Effect of ice on pain after corticosteroid injection in the hand and wrist: a randomized controlled trial.

This prospective, randomized controlled study was designed to determine if applying ice to the site of corticosteroid injections in the hand and wrist reduces post-injection pain. Patients receiving corticosteroid injections in the hand or wrist at a tertiary institution were enrolled. Subjects were randomized to apply ice to the injection site and take scheduled over-the-counter analgesics ( n = 36) or take scheduled over-the-counter analgesics alone ( n = 32). There were no significant differences in the mean pain score between the two groups at any time-point (pre-injection or 1-5 days post-injection). In regression modelling, the application of ice did not predict pain after injection. Visual analogue pain scores increased at least 2 points (0-10 scale) after injection in 17 out of 36 patients in the ice group versus ten out of 32 control patients. We conclude that the application of ice in addition to over-the-counter analgesics does not reduce post-injection pain after corticosteroid injection in the hand or wrist. LEVEL OF EVIDENCE: I Therapeutic Study.

Higher severity grade of erlotinib-induced rash is associated with lower skin phototype.

BACKGROUND: Epidermal growth factor receptor inhibitors (EGFRIs) are associated with a characteristic papulopustular rash, an adverse event considered to be a class effect of these agents. Erlotinib, a small-molecule EGFRI, causes a papulopustular rash in 68-75% of patients. The limited reported data suggest that deleterious effects of ultraviolet radiation (UVR) may enhance the development of EGFRI-induced rash. Because the level of the biological pigment melanin correlates with increased protection against UVR, we hypothesized that lighter levels of skin pigmentation are associated with greater severity of rash. AIM: To characterize the relationship between skin phototype (SPT) and rash severity. METHODS: A retrospective chart review was conducted of 40 patients on erlotinib. Skin sensitivity to UVR was categorized using the Fitzpatrick SPT classification scheme. Grading of rash was performed using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 3. RESULTS: There was an inverse relationship between SPT and rash severity. Grade 0 was seen in the majority of patients with SPT V/VI, grade 1/2 in the majority of patients with SPT III/IV, and grade 3/4 rash in the majority of patients with SPT I/II (grade 0: 7% SPT I/II, 32% SPT III/IV and 50% SPT IV/V; grade 1/2: 33%, 63% and 50%, respectively; grade 3/4: 60%, 5% and 0%, respectively) (P < 0.01, Fisher exact test). CONCLUSIONS: Prevention and management of cutaneous side-effects from EGFR inhibitors is important to achieve maximum patient compliance and therapeutic benefit. The results of this study suggest that SPT may be an independent predictive factor for EGFRI-induced papulopustular rash, thus pre-therapy counselling and early intervention are important.

Follicular mycosis fungoides: a histopathologic, immunohistochemical, and genotypic review.

Follicular mycosis fungoides (FMF) is a recognized variant of mycosis fungoides. In this review, the authors characterize the distinct histopathological and immunohistochemical patterns of FMF that have been reported in the literature. This article is an extensive review of the literature cited in Medline and own data of the authors. The major patterns of FMF histopathology, immunohistochemistry, and molecular genetics are summarized in this review. Histologically, the quintessential finding in FMF is small to medium atypical CD3+ CD4+ CD8- T lymphocytes around and within the epithelium of the hair follicles. This finding is requisite to the diagnosis. However, this finding may be obscured by a host of other patterns often identified in FMF. This includes basaloid folliculo-lymphoid hyperplasia, a granulomatous reaction, eosinophilic folliculitis, and follicular cystic changes with subtle atypical lymphocytes in the cyst wall. Follicular mucinosis (MF) and syringo-tropism are also variably present. Immunohistochemistry of all reported cases uniformly show a CD4+ T cell infiltrate. This review emphasizes and discusses the broad spectrum of histologic changes which may be seen in FMF, clues to the diagnosis, and some potential mimickers.

Aggression in African-American boys: a discriminant analysis.

The main purposes of this study were to determine whether familial variables found to be related to the development of aggressive behavior in Caucasian boys may also be related to similar aggressive patterns in inner-city African-American boys and to assess the relative importance of these variables for classifying the subject population into aggressive and nonaggressive groups. Discriminant analyses were performed using 83 African-American boys, with a mean age of 13.9 years, who were classified as institutionalized aggressive, noninstitutionalized aggressive, and noninstitutionalized nonaggressive subjects. Although the same father and mother variables were used in the analyses, the father variables were not related to group membership. Furthermore, the results showed that both groups of aggressive boys reported more aggression within as well as outside their family home settings than their nonaggressive counterparts. Socioeconomic-related factors such as employment status of parent(s), size of family, and number of parents in the household were not useful predictors of aggressive and nonaggressive group membership.

Aggression and paternal absence: racial-ethnic differences among inner-city boys.

Aggression scores were obtained for 132 preadolescent inner-city males to test the hypothesis that paternal absence may differentially influence aggressive behavior. A statistically significant, two-way race by paternal absence interaction (p less than .01) indicated that, when compared to their racial-ethnic counterparts living with both parents, father-absent Puerto Ricans were equally as aggressive, father-absent blacks were less aggressive, and father-absent whites were more aggressive. Tentative interpretations of these findings were developed with a view to the demographic realities of an American inner-city.

Aggression and family size.

The aggression displayed under controlled conditions by 56 inner-city Hispanic boys ages 7-8 was measured to test the hypothesis that S s from large families will display less antisocial aggression than S s from small families. The results indicate that aggression and family size were related in a linear manner: decreasing aggression was linked to increasing family size. These behavioral results may be, in part, the result of increased accelerated development of social skills within children living in large families.