Faculty Bibliography

BACKGROUND: The apical triangle is the superior portion of the cutaneous upper lip lying between the medial cheek and alar margin. Defects involving this subunit are often repaired without taking into consideration the aesthetic implications of its potential loss or reduction. We present a simple option for repair of apical triangle defects to address this concern. METHODS: We collected a series of 69 patients with apical triangle defects treated from 2002 to 2008 with Mohs micrographic surgery. Their defects were reconstructed using various flaps (advancement, rotation, island pedicle, or M-plasty). A subset of 27 patients was identified who had undergone a standard cheek advancement flap or a modified flap. The modified design introduces an incision extending from the alar crease onto the nasal sill along the cutaneous upper lip, creating a second sliding flap to assist in recreating the apical triangle. RESULTS: A modified flap design introduced the ability to transfer adjacent tissue of the cutaneous upper lip to reconstruct the apical triangle subunit. CONCLUSION: This flap modification is a simple and efficient method of repairing peri-alar defects that restores the apical subunit, preserving facial symmetry.

Use of the biologic agents in moderate to severe chronic plaque psoriasis has provided novel and highly efficacious treatment options. Generally less systemically toxic than more traditional agents, the risks and benefits for these agents must also be considered. We present a review of the iatrogenic effects associated with use of the biologic agents in psoriasis. Focus is placed on antitumor necrosis factor agents, because they are the most studied and commonly used agents, as well as T-cell modulators and interleukin inhibitors.

Female-pattern androgenetic alopecia is a very common disorder that has been associated with extreme psychological morbidity. Few treatments have documented utility and many physicians are often overwhelmed with how little is pharmacologically available to treat this condition. Novel treatments that are effective, safe, less costly and simple are in high demand. We report a case of female-pattern androgenetic alopecia that failed to respond to a novel treatment with injected bimatoprost solution. Hypothetically, the treatment should have been effective and although we did not have success, this report suggests critical points to consider in the future of prostaglandin analogs, as well as other therapies being considered for the treatment of female-pattern hair loss.

OBJECTIVE: To determine whether certain patient demographics are associated with poorer specificity for the diagnosis of melanoma in nevi undergoing short-term sequential digital dermoscopic imaging. DESIGN: Retrospective cohort study performed from April 1, 1998, through May 31, 2007. SETTING: Sydney Melanoma Diagnostic Centre, a tertiary referral institution. PATIENTS: A total of 2497 benign melanocytic lesions in 1765 patients undergoing short-term sequential digital dermoscopic imaging during 2.5 to 4.5 months (42.3% male; mean [SD] age, 40 [14] years; age range, 1-86 years). MAIN OUTCOME MEASURES: Proportion of changed nevi as a function of age, sex, lesion diameter, and anatomical site. RESULTS: The only variable significantly associated with nevus change was age group (P = .002). When compared with the middle-aged (aged 36-50 years) group, the odds of change were significantly increased in the child and adolescent (aged 0-18 years: odds ratio, 2.60; 95% confidence interval, 1.30-5.22), young adult (aged 19-35 years: 1.50; 1.04-2.17), and elderly (> 65 years old: 2.04; 1.04-3.99) age groups. Within the changed benign lesions, a significant association was observed between histologic subtype and age group (P = .01). The proportion of changed lesions of the banal nevi type decreased and the proportion of the dysplastic nevi type increased with age. In the elderly group, 75.9% of changed lesions were of the dysplastic nevi type compared with 35.7% in the youngest group. CONCLUSION: A poorer specificity is observed for the diagnosis of melanoma for nevi undergoing short-term sequential digital dermoscopic imaging in children and adolescents (75.7%) and elderly patients (77.9%) compared with other patients (84.6%).

INTRODUCTION: Guillain-Barre syndrome is an immune-mediated polyneuropathy that is routinely initially treated with either intravenous immunoglobulin or plasmapheresis. To the best of our knowledge, no association between plasmapheresis treatment and acute onset of facial neuropathy has been reported. CASE PRESENTATION: A 35-year-old Caucasian man with no significant prior medical history developed ascending motor weakness and laboratory findings consistent with a diagnosis of Guillain-Barre syndrome. Plasmapheresis was initiated. Acute facial palsy developed during the plasma exchange that subsequently resolved and then acutely recurred during the subsequent plasma exchange. CONCLUSION: To the best of our knowledge, no prior cases of acute facial palsy developing during plasmapheresis treatment are known. Although facial nerve involvement is common in typical Guillain-Barre syndrome, the temporal association with treatment, near-complete resolution and later recurrence support the association. The possible mechanism of plasmapheresis-induced worsening of peripheral nerve function in Guillain-Barre syndrome is unknown.

Two-dimensional DNA lattices are grown under conditions that also are suitable for the magnesium-free growth of three-dimensional calcium carbonate crystals. These lattices are used to template morphology changes in calcium carbonate. The effects of DNA lattices, sub-assemblies, duplexes, single strands, dinucleotides, and mononucleotides on calcium carbonate morphology are studied. A "rotated" morphology of calcite is found to predominate when a critical concentration of any polynucleotide is reached in the templating solution.