USA: victory over gag rule for family planning groups.

PIP: November 3, 1992 marked both the defeat of President Bush in the US presidential elections and the end to a "gag rule" on health professional providing counseling or referral for abortion in federally funded family planning clinics. the US Court of Appeals for the District of Columbia Circuit handed down the decision in Rust v. Sullivan; the decision was based on procedural grounds only. the history of the "gag rule" is presented. Arguments for restricting abortion counseling were generated in the late 1970s. Policy cemented this position during the 1980s and Republican presidencies. Opposition to the policy decision was mounted by the American Medical Association which considered it "frightening and abhorrent" and the american College of Obstetricians and Gynecologists which beseeched Congress to restore the patient's rights to receive full information and the health professional obligation to provide the information. Legislative efforts were made in November, 1991 with HR 2707 to attach an anti-gag rule measure to a massive appropriations bill. President Bush rescinded the "gag rule" for doctors only, knowing that health professionals did most abortion counseling. HR 2707 was passed and vetoed. The override attempt failed by a close margin. In March 19192, Health and Human Services ordered compliance with the President's November 1991 memorandum. In April 1992 the case or National Family Planning and Reproductive Health Association, Inc., et al. v. Sullivan was filed. The argument was that, since "notice and comment" rulemaking under the Federal Administrative Procedures Act applied to the original "gag rule," the directives constituted new rules subject to "notice and comment" rulemaking which requires months of public discussion and debate. This action forced President Bush into enforcing the original "gag rule" or complying with the "notice and comment" on his directive. Time was running out. It is expected that President Clinton will repeal the "gag rule."^ieng

New primary nonmelanoma skin cancer in patients with a history of squamous cell carcinoma of the skin. Implications and recommendations for follow-up.

BACKGROUND: Rational follow-up guidelines for skin cancer patients should be based on the risk of three separate events: cancer recurrence, cancer metastasis, and the development of subsequent skin cancers. However, currently no guidelines exist for follow-up of patients with squamous cell carcinoma of the skin (SCC), which take into account all three of these risks. OBJECTIVE: The purpose of this study is to establish rational minimum guidelines for follow-up of patients with SCC. To do this, we first must determine the risk of SCC patients for the development of subsequent skin cancers. Combining these data with previously published data on SCC recurrence and SCC metastasis, we then propose guidelines for follow-up of patients with SCC. METHODS: We followed up 101 SCC patients on a yearly basis for 5 years after treatment and recorded the date and site of subsequent nonmelanoma skin cancers (NMSCs). RESULTS: Thirty percent of SCC patients developed additional SCCs and 52% developed subsequent NMSCs within 5 years of therapy for their first SCC. Patients showing the highest risk of subsequent NMSC were those presenting with multiple SCC, SCC greater than 1 cm in diameter, SCC requiring more than 1 Mohs surgery layer to remove, or SCC occurring on the scalp, ear, nose, or extremities. One hundred percent of subsequent NMSCs were detected by the fourth year of follow-up; 54% of these occurred within the first year of follow-up. CONCLUSION: After combining our data with previously published studies of SCC recurrence and metastasis, we recommend that all patients with SCC be followed up for at least 4 years after treatment. Moreover, because most subsequent NMSCs, SCC recurrences, and SCC metastases developed early in the follow-up period, we recommend that patients be reexamined at least every 3 months during the first year of follow-up and every 6 months thereafter. It must be stressed that these are meant as minimum follow-up guidelines.

Hendersonula toruloidea infection in man. Index cases in the non-endemic North American host, and a review of the literature.

Hendersonula toruloidea (HT) is a dematiaceous fungus that is an endemic human pathogen in tropical and subtropical countries. Infection with this fungus is often clinically indistinguishable from Trichophyton rubrum or other dermatophytoses. However, because HT will not grow on standard cycloheximide containing fungal media, and because HT is usually resistant to standard anti-fungal therapies, we believe that HT is a more common cause of 'recalcitrant dermatophytosis' in the United States than is currently recognized. HT may be especially prevalent among immigrant patients from endemic countries. We report the first cases of HT to occur in a non-endemic region of the United States. This suggests that HT may become a significant pathogen in the native American host as well. Moreover, we report the first case of a tinea capitis-like infection due to HT.

The use of a combination skin hook and tissue forceps: a new instrument for dermatologic surgery ("Frankel-Adson forceps").

The dermatologic surgeon frequently uses both skin hook and tissue forceps to accomplish atraumatic wound closure. Since this requires the surgeon to change instruments frequently during the course of the procedure, a combination skin hook and tissue forceps has been developed to make possible the simultaneous use of these two instruments. In addition, using a new technique that combines the two capabilities of this instrument, the surgeon can further reduce the risk of tissue trauma during surgery. The instrument and this technique are described.