Sampler Quilt in Blue, Green, and White

This sampler quilt began as a way to do something with three of the blocks I had made over the years for various projects and not used.  Those three blocks are (#2, #8, #11).  More recently were the left over autograph blocks which I used in 9-patch blocks #5, #10, and #12. 

Blocks #1 and #9 are rail fence blocks using up strips of blue fabrics.  Blocks #2, #6, and #7 are Ohio star blocks with working pockets as the centers.  Blocks #4 and #11 are shoo fly blocks.

The quilt is 51 in X 65.5 in.  It is machine pieced and quilted.  I have given it to a friend’s mother.

I used a navy blue fabric for the back and the sashing.  I decided (still not sure if it was a bold move or dumb as minor mistakes show up easily) to use a light gray thread in the bobbin so the quilting would show on the back.  The next two photos show the front block and the corresponding back.

I love to recycle pockets into quilts.  The Ohio star block is a nice one for showing off the pocket.   I had to tie the center of the pocket area so the pocket would still function.

This back photo shows the quilting of #11 block.

Microcystic Lymphatic Malformations of the Tongue – an Article Review

I stumbled across this article while previewing JAMA & Archives CME articles (full reference below). The article gives an overview of lymphatic malformations, noting that both sexes are equally affected, and there is no predilection for any race.

Lymphatic malformations are vascular malformations with an unknown cause. They are estimated to make up 6% of all benign soft-tissue tumors in children. While they may be rare, 50% of all lymphatic malformations are already obvious at the time of birth. Most (90%) are diagnosed by the end of the second year of life owing to clinical symptoms.

About 60% of all lymphatic malformations are found in the head and neck region. Regarding the mouth, the tongue is most commonly affected.

When the malformations occur in the tongue, the symptoms may include hemorrhage, excessive salivation, speech disturbances, difficulties chewing and swallowing, airway obstruction, and orthodontic abnormalities such as mandibular prognathism and malocclusion. Functional impairment and cosmetic deformity significantly affect the quality of life of patients with lymphatic malformations of the tongue.

Along with the overview, the authors present the review of their patients between January 1, 1998, through December 31, 2008, with respect to age and sex distribution, symptoms, clinical presentation, management, treatment outcome, and follow-up.

Twenty patients (13 male and 7 female) with microcystic lymphatic malformations of the tongue were included in the evaluation. Their ages at initial presentation ranged from newborn to 20 years (mean age, 7.4 years). Thirteen of them had been treated at another hospital before the initial presentation at our department. The treatment methods included surgical reduction, laser therapy, corticosteroid therapy, and OK-432 (Picibanil; Chugai Pharmaceutical Co, Ltd, Tokyo, Japan) injections.

The authors present the classification of lymphatic malformations (photo credit)

• Isolated superficial microcystic lymphatic malformations of the tongue (stage I)
• Isolated lymphatic malformations of the tongue with muscle involvement (stage II; stage IIA, involving a part of the tongue; stage IIB, involving the entire tongue)
• Microcystic lymphatic malformations of the tongue and the floor of mouth (stage III)
• Extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures (stage IV)

• 
  

The article discusses treatment options:

In the present series of patients with microcystic lymphatic malformations of the tongue, it was possible to perform complete excision with a CO₂ laser in all patients with stage I disease and in 3 patients with stage IIA disease. …….. The advantages of the CO₂ laser compared with conventional surgery include less postoperative edema, tissue trauma, and blood loss……... For stages I and IIA microcystic lymphatic malformations of the tongue, CO₂ laser surgery seems to be an excellent curative treatment option. In stages IIB, III, and IV disease, CO₂ laser surgery seems to be useful as a part of a combined or staged approach.

Other treatment modalities discussed include radiofrequency ablation, sclerotherapy (specifically OK-432 injections), and other surgical options, including wedge resection, bilateral marginal resection, U-shaped resection, and Jian or Dingman glossectomy.

Treatment of infected cysts before surgery:

The combination of antibiotics and short-duration systemic corticosteroids usually leads to a reduction of symptoms and a decrease of swelling and inflammation as described in patient 2.

I think the article is well written and well worth reading.

REFERENCE

Microcystic Lymphatic Malformations of the Tongue: Diagnosis, Classification, and Treatment; Arch Otolaryngol Head Neck Surg. 2009;135(10):976-983; Susanne Wiegand, MD; Behfar Eivazi, MD; Annette P. Zimmermann, MD; Andreas Neff, MD, PhD; Peter J. Barth, MD, PhD; Andreas M. Sesterhenn, MD, PhD; Robert Mandic, MD, PhD; Jochen A. Werner, MD, PhD

My post: Vascular Birthmarks (July 15, 2007)

Help Fight the BoTax: Send Your Senator a Letter

I am against the Cosmetic Surgery Tax (or BoTax). I feel it is an unfair tax which will heavily affect women more so than men. It will also affect many more in the middle class than in the wealthy class. I’d like to join the Aesthetic Society and all of organized Plastic Surgery in fighting this unfair tax.

For more on how the tax is a bad idea, check out this article Breast-Enlargement Tax That Failed in Jersey Taints U.S. Plan by Nicole Gaouette over at Bloomberg.com (H/T to Jeff Frentzen, PSP Blog)

”It was a real education,” said Cryan, a Democrat who now wants the levy repealed, in a telephone interview. “We essentially discouraged the business from happening at all.”

Susan Hughes, a Cherry Hill, New Jersey, facial surgeon, said her business dropped by 10 percent when patients began crossing the state line to Pennsylvania. Administering the tax strained relationships with patients, and created extra work and costs for her office, she said.

‘You Idiots’

“We become the tax collector,” Hughes said in a telephone interview. “Now you’re going to repeat that on a national level? You idiots!” Hughes’s office manager, Jaime Castle, said she’s also concerned about layering the taxes, making New Jersey residents pay a combined 11 percent. ………….

The following is the template for a letter that patients can use to express their opinion and dissent toward the proposed cosmetic surgery tax:

Dear Senator ______,

HEALTHCARE PLAN IN THE SENATE WILL UNFAIRLY DISCRIMINATE AGAINST US!

I am writing you today about an issue that affects everyone who utilizes plastic surgery services for anything from Botox to Tummy Tucks.

The healthcare bill approved by the US Senate this weekend, Page 2045 Sec. 9017, Excise Tax on Elective Cosmetic Medical Procedures included in the “Patient Protection and Affordable Care Act.

This dense legalese translates to a tax on all cosmetic procedures as partial payment for the healthcare overhaul our current administration is attempting to implement.

The problem is that we would be paying this tax, the FIRST time this country has levied a tax on patients for medical procedures. This Bill is objectionable in many ways, including:

· This is a discriminatory tax. According to the Aesthetic Society Annual Statistics, 91% of all cosmetic procedures are requested by women

· This will not have considerable consequences on the wealthiest patients but, as usual, affects the middle class. We working women, soccer moms, and scores of others who carefully save and budget to improve our appearance and self esteem will be penalized for doing so.

· Procedures such as breast reduction that have been cited in the literature for improving self esteem and quality of life would be taxed as well.

· Our doctor as tax collector: This provision places physicians in the role of tax collector and holds physicians liable should an individual fail or refuse to pay the tax. That is not the relationship we want with our medical provider!

Please, do not allow this portion of the tax bill to pass!

Sincerely,

______________________

You can find your elected representative by clicking here.

Shout Outs

Nuts for Healthcare is this week's host of Grand Rounds. You can read this week’s “Broadway” edition here.

I’m excited to be hosting Grand Rounds this week and feel refreshed to read all the submissions and stories that came my way.  Health care has always been a deep, personal passion of mine, as I continue to be both a student and voice in the various ways that the field is taking shape today.

Another passion of mine is the music and fanfare, dramaturgy and razzle-dazzle of Broadway theatre. … 

And then I thought: why not make this edition of Grand Rounds an intersection of my two favorite things?  So let me raise the curtains

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Medgadget discussed the Lancet article on  Scientists Grow Skin Tissue in Preclinical Study.  Their discussion includes the Lancet podcast discussing the research with two of the study authors, Marc Peschanski MD and Dr Christine Baldeschi PhD.

A team of researchers from France and Spain managed to grow complete human skin epidermis from skin-derived stem cells on laboratory mice. The finding could lead to the rapid production of one's own skin patches for people with burns and other severe skin problems.

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Chris, Life in the Fast Lane, wrote about  A Philosophical Death with a video of Simon Critchley’s lecture.  Good listening!

When pondering death I sometimes wonder how the great philosophers faced death, and what we the living might learn from them…

We need wonder no more.

Listen to ‘From Cow Dung to Poison: A History of Philosopher’s Deaths’, an excerpt of a longer talk by Simon Critchley titled ‘To Philosophize is to Learn How to Die‘ (hat tip to Berto: Philosophy Monkey).

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H/T to @amednews for the following tweet/link (above photo credit):

RT @PSeditor RT @HospitalSafety: Advice about allowed holiday decorations in hospitals http://bit.ly/Q4mhJ

The article gives these tips for safe holiday decorating in hospitals/offices:

There are certainly simple things you can do:

• No “gift-wrapping” of corridor doors
• No hanging ornaments or other stuff from sprinkler heads
• Limited amounts of lighting (one or two strings, UL approved, etc.)
• No fresh-cut live stuff
• Nothing that obstructs egress

And as a reminder, you can download a free holiday decoration monitoring checklist at the Hospital Safety Center.

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Check out @headmirror's radio essay -- The Christmas Letter: WUWM: Lake Effect - Thursday December 3, 2009

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It’s time to vote for the winner in the US Healthcare Reform Photoshop Contest. Winner will receive an 8Meg iPod Touch.

Okay, the entries for the 2009 US Health Care Reform Photoshop Contest are in and it's time to vote! The idea was to create a single picture using your snark, your wit, your creativity to encapsulate your feelings about the US Health Care Reform efforts underway in a single photograph.

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Isn’t this dog sweater adorable?  cal patch shared a tutorial on “ How to Make a Recycled Dog Sweater” over at CraftStylish (photo credit)

Refashioning old or thrifted sweaters into dog sweaters is easy and fun. You'll be amazed at how even the ugliest sweater can take on a whole new look as canine couture! Case in point: this vest. I picked it up at the thrift store because the details in the knit are adorable, but this style would flatter no human! My little Gertie, on the other hand, will look smashing in it.

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There is no guest listed for the Dr Anonymous’ show this week, but don’t let that keep you from joining us.   The show is Thursday night,  9 pm EST.

You may also want to listen to the shows in his Archives. Here are some to get you started:

GruntDoc, Sid Schwab, Dr. Val, Kevin MD, Rural Doctoring, Emergiblog, Crzegrl, Dr. Wes, TBTAM, Gwenn O'Keeffe, Bongi, Paul Levy, John Halamka, and ScanMan

The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant—an Article Review

The stated objective of the article (full reference below) is simply to “discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant.” I think they did an excellent job.

As you may recall, Cleveland Clinic did it’s first face transplant in December 9, 2008. It was a combined face and maxilla transplant done as a salvage operation. The patient was a 46-year-old woman with a history of a gunshot wound to the midface who had had 23 major reconstructive procedures prior to the face transplant. (photo credit)

The article includes some nice photos and illustrations along with an abbreviated list of the major anatomical deficits, preoperative planning, the operative protocol, and a discussion of how she has done since surgery. Anyone with an interest in facial reconstruction &/or transplantation surgery will find this article worth reading.

Their conclusion comment:

The concept of facial transplantation has become a reality with 7 successful procedures at the time of this report. With many other institutions interested in performing this procedure, the number of cases will likely increase in the future, and if the promising initial results continue, the operation may become standard of care for extensive facial injuries.

………... The importance of transferring facial bone to incorporate important facial ligaments and prevent ptosis of the donor flap is an important anatomical concept that is becoming clear as the initial transplant cases are followed up further from their surgery. These patients have needed suspension and/or lift revisions to keep the facial tissues elevated. The need for these procedures may be greatly obviated by including the bony attachments of the cutaneous ligaments. On the basis of our findings, we believe that this may be feasible with the facial arterial arcade alone.

………. This raises the important potential role of facial transplant as a salvage procedure in cases in which other options are unavailable and/or suboptimal. As with any novel surgical innovation, information gathered in the nascent stages of the procedure will be vital to define the indications and appropriate patient selection. Our findings will hopefully contribute to this active discussion.

REFERENCE

The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant; Arch Facial Plast Surg. 2009;11(6):369-377; Daniel S. Alam, MD; Frank Papay, MD; Risal Djohan, MD; Steven Bernard, MD; Robert Lohman, MD; Chad R. Gordon, DO; Mark Hendrickson, MD; Maria Siemionow, MD, PhD, DSc

The First Composite Face and Maxilla Transplant; JAMA. 2009;302(20):2250-2251; Wayne F. Larrabee; Peter A. Hilger

SurgeXperiences 312 -- Call for Submissions

Steve, Adventures of a Funky Heart, will be the host for SurgeXperiences 312 (December 13th).   The deadline for submissions is midnight on Friday, December 11th.  Be sure to submit your post via this form. 

Here is how Steve describes himself:

My name is Steve; I live in rural South Carolina and I was born with a Congenital Heart Defect (CHD) known as Tricuspid Atresia. CHD’s are the most common birth defect, affecting 1 out of 125 live births. Tricuspid Atresia is one of the rarer defects — only about 1 person in 10,000 has it. I have survived 3 heart surgeries, outlived a pacemaker, and I am doing well.

I love the Braves and baseball in general, construct my own action figures, and enjoy 1980’s music. I am also a member of the Adult Congenital Heart Association (ACHA). I support the ACHA in their effort to improve the quality of life for Adult Congenital Heart Defect patients, helping out whenever I can.

If you would like to be the host  SurgeXperiences in the future, please contact Jeffrey who runs the show here.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit. 

Here is the catalog of past SurgeXperiences editions for your reading pleasure.

Christmas Tree Skirt

I made this Christmas Tree Skirt back in the mid 1990’s, but have used it only once. After I invited the dogs into my life, Christmas trees have pretty much gone out. Their tails are not tree friendly. So I decorate with Poinsettias, wreaths, etc.

The skirt is features red, green, and yellow 8-point stars on a black background. The star blocks are 16 in square. It is machine pieced and quilted. It closes with snaps. The skirt is 30 in from center to outer point.

I’ll be adding this post to SewCalGal’s Virtual Christmas Quilt Show.  I hope you will check it out as I am sure there will be many lovely quilts.

Here is a close shot of one of the star blocks.

I have put the Christmas tree skirt up for sale on Etsy if you are interested.

Case Report of a Cystosarcoma Phyllodes – an Article Review

Flipping through my current copy of The Journal of the Arkansas Medical Society, I was surprised to see this case report (full reference below) of a 30.8 pound cystosarcoma phyllodes of the breast. The accompanying photos are impressive. Many questions filled my head – Why did the woman wait so long to seek care? How did she manage to physically do her daily chores on the farm? How did she manage to find clothing to wear?

I scanned this photo in from the article. The patient’s history is as follows:

A 54-year-old self-employed cattle farmer first noticed a small tumor in her left breast at age 19. Over time, the tumor grew from the size of a small pea to a massive size. Finally, family members convinced the patient to seek medical attention. …. Also, there was
no family history of breast cancer on either side of her family. …….The patient, 5’5”, 201 pounds, presented with the left breast entirely replaced with a solid, irregularly shaped, somewhat moveable mass of tremendous size. She had a very deep groove on her left shoulder from her bra strap, very enlarged veins, and no ulcerations, bleedings, or discharge noted. The nipple-areolar complex was shifted medially about 10 cm, and there were no palpable supraclavicular or axillary nodes. The tumor extended toward, but not into, the left axilla. The tumor measured 60 cm from the superior to the inferior tip, and 97 cm circumferentially from laterally to medially.

The article gives a short review of cystosarcoma Phyllodes, pointing out that this is a rare, predominantly benign tumor of
the breast. They point out the tumor was first described in 1928. The name cystosarcoma phyllodes comes from the Greek word, “sarcoma” implying a fl eshy tumor, and “phyllo” for leaf.

Currently, the tumor is more commonly called a Phyllodes Tumor. Whichever term is used, the tumor accounts for only 0.4-1% of all breast tumors. This tumor is most common in women in their 40’s to 50’s. The usual presentation is a patient who felt a small mass which then rapidly increased in size over a few weeks.

Most are benign, but 10-30% may be malignant —either low-grade or high-grade. Benign tumors do not metastasize,
but may grow aggressively and can reoccur locally.

The tumor rarely involves the nipple-areolar complex. Most ( 64-76%) present in the upper outer quadrant of the breast. Most (73%) are over 5 cm in diameter. This mobile mass has distinct borders like a fibroadenoma, and mammagram
findings may be similar.

The primary treatment is complete surgical removal of the tumor with adequate margins. This may be wide local excision or a total mastectomy. Low axillary node dissection is recommended if nodes are enlarged, the tumor is greater than 4 cm, or the biopsy shows a high-grade tumor.

Chemotherapy is not recommended though radiation therapy may be with high-grade malignant tumors.

The article is a nice case report and interesting review.

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Related posts

Breast Masses in Adolescent Girls (July 24, 2008)

REFERENCES

Case Report of a 30.8 Pound Cystosarcoma Phyllodes of Breast; Journal of the Arkansas Medical Society, Vol 106, No 6, pp134-136; Connie Hiers MD, John Cook MD, Elizabeth Sales MD

Are BPA Products Safe?

I love the convenience of my microwave. It is especially good for reheating leftovers like the chili I made recently. I took the chili to the office in a plastic container for lunch the next day. The question is: are the BPAs in the plastic container a health risk? Should I put my chili in a Pyrex or ceramic bowl before microwaving?

Yesterday afternoon, I participated in Better Health's very first blogger briefing. The subject was Bisphenol-A (BPA) plastic safety. The briefing included an interview with Steve Hentges, PhD., Executive Director of the Polycarbonate/BPA Global Group of the American Chemistry Council (ACC), and was moderated by Dr. Steven Novella, founder of the blog Science-Based Medicine and the new policy non-profit, The Institute For Science In Medicine.

Bisphenol-A (BPA) is a chemical widely used to produce polycarbonate, a hard plastic. More than 2 million metric tons of BPA were produced worldwide in 2003. There is an increase in demand of 6% to 10% annually. BPA can be found in a wide range of products, including baby bottles, plastic utensils, and plastic food containers. It has been the focus of some controversy over its safety, and the resulting debate reveals much about how the current system deals with such issues.

The concern is that BPA can leech from plastic containers into the food or liquid it contains, and when consumed can have negative health effects. The debate is over how to interpret existing evidence about BPA safety, which gives conflicting results. Essentially it is a debate about how to weight different kinds of evidence, and where safety thresholds should be.

The Food and Drug Administration is getting ready to look at this question of BPA safety again. The history of the FDA’s stance is as follows (dated Aug 31, 2009):

In August 2008, FDA released a draft report finding that BPA remains safe in food contact materials. On October 31, 2008, a subcommittee of FDA's science board raised questions about whether FDA's review had adequately considered the most recent scientific information available. Most recently, on June 3, 2009, FDA Commissioner Dr. Margaret A. Hamburg testified before the House Committee on Energy and Commerce's Subcommittee on Health (written testimony is available at http://www.fda.gov/NewsEvents/Testimony/ucm164186.htm).

In response to a question about BPA, Dr. Hamburg emphasized that she takes the questions that have been raised about BPA very seriously, and she stated that the FDA's new Acting Chief Scientist, Dr. Jesse Goodman, is working with FDA scientists to take a fresh look at the science of BPA. FDA intends to explain the results of this review in late summer or early fall.

In August 2009, Massachusetts joined Connecticut in taking a stance on BPA. Connecticut has banned the use of BPA from infant formula and baby food cans and jars, as well as in reusable food and beverage containers sold with the state. Massachusetts has considered the same ban, but for now has only told parents of young children to avoid using baby bottles and other food and beverage containers made with the plastic-hardening chemical bisphenol A (BPA). Massachusetts is waiting the FDA’s decision on BPA.

As of the spring of this year, six major companies have agreed to stop selling hard-plastic baby bottles which contain bisphenol-A in the United States. The companies decision was in response to growing public concern. The companies are Playtex Products Inc., Gerber, Evenflo Co., Avent America Inc., Dr. Brown and Disney First Years.

From the FDA Draft Assessment:

Exposure of adults or infants to residual BPA through uses in food additives is relatively low (i.e., no more than 11 μg/person/day for any segment of the population). Traditionally, FDA’s evaluation of chemical migrants to food from the use of food contact materials at exposures of ≤ 150 μg/person/day focuses primarily on carcinogenicity and on genetic toxicity as an indicator of carcinogenicity1, unless data are available (biological or predictive) that indicate a concern for another endpoint of toxicity at this level.
It is well documented that BPA binds to estrogen receptors (ERα and ERβ), although its affinity is orders of magnitude lower than that of endogenous estrogen2,3. In addition, several in vitro studies have indicated that BPA may also interact with other receptors, including membrane bound ER and estrogen-related receptor γ (ERR γ)4. Since the late 1990s, a large volume of research has been generated suggesting a possible ‘low’ dose effect for weakly estrogenic environmental contaminants, such as BPA. The National Toxicology Program (NTP) defines ‘low’ dose for BPA as ≤ 5 mg/kg bw/day5

While BPA may bind to estrogen receptors, its metabolites don’t. The oral route is most important in this discussion. BPA is rapidly metabolized to the monoglucuronide and cleared from the body via urinary excretion. The metabolite, monoglucuronide, is biologically inactive. BPA does not accumulate in body fat or sex organs of either male or female test animals given either 10 or 100 milligrams per kilogram body weight of bisphenol A administered by oral exposure, or intraperitoneal or subcutaneous injection.

So while scientist will continue to look at BPA and its safety, I will feel safe in using plastic water bottles. I will feel safe in storing my leftovers in plastic containers. I will feel safe in reheating my leftovers in those plastic containers.

Listen to the briefing here at Better Health.

Sources

Bisphenol A in Plastics – Should We Worry? by Steven Novella (September 17, 2008)

Bisphenol A (BPA) -- FDA

FDA DRAFT Assessment of Bisphenol A for Use in Food Contact Applications (2008)

Pharmacokinetic Studies and Bisphenol A Metabolism

Shout Outs

Health Technology News is this week's host of Grand Rounds. You can read this week’s edition here.

Welcome to Grand Rounds! A special post-Thanksgiving edition serving up Seinfeld as the lighter fare after the big holiday meal.

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 4, No 11) !   It is the Thanksgiving edition.  You can find the schedule and the COS archives at Emergiblog. (photo credit)

Happy Thanksgiving from Change of Shift!

A ton of great submissions, and not a single turkey among them!

Sit down, grab a hot cup of coffee, let that Thanksgiving dinner settle (all diets start tomorrow) and enjoy the best of the nursing blogosphere!

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H/T to T, Notes of an Anesthesioboist, for the link to this post:   The Art of Inclusive Language  by Ann Pietrangelo

Inclusive language can be a virtual minefield for writers, where any misstep can result in offending the reader. Even if the writer lives with chronic illness or disability, the possibility of offending others is ever-present.

Did I say that right… “lives with chronic illness or disability?” I ask because I’ve been taken to task about my terminology. The brief bio that appears after each post in this space includes the phrase, “as a multiple sclerosis patient…” Feedback indicates that this may not be the correct term and is, in fact, insulting and just plain wrong

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I caught this on NPR last week.  It is something all of us need to think and talk about:  “What Would You Give Up For Safer Roads?”

As part of NPR's "On The Road To Safety" series, we'll ask listeners what they'd be willing to do for safer roads. Tell us: Would you pay more taxes for better highways? Ban cell phone use entirely? Take the keys from mom and dad? Change speed limits? Buy different cars?

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H/T to @laikas for the following tweet which links to a very informative posts for all of us who blog (I am guilty of many of those 10 mistakes.):

Do U Make these 10 Mistakes When U Blog? http://bit.ly/5EZc8S - I fear I do make some of these mistakes, good tips

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Don’t forget the contest Dr Wes and his wife, Diane, are holding: US Healthcare Reform Photoshop Contest. Winner will receive an 8Meg iPod Touch.

 

 

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H/T to @Christina1973 for the link to this wonderful article on an 83 year old retired nurse doing mission work!

At 83, Sarah Hackett could have spent Thanksgiving with her great-grandchildren in the gracious Annisquam village home her family has owned since 1829, overlooking placid Lobster Cove.

Instead, she rose at 3:30 a.m. Thursday to catch a dawn flight from Boston to Haiti, trekking once more to the poor mountain town of Fond des Blancs where she will live for the next several months. Since she retired in 1993 from a nursing career, she has returned every year for seven or eight months at a time, creating projects that help some of the poorest people in the Western Hemisphere stay healthy and make a living……….

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H/T to @purplesque  for the link to the New York Times article on surgery for OCD.  It’s the same article that Shrink Rap discusses in their post:  Surgery for OCD?

Benedict Carey writes about surgical treatments for obsessive compulsive disorder in yesterday's New York Times in "Surgery for Mental Ills Offers both Hope and Risks,"

In one procedure, called a cingulotomy, doctors drill into the skull and thread wires into an area called the anterior cingulate. There they pinpoint and destroy pinches of tissue that lie along a circuit in each hemisphere that connects deeper, emotional centers of the brain to areas of the frontal cortex, where conscious planning is centered.

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This week Dr. Lisa will be the guest on  the Dr Anonymous’ show.   The show returns to its usual Thursday night slot,  9 pm EST.

You may also want to listen to the shows in his Archives. Here are some to get you started:

GruntDoc, Sid Schwab, Dr. Val, Kevin MD, Rural Doctoring, Emergiblog, Crzegrl, Dr. Wes, TBTAM, Gwenn O'Keeffe, Bongi, Paul Levy, John Halamka, and ScanMan

Acne Hypertrophica or Rhinophyma

Flipping through the 1908 textbook A Text-Book of Minor Surgery by Edward Milton Foote, MD the photos accompanying the acne hypertrophica section caught my eye. Allow me to share that section of the book with you.

Acne Hypertrophica

This is an overgrowth of the nose, which is generally considered to be one of the forms of acne rosacea, but is here included with the tumors to which it belongs clinically, for the appearance of the lesion and the treatment warrant this classification.

This is a disease of middle life, or later, marked by a great overgrowth of the sebaceous follicles, with thier ducts, as well as of blood-vessels and fatty tissue. The skin itself is not greatly thickened, and may even be thinned, apparently the result of over-stretching it. The tumor as a whole is soft and flabby, of dark red color, due to the venous congestion. It is not necessarily the result of alcoholism, and many of these patients are unjustly accused of intemperate habits.

Lesser degrees of hypertrophic acne of the nose are frequently found. Such an extreme overgrowth as is shown in Figs 42 and 43 is decidedly exceptional, although even more marked instances are occasionally seen.

Although this overgrowth is benign in character, the excess tissue should be removed, as this can be accomplished without much risk, and the feelings of the patient will thereby be spared many mortifying remarks.

Today we tend to call this problem rhinophyma which is a descriptive term derived from the Greek "rhis" meaning nose and "phyma" meaning growth.

Treatment:

This consists in the removal of wedge-shaped pieces of the growth, so that the normal contour of the nose may be restored. The spongy tissue is very insensitive, so that a small amount of eucain or cocain is sufficient. Hemorrhage is free, but may be controlled by pressure and ligatures. Although these patients are usually plethoric and stand very well the loss of blood, it may be advisable to remove only a potion of the growth at one sitting. This plan has the further advantage of enabling the surgeon to observe the effect of a partial removal of the tumor before completing the task. Removal may be effected in such a way that pedicled flaps are utilized to cover the raw spaces. Their vitality is low, and unless the pedicle is very broad, they are likely to slough. Therefore it is advisable not to undermine them too extensively. The results of this plastic surgery are very satisfactory (Figs 44 and 45). In some cases, if the quality of the skin is too poor, it is better to shave off all of the tissue down to the cartilage and to cover the wound with skin grafts.

Medical treatment through the years has included avoidance of stimulation factors (ie alcohol), appropriate cleanliness, and treatment of secondary infection and inflammation with antibiotics and steroids. In the 1920’s, treatment of the condition included X-ray and radium. Unfortunately, this was found to lead to a greater incidence of skin cancer and thyroid tumors 20 years later.

Surgical treatment has greatly benefited from the addition of lasers. Between 1908 and now, not only were scalpel used to “debulk” the tissue, but so have cryosurgical techniques, chemical peels, dermabrasion, the Shaw knife (a thermally heated scalpel), the Bovie, hot wire loops, and lasers.

The removal of the tissue is often referred to as “decortication.” The goal is to remove the tissue in layers and to avoid injury to the underlying cartilage. If 2-3 mm of skin tissue is left above the cartilage level, the nose regains its shape and there should remain enough sebaceous glands elements for re-epithelialize of the nose. A major advantage of the laser is the near bloodless field.

There is a beautiful example of the results obtained by use of the laser for treatment of rhinophyma here.

 

REFERENCES

Rhinophyma (Grand Rounds presentation at Baylor College of Medicine) by Randall S. Zane, MD; October 29, 1992

Diagnosis and Treatment of Rosacea; MedScape Article, May 21, 2002; Aaron F. Cohen, MD, Jeffrey D. Tiemstra, MD

SurgeXperiences 311 is Up

Jeffrey, Vagus Surgicalis, is the host of this edition of SurgeXperiences.  Here is the beginning of this edition which you can read  here (photo credit). 

Surgeons have to be quick and decisive. Surgeons have to hurt you first so that they can heal you. Surgeons heal with cold steel.

Thank you for dropping by this latest edition of SurgeXperiences, your one and only online Surgical Grand Rounds. ……Today, it is my turn, and I shall do so in “bullet” style. Enjoy.

The host of the next edition (312), December 13th, will be Steve, Adventures of a Funky Heart. The deadline for submissions is midnight on Friday, December 11th. Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.