APOE genotype influences acquisition and recall following traumatic brain injury.

APOE has been demonstrated to influence traumatic brain injury (TBI) outcome. The relationship between APOE genotype and memory following TBI was examined in 110 participants in the Defense and Veterans' Head Injury Program. Memory performance was worse in those who had an APOE epsilon 4 allele (n = 30) than those who did not (n = 80), whereas genotype groups did not differ on demographic or injury variables or on measures of executive functioning. These data support a specific role for the APOE protein in memory outcome following TBI, and suggest an APOE isoform-specific effect on neuronal repair processes.

Lichen aureus.

A case of lichen aureus is described to record its clinical and histopathologic features. The disease is a variant of the pigmented purpuric eruptions, the common characteristic of which apparently resides in an abnormality of the minute cutaneous blood vessels.

Carcinoma of the inframammary crease.

Carcinoma of the inframammary crease is an uncommon but distinctive manifestation of carcinoma of the breast. This report of a case illustrates the clinical and histophathologic features. The patient's tumor was exophytic and fissured, and the initial biopsy specimen mimicked basal cell epithelioma.

Basal cell nevus syndrome in a black patient: report of a case and review of the literature.

An 80-year-old black man had multiple basal cell epitheliomas (BCEs), palmar pits, and mandibular cysts. This patient is unusual, not only because of multiple BCEs, but also becuase they developed when the patient was at age 77. Only three other black patients with multiple BCEs in association with basal cell nevus syndrome have been reported previously.

Maculopapular eruption in hypoparathyroidism.

A 12-year-old girl with idiopathic hypoparathyroidism manifested an erythematous, follicular, maculopapular eruption on her truck and arms. The eruption abated when the serum calcium rose to normal levels.

Topical clindamycin in acne vulgaris. Safety and stability.

Eighteen patients with acne vulgaris used a hydroalcoholic solution of clindamycin hydrochloride topically. Serum samples were obtained and assayed for clindamycin; no evidence for systemic absorption was found. The clindamycin capsules used in this preparation contained insoluble fillers that may be removed by filtration without loss of in vitro antibacterial activity. This solution is stable for at least six months.

Bullous transient acantholytic dermatosis.

We have been three cases of a bullous variant of transient acantholytic dermatosis. Skin biopsy specimens showed histopathologic changes identical to pemphigus foliaceus, but immunofluorescent studies showed no tissue-fixed or circulating antibodies to intercellular antigens. The bullous eruption lasted a few weeks to several months and healed without scarring or recurrence. The lesions healed with topical and/or systemic corticosteroid therapy.

Topically administered clindamycin in the treatment of acne vulgaris and other dermatologic disorders.

Clindamycin is a macrolide antibiotic that has been used orally and topically in the treatment of acne vulgaris. Unfortunately, oral administration is associated with pseudomembranous colitis in up to 10% of patients; consequently, it is no longer a generally accepted form of acne therapy. Topical application is an effective, safer alternative. Topical formulations may be extemporaneously prepared or purchased as a pre-mixed hydroalcoholic solution. Adverse effects associated with topical preparations are few and mostly minor. Topical clindamycin is also used in the treatment of erythrasma, rosacea, periorificial facial dermatitis, and folliculitis.

Suppression of corneal allograft rejection by systemic cyclosporine-A in heavily vascularized rabbit corneas following alkali burns.

Immunologic rejection is the main cause of corneal graft failure, especially in vascularized corneal beds. The purpose of this study was to investigate the effect of systemic Cyclosporine-A (CsA) on the survival of corneal allografts in heavily vascularized rabbit corneal beds, following alkali burn. Heavy corneal vascularization was induced in one eye of 20 rabbits by alkali burn. Forty-five days later, penetrating keratoplasty was performed in all the heavily vascularized corneas. Twenty-five mg/kg/day of CsA was intramuscularly administered to 10 rabbits for 30 days. The other 10 rabbits were treated with the solvent without CsA and were used as a matched control group. The results show a significant difference in corneal allograft survival between the two groups. All corneal grafts in the untreated group were intensely rejected and vascularized within 3 weeks. Nine of the 10 corneal transplants, in the CsA-treated group, remained transparent without signs of immunologic rejection for > 180 days. In one corneal transplant, minor signs of rejection occurred. We suggest that CsA, when given systemically, is a potent drug in the prevention of immunologic rejection in high-risk corneal transplantations, such as allografts, in heavily vascularized corneas following alkali burn.

Postoperative cerebrospinal fluid leakage after lumbar spine operations. Conservative treatment.

Cerebrospinal fluid (CSF) leakage from a postoperative wound after lumbar spine operation is an uncommon complication. It may result from excessive traction of the nerve roots, direct trauma, or laceration at the time of operation, causing the dura to be inadvertently opened. Other reasons for this complication are postlaminectomy residual bone spikes, traumatic myelography puncture, and improper suture of dura defects. Eight patients who had postoperative CSF leakage as the only complication after lumbosacral spine operations were examined. They were all treated conservatively with bed rest in the Trendelenburg position, antibiotic coverage, watertight skin suturing, and daily subcutaneous punctures. No patient was operated on for the same type of complication.

Pityriasis rotunda.

Pityriasis rotunda affects dark-skinned persons and appears as nearly perfectly round or oval scaling patches. Often associated with chronic and debilitating illness or malignant disease, it is probably a localized variant of acquired ichthyosis.

Tumor of the follicular infundibulum.

A histopathologically unique tumor originating from the infundibular portion of vellus hair follicles is presented and the clinical and microscopic features of such a case are described. A superficial subepidermal shelf of trichilemmal structure differentiates the lesion from the lobular acanthosis of trichilemmoma.

Contact dermatitis caused by Brucella.

We report a case of a distinctive dermatitis in a dairy worker exposed to Brucella abortus while manually delivering an infected calf. The rapid onset of pruritus, the strict limitation of lesions to the upper extremities, and the negative results on growth of culture for microorganisms make direct bacterial infection an untenable cause in this case. Allergic hypersensitivity is the probable mechanism, manifesting itself initially as contact urticaria. Coincidentally our patient also had systemic brucellosis, the symptoms of which antedated and were unrelated to his cutaneous disease.

Bowen's disease of the palm.

Bowen's disease is a squamous cell carcinoma characterized by isolated, grouped or confluent nodules, either flat, scaling, or crusted, with an arcuate or serpiginous configuration. Malignant dyskeratosis throughout the epidermis, the bowenoid hallmark, is not sufficient by itself to identify a lesion as Bowen's disease. It has been suggested, but not proven, that arsenic has a role in the etiology of Bowen's disease. A case of Bowen's disease affecting the palm, an unusual location, is reported.

A clinical look at the aging skin.

The aging Caucasian skin becomes yellow, dry, wrinkled and inelastic. Deterioration increases its susceptibility to malignant neoplasms, pruritus, and candidal infection. In addition, psychosomatic problems vascular disease, "little strokes," and chronic malnutrition may precipitate or exacerbate skin disorders in the elderly. Treatment with "strong" medications should be taboo because of the fragility of senile skin. The risk of toxic reactions or of allergic sensitization is great. Because healing is retarded in old tissue, time is an indispensable component of successful treatment.

[Conservative treatment of CSF leakage after lumbosacral operations].

CSF leakage through a postoperative lumbosacral wound is an uncommon complication. It may result from excessive traction on nerve roots, or direct trauma or laceration at operation, causing inadvertent opening of the dura (1,4). Other reasons for this complication are residual bone spikes postlaminectomy, traumatic myelography puncture (2), and improper suture of dural defects. We examined 8 patients who had postoperative CSF leakage as the sole complication of lumbosacral spinal operations. They were all treated conservatively with bed rest in the Trendelenburg position, antibiotic coverage, watertight skin suturing and daily subcutaneous puncture. Each patient had been operated on for a different condition.

[Percutaneous trephine for vertebral biopsy].

We performed percutaneous vertebral biopsy on 18 patients (March 1978 to March 1992) using a Craig trephine needle under fluoroscopic control, a more reliable and safer procedure than open vertebral body biopsy. Material for histopathologic examination was obtained in 17 of the 18 patients and there were no complications. Possible complications involve mostly in the cervical and dorsal spine. They can be prevented by using very precise and delicate technique under reliable fluoroscopic control in the operating room.

[Posterior approach for excision of sacral chordoma].

Chordoma is considered to be a malignant, fatal tumor. According to most authors it constitutes between 1-4% of all malignant bone tumors. In 50% of the cases it is located in the sacrum, in 35% in the cervical spine and skull, and in 15% in the thoracic spine and elsewhere. It is an aggressive, locally invasive, slowly-growing tumor. Although metastases are rare, when they occur they are of an anaplastic type, especially in the lungs, liver, regional lymph nodes, skin and muscles. Chordoma is a rare tumor, and its location and slow growth often result in delayed diagnosis. Complete excision of the chordoma was formerly considered impossible. There is often local recurrence, and often, by its very nature, excision results in neurological defects. Lately, there is more optimism regarding complete cure, due to more advanced surgical methods. We present a 66-year-old man in whom a tumor developed in the sacrococcygeal area and the right buttock. The tumor was diagnosed by CT, MRI and biopsy as a chordoma of the sacrum, without intra-abdominal infiltration. He was operated through a posterior approach, with complete resection of the tumor, including almost the whole sacrum and the coccyx. We consider this approach simpler than the abdominal-dorsal approach, which in cases of intra-abdominal infiltration is necessary. We regard this simple incision as a significant advance in the treatment of this condition.(ABSTRACT TRUNCATED AT 250 WORDS)