ABSTRACT
BACKGROUND: The effect of size on diagnostic performance of dermoscopy in basal cell carcinomas (BCCs) is yet to be determined. OBJECTIVES: To investigate the differences in dermoscopic features between small- and large-sized BCCs. METHODS: A total of 151 BCCs consecutively collected during a 2-year period were analysed. These tumours were evaluated for the presence of various dermoscopic features (colours, structures and vessels) using the contact polarized dermoscopy. Differences in proportions were evaluated by means of chi-squared test and Fisher's exact test, when appropriate. RESULTS: In all, 62 (41.1%) small (≤ 1 cm) and 89 (58.9%) large (>1 cm) BCCs were included. Arborizing vessels, short fine telangiectasias (SFT) and multiple small erosions were significantly (P < 0.05) more frequent in the group of large BCCs. Further analysis of the effect of size on dermoscopic features within the specific groups, nodular, superficial and ulcerated, found significant difference only in the group of nodular BCCs. Structureless hypopigmentation was significantly (P < 0.05) more frequent in the group of large nodular BCCs in comparison with the small ones. CONCLUSIONS: Despite determined differences in vascular features and multiple erosions between the small and large BCCs, the results of further investigation within the specific groups indicate that dermoscopy is reliable for the diagnosis of BCC regardless of its size.
Subject(s)
Carcinoma, Basal Cell/pathology , Dermoscopy , Skin Neoplasms/pathology , Tumor Burden , Adult , Aged , Aged, 80 and over , Blood Vessels/pathology , Carcinoma, Basal Cell/blood supply , Carcinoma, Basal Cell/diagnosis , Female , Humans , Male , Middle Aged , Neovascularization, Pathologic , Skin Neoplasms/blood supply , Skin Neoplasms/diagnosisABSTRACT
We studied the hemodynamic response to intravenous nitroglycerin (NTG) in 40 patients with and without acute heart failure (hemodynamic subsets I-IV) during acute myocardial infarction. Hemodynamic measurements were performed by right heart catheterization. The results showed that NTG response influenced mainly the preload and to a lesser extent the afterload, however these changes were dependent on initial hemodynamic status. The changes in mean arterial pressure and cardiac index were predominantly related to pretreatment pulmonary wedge pressure and slightly to systemic vascular resistance. Response to NTG could be predicted with 85% probability as a decrease of pulmonary wedge pressure, with 58% probability as a decrease in mean arterial pressure and cardiac index, and with 32% probability as an increase in cardiac index and a decrease in systemic vascular resistance. These results indicate that NTG therapy could have optimal results in patients with elevated pulmonary wedge pressure and normal cardiac index, while in the subsets with low mean arterial pressure or low cardiac index potentially deleterious decrease in these values could occur. Therefore the optimal condition for use of intravenous nitroglycerin in the patients with acute heart failure is isolated pulmonary congestion.
Subject(s)
Myocardial Infarction/physiopathology , Nitroglycerin/therapeutic use , Adult , Aged , Heart Failure/drug therapy , Heart Failure/physiopathology , Hemodynamics , Humans , Infusions, Intravenous , Male , Middle Aged , Myocardial Infarction/drug therapy , Nitroglycerin/administration & dosage , Pulmonary Wedge PressureSubject(s)
Diarrhea/etiology , Mesenteric Vascular Occlusion/diagnosis , Thrombosis/diagnosis , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
The hemodynamic effects of intravenously administered trinitroglycerin (TNT) and isosorbide dinitrate (ISDN) in stechiometric equivalent doses were studied in 30 patients with acute myocardial infarction. Both drugs were given over 30 min in every patient, and the stability of the condition of the patient was checked by administering the initial drug again. Measurements were made by right heart catheterization using a balloon tip thermodilution catheter and a catheter in the radial artery. TNT and ISDN have different hemodynamic effects. By multivariate analysis it could be shown that TNT is a venous dilator, lowering mainly pulmonary capillary pressure, while ISDN acts more as a mixed vasodilator, diminishing mainly peripheral vascular resistance and increasing cardiac output. These drugs have, therefore, a different spectrum of indications in patients with acute myocardial infarction.
