Multiple perineuriomatous melanocytic nevi.

Perineuriomatous differentiation in solitary cutaneous melanocytic nevi has been described. We present an unusual case of a patient with multiple such perineuriomatous nevi. This presentation raises the possibility that a germline mutation may be responsible for the pathogenesis of these unusual lesions.

CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell Carcinoma.

Tricholemmoma, a benign follicular neoplasm with outer root sheath differentiation, typically comprises clear or pale cells, and when multiple is pathognomic of Cowden's syndrome. The tumor is probably underrecognized and in basaloid examples can be difficult to distinguish from basal cell carcinoma (BCC). We studied 55 tricholemmomas (including 15 basaloid cases) and compared immunohistochemical profile with nodular BCC from our archives. Basaloid and non-basaloid tricholemmomas had similar staining characteristics. BerEP4 was focally positive (range 10%-20%) in only 3/39 (7.7%) tricholemmomas compared with widespread positivity in BCC (90.8%, 139 of 151 cases with ≥50% tumor area stained). CD34 was expressed, usually focally (median 20%, range 10%-90%), in 52/53 (98.1%) tricholemmomas and was negative in all 21 BCCs stained. EMA staining lacked sensitivity or specificity in differentiating tricholemmoma from BCC. Five or more Merkel cells were found in 7/17 (40.1%) tricholemmomas and 1/23 (4.3%) nodular BCCs studied. In summary, immunohistochemistry is helpful in distinction between tricholemmoma, including difficult basaloid examples (BerEP4 negative or focal, CD34 positive) compared with BCC (BerEP4 widespread in most cases, CD34 negative). The presence of 5 or more Merkel cells is a relatively specific but not a particularly sensitive discriminator.

5% fluorouracil chemowraps in the management of widespread lower leg solar keratoses and squamous cell carcinoma.

Elderly patients with extensive hypertrophic solar keratoses and squamous cell carcinoma on the lower legs can pose significant management challenges. Typically these patients require surgical treatment which is complicated by comorbidities and poor background lower leg skin. 5% fluorouracil chemowraps provides a useful alternative technique for the management of diffuse hypertrophic solar keratoses and as an adjuvant, and in some situations as a palliative treatment, for squamous cell carcinomas on the lower legs.

Effect of education on the recording of medicines on admission to hospital.

BACKGROUND: The inaccurate recording of medicines on admission to hospital is an important cause of medication error. Medication reconciliation has been used to identify and correct these errors. OBJECTIVE: To determine if a multimodal intervention involving medication reconciliation with real-time feedback and education would reduce the number of errors made by medical staff when recording medicines at the time of admission to hospital. DESIGN: Observational study. PARTICIPANTS: Patients admitted to the general medical wards of a teaching hospital were studied prospectively. Patients > or =75 years of age and on > or =5 medications were identified as the 'target group.' INTERVENTION: After admission, a second medication history was taken, and discrepancies were identified and communicated to the medical teams. An educational intervention to encourage prescribers to obtain accurate medication histories was conducted at the same time. MEASUREMENTS: The discrepancy rate was measured before and after the intervention. MAIN RESULTS: There were 470 admissions in the 'target group.' Three hundred and thirty-eight of the admissions (71.9%) had one or more unintentional discrepancies. Although many discrepancies had little potential to cause harm, 33% were rated as clinically significant. During the study the discrepancy rate (prior to reconciliation) fell from 2.6 (SD 2.6) to 1.0 (SD 1.1) per admission (p < 0.0001). This decline in discrepancy rate remained significant (p = 0.001) even when only clinically important discrepancies were included. The proportion of admissions with one or more clinically important discrepancies also decreased during the study from 46% to 24% (p = 0.023). CONCLUSIONS: Errors in the recording of medicines at the time of hospital admission are common. Combining the feedback provided by medication reconciliation with prescriber education reduced the error rate. This approach may be useful when the resources are not available to perform medication reconciliation for all patients admitted to hospital.

Treatment efficiency of conventional vs self-ligating brackets: effects of archwire size and material.

INTRODUCTION: In this prospective clinical study, we assessed the relative speed of archwire changes, comparing self-ligating brackets with conventional elastomeric ligation methods, and further assessed this in relation to the stage of orthodontic treatment represented by different wire sizes and types. METHODS: The time taken to remove and ligate archwires for 131 consecutive patients treated with either self-ligating or conventional brackets was prospectively assessed. The study was carried out in the orthodontic department of a district general hospital in the United Kingdom. The main outcome measure was the time to remove or place elastomeric ligatures or open/close self-ligating brackets for 2 matched groups of fixed appliance patients: Damon2 self-ligating bracket (SDS Ormco, Orange, Calif) and a conventional mini-twin bracket (Orthos, SDS Ormco). The relative effects of various wire sizes and materials on ligation times were investigated. The study was carried out by 1 operator experienced in the use of self-ligating and conventional brackets. RESULTS: The Damon2 self-ligating system had a significantly shorter mean archwire ligation time for both placing (P <.001) and removing (P <.01) wires compared with the conventional elastomeric system. Ligation of an archwire was approximately twice as quick with the self-ligating system. Opening a Damon slide was on average 1 second quicker per bracket than removing an elastic from the mini-twin brackets, and closing a slide was 2 seconds faster per bracket. This difference in ligation time between the Damon2 and the conventional mini-twin brackets became more marked for larger wire sizes used in later treatment stages. CONCLUSIONS: The type of bracket and the size of wire used are statistically significant predictors for speed of ligation and chairside time. The self-ligating system offered quicker and arguably more efficient wire removal and placement for most orthodontic treatment stages.