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Importance: Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery., Objective: To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians., Evidence Review: A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines., Findings: The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief., Conclusions and Relevance: Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.

Background: Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment., Objective: To measure QOL before and after MMS and to identify risk factors associated with impaired QOL., Methods: Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS., Results: QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P = .0007). Age younger than 65 years (P = .0001), female sex (P = .0001), and tobacco use (P = .03) were associated with lower QOL scores at all assessment points., Limitations: Single-site observational study. Significant loss to follow-up at both time points after MMS., Conclusion: Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL., (Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Blood components have been implicated as factors which modulate organ injury in acute pancreatitis. To isolate these effects we compared a standardized isolated, blood-perfused, canine pancreas model as described by Herman-Taylor and modified by Cameron with a model using fluosol, a fluorocarbon, as the perfusate. Pancreatitis was induced using partial pancreatic duct obstruction with secretin induced hypersecretion. Twenty-four dogs were randomized into four groups; (1) blood-perfused control (BPC), (2) fluosol-perfused control (FPC), (3) blood-perfused injury (BPI), (4) fluosol-perfused injury (FPI). All glands were observed for 4 h for mean arterial pressure (MAP), weight gain, gross appearance, and venous amylase. Stability was monitored with blood gases and glucose. Specimens were taken at 4 h for light and electron microscopy., Results: BPI preps had a significantly higher vascular resistance at 3 and 4 h compared to FPI preps (3.85 vs 3.26 PRU and 4.8 vs 3.9 PRU, respectively) (P less than 0.002). Edema formation (3+ vs 1+) and venous amylase (18,543 vs 1961) (P less than 0.001) were greater in BPI than FPI preps. Light and electron microscopy confirmed injury but could not quantify it between injury groups., Summary: Hypersecretion and partial ductal obstruction causes a more severe injury in the blood than the fluosol perfused preparation. Changes in the peripheral resistance seen in the blood perfused model lend support to the theory that the primary injury in this model is at the capillary level and is modulated by a blood component.

Sixty-nine patients with pancreatic pseudocysts were reviewed. Chronic alcohol abuse was associated with pancreatitis in 78 percent of the patients. Presenting signs and symptoms were nonspecific. Ultrasonographic and computerized axial tomographic scans were most commonly used to established the diagnosis. Twenty patients were managed conservatively and resolution occurred in 11 of these patients. Forty-nine patients underwent operation. Internal drainage was performed on 31 occasions in 29 patients, and external drainage was performed in 11. In addition, pancreatic resection was carried out in 8 patients, and needle aspiration in 2 patients. Infected pseudocysts were present in 11 patients. Complications occurred in 18 patients in the operated group and 2 patients died (4 percent). There was recurrence of pseudocysts in 10 patients. Our results suggest that pseudocysts remain a common complication of pancreatitis, and infected pseudocysts are the major cause of postoperative morbidity. Computerized axial tomography and ultrasonography are the mainstays of diagnosis. Surgical therapy is safe, but continues to be associated with significant rates of morbidity and recurrence. When pseudocysts recur, they are generally anatomically distant from the original lesion and probably represent new disruptions of the pancreatic duct.