The role of skin biopsy in diagnosis of panniculitides.

Several factors hamper the clinical and histologic diagnosis of panniculitis. Clinically the patients tend to present with erythematous subcutaneous nodules with quite a monotonous appearance, without additional symptoms. Histopathologically, as the subcutaneous fat responds to a variety of insults in a limited number of forms, there are sometimes subtle pathologic differences among the conditions. Although the biopsy plays a critical role in the diagnostic process of a panniculitis, a series of prerequisites must be met in order to obtain as much information as possible from this procedure. If the biopsy is inadequate, i.e., does not include sufficient subcutaneous fat or the site of sampling site/biopsy timing is wrong, histopathologic assessment is limited and the correct diagnosis may be delayed and further sampling may be required. This article introduces the reader to the field of panniculitides under the histopathologic perspective through a brief description of the normal histology of subcutaneous fat. I also includes the definition of the types of fat necrosis, role of biopsy of panniculitis and its rules and pitfalls, up to a microscopic approach of a slide.

Falls: a comparison of trends in community, hospital and mortality data in older Australians.

BACKGROUND AND AIMS: Falls are major contributors to disability, morbidity and death for older people. Frequently, falls-related data for each of these areas is viewed in isolation. The aim of this study was to establish trends in incidence of falls-related events including: community reporting of falls and falls-related injuries, hospitalizations as a result of accidental falls, and mortality related to accidental falls for older people in two states of Australia (Victoria and South Australia). METHODS: We analysed data sets for falls hospitalizations and mortality rates for the period 1988 to 1997, and from two longitudinal population-based proportional samples during the same time period. RESULTS: Age-standardised falls mortality rates have steadily declined in Victoria, and remained unchanged between 1988 and 1997 in South Australia. In both states, age-standardised falls hospitalization rates have increased significantly (in Victoria, RR=1.32, 95% CI: 1.30-1.34; and South Australia, RR=1.05, 95% CI: 1.03-1.06). In both states, there was a clear age-related effect, with those in the 85-year and older age group having a falls-related mortality rate approximately 40 times that of those aged 65-69 years, and a hospitalization rate 9 times that of those in the 65-69 age group. The community studies indicated that falls rates remain high among older Australians, and that injurious falls occurred in 10% in the first wave of data collection in each of these studies. CONCLUSIONS: The results highlight that various indicators related to falls trends taken in isolation may yield differing conclusions. For a true reflection of the effectiveness of falls prevention programs, falls-related mortality, hospitalization and community data need to be integrated. Increased focus on falls prevention activity in Australia during the 1990's has not reduced the magnitude of this major public health problem.

Practice financing options for small to mid-sized medical practices.

In today's competitive marketplace, finding and using capital in the most effective manner can help bring greater economic success to medical practices. This article focuses on the most common capital needs of practices ranging in size from solo practices to 25 physicians--practice acquisition, real estate, operating cash needs, and medical equipment--and the types of capital providers for these size practices--health care financing firms, banks, and equipment leasing companies. Interviews with various capital finding providers and various research information, including a 1998 study commissioned by AMA Solutions, Inc. (a subsidiary of the American Medical Association) form the basis for the information provided.

Traditional medicine as a source of new therapeutic agents against psoriasis.

In the frame of traditional medicine, the use in the treatment of psoriasis of some plants typical of the flora of Sicily is reported. A preliminary search on some plants used for the treatment of psoriasis in Asia, South America and Africa is also reported.

The role of ethnobotanics in scientific research. State of ethnobotanical knowledge in Sicily.

This contribution deals with the traditional use of plants of the Sicilian flora. Special attention is given to the species used in popular medicine. Moreover, the importance of ethnobotanics in scientific research and its role in toxicology are shown.

[An unusual case of orbital cellulitis and perforating scleromalacia]. / Cas insolite de cellulite orbitaire et scléromalacie perforante.

We report the case of a diabetic patient with refractory anemia with excess blasts (RAEB) who developed bladder infection followed by orbital cellulitis and nodular skin lesions. After a short remission, the clinical aspect was complicated by corneal ulceration, scleromalacia, bulbar perforation and lens luxation.

[Morpho-functional evaluation of subjects who had undergone surgery for ano-rectal malformations using the Peña technique]. / Valutazione morfo-funzionale dei soggetti operati per malformazione ano-rettale secondo la tecnica di Peña.

The approach to patients with Ano-Rectal Malformations (ARM) has undergone a substantial change in these last years due to the evolution of the studies of the anatomy and physiology carried out by Peña and de Vries. The authors report their experience on 15 patients and analyse the clinical and instrumental results according to the quality of life of the patients. There are different clinical criteria for the postoperative evaluation of these patients. The authors considered the Kelly, Kiesewetter, Peña and Holdschneider methods and compared the different values obtained. Moreover, they analysed the results of anorectal manometry performed in 10 patients and their correlations with clinical scores. The authors assert that the TC or NMR tests are unnecessary for these patients, since these methods demonstrate a correct position of the rectum within the muscular structure, but do not allow a correct evaluation of the quality of life of these patients. The clinical results obtained by the authors are satisfying; however, the number of patients is limited and the follow-up is relatively short.

Gillespie's syndrome (incomplete aniridia, cerebellar ataxia and oligophrenia).

Two sisters presenting with a Gillespie's syndrome are reported. This autosomal recessive syndrome is characterized by a circumpupillary aplasia of the iris, non-progressive cerebellar ataxia and oligophrenia.

[Gillespie syndrome (incomplete aniridia, cerebellar ataxia and oligophrenia)]. / Gillespie-Syndrom (inkomplette Aniridie, zerebellare Ataxie und oligophrenie).

Two sisters presenting with a Gillespie 's syndrome are reported. This autosomal recessive Syndrome is characterized by a circumpupillary aplasia, non progressive cerebellar ataxia and oligophrenia.

Melanocytoma of the optic disc.

On the occasion of the observation of 4 cases of melanocytoma of the optic disc, the authors stress the relative rarity of this pigmented tumor, its benignity and its frequent association with a choroidalnevus. The melanocytoma is mostly stationary and produces no functional symptoms. It is generally diagnosed after the age of 30, and its pathogenesis is unknown.

Genetic study of hyperlipoproteinaemia types IV and V.

In a family, of which 32 members belonging to three generations could be examined, 21 subjects were normal, while 11 were affected by hyperlipoproteinaemia types IV and V or related biological disorders. Neither an autosomal dominant inheritance nor an autosomal recessive inheritance nor a multiple-type hyperlipoproteinaemia can unreservedly be accepted.

[Irvine-Gass-syndrome (author's transl)]. / Irvine-Gass-Syndrom.

Cystic edema or the macula of Irvine-Gass syndrome, accompanied by a diminution of the central vision, is observed in 5% of the patients who have been recently operated for cataract. Only the fluorescin angiography can confirm the diagnosis with certainty. The inflammatory and vitreous theories explain most satisfactorily the pathogenesis of the condition.