Annular plaques on the back.

Annular lichen planus is a rare clinical variant of the lichen planus presenting with round-oval, red to brown macules and plaques with no central atrophy and slightly raised, nonscaly borders. Histopathological features are indistinguishable from typical lichen planus. Given that the accurate diagnosis relies on both the clinical presentation and typical histological features, it is important to be aware of the clinical spectrum of lichen planus. Click https://wileyhealthlearning.com/#/online-courses/6be3b20c-e9c3-40e9-8f36-bfcda6718a73 for the corresponding questions to this CME article.

Qualitative and quantitative observations on the flea population dynamics of dogs and cats in several areas of Germany.

From an ongoing country-wide study on the spectrum, the epidemiology and the population dynamics of flea infestations in dogs and cats, important preliminary results from the three areas of Karlsruhe, Nuernberg and Leipzig are presented. A total of 1922 dogs and 1838 cats from 12 different veterinary practices or clinics in three areas of Germany were systematically examined between July 2003 and June 2004. All dogs and cats appearing for a clinical veterinary consultation on one regular working day per month, per practice, were clinically examined. Dogs and cats were examined irrespective of any kind of prior therapeutic or prophylactic insecticidal treatment. The results show that a total of 99 dogs (5.13%) and 263 cats (14.33%) were infested. Cats were more often flea-infested than dogs (p < 0.05). The highest infestation rates for dogs (x = 7.87%) were detected between July and October, and for cats (x = 21.14%) between July and September, the lowest infestation rates for dogs (x = 2.88%) were observed between November and May, and for cats (x = 12.16%) between November and April (p < 0.05). Although the prevalences were generally higher during the summer months, no statistical differences were detectable when looking at the pattern between the four seasons, neither for dogs, nor for cats. Interestingly, the highest prevalences in dogs (9.9%) were detected in June 2004 and comparatively, in cats (23.86%) in August. The lowest detection rates in dogs were seen (1.28%) in April and in cats (7.26%) in January. The preliminary results did not indicate any tendency for a relationship between climatic conditions and flea infestation rates. Similarly, no differences of the infestations rates were detectable between urban and rural areas, 56% (dogs) and 46% (cats) of the infested pets originated from urban habitats. The flea species collected include Ctenocephalides felis, Ctenocephalides canis, Archaeopsylla erinacei, Pulex irritans, Ceratophyllus gallinae, etc. The overall frequencies reveal that C. felis was the most prominent species (81.5%), followed by C. canis (12.5%), A. erinacei (2.7%) and P. irritans (1.7%).

Safety of gold in stapes surgery.

Gold prostheses in middle ear surgery were found to have a higher extrusion rate than prostheses made from titanium. Incidences of deafness after insertion of a gold piston into the vestibule during stapes surgery have been observed. The aim of this study was to find out to what degree gold cations can diffuse from the prosthesis piston into the perilymph. For this, gold prostheses were incubated in artificial perilymph for four months, after which the gold content of the perilymph was analysed. As gold exhibits a special behaviour in complex fluids like the perilymph, a new analysing method was developed. The results show that gold does leak out of the pistons, that it can be reliably measured and that the amount of gold reaching the perilymph depends on the contact area. As the amount of gold measured in the perilymph stays far below the toxic level, it is very unlikely that the gold cations diffusing from a stapes prosthesis into the perilymph have a toxic effect on the inner ear hair cells. Inflammatory or allergic reactions to gold induced by direct tissue contact, however, cannot be excluded.

A case report of lead paint poisoning during renovation of a Victorian farmhouse.

We describe a series of four cases of childhood lead poisoning and two cases of adult lead toxicity in a professional family exposed to lead dust and fume during renovation of a rural farmhouse. Initial blood lead levels in the children ranged from 2.70 to 4.20 microM/L (56 to 87 microns/dl) and all four required chelation therapy. Lead-based paint poisoning, a well recognized entity among young children in poor, urban neighborhoods, is not confined exclusively to such areas.