Mesencephalic form of meningoencephalitis in a patient with HLA-B51 Behçet's disease: case report.

This case report is a detailed description of the clinical, laboratory, imaging and therapeutic characteristics of the sixth patient with neuro-Behçet's disease reported by Bulgarian authors. The diagnosis was made in accordance with the international diagnostic criteria for Behçet's disease and was verified by skin biopsy. Therapeutic response was followed up by clinical and magnetic resonance imaging data for 6 months. Discussed are differences in the classical Behçet's disease presentation and other neuro-Behçet's disease cases found in Bulgaria. The current case supports the wide clinical heterogeneity of the disorder and the variety of therapeutic options.

A beneficial effect of a short-term formal training course in epiluminescence microscopy on the diagnostic performance of dermatologists about cutaneous malignant melanoma.

BACKGROUND: Epiluminescence microscopy (ELM) is a useful tool, which, in the hands of experienced dermatologists successfully helps in the diagnosis of early cutaneous malignant melanoma (CMM). As all imaging diagnostic methods, ELM also requires preliminary training of the physicians. OBJECTIVE: The aim of the study was to evaluate a possible beneficial effect of a short-term formal training course in ELM on the diagnostic performance of dermatologists about CMM. METHODS: The test group consisted of 32 dermatologists. Tests were performed in the beginning and in the end of the teaching course. Every time a total 50 histologically proven pigmented skin lesions (PSLs) photographed without oil immersion-Surface microscopy (SM) and with oil immersion-ELM was presented by slide projection. To assess the effect on the diagnostic performance before and after short- term training the data concerning diagnoses were analysed for the following: sensitivity, specificity, positive predictive value, and negative predictive value, index of suspicion and diagnostic accuracy. RESULTS: Before the training course the implementation of ELM leads to relative increasing of all studied indicators of ELM diagnosis towards SM diagnosis, but differences are not statistically significant (P > 0.05). After the course there is an improvement of diagnostic performance of dermatologists by ELM, manifested by enhancement of all indicators. The changes of the sensitivity, negative predictive value and diagnostic accuracy of ELM diagnosis was statistically significant (P < 0.05). CONCLUSION: The short-term formal course in ELM has a beneficial effect on the diagnostic performance of dermatologists about CMM. The improvement of early detection of CMM requires dermatologists enhanced training and higher qualification in the field of dermoscopy.

Benign dermoscopic network patterns in dysplastic melanocytic nevi.

BACKGROUND/AIMS: Epiluminescence microscopy (ELM) is a non-invasive clinical technique, which by employing the optical phenomenon of oil immersion makes surface structures of the skin accessible for in vivo examination and provides additional criteria for the diagnosis of pigment skin lesions (PSLs). Many ELM criteria have been described. One of the most important ELM criteria is the pigment network (PN). OBJECTIVE: The aim of this study is to identify benign ELM (dermoscopic) network patterns of dysplastic melanocytic nevi (DMN). METHODS: This study included 907 dysplastic melanocytic nevi in 178 patients. Prior to biopsy, each lesion was photographed with oil immersion, and the images were viewed on a high-resolution compact slide projector. For each PSL, the ELM Network Features and ABCD-score were evaluated. RESULTS AND DISCUSSION: The benign dermoscopic network features in DMN are the presents of a regular PN with delicate lines and margins, which predominantly thins out at the border of the lesion. For DMN, with these features, the mean ABCD score is smaller than ABCD-score for DMNs with irregular, prominent PN and network patches, ending abruptly at the periphery. In DMN with a network predominantly thinning out at the border of the lesion several uniform network patterns were found-diffuse network pattern, patchy network pattern, structureless center pattern, globular center pattern, and pigmented-blotch center pattern. CONCLUSIONS: Benign features of pigment network are regularity, delicacy and thinning out at the border of the lesion. Benign dermoscopic network patterns are diffuse network pattern, patchy network pattern, structureless center pattern, globular center pattern, and pigmented-blotch center pattern. They can be found in DMN with a network predominantly thinning out at the border of the lesion.