternal genital specimens obtained at delivery.

Viral culture amplification methods, including centrifugation, use of a cell pretreatment medium containing dimethyl sulfoxide and dexamethasone (DEX medium), and three commercial enzyme immunoassays (EIAs), were evaluated for use with low-titer, asymptomatic neonatal and obstetric samples obtained at delivery. The 4.5-h Ortho EIA was 59.7% sensitive at 16 h compared with 86.4% at 36 h in a spin-amplified format (SAT-EIA). After 36 h with DEX medium, the SAT-EIA was 97.3% sensitive using the 2.5-h modified Ortho EIA and 69.9% sensitive using the Fairleigh Dickinson EIA. Herpes simplex virus (HSV) cytopathic effect was reported in tube culture 1 to 2 days earlier in 8.1 to 35.9% of cells with DEX medium. Overall, the SAT-EIA using the modified Ortho EIA and cells with DEX medium detected 147 of 153 (96.1%) HSV isolates from samples obtained predelivery and 93.1% of 29 HSV positives from samples obtained at labor and delivery, with specificities of 100 and 99.9%, respectively, at 36 h.