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71.
72.
Role of Multiple Scouting Biopsies before Mohs Micrographic Surgery for Extramammary Paget's Disease 总被引:3,自引:0,他引:3
Appert David L. MD Otley Clark C. MD Phillips P. Kim MD Roenigk Randall K. MD 《Dermatologic surgery》2005,31(11):1417-1422
Background. Extramammary Paget's disease (EMPD) frequently extends subclinically, resulting in high recurrence rates after surgical excision. Mohs micrographic surgery (MMS) improves cure rates but may require time-consuming reexcision of subclinical extension. A mechanism to estimate the location and extent of subclinical extension would be helpful.
Objective. To describe and evaluate a technique for multiple scouting biopsies before MMS for EMPD.
Method. A retrospective review of patients at Mayo Clinic who had multiple scouting biopsies before MMS for EMPD without dermal invasion.
Technique. The clinical extent of EMPD is identified. The scouting biopsy sites are determined and documented with photographs. The scouting biopsy specimens are sent for permanent sections. The results of the scouting biopsies help guide the extent of the initial Mohs layer. The tumor is cleared with MMS. An additional 1 mm peripheral margin of tissue is usually submitted for permanent sections.
Results. Multiple scouting biopsies were done in five patients. Four of the five patients had at least one true-positive result. At least one true-negative result was obtained in all five patients. Two patients had at least one false-negative result.
Conclusion. Multiple scouting biopsies before MMS for EMPD without dermal invasion can be a beneficial adjuvant technique.
DAVID L. APPERT, MD, CLARK C. OTLEY, MD, P. KIM PHILLIPS, MD, AND RANDALL K. ROENIGK, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. 相似文献
Objective. To describe and evaluate a technique for multiple scouting biopsies before MMS for EMPD.
Method. A retrospective review of patients at Mayo Clinic who had multiple scouting biopsies before MMS for EMPD without dermal invasion.
Technique. The clinical extent of EMPD is identified. The scouting biopsy sites are determined and documented with photographs. The scouting biopsy specimens are sent for permanent sections. The results of the scouting biopsies help guide the extent of the initial Mohs layer. The tumor is cleared with MMS. An additional 1 mm peripheral margin of tissue is usually submitted for permanent sections.
Results. Multiple scouting biopsies were done in five patients. Four of the five patients had at least one true-positive result. At least one true-negative result was obtained in all five patients. Two patients had at least one false-negative result.
Conclusion. Multiple scouting biopsies before MMS for EMPD without dermal invasion can be a beneficial adjuvant technique.
DAVID L. APPERT, MD, CLARK C. OTLEY, MD, P. KIM PHILLIPS, MD, AND RANDALL K. ROENIGK, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. 相似文献
73.
The response of the unattached 218Po activity size distribution to variations in H2O and SO2 concentration was investigated in a high-purity N2 atmosphere. Lognormal size distributions were reconstructed from screen diffusion battery data using a random search and optimization procedure. For relative humidities of 1% to 90%, SO2 concentrations of 0-6 ppm, and residence times of 38 s, median diameters of the unattached mode ranged from 0.50 (+/- 0.04) to 0.80 (+/- 0.06) nm, corresponding to diffusion coefficients of 0.1-0.05 cm2 s-1. Increases in water vapor concentration resulted in an enhanced rate of ion neutralization and suppression of ion cluster formation. Decreases in cluster diameter with increasing humidity were therefore observed. Addition of SO2 at constant relative humidity resulted in an initial increase in diameter, with a subsequent decrease. Geometric standard deviations averaged 1.05 (+/- 0.01) to 1.06 (+/- 0.01) in all cases, with the unattached fraction comprising 83% to 88% of the total distribution. Results suggest that increases in water vapor concentration enhance neutralization in the immediate vicinity of the recoil path through water radiolysis. Conversion of OH to H2OSO4 on addition of SO2 provides a binary condensable phase capable of clustering around the ion at low relative humidities, increasing particle size. High H2O and SO2 concentrations enhance neutralization through electron scavenging and subsequent ion collision near the end of the recoil path, decreasing the number of available cluster sites and suppressing cluster formation. This reduction is more significant than the increasing size of the stable ion cluster, with increasing H2O and H2SO4 concentrations as predicted by Raes, resulting in decreases in both median diameter and distribution spread. 相似文献
74.
Part III of this series of articles, like Part II, reviews the pioneering efforts in the 19th century to improve the quality of artificial teeth. The focus of this article, unlike that of Part II, is specifically modifications in the design of the occlusal anatomy of the 19th century denture teeth, along with the theories of mandibular movement that inspired those modifications. This article concludes the introductory phase of this project, which seeks to unravel the confusing history of the development of (posterior) denture teeth. 相似文献
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David W. Farley DDS John D. Jones DDS Robert J. Cronin DDS MS 《Journal of prosthodontics》1998,7(2):84-90
Phonetics, esthetics, function, and comfort form the foundation of a successful dental prosthesis. A review of the mechanics of speech as well as common speech problems encountered with a removable maxillary prosthesis are presented. The use of a palatogram to aid the clinician in the assessment and resolution of speech problems associated with a maxillary denture is demonstrated. 相似文献
80.
The importance of intraoperative cholangiography during laparoscopic cholecystectomy 总被引:4,自引:0,他引:4
E H Phillips G Berci B Carroll L Daykhovsky J Sackier M Paz-Partlow 《The American surgeon》1990,56(12):792-795
Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC. 相似文献