Clinicopathologic Characterization of Kaposi Sarcoma on the Foot and Ankle: Analysis of 11 Patients Seen in Our Clinics.

BACKGROUND: Kaposi sarcoma (KS) has multiple clinical variants, and most frequently presents on the lower extremities. Anti-human immunodeficiency virus (HIV) therapy has significantly reduced the incidence of KS. However, KS is still prevalent in both HIV-infected and HIV-uninfected patients. This case series analysis aims to reveal the clinical presentations, differential diagnosis, and treatment options of KS on the foot and ankle. METHODS: Eleven cases of KS involving the foot and ankle were retrieved from our patient database, and their clinicopathologic features were analyzed. RESULTS: All patients were men, aged 29 to 85 years. Two types of KS were found: classic and acquired immunodeficiency syndrome-associated epidemic. The average ages of classic and epidemic KS were 65.7 and 41.8 years, respectively. Clinically, three patients manifested multiple erythematous or deep violaceous, or blue-violaceous macules on either the dorsal or plantar surfaces of both feet. Eight patients showed exophytic, pyogenic granuloma-like nodules on the plantar surface, heels, and toes. Histologically, all KSs had uniform intervening fascicles of elongated spindle cells with slit-like vascular spaces filled with red blood cells and immunoreactivity with human herpesvirus-8. The patients were treated according to HIV infection status. Human immunodeficiency virus-infected patients were treated with anti-HIV therapy after primary surgical excision or biopsy. Human immunodeficiency virus-negative patients were treated with either surgical excision, Mohs surgery, or a combination of surgical excision and local radiotherapy according to individual patient clinical presentation. CONCLUSIONS: Kaposi sarcoma is still prevalent in both HIV-infected and HIV-uninfected patients with a variety of clinical presentations. Biopsy, with histologic evaluation, in combination with immunohistochemistry is essential for the differential diagnosis. The patient should be treated according their clinical manifestation, staging, comorbidity, and immune function.

Mycosis Fungoides Palmaris et Plantaris on the Plantar Aspect of the Foot: A Case Report.

BACKGROUND Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of the cutaneous T cell lymphoma mycosis fungoides (MF). Here we report the case of a middle-aged man with MF on the sole of his left foot. CASE REPORT A 54-year-old man had a diffuse, hard lesion in the middle of the arch on the sole of his left foot for 3 years. Physical examination revealed a 3-cm scaly, keratotic patch with slight erythema on the left plantar central arch. Histopathological evaluation of a punch biopsy specimen revealed infiltration of atypical lymphocytes in the upper dermis. Immunostaining of the atypical lymphocytes showed strong expression of CD3, CD4, and CD5; reduced expression of CD7 and CD8; and no expression of CD20. Periodic acid-Schiff staining was negative for fungi. The patient's lesion was diagnosed as MFPP and he was treated with topical psoralen plus ultraviolet A (PUVA) photochemotherapy. At 5-year follow-up, his condition was in complete remission. CONCLUSIONS MFPP is a rare clinical variant of MF restricted to the palmoplantar area, and is histologically characterized by upper dermal infiltration of atypical lymphocytes with preserved CD3, CD4, and CD5 expression but decreased CD7 and CD8 expression. PUVA photochemotherapy is a treatment option associated with excellent prognosis.

Overcoming diagnostic and treatment challenges in uveitic glaucoma.

Uveitic glaucoma is a range of disorders that results in optic nerve damage from elevated intraocular pressure secondary to intraocular inflammation. As compared to primary open angle glaucoma, uveitic glaucoma is associated with a more aggressive disease course caused by very high intraocular pressure levels that wax and wane. Diagnosis is often based on clinical presentation, disease course, and associated systemic manifestations. Diagnostic imaging plays an important role in both diagnosis and management. While the mechanisms of uveitic glaucoma vary, treatment requires strict control of the inflammation and may involve additional intraocular pressure lowering techniques. Management often dictates an interdisciplinary approach as systemic association and treatment is common. When topical management does not slow the progression of optic nerve damage and vision loss, surgical intervention is required. A significant portion of patients with uveitic glaucoma will eventually require surgical intervention and the appropriate referrals should be made. By nature, success rates of surgical intervention in uveitic glaucoma patients are lower than non-inflammatory causes of elevated intraocular pressure and glaucomatous damage. Chronic inflammation, multiple mechanisms, systemic associations, and unpredictable response to treatment make uveitic glaucoma challenging to manage. This review will discuss the pathophysiology, diagnosis, and management of uveitic glaucoma to provide a guide for eye-care providers.

The critical role of second-order normative beliefs in predicting energy conservation.

Sustaining large-scale public goods requires individuals to make environmentally friendly decisions today to benefit future generations1-6. Recent research suggests that second-order normative beliefs are more powerful predictors of behaviour than first-order personal beliefs7,8. We explored the role that second-order normative beliefs-the belief that community members think that saving energy helps the environment-play in curbing energy use. We first analysed a data set of 211 independent, randomized controlled trials conducted in 27 US states by Opower, a company that uses comparative information about energy consumption to reduce household energy usage (pooled N = 16,198,595). Building off the finding that the energy savings varied between 0.81% and 2.55% across states, we matched this energy use data with a survey that we conducted of over 2,000 individuals in those same states on their first-order personal and second-order normative beliefs. We found that second-order normative beliefs predicted energy savings but first-order personal beliefs did not. A subsequent pre-registered experiment provides causal evidence for the role of second-order normative beliefs in predicting energy conservation above first-order personal beliefs. Our results suggest that second-order normative beliefs play a critical role in promoting energy conservation and have important implications for policymakers concerned with curbing the detrimental consequences of climate change.