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Vascular surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Malignant ulcers: classically a rolled (basal cell carcinoma (BCC)), or everted edge (squamous cell carcinoma (SCC)); can occur within an existing ulcer, e.g. Marjolin’s ulcer. A punch biopsy should be performed if suspected.
Introduction to dermatological diagnosis
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
If the diagnosis is in doubt an ellipse of skin can be taken through the edge of the lesion, so that both normal and abnormal skin are included in the specimen. It should include epidermis, dermis and fat. Immune complexes can be identified by immunofluorescence. The sample needs to be sent to the laboratory in Michel's medium. A ‘punch biopsy’ takes a 3–6 mm core of tissue, but this technique produces only a limited sample. It is useful for diagnosis of skin tumours where full excision is not possible. It should not be used for histological examination of inflammatory dermatoses. If a skin tumour is present, the whole lesion should be excised if possible as an ellipse so that the wound can be sewn up in a straight line. A punch biopsy should only be taken if the diagnosis is in doubt, or the lesion too large to remove routinely.
Comparative Anatomy, Physiology, and Biochemistry of Mammalian Skin
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
A punch biopsy is performed after the administration of a local anesthetic and a sharp stainless steel or disposable punch is used to create, loosen, and remove an area of skin (2 to 6 mm usually, depending on the diameter of the punch). The biopsy should be handled carefully. A pair of forceps should be used to lift up one end of the biopsy and, simultaneously, small scissors should be used to cut through the subcutaneous fat as close to the base as possible. Usually after a 2 to 4 mm biopsy, suturing is not required; however, placing two to three sutures is aesthetically pleasing. The use of an antibacterial ointment is recommended to prevent bacterial infections.
Complications after minor salivary gland biopsy: a retrospective study of 630 patients from two Swedish centres
Published in Scandinavian Journal of Rheumatology, 2023
P Olsson, F Ekblad, A Hassler, M Bengtsson, G Warfvinge, T Mandl, M Kvarnström
Different procedures for obtaining a MSGB have been described. The aim is to gain access to salivary gland tissue with minimal risk of complications. In the publication by Chisholm and Mason, a 3 cm ellipse of mucosal membrane was removed for analysis (4). In 1974, Greenspan et al suggested a 1.5–2 cm horizontal incision on the inside of the lower lip, where minor salivary glands can be identified and harvested, after which the wound is sutured. This technique has been commonly used ever since. Vertical incisions, oblique incisions, punch biopsy, minimal incision by needle-tip, and multiple minimal incisions by scalpel have also been described (10–15). Reported complications of the procedure include pain, haematoma, swelling of the lip, scarring and granuloma formation, as well as transient or permanent impaired sensation of the lip (11, 13, 16–20). In general, the complication rate is reported to be low, but only a few studies specifically addressing complications exist, and the surgical methods in these studies vary. Long-standing or permanent impaired sensation of the lower lip is reported in 0.8–6.3% when using incision by scalpel (10, 11, 16, 17, 20–22). There have been, to the best of our knowledge, only five prospective studies, by Caporali et al, Pijpe et al, Saruhanoglu et al, Lee et al, and Delli et al (14, 15, 18, 20, 23), and two small retrospective studies, by Berquin et al and Richards et al (11, 17), evaluating the complications of MSGB in a structured way. Only five of these studies evaluated long-term complications (14, 17, 18, 20, 23) (Table 1).
Vasculitis in a case of rupioid syphilis in HIV
Published in Baylor University Medical Center Proceedings, 2022
Connor Rodriguez, Parneet Dhaliwal, Allison Readinger
Aspiration of the left knee was initially concerning for infection, and the patient was started on empiric antibiotics, but routine cultures were later determined to be negative. Dermatology was consulted and performed a punch biopsy of the skin. Histology demonstrated an abscess with medium- to large-sized blood vessels with fibrinoid necrosis of the vessel wall and neutrophilic infiltrate in and around the vessel walls (Figure 1b). Grocott methenamine silver, acid-fast bacilli, and Gram stains were negative for organisms as well as spirochete immunostain and human herpesvirus-8, likely due to treatment with empiric antibiotics. After communication between the clinician and the pathologist, with review of clinical lesions and pathologic findings, serologic testing was performed, showing a positive rapid plasma reagin (RPR) (1:128 titer), consistent with syphilis. The patient was started on intravenous benzathine penicillin G. He was continued on penicillin at his 4-week follow-up visit. The patient’s lesions resolved the next month with no recurrence.
Comparison of topical lidocaine spray with forced coughing in pain relief during colposcopic biopsy procedure: a randomised trial
Published in Journal of Obstetrics and Gynaecology, 2019
Erbil Karaman, Ali Kolusarı, İsmet Alkış, Orkun Çetin
In the literature, there are numerous studies with conflicting results that have evaluated the effectiveness of LS during a colposcopic biopsy procedure. Öz et al. (2015) conducted a randomised study for the comparison of LS with placebo and they reported no evidence to recommend the use of routine locally sprayed lidocaine anaesthesia before cervical punch biopsy procedure. In another study, Clifton et al. (1998) used benzocaine spray during a colposcopy, and they found that benzocaine in a spray vehicle confers no benefit when used to decrease pain and anxiety in women undergoing colposcopic procedures. However, local anaesthetic injections have been found to be effective in pain relief during the colposcopic biopsy procedure in different studies (Clifton et al. 1998; Oyama et al. 2003). Our study differs from the former mentioned studies because that current study is the first investigation which compared the pain relieving effects of LS form with FC. And the LS was found to be superior to the forced cough during colposcopic biopsy procedure in terms of pain relief.