An unclassifiable cellular myofibroblastic proliferation with an unusual clinical presentation.

We present a case of a 50-year-old man with unusual extensive linear lesions on the right leg that had been present from the age of 2 years. As a child he had been treated with oral steroids under a working diagnosis of linear scleroderma. He went on to undergo multiple operations and skin-grafting procedures under the care of the plastic surgeons and presented to the dermatology department in 2004 because of itchy, scaly and painful lesions extending from the original area. Multiple biopsies had been taken, all showing similar histopathological features of a poorly differentiated dermal lesion composed of fibrohistiocytic cells arranged in a whorled pattern, similar to that seen in dermatofibroma. There was positive staining with vimentin and SMA, and negative staining with caldesmon, D33, CD34, S100 and factor 13a, indicating that the cell of origin was a myofibroblast. Clinically this extensive lesion does not fit the characteristics of a dermatofibroma. It also does not fit readily into any previously described fibrous tissue tumour condition, and, to our knowledge, is a unique case. The patient remains under close clinical observation given that there is no way of predicting the long-term prognosis, but to date no suspicious features have been seen.

Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities.

Color flow duplex scanning was used to "map" the iliofemoral and femoral popliteal segments in 61 patients (84 extremities) undergoing evaluation for excimer laser angioplasty. Eight locations, iliac, common femoral, profunda femoris, proximal and distal superficial femoral artery, proximal and distal popliteal, and tibioperoneal trunk were scored as normal versus abnormal, greater than 50% stenosis, or occluded, and occlusions were measured in centimeters. Specificity, sensitivity, and accuracy were calculated with the arteriogram as the gold standard (83% and 96%, respectively, for normal vs abnormal, 87% and 99% for 50% stenosis, and 81% and 99% for occlusions). Color flow accurately identified the presence and extent of occlusions in 48 of 51 extremities (94%) when compared to arteriography plus operative findings, since arteriography alone tended to overestimate occlusion length. It is concluded that color flow Doppler alone may be used to screen patients with peripheral vascular disease to assess candidacy for endovascular procedures without antecedent arteriography, and that arteriography alone would exclude some patients from consideration by falsely overestimating occlusion lengths.

The therapist's duty to protect victims of domestic violence: where we have been and where we are going.

After ten years of court decisions that have gradually broadened the scope of the psychotherapist's duty to protect potential victims from violence, California has recently passed legislation that limits liability only to those cases where a patient has made a specific threat to an identifiable victim. Although this legislation has articulated the appropriate clinical response in such situations, it may have created a false sense of security for therapists treating patients who are perpetrators or victims of family violence. Though some perpetrators of violence do make a specific verbal threat, therapists are likely to encounter many more who do not verbalize a threat, but nevertheless pose a serious danger to their family members. This article briefly discusses the recent history of the duty-to-protect issue and the violence prediction literature as they relate to domestic violence. Specific interventions are suggested for clinicians in cases where the violence potential is great but no specific threat is made by the client.

Dual role for Dictyostelium contact site B in phagocytosis and developmental size regulation.

Three cohesion molecules have been discovered in the slime mould Dictyostelium discoideum. Two of these molecules are involved in morphogenesis at the aggregation stage of the life cycle and thereafter, and may also provide an essential trigger for late gene expression. The third glycoprotein 126 (gp126) or contact site B, is present on axenically grown vegetative amoebae and persists to the aggregation stage where it is involved in the side-to-side cohesion of cells in aggregation streams. It is puzzling that vegetative amoebae should possess a cohesion molecule because their solitary habit does not necessitate cohesion. However, they do need to adhere to the substratum and adhesion of bacteria to the cells is a prerequisite for phagocytosis. Vogel et al. have proposed that the same receptor is involved in phagocytosis and cohesion. It has also been suggested that contact site B-mediated cohesion is a trigger for development. Using a specific antibody against gp126, we now show that contact site B is a phagocytosis receptor. Furthermore, contact site B is involved in regulating the size of aggregates formed during morphogenesis; it also seems to be involved in cell-substratum adhesion but is not a developmental trigger.