Segmental neurofibromatosis.

Three cases of segmental neurofibromatosis (NF) and one case of bilateral segmental NF are described. Previous cases described as segmental NF are reviewed and evaluated in light of Riccardi's rigid definition of segmental NF. The previously reported cases are then placed in four subgroups. Segmental NF may evolve into a generalized form over time. Also, this disorder may occur in a heritable manner, Genetic counseling of affected individuals must include these facts.

Eosinophilic infiltrates in epidermolysis bullosa.

Inherited epidermolysis bullosa encompasses many subsets of diseases, distinguished by skin fragility and blister formation after minor trauma. Histologically, epidermolysis bullosa usually presents as bullae without inflammatory cells. We present four cases of epidermolysis bullosa, including examples of epidermolytic, junctional, and dermolytic types that have eosinophilic infiltrates. These cases do not represent subtypes of epidermolysis bullosa, but simply the influx of eosinophils in neonatally manifested disease. Several hypotheses for the presence of these eosinophils are presented.

Stevens-Johnson syndrome secondary to ingestion of salmon berries.

Stevens-Johnson syndrome is an immune mucocutaneous disorder which can follow viral infections, mycoplasma infections and the ingestion of some drugs. There is also evidence supporting this disease as a hypersensitivity disorder. We observed a four-year-old girl with Stevens-Johnson syndrome attributed to ingestion of salmon berries (Rubus spectabilis).

A synthetic skin substitute as a temporary dressing in Mohs surgery.

Epigard (Synthes, Paoli, PA), a synthetic skin substitute, is useful in the temporary covering of surgical wounds. The dressing adheres to the wound bed, provides hemostasis, and aids neovascularization. When removed after 2-3 days, the surgeon has a wound ready to accept a graft.

Microbiology of the skin: resident flora, ecology, infection.

Humans exist in an environment replete with microorganisms, but only a few become resident on the skin surface. The skin possesses protective mechanisms to limit colonization, and the survival of organisms on the surface lies in part in the ability of the organisms to resist these mechanisms. Microbial colonization on the skin adds to the skin's defense against potentially pathogenic organisms. Although microbes normally live in synergy with their hosts, occasionally colonization can result in clinical infection. Common infections consist of superficial infections of the stratum corneum or appendageal structures that can respond dramatically to therapy but commonly relapse. In rare circumstances, these infections can be quite severe, particularly in immunocompromised patients or in hospitalized patients with indwelling foreign devices. These infections are often resistant to conventional antibiotics and can result in infection with other opportunistic pathogens.

Microbial ecology of the skin.

Humans exist in an environment replete with microorganisms, yet only a few of these microorganisms become residents on the skin surface. These resident flora and the skin constitute a complex ecosystem in which organisms adapt to changes in the microenvironment and to coactions among microorganisms. The skin possesses an assortment of protective mechanisms to limit colonization, and the survival of organisms on the surface lies in part in the ability of the organisms to resist these mechanisms. Microbial colonization on the skin adds to the skin's defense against potentially pathogenic organisms. Although microbes normally live in synergy with their hosts, at times colonization can lead to clinical infection. Common infections consist of superficial infections of the stratum corneum or appendages, which can respond dramatically to therapy but commonly relapse. In rare circumstances these infections can be severe, particularly in immunocompromised patients or hospitalized patients with indwelling foreign devices.

Testicular abnormalities of the subfertile male.

Evaluation of 48 cases of male infertility included testicular biopsy. The histologic classification included normal spermatogenesis (normal or abnormal supporting tissue, maturation arrest (spermatocyte or spermatid stage), hypospermatogenesis, Klinefelter's syndrome and Sertoli-cell-only syndrome. No diagnostic advantage was found in bilateral over unilateral testicular biopsies. Clinical presentation of the patient was correlated with histologic classification: 1) 4 of 13 azoospermic cases had normal spermatogenesis, suggesting post-testicular obstruction, 2) severe oligospermic cases (1 X 10(6) sperm per ml.) had spermatogenic abnormalities and 3) only 1 of 8 mild oligospermic cases (10 to 20 X 10(6) per ml.) had abnormalities of spermatogenesis. The histologic pattern in patients with varicocele seemed consistent with hypospermatogenesis in 9 of 13 cases studied. Testicular biopsy may be useful in the diagnosis of reversible post-testicular obstruction in some azoospermic patients. In addition, some patients with severe oligospermia may find an advantage of increased accuracy of diagnostic counseling based on histologic information. Testicular biopsy in cases of moderate oligospermia may be useful as investigational information in determining histologic patterns that may be responsive to certain modes of therapy. Histologic information obtained in cases of mild oligospermia was not sufficient to provide indication for testicular biopsy in mild oligospermic patients.

The attitudes of family physicians toward the peer review process.

We conducted a study to determine family physicians' attitudes and perceptions toward current peer review practices, and to discover if family physicians, general surgeons, and hospital-based physicians view the process differently. A survey instrument measured perceptions of physicians on the following four areas of the peer review process: (1) how peer reviews are administered, (2) the educational value of peer reviews, (3) the performance of peer review committees, and (4) the effect of the peer review process on physician morale. The survey was mailed to all 3528 practicing physicians who were members of a state medical society. A subgroup of 1695 family physicians, general surgeons, and hospital-based physicians was used for this study, of whom 774 (46%) responded to the questionnaire. Over one half of the family physicians responded negatively toward the peer review process on all items of the survey, with over 70% dissatisfied on five of the 17 items. Family physicians, general surgeons, and hospital-based physicians viewed the peer review process differently in the four areas measured. We found statistically significant differences of opinions regarding present peer review practices among the specialties cited. However, the overall dissatisfaction of the specialty groups studied may suggest that the concern resides more with the profession at large than with any one medical specialty group.