[Symmetrical bilateral apocrine hidrocystomas of the eyelids]. / Beidseitig symmetrisch auftretende apokrine hidrozystome der Augenlider.

A case of a 37-year-old woman with symmetrical bilateral apocrine hydrocystomas at the lateral margins of the eyelids is presented. The symmetrical, simultaneous and bilateral appearance of the lesions, the lack of association with other abnormalities and the absence of the lesion in the family history make this case remarkable.

Agminated intradermal Spitz nevi arising on an unusual speckled lentiginous nevus with localized lentiginosis: a continuum?

We report an 18-year-old boy with a congenital pigmented lesion measuring 2 x 6 cm on his right thigh. About a third of the lesion was composed of numerous lentiginous macules superimposed on histologically normal and clinically nontan skin; in the remainder of the lesion, several macules and papules with histologic features of junctional and compound nevi were superimposed on clinically normal skin, which had a lentiginous pattern histologically. Some years later, eruptive intradermal Spitz nevi developed at one corner of the lesion. The combined clinical and histological features of the lesion fulfill descriptions for both segmental lentiginosis and an unusual variant of speckled lentiginous nevus. Our case points out the limitations of using strict diagnostic criteria to define speckled lentiginous nevus and offers an opportunity to consider the natural history of the lesion as a continuum from lentigines to melanocytic nevi. Moreover, the presence of eruptive intradermal Spitz nevi arising within the area of speckled lentiginous nevus lacking a distinct tan background, suggests the possibility that the entire area of the lesion per se constitutes an environment where development of nevi is enhanced.

Agminate and plaque-type blue nevus combined with lentigo, associated with follicular cyst and eccrine changes: a variant of speckled lentiginous nevus.

Agminate and plaque-type blue nevi are rarely described. We report the occurrence of such a type of blue nevus associated with eccrine changes and a follicular cyst all arising on a macular brown background in a 38-year-old man. The patient presented numerous blue papules and a plaque, overlapping a light tan patch present since birth, on his left thigh. In addition, within the plaque, 3 papules, discharging at intervals a serous fluid, were present. Since the lesion hardened and enlarged, it was surgically excised. Histologic findings revealed a lentigo pattern of the epidermis, corresponding to the light tan macular background and a plaque-type blue nevus, and areas of eccrine ductal proliferations with a ruptured follicular cyst. The association of agminate and plaque-type blue nevus, arising on a light brown patch of lentigo, might represent a variant of speckled lentiginous nevus. Eccrine proliferations may be reactive in nature or represent a more complex hamartomatous lesion. The possibility of malignant transformation and the recent enlargement of the lesion caused by the ruptured follicular cyst convinced us to carry out a wide surgical excision.

Successful cryotherapic treatment and overview of multiple clear cell acanthomas.

BACKGROUND: Clear cell acanthoma (CCA) is a usually solitary benign epidermal-tumor. Multiple lesions are infrequently reported. OBJECTIVE: A case of multiple eruptive CCA is reported in which a successful cryotherapic treatment was performed. METHODS: A 59-year-old man with varicose veins and dry skin presented with 17 eruptive asymptomatic papulo-nodular lesions on both legs. RESULTS: Two lesions were excised with a histologically confirmed diagnosis of CCA. Other lesions were treated with liquid nitrogen. All the lesions resolved with minimal residual scarring after three to four treatments. CONCLUSIONS: Multiple CCA is a rare condition; fewer than 20 cases having been described. The presence of associated conditions like dry skin and varicose veins are discussed. Because of the tendency of persistence of the lesions, cryotherapic treatment may be a useful method of therapy.

Vectorcardiographic evaluation of diabetic cardiomyopathy and of its contributing factors.

In order to investigate the prevalence of vectorcardiographic bites, expression of small areas of fibrosis, atrophy or degeneration of the myocardium, we studied, using the vectorcardiograms (VCG) of 101 diabetic patients (35 with insulin-dependent and 66 with non-insulin-dependent diabetes mellitus, aged from 25 to 60 years, without hypertension, coronary artery disease, or intraventricular conduction defects) and 228 normal control subjects, matched for age and sex. The prevalence of bites was 38.6% in diabetic patients and 10.0% in the control group (p less than 0.001). Diabetic patients were also subdivided into groups according to age, sex, metabolic control, risk factors for coronary heart disease, type of diabetes, duration of diabetes and diabetic microangiopathy. No correlation was found between any of the variables investigated nor of a combination of these, and the presence of bites. We conclude that VCG is a sensitive test for cardiac involvement in diabetic patients but that it cannot be used to identify any specific factor able to influence the onset and evolution of this involvement.

Evaluation of acute hemodynamic effects and pharmacokinetic behaviour of ibopamine in patients with severe heart failure.

The aim of the present investigation was to evaluate the acute hemodynamic effects of a single oral dose of 200 mg ibopamine (SB-7505), the 3,4-diisobutyryl ester of N-methyldopamine (epinine) in 11 patients with congestive heart failure (CHF) and to compare the influence of dopamine infusion and oral ibopamine on left ventricular function. Free and conjugated epinine plasma levels were also investigated in these patients and in a group of healthy volunteers to evaluate the correlation between epinine plasma levels and hemodynamic effects. The oral administration of 200 mg ibopamine to patients with CHF, increased cardiac index (+35%) and reduced peripheral and pulmonary vascular resistance (-29% and -26%) without modifying heart rate and systemic or pulmonary arterial pressure. The hemodynamic effect reached its maximum at about 90 min and was still present at 240 min. Ibopamine at a dose of 200 mg elicited similar effects to those observed with dopamine, 2-4 micrograms/kg/min. The pharmacokinetic behaviour of ibopamine in these patients was similar to that observed in a group of healthy volunteers. Free epinine plasma levels peaked at 30-60 min and decreased rapidly, thus showing a shorter time course than the hemodynamic effects.

Relationship between changes in R wave voltage and cardiac volumes. A vectorcardiographic study during hemodialysis.

The effects of acute changes in cardiac volumes determined by hemodialysis on cardiac voltages were assessed in 18 chronically uremic patients by means of a vectorcardiographic and scalar Frank leads recording, immediately before, at the 90th and 180th minute, and immediately after hemodialysis. The following parameters were simultaneously monitored: body weight, systolic and diastolic blood pressure, heart rate, hematocrit and, in eight patients, echocardiographic systolic and diastolic diameters of the left ventricle. During hemodialysis all voltages considered except R wave in X lead increased significantly. They were inversely correlated with body weight, blood pressure, and systolic and diastolic diameters and directly with hematocrit (volemia-dependent parameters). The maximal vector on the left sagittal plane and the R wave amplitude in Z lead, representing left ventricular posterolateral wall activation, showed the greatest increase. When, at the end of hemodialysis, an amount of fluids ranging from 300 to 800 ml was restored, these cardiac voltages decreased paralleling the increase of left ventricular diameters. In conclusion, these results demonstrate that cardiac voltage and volumes are inversely related.