Sutter Solano Medical Center

No published prospective studies have been published for several decades examining the incidence of hemangiomas. Older studies were performed before the delineation of "hemangiomas" from other vascular birthmarks was well-established. The objective of our study is to critically re-examine the literature reporting the incidence of infantile hemangiomas to determine if the true incidence is actually known. We performed both an electronic database search and hand search of the medical literature on the natural history of hemangiomas in full-term newborns and infants. A total of seven articles were found comprising two study populations: newborns <2 weeks of age and infants over the age of 2 weeks. All studies included samples sizes >500 patients including both hospital-based and primary care settings. Study designs ranged from retrospective chart reviews to cross-sectional cohort studies. Descriptive nomenclature was not uniform between studies, and all had methodologic limitations including problems of definition and study design. Studies estimating the true incidence of infantile hemangiomas are all many decades old and have significant methodologic issues limiting their ability to determine hemangioma incidence. Future studies in primary care settings using the currently accepted classification schema of vascular birthmarks may more accurately define the incidence and potential impact of this common vascular tumor of infancy.

External genital warts (EGWs) are visible warts that occur in the perigenital and perianal regions. They are due primarily to non-oncogenic human papillomavirus (HPV) types, usually types 6 and 11. Physical examination assisted by bright light and magnification is the recommended approach for primary diagnosis. Biopsy is indicated when EGWs are fixed to underlying structures or discolored or when standard therapies are not effective. Recurrences are common, and there is no single treatment that is superior to others. Among women with atypical squamous cells, molecular HPV testing may be useful in determining who should be referred for colposcopy. Condoms may provide some protection against HPV-related diseases and thus are recommended in new sexual relationships and when partnerships are not mutually monogamous. Because the efficacy of cesarean section in preventing vertical transmission of HPV infection from women with EGWs to their progeny has not been proved, it is not recommended.

Genital human papillomavirus infection is one of the most common sexually transmitted diseases. Imiquimod is a new agent, an immune-response modifier, that has been demonstrated to have potent in vivo antiviral and antitumor effects in animal models. The present prospective, multicenter, double-blind, randomized, vehicle-controlled trial evaluated the efficacy and safety of daily patient-applied imiquimod for up to 16 weeks for the treatment of external genital warts. Wart recurrence was investigated during a 12-week treatment-free follow-up period. In the intent-to-treat analysis, baseline warts cleared from 49 of 94 (52%) patients treated with 5% imiquimod cream, 13 of 90 (14%) patients treated with 1% imiquimod cream, and 3 of 95 (4%) vehicle-treated patients; the differences between the groups treated with vehicle and imiquimod were significant (P < 0.0001). For subjects who completed the follow-up period, recurrence rates after a complete response were 19% (9 of 48 patients) in the 5% imiquimod cream group, 17% (2 of 12) in the 1% imiquimod cream group, and 0% (0 of 3) in the vehicle-treated group. There were no systemic reactions, although local skin reactions (generally of mild or moderate severity) were common, particularly in the 5% imiquimod cream group. Local reactions caused two patients to discontinue treatment. The most frequently reported local skin reactions were erythema, excoriation or flaking, and erosion. Patient-applied 5% imiquimod cream is effective for the treatment of external genital warts and has a favorable safety profile.

BACKGROUND: Early detection and treatment of melanoma is important for optimal clinical outcome, leading to biopsy of pigmented lesions deemed suspicious for the disease. The vast majority of such lesions are benign. Thus, a more objective and accurate means for detection of melanoma is needed to identify lesions for excision. OBJECTIVES: To provide proof-of-principle that epidermal genetic information retrieval (EGIR™; DermTech International, La Jolla, CA, U.S.A.), a method that noninvasively samples cells from stratum corneum by means of adhesive tape stripping, can be used to discern melanomas from naevi. METHODS: Skin overlying pigmented lesions clinically suspicious for melanoma was harvested using EGIR. RNA isolated from the tapes was amplified and gene expression profiled. All lesions were removed for histopathological evaluation. RESULTS: Supervised analysis of the microarray data identified 312 genes differentially expressed between melanomas, naevi and normal skin specimens (P<0·001, false discovery rate q<0·05). Surprisingly, many of these genes are known to have a role in melanocyte development and physiology, melanoma, cancer, and cell growth control. Subsequent class prediction modelling of a training dataset, consisting of 37 melanomas and 37 naevi, discovered a 17-gene classifier that discriminates these skin lesions. Upon testing with an independent dataset, this classifier discerned in situ and invasive melanomas from naevi with 100% sensitivity and 88% specificity, with an area under the curve for the receiver operating characteristic of 0·955. CONCLUSIONS: These results demonstrate that EGIR-harvested specimens can be used to detect melanoma accurately by means of a 17-gene genomic biomarker.

Genital warts are manifestations of a common viral sexually transmitted disease (STD) that are often diagnosed and treated with a variety of clinical specialties. Unlike for other STDs, there is a general lack of a well-established treatment algorithm for the management of external genital warts. This, coupled with a wide variety of treatments and clinical settings, makes the development of a simple algorithm virtually impossible. In this review what is known and not known about current treatments and case management will be discussed.

BACKGROUND: Produce-associated outbreaks of Shiga toxin-producing Escherichia coli (STEC) were first identified in 1991. In April 2018, New Jersey and Pennsylvania officials reported a cluster of STEC O157 infections associated with multiple locations of a restaurant chain. The Centers for Disease Control and Prevention (CDC) queried PulseNet, the national laboratory network for foodborne disease surveillance, for additional cases and began a national investigation. METHODS: A case was defined as an infection between 13 March and 22 August 2018 with 1 of the 22 identified outbreak-associated E. coli O157:H7 or E. coli O61 pulsed-field gel electrophoresis pattern combinations, or with a strain STEC O157 that was closely related to the main outbreak strain by whole-genome sequencing. We conducted epidemiologic and traceback investigations to identify illness subclusters and common sources. A US Food and Drug Administration-led environmental assessment, which tested water, soil, manure, compost, and scat samples, was conducted to evaluate potential sources of STEC contamination. RESULTS: We identified 240 case-patients from 37 states; 104 were hospitalized, 28 developed hemolytic uremic syndrome, and 5 died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty subclusters were identified. Product traceback from subcluster restaurants identified numerous romaine lettuce distributors and growers; all lettuce originated from the Yuma growing region. Water samples collected from an irrigation canal in the region yielded the outbreak strain of STEC O157. CONCLUSIONS: We report on the largest multistate leafy greens-linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination.

BACKGROUND: Osteonecrosis of the jaws in patients treated with bisphosphonates is mostly associated with intravenous bisphosphonates while the incidence associated with oral bisphosphonates is not significant. PURPOSE: The purpose of this paper is to describe a series of cases of jaw osteonecrosis that may be associated with dental implant placement in patients who had taken nitrogen containing bisphosphonates via oral and/or intravenous route. PATIENTS: Six female patients were treated for osteonecrosis of the jaw after implant placement. An average age was 71.8 ± 6.5 years old and they had a history of bisphosphonate use. Two patients suffered from cancer and the other patients had osteoporosis. Two osteoporosis patients had taken only oral bisphosphonate and the other patients received intravenous bisphosphonates. RESULTS: Resection of necrotized bone, implant removal, and primary closure were performed in five patients and four patients showed uneventful healing. One patient presented recurrence at the maxilla and underwent further extraction and resection. One patient presented with an exposure of the bone after implant placement was treated with an advanced flap closure, and the implants were preserved. CONCLUSION: Unusual jaw necrosis after dental implant surgery might be related with oral and/or intravenous bisphosphonates. Wide resection of necrotic bone, collagen graft, and primary closure are key factors for successful healing.

A prospective study of false-positive cultures of Mycobacterium tuberculosis that resulted from laboratory cross-contamination was conducted at three laboratories in California.Laboratory cross-contamination accounted for 2% of the positive cultures.Cross-contamination should be a concern when an isolate matches the genotype of another sample processed during the same period.ulture remains the reference standard for diagnosis of disease caused by Mycobacterium tuberculosis.However, false-positive results can be caused by cross-contamination of cultures in the laboratory, e.g., when M. tuberculosis bacilli are transferred from one specimen to another specimen that does not contain viable bacilli (1-10).Historically, determining whether false-positive results are caused by laboratory crosscontamination has been difficult because of the lack of specific strain identification and nonsystematic criteria.False-positive cultures for M. tuberculosis have important implications for clinical management of patients.Many patients are treated on the basis of the results; therefore, patients can be exposed to unnecessary, potentially toxic, and costly treatment.Genotyping of M. tuberculosis strains has become the standard method for determining whether isolates are clonal (11)(12)(13)(14).This technique, in combination with a review of clinical and radiographic data, allows a determination of the incidence of laboratory cross-contamination of M. tuberculosis cultures.In this study, we used predefined criteria to investigate possible laboratory cross-contamination of M. tuberculosis cultures and prospectively determine its incidence in an effort to find methods to decrease the occurrence of cross-contamination. Methods Study Laboratories and PatientsThis study was conducted by staff of the Microbial Diseases Laboratory, California Department of Health Services, Berkeley, California, which is one of seven participants in the National Tuberculosis Genotyping and Surveillance Network of the Centers for Disease Control and Prevention.Participating California laboratories included those at the San Francisco

To determine whether men are able to self-diagnose external genital warts (EGWs), we studied data from 1115 men with and without human immunodeficiency virus infection. Men were largely unable to accurately assess the presence of EGWs. Self-reporting of EGWs was not a sensitive tool; only 38% of men who had EGWs diagnosed by a trained examiner who used bright light and visual inspection also reported having them. When we controlled for other covariates in a multivariate model, men who had EGWs diagnosed by an examiner were 14 times less likely to show concordance between examiner findings and self-report than were men who did not have EGWs diagnosed by an examiner (odds ratio, 0.07; 95% confidence interval, 0.06-0.09). Self-diagnosis and self-assessment may not accurately reflect the presence of EGWs, and self-diagnosis should not be used in place of an examiner's findings for epidemiologic studies that seek to determine the cause of disease.

Deoxycholic acid (KybellaTM, Allergan Pharmaceuticals, Irvine, CA) is a novel injectable treatment used for the cosmetic reduction of redundant submental fat. By inducing adipose cell lysis, the soft tissue alteration induces subsequent contour change and sharpening of the cervicomental angle.The safety and efficacy have been well established in several prospective clinical trials and subsequent FDA approval for this purpose. This has provided an effective and less invasive alternative to surgical liposuction with virtually no recovery time and less overall discomfort. Given its success for use in this context, a logical step would be to extrapolate to other regions of the body where cosmetic deformity is caused by excessive adipose tissue. In the current article, the authors propose potential options for further use in various targeted areas where subcutaneous fat may be amenable to reduction with deoxycholic acid injection, understanding that such uses would be off-label and require an understanding of the regional anatomy and possible complications. J Drugs Dermatol. 2017;16(1):43-46.

No AccessJournal of Urology1 Feb 1957The Treatment of Hydronephrosis by Sacral Rhizotomy in Paraplegics John A. Hutch John A. HutchJohn A. Hutch Present address: 2100 Monument Blvd., Pleasant Hill, Calif. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)66533-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1957 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByMcGuire E and Savastano J (2018) Urodynamic Findings and Clinical Status Following Vesical Denervation Procedures for Control of IncontinenceJournal of Urology, VOL. 132, NO. 1, (87-88), Online publication date: 1-Jul-1984.Mulcahy J and Bryon Young A (2018) Percutaneous Radiofrequency Sacral Rhizotomy in the Treatment of the Hyperreflexic BladderJournal of Urology, VOL. 120, NO. 5, (557-558), Online publication date: 1-Nov-1978.Lapides J and Diokno A (2018) Editorial CommentJournal of Urology, VOL. 120, NO. 5, (558-558), Online publication date: 1-Nov-1978.Hackler R, Dalton J and Carl Bunts R (2018) Changing Concepts in the Preservation of Renal Function in the ParaplegicJournal of Urology, VOL. 94, NO. 2, (107-111), Online publication date: 1-Aug-1965.Misak S, Bunts R, Ulmer J and Eagles W (2018) Nerve Interruption Procedures in the Urologic Management of Paraplegic PatientsJournal of Urology, VOL. 88, NO. 3, (392-401), Online publication date: 1-Sep-1962.Reynolds C and Smith R (2018) Practical Approach to the Male Chronic Neurogenic BladderJournal of Urology, VOL. 84, NO. 6, (710-712), Online publication date: 1-Dec-1960.Ambrose S and Swanson H (2018) The Hypertonic Neurogenic Bladder in Children: Its Sequelae and ManagementJournal of Urology, VOL. 83, NO. 5, (672-678), Online publication date: 1-May-1960.Bunts R (2018) Preservation of Renal Function in the ParaplegicJournal of Urology, VOL. 81, NO. 6, (720-727), Online publication date: 1-Jun-1959. Volume 77Issue 2February 1957Page: 123-134 Advertisement Copyright & Permissions© 1957 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John A. Hutch Present address: 2100 Monument Blvd., Pleasant Hill, Calif. More articles by this author Expand All Advertisement PDF DownloadLoading ...

Margaret Knott, B.S.; Report of a Case of Parkinsonism Treated with Proprioceptive Facilitation Technics, Physical Therapy, Volume 37, Issue 4, 1 April 1957, Pa

BACKGROUND: Oral antibiotics are commonly prescribed for moderate or severe acne, but there may be limitations due to concerns about side effects associated with systemic treatments. OBJECTIVE: To evaluate the efficacy and safety of a fixed combination clindamycin phosphate 1.2% and benzoyl peroxide 2.5% (clindamycin-BP 2.5%) aqueous gel in the treatment of moderate or severe acne subpopulations. METHODS: Two multicenter, double-blind studies randomized 2,813 subjects with moderate or severe acne to clindamycin-BP 2.5% gel, each active ingredient, or vehicle gel, once daily for 12 weeks. Efficacy evaluations included inflammatory and non-inflammatory lesion counts and evaluator's global severity score at baseline and weeks 4, 8 and 12. Adverse events and subjects' evaluations of product tolerability were also monitored. Subpopulation efficacy and safety analyses by baseline acne severity were performed for the combined data from the two phase 3 studies. RESULTS: Clindamycin-BP 2.5% gel significantly reduced inflammatory, non-inflammatory and total lesions compared with each active ingredient and vehicle in subjects with moderate acne and compared with vehicle in severe acne subjects at week 12. Significant improvements in evaluator's global severity score were evident for subjects with moderate acne in the clindamycin-BP 2.5% group compared with each active ingredient and vehicle and compared with vehicle in subjects with severe acne at week 12. Rates of adverse events were low and similar between treatment groups and baseline acne severity. CONCLUSION: Clindamycin-BP 2.5% aqueous gel is an effective and safe once-daily treatment for moderate or severe acne.

*Solano Dermatology Associates, San Francisco, California †Solano Dermatology Associates, Vallejo, California ‡Department of Dermatology, University of California, San Francisco, California Address correspondence and reprint requests to: John K. Geisse, MD, Solano Dermatology Associates, 127 Hospital Drive, Suite 204, Vallejo, CA 94589, or e-mail: [email protected]

In vaccine trials, diary questionnaires or vaccination report cards (VRCs) are used extensively to collect complaints reported by subjects or guardians following vaccination. These have not been evaluated for accuracy or standardized to facilitate tolerability comparisons among vaccines.Objectives -(1) Develop standardized, age-specific VRCs for collecting self-reported adverse events (AEs) in trials; (2) Evaluate whether complaints elicited by nurse examinations or telephone interviews were missed by VRCs.Methods -Vaccine-trial databases, focus groups, experts and experienced nurses were used to develop paediatric and adolescent/adult VRCs. VRCs were evaluated at four sites. The primary outcome was subjects with AEs missed on the VRC and reported in nurse examinations (for injection-site reactions) or telephone interviews (for systemic complaints).Results -Of 855 subjects, 96.5% completed VRCs. For systemic complaints, 1.5% (12/812) reported both no complaint on VRCs and at least one complaint in telephone interviews. For injection-site reactions, 5.1% (53/1030) of injection sites had both no reaction reported on VRCs and had reactions noted by nurse examination. No missed AEs were rated as severe.Conclusion -The data suggest VRCs provide a practical and reasonably complete method of eliciting complaints following vaccination. Copyright (c) 2000 John Wiley & Sons, Ltd.

A multi‐center, randomized, double‐blind, placebo‐controlled trial was performed to evaluate the effectiveness of butenafine, a fungicidal benzylamine derivative, in the once daily treatment of interdigital tinea pedis. One hundred and fifty patients with interdigital tinea pedis characterized by a minimum erythema score of 2 and a minimum score of 2 for either pruritus or scaling (on a scale of 0–3, where ‘2’ defines moderate severity) were initially enrolled, pending confirmation by mycologic culture and KOH testing. Patients were excluded if the evaluation of tinea pedis might have been impaired by concomitant conditions, if they were hypersensitive to allylamines or ingredients of the study medications, or if they had clinically significant abnormal laboratory values. Women of childbearing potential were also excluded if they were pregnant, lactating, or not using adequate contraceptive measures. The patients were randomized and given study formulations in coded tubes containing either butenafine hydrochloride cream 1% (butenafine) or the vehicle. They were instructed to apply the formulation to all tinea pedis lesions one daily, for 4 weeks. They were evaluated after 1, 2, and 4 weeks of treatment, and again 4 weeks post‐treatment, using the following measures: (i) mycologic cure: negative fungal culture and KOH test; (ii) effective treatment: mycologic cure and investigator global assessment of 80% or more improvement in signs and symptoms; (iii) investigator global assessment of clinical response: cleared (100% improvement in signs and symptoms), excellent (80–99% improvement), good (50–79% improvement), fair (25–49% improvement), poor (less than 25% improvement), unchanged, or worse, (iv) patient’s assessment of change since baseline: 5=greatly improved, 4=somewhat improved, 3=the same, 2=somewhat worse, and 1=much worse. Mycologic cure and effective treatment were each analyzed using the Cochran–Mantel–Haenszel (CMH) test of response by treatment partialled on investigator. Patient perceptions and investigator evaluations of global response were analyzed as ordered categorical data using the CMH mean score test with uniform scores.

Two advanced formulations of clobetasol propionate (CP) 0.05% (Clobex Spray; Galderma Laboratories, L.P., Fort Worth, TX, USA and Olux Foam; Stiefel/Connetics Corp., Coral Gables, FL, USA) were compared in a study of 77 randomized patients with moderate to severe plaque psoriasis. At the end of the treatment period (2 weeks for CP foam or up to 4 weeks for CP spray per product labeling), patients treated with CP spray had a median 64% reduction in affected body surface area (BSA) compared to a median 25% reduction in patients treated with the CP foam (p = 0.004). Also at the end of the treatment period, 22% of CP spray-treated patients were completely clear compared to 5% of CP foam-treated patients (p = 0.04). Improvements in quality of life as determined by the Dermatology Life Quality Index were statistically significantly greater at all time points for patients treated with CP spray compared to patients treated with CP foam (p<0.04 for all). The majority of adverse events for both products were mild in severity. Thus, while both of these formulations contain the same active ingredient at the same concentration, differences in their efficacy were observed when each treatment was used within its approved labeling guidelines.

1 Department of Dermatology and Pathology, University of California, San Francisco, California and Solano Dermatology Associates, Vallejo, California Address correspondence and reprint requests to: John K. Geisse, MD, Solano Dermatology Associates, 127 Hospital Dr., Suite 204, Vallejo, CA 54589, or e-mail: [email protected]. Cutaneous Oncology Update is a section devoted to basic science and clinical aspects of skin cancer. Recent advances in the literature that have relevance to clinicians will be discussed, and viewpoints on controversial or "grey-zone" topics will be presented. Anyone wishing to suggest a topic or article for this section should contact Stanley J. Miller, M.D. at 410-955-1588, 410-955-7100 (fax) or [email protected].

High production costs and perceived declines in soil quality due to agricultural intensification have led to recent interest in conservation tillage production practices. We conducted field experiments in Five Points in 1997 and 1998 to evaluate the effectiveness of maintaining a cover crop mulch on the soil surface in a no-till system compared to a standard tillage system for conserving soil moisture and improving water infiltration and other soil physical properties in a furrow-irrigated tomato field. Soil water content did not differ among treatments in 1997, but was higher under no-till cover crop mulches than conventionally tilled plots during the 1998 growing season. Soil carbon was increased more than 8% and more earthworms were found under no-till mulches relative to the conventionally tilled plots in the second year of the study. Soil compaction was lower in no-till treatments, especially at the 1-to-2-foot depth. In this study, furrows were swept clean and therefore furrow irrigation did not constitute a limitation to this no-till system.

Rainfall dependent inflow and infiltration (RDII) is a significant, though undesirable, component of the m•ban wet-weather water budget in many sanitary sewer systems.Costs and environmental damage attributable to RDII are significant.Costs may be accrued tlu•ough increased treatment and conveyance cost-:, increased maintenance costs, and sanitary sewer overflows (SSOs ).To reduce these coste; and mitigate environmental damage, engineered solutions require estimations of the long-term characteristics of the RDII response to wet weather.This in turn requires estimation of the performance of the existing collection and treatment system, as well as the expected perfonnance of various possible solutions.Due to the complex number of available pathways that RDII may enter a sanitary sewer, RDII is one of the most difficult components ofthe urban wetweather water budget to estimate.RDII observations typically indicate response times that may range from several minutes to several days or weeks.This is confounded by regional and/or seasonal groundwater trends that influence RDII response.Various tools have been applied to estimating this special hydrologic response, including the rational method and several unithydrograph methods.This chapter provides an overview of available RDII estimation methods and highlights results from arelativelynewphysically based conceptual method first introduced by Kadota and Djebbar ( 1998).Kadota and Djebbar (1998) reported on modifications to the USEPA SWMM RUNOFF model that include the response of a conceptual non-linear reservoir to changes in groundwater elevations resulting from permeable-area infiltration.