Search

The article describes the diagnosis of subcutaneous forehead nodule (SFN). The authors note that if a SFN is determined preoperatively to be a button osteoma or frontalis-associated lipoma, each has a unique approach with which dermatologic surgeons should be proficient. They note that minimal specialized equipment is required for the button osteoma excision and none is required for the frontalis-associated lipoma.

BACKGROUND. Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds. OBJECTIVE. To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon. METHODS. Comprehensive review of the literature. RESULTS. A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth. CONCLUSION. Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting. [ABSTRACT FROM AUTHOR]

D. C. ADAMS, MD, M. L. RAMSEY, MD, AND V. J. MARKS, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

Background: Observational studies on pediatric anesthesia neurotoxicity have been unable to distinguish long-term effects of general anesthesia (GA) from factors associated with the need for surgery. A recent study on elementary school children who had received a single GA during the first year of life demonstrated an association in otherwise healthy children between the duration of anesthesia and diminished test scores and also revealed a subgroup of children with "very poor academic achievement" (VPAA), scoring below the fifth percentile on standardized testing. Analysis of postoperative cognitive function in a similar cohort of children anesthetized with an alternative to GA may help to begin to separate the effects of anesthesia from other confounders., Methods: We used a novel methodology to construct a combined medical and educational database to search for these effects in a similar cohort of children receiving spinal anesthesia (SA) for the same procedures. We compared former patients with a control population of students matched by grade, gender, year of testing, and socioeconomic status., Results: Vermont Department of Education records were analyzed for 265 students who had a single exposure to SA during infancy for circumcision, pyloromyotomy, or inguinal hernia repair. Exposure to SA and surgery had no significant effect on the odds of children having VPAA. (mathematics: P = 0.18; odds ratio 1.50, confidence interval (CI), 0.83-2.68; reading: P = 0.55; odds ratio = 1.19, CI, 0.67-2.1). There was no relationship between duration of exposure to SA and surgery and performance on mathematics (P = 0.73) or reading (P = 0.57) standardized testing. There was a small but statistically significant decrease in reading and math scores in the exposed group (mathematics: P = 0.03; reading: P = 0.02)., Conclusions: We found no link between duration of surgery with infant SA and scores on academic achievement testing in elementary school. We also found no relationship between infant SA and surgery with VPAA on elementary school testing, although the CIs were wide.

Phenylephrine was administered to increase arterial blood pressure in 6 monkeys anesthetized with isoflurane during both normocapnia (arterial partial pressure of CO2 35 to 44 mm Hg) and hypocapnia (arterial partial pressure of CO2 23 to 29 mm Hg). The doses of phenylephrine required to increase mean blood pressure to 33% and 66% above control pressure during hypocapnia [1.7+/-0.9 and 3.1+/-1.7 microg/kg/min (mean+/-SD), respectively] were significantly less than the doses required to achieve the same changes in blood pressure during normocapnia (2.4+/-0.9 and 4.9+/-2.4 microg/kg/min, respectively, P<0.05). In patients with intracranial pathology, for whom hypocapnia is frequently induced, phenylephrine dosage may need to be appropriately reduced.

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.