Incidence of residual nonmelanoma skin cancer in excisions after shave biopsy.

BACKGROUND: Nonmelanoma skin cancer is an increasingly common disease that is typically treated surgically. After histopathologic confirmation by biopsy, the carcinoma is typically removed by excision, but not all excisional specimens contain residual carcinoma. OBJECTIVES: To define the rate of residual basal and squamous cell carcinomas within excisional specimens after shave biopsy in a general dermatology office. METHODS: We retrospectively reviewed 439 consecutive cases sent to a single dermatopathology lab from a practitioner's general dermatology office who also performs Mohs micrographic surgery. One hundred cases had a histopathologically proven carcinoma on biopsy with subsequent excision. Histopathologic type, location, age, sex, and time from biopsy to excision were all analyzed for statistical association. RESULTS: Of 57 cases of basal cell carcinoma, 34 (59.6%) had positive residuals. Of 43 cases of squamous cell carcinoma, 12 (27.9%) had positive residuals. Histologic type was significantly associated (p = .002) with residual carcinoma in excisional specimens, with basal cells 2.13 times as likely to have residual carcinoma present. CONCLUSION: The rate of residual nonmelanoma carcinoma in excision specimens after shave biopsy was found to be different from previously reported in the literature. These data may have therapeutic ramifications if further substantiated.

Graduating osteopathic medical students' perceptions and recommendations on the decision to take the United States Medical Licensing Examination.

CONTEXT: Osteopathic medical students have a choice to take the United States Medical Licensing Examination (USMLE) in addition to the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA). However, taking the USMLE requires additional commitments of time, effort, and expense, often for uncertain return. No data are available about the attitudes of graduating osteopathic medical students toward their options regarding the USMLE and how they decide whether to take this examination. OBJECTIVE: To uncover attitudes among graduating osteopathic medical students on taking the USMLE. METHOD: Using an Internet-based questionnaire, the authors surveyed graduating osteopathic medical students about their experiences with deciding whether to take the USMLE and whether they would advise other students to take the examination. RESULTS: Nineteen osteopathic medical colleges agreed to participate in the survey. Of the 2744 graduating students at those schools, 978 (35.7%) completed the survey. Students in higher quintiles (ie, top 40%) of class rank were more likely to take the USMLE than those in lower quintiles (ie, bottom 40%) (P<.001). The most common reason cited by students for taking the USMLE was to "keep [their] options open" for residencies (233 of 507 respondents [46%]). Of the 474 students who did not take the USMLE, 171 respondents (36.1%) reported experiencing discrimination for not taking the examination. Four hundred seventy of 981 respondents (47.9%) reported finding residency programs that specifically require the USMLE, and 689 of 981 respondents (70.2%) recommended that future students take at least 1 step of the USMLE. CONCLUSION: The majority of graduating osteopathic medical students polled in the present study believed that osteopathic medical students should take the USMLE.

Trends in Kaposi's Sarcoma in Miami Beach from 1987 to 2007.

Purpose. Kaposi's sarcoma (KS) is a rare low-grade vascular tumor associated with the human herpes virus 8. By analyzing the epidemiology, staging, and treatment of KS, we hoped to improve the quality of care at our institution. Methods. Review of the Mount Sinai Medical Center tumor registry database in Miami Beach, FL, USA, identified 143 cases of KS between January 1, 1987 and December 31, 2007. Results. The majority of patients were non-Hispanic whites, non smoking males diagnosed between 1987 and 1996. Most of the patients were HIV positive, with an equal percentage diagnosed with local or distant disease. Most patients received no chemotherapy or radiation. There were no significant differences in patient survival based on sex, HIV status, or radiation received. There was a trend toward improved survival among older patients who smoked, received no chemotherapy, and had localized stage at diagnosis. Multivariate analysis revealed that non-Hispanic whites had a significant worse survival than Hispanic whites (HR = 0.55, 95% CI (0.33, 0.90), P = 0.02). Patients diagnosed between 1987 and 1996 had a worse survival than those between 1997 and 2007 (HR = 0.33 (95% CI 0.19, 0.55), P < 0.0001). Conclusion. This large retrospective study provides further insight into KS. Ethnicity and date of diagnosis are important predictors of long-term survival.

Do observer and self-reports of ictal eye closure predict psychogenic nonepileptic seizures?

PURPOSE: Diagnostic delay in distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures may result in unnecessary therapeutic interventions and higher health care costs. Previous studies demonstrated that video-recorded eye closure is associated with PNES. The present study prospectively assessed whether observer or self-report of eye closure could predict PNES, prior to video-EEG monitoring. METHODS: Adults referred to an epilepsy monitoring unit (EMU) were prospectively enrolled into the study. At baseline, self-report of eye closure was assessed by questionnaire, and observer report was obtained by interview. Physicians viewed video clips independent of EEG tracings and determined the duration of eye closure during PNES and epileptic seizures. We evaluated whether video-recorded eye closure identified an episode as PNES using random effects models that accounted for episode clustering by subject. The utility of observer and self-report of eye closure in predicting a diagnosis of PNES was tested using logistic regression. RESULTS: Of 132 enrolled subjects, 112 met study criteria during EMU stay for either PNES (n = 43, 38.4%) or epilepsy (n = 84, 75.0%). Fifteen of the 43 PNES subjects (34.9%) had coexisting epilepsy. Self and observer reports of eye closure were neither sensitive nor specific for the diagnosis of PNES. Self-report of eye closure more accurately predicted actual video-recorded eye closure than observer report. Video-recorded eye closure was 92% specific, but only 64% sensitive for PNES identification. DISCUSSION: Neither observer nor self-report of eye closure, prior to VEEG monitoring, predicts PNES. Video-recorded eye closure may not be as sensitive an indicator of PNES as previously reported.

Preterminal gasping during hypoxic cardiac arrest increases cardiac function in immature rats.

Newborn animals are more resistant to anoxia than older animals, partly due to an increased tolerance of the immature heart to anoxia. Newborn animals also have a more robust preterminal gasp. We investigated the relationship between gasping and cardiac function in immature and maturing rats exposed to anoxia. Immature postnatal day 7 (PND7) rats (n = 13) and maturing PND17 rats (n = 13) were exposed to 100% nitrogen (anoxia) for 10 min. Echocardiography was used to calculate cardiac contractility (CC) by left ventricular shortening fraction and cardiac output (CO) from Doppler velocity recordings of pulmonary artery blood flow. In a separate group of PND7 rats, CC and CO were recorded after the paralytic agent pancuronium was used to prevent gasping. Anoxia decreased CC and CO in PND7 and PND17 rats, followed by a partial and transient recovery. Gasping preceded recovery of CO and was required to sustain CO. Gasping in PND7 rats lasted longer (541 s versus 351 s, p < 0.01) and resulted in a greater recovery of CC and CO. Anoxia-induced gasping and the associated recovery of cardiac function were abolished by paralysis. Thus, anoxia-induced gasping transiently improves cardiac function, and more robust gasping in immature rats is associated with increased cardiac anoxic tolerance.