Use of a lyophilized bovine collagen matrix in postoperative wound healing.

BACKGROUND: Immediate reconstruction is the preferred approach to the management of defects following Mohs micrographic surgery. In a minority of patients, however, reconstruction is contraindicated, and a long-term biological dressing that stimulates wound healing and minimizes wound care is desirable. OBJECTIVE: We wanted to assess the utility of a lyophilized, type I bovine collagen matrix (SkinTemp) in wound care and wound healing following Mohs micrographic surgery. METHODS: Fifteen patients were treated with a bovine collagen matrix following Mohs micrographic surgery. Study wounds were evaluated for time to complete granulation, time to complete epithelialization, and adverse reactions including infection and allergy. The time to complete healing (granulation and epithelialization) for this group was compared to 15 size- and site-matched surgical defects. RESULTS: The use of bovine collagen matrix provided more rapid wound healing than traditional second intention healing at all anatomic sites studied. The time to complete healing averaged 6.1 weeks with bovine collagen matrix versus 9.4 weeks for the control group. Use of bovine collagen matrix required an average of 3.0 dressing changes weekly compared to 7.0 changes weekly in the control group. There were no wound infections or allergic reactions to it. CONCLUSIONS: A Type I bovine collagen matrix provided a safe, readily available alternative to traditional methods of second intention healing. It minimized wound care while reducing the time for complete healing. A larger study should be performed to confirm the results of this pilot study.

Additional courses of total skin electron beam therapy in the treatment of patients with recurrent cutaneous T-cell lymphoma.

BACKGROUND: Recurrent cutaneous T-cell lymphoma (CTCL) is managed with a variety of modalities. Repeat treatment with additional courses of total skin electron beam therapy (TSEBT) has not been formally evaluated. OBJECTIVE: Our purpose was to evaluate the efficacy and toxicity of additional TSEBT for recurrent CTCL. METHODS: A total of 14 patients were treated with TSEBT and received at least two courses, with five of those patients receiving a third course. Patients were offered additional TSEBT if they suffered recurrence despite other therapy if the extent of the recurrence precluded localized radiation. The median follow-up was 36 months. RESULTS: The median dose for the entire group was 57 Gy. Thirteen patients (93%) achieved a complete response (CR) after the initial course. After the second course, 12 patients (86%) had a CR; of the five patients who underwent a third course, three (60%) achieved a CR. The median disease-free interval after the first course of therapy for those with a CR was 20 months and 11.5 months after the second course. Median survival after the second course was 15 months. All patients had xerosis, pruritus, desquamation, mild erythema, epilation, and anhidrosis of the skin. CONCLUSION: Patients with recurrent CTCL recalcitrant to other forms of therapy or too diffuse for treatment with localized radiation fields are candidates for additional TSEBT. This therapy is effective and well tolerated with an acceptable risk profile.

The use of cryopreserved human skin allografts in wound healing following Mohs surgery.

BACKGROUND: Immediate reconstruction has become the preferred approach to management of full-thickness cutaneous defects following microscopically controlled excision (MCE) of tumors. In a minority of patients, however, large reconstructive procedures are contraindicated, and a long-term biological dressing that stimulates healing while minimizing wound care is desirable. OBJECTIVE: To assess the utility of cryopreserved human skin allografts (HSA) in wound care and wound healing following Mohs surgery. METHODS: Sixteen patients were treated with HSA following MCE and followed postoperatively for evidence of infection, involution, or survival of HSA, and granulation tissue production. Follow-up was 2-26 months. RESULTS: The use of HSA resulted in one of three general outcomes: rapid healing and rejection, subsequent full-thickness skin grafting, or persistence of HSA during prolonged healing. CONCLUSIONS: HSA are a safe alternative to immediate reconstruction in a carefully selected population of skin cancer patients. They minimize wound care while providing continuous wound coverage during healing, and are an efficient bridge to full-thickness skin grafting.

Atrophia maculosa varioliformis cutis. Report of two cases and review of the literature.

Atrophia maculosa varioliformis cutis was initially described in 1918 as an entity in which both linear and punctate scars appeared spontaneously on normal facial skin. To the best of our knowledge, only five additional cases have been described. We describe two patients, 14 and 20 years of age, whose histories and clinical lesions fit the description of atrophia maculosa varioliformis cutis. The histologic findings are also described, and the literature to date is reviewed.

Engineering considerations in the development of the automatic implantable cardioverter defibrillator.

Each of the authors played a significant role in the design and development of one or more of the Medrad/Intec/Cardiac Pacemakers Inc defibrillators. In so doing, each has contributed to the realization of Dr Mirowski's dream. That tens of thousands of patients have now benefitted from his leadership and that many AICDs will soon be competing in the marketplace is testimony to his truly remarkable vision and persistence.

[In situ transcription and determination of mRNA in human thymic antigen 1a positive cells within epidermis].

This paper introduces a method of study on the characteristics of cell surface protein. We used human thymic antigen 1a anti-sense oligonucleotide primer, radiolabeled deoxynucleotide and in situ transcription with cells. The results of in situ transcription and determination of mRNA in CD1a positive cells isolated from the epidermis of the prepuce of normal neonate showed that most of the positive cells contained specific CD1a mRNA, and the specificity and sensitivity of this method were higher and the procedure was relatively simple.

Regional homovanillic acid levels and oral movements in rats following chronic haloperidol treatment.

Rats with more severe orofacial movements after 51 days of haloperidol administration showed lower levels of the dopamine metabolite homovanillic acid (HVA) in the caudate compared to animals who did not develop significant mouth movements. This effect was not observed in other brain regions sampled. This finding is consistent with the hypothesis that dopaminergic receptor supersensitivity in neostriatal structures plays some role in the development of orofacial movements in rats, in association with chronic neuroleptic administration.

Hydrogen-induced microelectronic capacitor failure in pacemakers.

Ceramic chip capacitors used in hybrid microelectronics for cardiac pacemakers are usually highly reliable. However, under certain conditions of capacitor construction, capacitor materials, mounting techniques, and environmental conditions, high failure rates may occur. A specific example is presented in which a ceramic capacitor used in an implanted pacemaker delaminated and failed approximately 30 days after being implanted. The failed capacitor caused a pulse rate rise, but due to circuit design techniques, the rate increase was limited to an acceptable value. The capacitor that failed was from an isolated lot of capacitors that was manufactured using pure palladium plates. The circuit containing this capacitor was hermetically sealed within a titanium case by welding. During the welding, a small amount of hydrogen was released from the titanium which, over a period of 2 to 4 weeks, was absorbed by the palladium plates in the capacitor. By absorbing the hydrogen, the palladium plates exhibit a volumetric expansion of sufficient magnitude to crack and delaminate the capacitor to the point of failure. Subsequently, the recurrence of this failure mode has been avoided by using capacitors containing special palladium alloys that cannot absorb hydrogen. This phenomenon is of interest to pacemaker designers since mercury batteries used in conventional pacemakers generate large amounts of hydrogen and potentially may be responsible for complications when used in conjunction with capacitors containing palladium.