All monofilament knots assume sliding conformation in vivo.

BACKGROUND: Surgeons are not always cognizant of the knots they tie. It has been thought that suture material does not determine what types of knots are tied. DESIGN: Experienced surgeons were asked to tie square monofilament knots that were salvaged and microscopically evaluated. RESULTS: Tightly cinched monofilament knots assume sliding conformation in vivo regardless of configuration, instrumentation, suture polymer, or surgeon. CONCLUSIONS: When monofilament suture is securely cinched in vivo, kinetic energy forces even a flat throw into sliding conformation. A well-crafted, intentionally sliding square knot appears compacter than any other monofilament knot.

The spectrum of histopathologic findings in cutaneous eruptions associated with influenza A (H1N1) infection.

Influenza A (H1N1), like many other viral infections, has been associated with cutaneous eruptions. Differential diagnoses in a viral exanthem generally include spongiotic dermatitis, urticaria and drug reaction. The aim of this series was to retrospectively review three cases (five biopsies) involving patients with a clinical history of H1N1 and an accompanying rash, and to evaluate whether unique histopathologic and immunohistochemical features exist among these patients' cutaneous eruptions. Findings among all cases included a sparse superficial perivascular infiltrate, and interestingly, scattered interstitial and prominent intravascular neutrophils. Two cases demonstrated mild spongiosis and mild interface change. Immunohistochemistry in all cases revealed a CD4-predominant lymphocytic infiltrate of the dermis with a sparse intraepidermal population of admixed CD4 and CD8 positive lymphocytes. Many changes found in the cutaneous eruption associated with H1N1 are similar to those of other viral eruptions, including a mild perivascular lymphocytic infiltrate, mild spongiosis and mild interface change; however, sparse dermal and intravascular neutrophils and intraepidermal lymphocytes appear to be the features unique to these cases of H1N1-associated cutaneous eruptions. Such a distinction may prove diagnostically important in the clinical setting and useful in the surveillance of this historically pandemic virus.

Autoimmune clustering: sweet syndrome, Hashimoto thyroiditis, and psoriasis.

Acute febrile neutrophilic dermatosis (AFND; Sweet syndrome) is characterized by a constellation of symptoms and findings: fever, neutrophilia, and tender erythematous skin lesions that typically show an upper dermal infiltrate of mature neutrophils. Whereas some cases are idiopathic, others have been associated with a variety of disorders. In this report, we describe the occurrence of AFND with chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and preexisting psoriasis. This is the first case report of the association of chronic lymphocytic thyroiditis with AFND from the United States and only the third reported in the world's literature. Because the coexistence of these disorders is rare, an underlying common pathogenic mechanism is a possibility. We postulate this to be CD4(+) T-cell dysfunction.

Combination forceps fuse both safety and efficiency.

BACKGROUND: Instrumentation prevents needle stick injury. OBJECTIVE: To review forceps that insure safety and facilitate tissue-handling and knot-tying efficiency. METHOD: Medical literature reports were reviewed using Ovid. Commercially available instruments were qualitatively tested. RESULTS: Suture platforms securely hold suture needles and can be used during knot tying. A wide range of combination forceps have been invented and can be broadly categorized as either skin hook or toothed combination forceps. CONCLUSIONS: Combination forceps fuse both efficiency and safety. Skin hook forceps may eventually be the optimal combination instrument, but toothed combination forceps are recommended.

Preparation of frozen sections.

BACKGROUND: For dermatologists the preparation of frozen sections means micrographic surgery. The preparation of frozen sections is meant to be rapid, but has multiple, discrete steps that demand attention to detail. OBJECTIVE: The objective was to summarize both the proven and the cutting-edge techniques of frozen section preparation. MATERIALS AND METHODS: Reports from the medical literature were used to augment techniques used in our practices. CONCLUSION: We dissect each step of micrographic cancer removal, report on the standard and preferred methods of tissue preparation, and summarize the progress achieved in the past decade.