Electronic brachytherapy (EBT) has seen a significant rise in use over the past few years in treating non-melanoma skin cancer (NMSC). However, the current literature in EBT remains scarce. Existing data on high-dose rate brachytherapy (HDR-BT) with surface applicators is often used to justify its efficacy and safety. In this review we study the two treatment modalities on their efficacy in treating NMSC and we explore the reasons behind the recent uprise in EBT. A literature review using PubMed was performed for articles published until January 2017 studying efficacy of HDR-BT and EBT for treating NMSC. HDR-BT demonstrated effective local control ranging from 96.2% to 100% up to 66 months of follow-up with acceptable cosmesis. For EBT, local control rates ranged from 90% to 100% with generally favorable tolerance and cosmesis outcome after roughly one year. While longer term data on EBT is needed, its short term efficacy shows promise as a possible alternative to surgery or other radiation therapy in a select group of patients.
Langerhans cell histiocytosis is a rare group of disorders that results from the abnormal proliferation and accumulation of dendritic-derived cells in various organs of the body, such as the skin and bones. Hypopigmented macules are a rare cutaneous presentation of Langerhans cell histiocytosis that may pose a diagnostic dilemma when no other findings of Langerhans cell histiocytosis are present at the time of examination. We present 2 cases of the hypopigmented variant of Langerhans cell histiocytosis, including a case with histopathologic features of regression, and a review of the literature. These cases highlight the importance of including Langerhans cell histiocytosis in the differential diagnosis of an infant with hypopigmented macules and papules.
Despite its great importance in surgical approaches to intestinal resection, little definitive information is available on human gut tract length. Previous studies have correlated various measures with sex, age, weight, height, and “ethnic background.” Better knowledge of these relationships may aid in avoidance of surgical complications such as the nutritional disorder “short bowel syndrome.” This study examined length of the intestinal tract and its components (small intestine and colon) in 10 donor bodies. The small intestine was measured from pyloric sphincter to ileocecal junction while the large intestine was measured from caecum to sigmoid colon. Results indicate strong correlation (r=0.827) between colon length and body height from cranial vertex to heel, likely a result of the colon's function in water absorption. This relationship was stronger than the ones among total gut length, small intestine length, and body height. In particular, the weakest correlation was between small intestine length and height (r=0.337), suggesting that the combined lengths of the duodenum, jejunum, and ileum are not closely related to body size. Indeed, this measure had the highest coefficient of variation (0.26) while colon length showed the lowest (0.085). Future research will test hypotheses related to population differences in gut length and its physiologic consequences.
Mesenteric ischemia (MI) is characterized by disabling postprandial abdominal angina stemming from hypoperfusion of the midgut due to inadequate vascular compensatory mechanisms in the superior mesenteric artery (SMA). Duplex ultrasound was used to measure the vascular diameter, peak systolic velocity (PSV), and end diastolic velocity (EDV) of the SMA in 6 healthy subjects after an overnight fast and 30 minutes after eating. Results show a preprandial PSV range of 100.3 – 123.2 cm/s and DV of 18.0 – 26.7 cm/s, and a postprandial PSV of 194.9 – 246.5 cm/s and EDV 41.1 – 73.7 cm/s. All subjects experienced significant increases in SMA postprandial blood velocities (p<.05) with only a slight increase in its diameter (p>.05). In the fasting state, early diastolic flow reversal was observed, yet it was absent postprandially. Normal SMA flow is characterized by a high‐resistance outflow bed in the fasting state. These data suggest that postprandial abdominal pain in MI may indeed be related to increased mesenteric blood flow met by an inadequate vascular response resulting in tissue ischemia.Grant Funding Source: Alumni Association
Dermatology is a branch of medicine that focuses on diagnosis of over 3,000 skin diseases and disorders. The unique nature of this medical discipline requires the physician to be proficient in delicate surgical procedures, pathology, and pharmacologic practice, thus dermatologists are highly skilled specialists. An anatomical workshop for residents of the department of dermatology was held at SUNY Downstate to review and augment foundational knowledge of underlying craniofacial anatomy with the goal of facilitating and translating basic principles of cutaneous surgical procedures. Intimate spatial relationships of dermal, subcutaneous and fascial layers, muscle, nerves, and bone were “brought to life” for residents rarely afforded the opportunity to perform human dissection. Important concepts reviewed included significance of the mid‐pupillary reference line, utilized in location of supraorbital, infraorbital and mental foramina for safe injection of Onabotulinum toxinA (Otx), a potent neuromuscular inhibitor. Review of muscular anatomy with particular attention to the overlapping zygomaticus minor (Zm) and orbicularis occuli (Oo) demonstrated the manner in which inadvertent delivery of Otx to the Zm can induce “relaxation” (paralysis) of Oo when injected beyond the ‘safe‐zone’ (2 mm lateral to mid‐pupillary line). Mastery of craniofacial anatomy remains indispensable for proper and safe cutaneous and cosmetic procedures.
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