George Hruza - Academia.edu (original) (raw)
Papers by George Hruza
Annals of Plastic Surgery, 1996
Journal of the American Academy of Dermatology, 2020
Journal of the American Academy of Dermatology, 2021
Background: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been repo... more Background: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. Objective: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. Limitations: Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusions: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose.
Journal of the American Academy of Dermatology, 2020
Dermatologic Surgery, 2012
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice exper... more The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
The Lancet Infectious Diseases, 2021
Journal of the American Academy of Dermatology, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. both, we ruled out herpes simplex virus and varicella zoster virus clinically and by performing polymerase chain reaction. Most patients who presented with an erythematous rash had mild itch. There was no correlation between the presence of rash and fever. Involved sites were primarily the trunk and upper limbs, but the head and face were largely spared. In this group, younger patients seem to display more intense and disseminated cutaneous manifestations, including darker red, larger wheal-like and purpuric lesions. All exanthems were short-lived and resolved spontaneously without specific dermatologic treatment after mean of 3 days (range, 2-5 days). The dermatologic manifestations could not be correlated to COVID-19 severity. Diffuse petechiae, gravity-dependent, and multiple, generalized palpable purpura, and acroischemia (primarily finger/toe cyanosis, but neither skin bulla nor dry gangrene) were seen in more severe cases. These manifestations were associated with clotting disorders, reflected in increased prothrombin time and fibrinogen and D-dimer levels, which are seen in intensive care patients. 3-5 In conclusion, some patients with COVID-19 present with inflammatory cutaneous findings: 7.8% in our cohort of hospitalized adults. These skin findings are generally mild and self-limiting and do not correlate with overall prognosis. They generally resolve promptly without specific therapy.
Mayo Clinic Proceedings, 2017
From the Surgical Derma
Plastic and Reconstructive Surgery, 1995
Dermatologic Surgery, 2003
BACKGROUND AND OBJECTIVES. Nonablative dermal remodeling is an evolving technology that has gener... more BACKGROUND AND OBJECTIVES. Nonablative dermal remodeling is an evolving technology that has generated great interest among both laser surgeons and patients. Evidence indicates that dermal collagen formation is the key mechanism of action for the nonablative techniques. We studied, with ultrasound, new collagen formation after nonablative laser irradiation. METHODS. Ten patients with facial rhytids underwent a single treatment with a 585-nm pulsed dye laser. The patients were all female, ranging in age from 47 to 67, and were Fitzpatrick skin types I-III. Laser parameters were as follows: an energy fluence of 2.4 to 3.0 J/cm 2 , a pulse duration of 350 lsec, and a spot size
Annals of Plastic Surgery, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > ...
Archives of Dermatology, 1999
A 43-year-old man presented with a pigmented lesion on the left earlobe. Histologic evaluation of... more A 43-year-old man presented with a pigmented lesion on the left earlobe. Histologic evaluation of a biopsy specimen demonstrated lentigo maligna. The patient was referred to our institution for micrographic excision of the lesion. CASE 2 A 56-year-old man presented with a pigmented lesion on the right preauricular cheek. A biopsy specimen demonstrated lentigo maligna. The lesion was excised in a standard fashion with 0.5-cm margins. Histologic evaluation of the excised specimen showed persistence of the tumor at the surgical margin. A second attempt at excision failed to fully excise the tumor. The patient was referred to our institution for micrographic excision of the residual tumor.
JAMA Dermatology, 2013
IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with M... more IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
Archives of Dermatology, 2008
Dermatologic Surgery, 1995
Supplemental Appendix for JAAD manuscript "Timing of PCR and Antibody Testing in Patients wi... more Supplemental Appendix for JAAD manuscript "Timing of PCR and Antibody Testing in Patients with COVID-19 associated dermatologic manifestations"
Seminars in Dermatology, 1995
Peter A. Adamson, MD Shan R. Baker, MD William J. Binder, MD David Bloom, MD Dale S. Bloomquist, ... more Peter A. Adamson, MD Shan R. Baker, MD William J. Binder, MD David Bloom, MD Dale S. Bloomquist, DDS DeWayne Bradley, MD Lawrence P. Burgess, MD Patrick J. Byrne, MD Paul J. Carniol, MD Roxana Cobo, MD Richard E. Davis, MD Edward Ellis, MD Neal A. Futran, MD Robert A. Goldberg, MD David B. Hom, MD George Hruza, MD Nick S. Jones, MD Frank M. Kamer, MD Gregory S. Keller, MD Robert M. Kellman, MD Kriston J. Kent, MD Douglas J. Kibblewhite, MD Russell W. H. Kridel, MD J. David Kriet, MD Keith A. LaFerriere, MD William Lawson, MD Joseph Leach, MD Corey S. Maas, MD Lawrence J. Marentette, MD Becky L. McGraw-Wall, MD Michael Melvin, MD Martyn Mendelsohn, MD Sam P. Most, MD Ronald L. Moy, MD Craig S. Murakami, MD Gilbert J. Nolst-Trenite, MD Ira D. Papel, MD Stephen S. Park, MD Jonathan Perkins, MD Jennifer Parker Porter, MD Dale H. Rice, MD Mark Rubin, MD Sigmund L. Sattenspiel, MD Anthony P. Sclafani, MD Carig W. Senders, MD William W. Shockley, MD Bryan S. Sires, MD Jeffrey Spiegel, MD Sherard A. Tatum, MD Dean M. Toriumi, MD Jon B. Turk, MD Tom D. Wang, MD Ivan Wayne, MD Phil Werschler, MD Edwin F. Williams, MD Troy Woodman, MD Marc S. Zimbler, MD Wayne F. Larrabee, Jr, MD Editor
Annals of Plastic Surgery, 1996
Journal of the American Academy of Dermatology, 2020
Journal of the American Academy of Dermatology, 2021
Background: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been repo... more Background: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. Objective: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. Limitations: Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusions: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose.
Journal of the American Academy of Dermatology, 2020
Dermatologic Surgery, 2012
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice exper... more The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
The Lancet Infectious Diseases, 2021
Journal of the American Academy of Dermatology, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. both, we ruled out herpes simplex virus and varicella zoster virus clinically and by performing polymerase chain reaction. Most patients who presented with an erythematous rash had mild itch. There was no correlation between the presence of rash and fever. Involved sites were primarily the trunk and upper limbs, but the head and face were largely spared. In this group, younger patients seem to display more intense and disseminated cutaneous manifestations, including darker red, larger wheal-like and purpuric lesions. All exanthems were short-lived and resolved spontaneously without specific dermatologic treatment after mean of 3 days (range, 2-5 days). The dermatologic manifestations could not be correlated to COVID-19 severity. Diffuse petechiae, gravity-dependent, and multiple, generalized palpable purpura, and acroischemia (primarily finger/toe cyanosis, but neither skin bulla nor dry gangrene) were seen in more severe cases. These manifestations were associated with clotting disorders, reflected in increased prothrombin time and fibrinogen and D-dimer levels, which are seen in intensive care patients. 3-5 In conclusion, some patients with COVID-19 present with inflammatory cutaneous findings: 7.8% in our cohort of hospitalized adults. These skin findings are generally mild and self-limiting and do not correlate with overall prognosis. They generally resolve promptly without specific therapy.
Mayo Clinic Proceedings, 2017
From the Surgical Derma
Plastic and Reconstructive Surgery, 1995
Dermatologic Surgery, 2003
BACKGROUND AND OBJECTIVES. Nonablative dermal remodeling is an evolving technology that has gener... more BACKGROUND AND OBJECTIVES. Nonablative dermal remodeling is an evolving technology that has generated great interest among both laser surgeons and patients. Evidence indicates that dermal collagen formation is the key mechanism of action for the nonablative techniques. We studied, with ultrasound, new collagen formation after nonablative laser irradiation. METHODS. Ten patients with facial rhytids underwent a single treatment with a 585-nm pulsed dye laser. The patients were all female, ranging in age from 47 to 67, and were Fitzpatrick skin types I-III. Laser parameters were as follows: an energy fluence of 2.4 to 3.0 J/cm 2 , a pulse duration of 350 lsec, and a spot size
Annals of Plastic Surgery, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > ...
Archives of Dermatology, 1999
A 43-year-old man presented with a pigmented lesion on the left earlobe. Histologic evaluation of... more A 43-year-old man presented with a pigmented lesion on the left earlobe. Histologic evaluation of a biopsy specimen demonstrated lentigo maligna. The patient was referred to our institution for micrographic excision of the lesion. CASE 2 A 56-year-old man presented with a pigmented lesion on the right preauricular cheek. A biopsy specimen demonstrated lentigo maligna. The lesion was excised in a standard fashion with 0.5-cm margins. Histologic evaluation of the excised specimen showed persistence of the tumor at the surgical margin. A second attempt at excision failed to fully excise the tumor. The patient was referred to our institution for micrographic excision of the residual tumor.
JAMA Dermatology, 2013
IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with M... more IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
Archives of Dermatology, 2008
Dermatologic Surgery, 1995
Supplemental Appendix for JAAD manuscript "Timing of PCR and Antibody Testing in Patients wi... more Supplemental Appendix for JAAD manuscript "Timing of PCR and Antibody Testing in Patients with COVID-19 associated dermatologic manifestations"
Seminars in Dermatology, 1995
Peter A. Adamson, MD Shan R. Baker, MD William J. Binder, MD David Bloom, MD Dale S. Bloomquist, ... more Peter A. Adamson, MD Shan R. Baker, MD William J. Binder, MD David Bloom, MD Dale S. Bloomquist, DDS DeWayne Bradley, MD Lawrence P. Burgess, MD Patrick J. Byrne, MD Paul J. Carniol, MD Roxana Cobo, MD Richard E. Davis, MD Edward Ellis, MD Neal A. Futran, MD Robert A. Goldberg, MD David B. Hom, MD George Hruza, MD Nick S. Jones, MD Frank M. Kamer, MD Gregory S. Keller, MD Robert M. Kellman, MD Kriston J. Kent, MD Douglas J. Kibblewhite, MD Russell W. H. Kridel, MD J. David Kriet, MD Keith A. LaFerriere, MD William Lawson, MD Joseph Leach, MD Corey S. Maas, MD Lawrence J. Marentette, MD Becky L. McGraw-Wall, MD Michael Melvin, MD Martyn Mendelsohn, MD Sam P. Most, MD Ronald L. Moy, MD Craig S. Murakami, MD Gilbert J. Nolst-Trenite, MD Ira D. Papel, MD Stephen S. Park, MD Jonathan Perkins, MD Jennifer Parker Porter, MD Dale H. Rice, MD Mark Rubin, MD Sigmund L. Sattenspiel, MD Anthony P. Sclafani, MD Carig W. Senders, MD William W. Shockley, MD Bryan S. Sires, MD Jeffrey Spiegel, MD Sherard A. Tatum, MD Dean M. Toriumi, MD Jon B. Turk, MD Tom D. Wang, MD Ivan Wayne, MD Phil Werschler, MD Edwin F. Williams, MD Troy Woodman, MD Marc S. Zimbler, MD Wayne F. Larrabee, Jr, MD Editor