Congenital naevi treated with erbium:YAG laser (Derma K) resurfacing in neonates: clinical results and review of the literature.

BACKGROUND: Giant congenital melanocytic naevi (CMN) are often disfiguring, potentially malignant pigmented lesions present at birth. Their management is based on two main considerations: attempt to minimize the risk of malignancy and to obtain an acceptable cosmetic result. In the past various approaches have been used to treat these naevi. OBJECTIVES: To describe clinical and histopathological results after treatment of CMN in neonates with erbium:YAG (Er:YAG) laser resurfacing. METHODS: Ten children with CMN were treated with Er:YAG laser resurfacing in the first weeks of life. RESULTS: Laser ablation was well tolerated by all children and immediate results were good. At a total follow-up ranging from 3 to 36 months we saw good results, with no or minimal repigmentation, in eight of 10 patients. Patients experienced minimal side-effects such as postoperative pain, bleeding and scar formation. Postoperative histopathology showed disappearance of heavily pigmented cells in the upper part of the dermis. CONCLUSIONS: Er:YAG laser resurfacing is an effective method of ablating CMN, with minimal scarring and postoperative complications.

Microcystic adnexal carcinoma: an uncommon tumor with debatable origin.

BACKGROUND: Microcystic adnexal carcinoma is an uncommon skin appendage neoplasm exhibiting both pilar and sweat duct differentiation. This tumor remains a subject of controversy as to its differentiation profile, histogenesis, and classification which is reflected in the nomenclature used to designate the neoplasm in question. Beyond this controversy the tumor remains a diagnostic challenge because of its rarity, the histologic mimicry it may display, and its banal cytologic appearance; it also poses a therapeutic challenge, as it is characterized by slow but aggressive and destructive local growth extending beyond clinical margins together with a high tendency for perineural invasion and recurrence. OBJECTIVE: We report two cases of this unusual tumor illustrating some of its characteristics. Our review emphasizes the divergent opinions concerning its differentiation profile and its origin. An organoid nevus as the origin of microcystic adnexal carcinoma in one of our patients is discussed in this context.

Tinea incognito due to Trichophytom rubrum after local steroid therapy.

The term "tinea incognito" refers to dermatophyte infections with clinical presentations that have been modified by the administration of corticosteroids. We describe a patient who had pustular inflammatory skin lesions due to Trichophyton rubrum after receiving treatment with potent topical corticosteroid creams.

[Mohs' method of micrographic surgery as treatment for recurrent basal cell carcinoma]. / Micrografische chirurgie volgens Mohs als behandeling voor recidief van basalecelcarcinoom.

OBJECTIVE: Evaluation of Mohs' micrographic surgery as treatment for recurrent basal cell carcinoma of the skin. DESIGN: Retrospective. SETTING: University Hospital Maastricht, the Netherlands. METHOD: In the period April 1992 to December 1995, 91 recurrent basal cell carcinomas (88 patients) were treated by Mohs' micrographic surgery. Medical records were analysed retrospectively with respect to different aspects. RESULTS: The mean age of the patients was 69 years. The recurrent basal cell carcinomas, with an mean diameter of 19.7 mm, were mainly localized on the nose and forehead. There were equal numbers of solid and morphea-like types of basal cell carcinomas. Most of these tumours had been treated by means of surgical excision in the past. The last treatment had taken place 3 years previously on average. Reconstruction was performed by means of primary closure, a graft or a flap. The mean follow-up period after Mohs' micrographic surgery was 12 months, in which one tumour recurred. CONCLUSION: Mohs' micrographic surgery is a surgical technique which provides the best prospect of total tumour removal together with maximal functional and cosmetic preservation. Mohs' micrographic surgery is of particular value for the treatment of recurrent basal cell carcinomas.

Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement.

From a group of 1480 patients, 1036 were treated with metal frame removable partial dentures (RPDs) at least 5 years before this analysis. Of those, 748 patients who wore 886 RPDs were followed up between 5 and 10 years; 288 patients dropped out. The 748 patients in the study groups were wearing 703 conventionally designed metal frame RPDs and 183 RPDs with attachments. When dropout patients and patients who remained in the study were compared, no differences were shown in the variables analyzed, which indicated that the dropouts did not bias the results. Survival rates of the RPDs were calculated by different failure criteria. Taking abutment retreatment as failure criterion, 40% of the conventional RPDs survived 5 years and more than 20% survived 10 years. In RPDs with attachments crowning abutments seemed to retard abutment retreatment. Fracture of the metal frame was found in 10% to 20% of the RPDs after 5 years and in 27% to 44% after 10 years. Extension base RPDs needed more adjustments of the denture base than did tooth-supported base RPDs. Taking replacement or not wearing the RPD as failure criteria, the survival rate was 75% after 5 years and 50% after 10 years (half-life time). The treatment approach in this study was characterized by a simple design of the RPD and regular surveillance of the patient in a recall system.

Leucocytoclastic vasculitis induced by prolonged exercise.

Many people develop skin symptoms after long-distance walks, but little is known about the aetiology of these. In this study we took 11 biopsies from 10 long-distance walkers who walked 80 km. All biopsies originated from purpuric lesions on the lower legs, which had appeared during walking. In all 11 specimens, signs of a leucocytoclastic vasculitis were present with leucocytoclasis, exocytosis of erythrocytes and a granulocyte/mononuclear perivascular infiltrate. Immunofluorescence investigations showed deposition of C3c in many specimens and immunoglobulin M in some. The occurrence of a leucocytoclastic vasculitis after prolonged exercise may be explained by the existence of an exercise altered cutaneous microcirculation, complement activation and an altered immune function.

Histochemical detection of osteocalcin in normal and pathological human bone.

We investigated the immunohistochemical localization of osteocalcin in demineralized, paraffin-embedded normal and pathological human bone. Acid decalcification protocols appeared to be more suitable for osteocalcin detection than mild chelating agents. In normal lamellar bone, osteocalcin was detected in osteocytes and along the lamellar bone matrix in fine granular deposits. Under pathological conditions (osteomyelitis, neoplasia), appositional bone showed immunoreactivity in osteoblasts and osteocytes but not in the provisory woven bone matrix. Intense immunoreactivity could be seen at the cell borders of osteoclasts and the bone margins of Howship lacunae. In primary bone-forming tumors, osteocalcin immunoreactivity was detected in osteoblasts and their malignant counterparts. On the basis of these results, we conclude that optimal preservation of osteocalcin is obtained through mild acid decalcifiers. Osteocalcin is deposited in bone matrix, especially that of metabolically inactive bone. In neoplasms, osteocalcin could be a marker of osteoblastic differentiation.

IUD and salpingitis: a prospective study of pathomorphological changes in the oviducts in IUD-users.

A prospective study on pathomorphological changes in the oviducts in 253 women who underwent voluntary sterilization via posterior colpotomy performed at the Catharina Ziekenhuis, Eindhoven, was performed in order to investigate the effect of the intrauterine device (IUD). Some form of salpingitis was found in 54% of the IUD-group and in only 6% of the control group (P less than 10(-6), four-fold table, chi-squared test.) Microbiological study in 51 patients did not explain the pathoanatomical changes. As the IUD-and control-groups were comparable in all investigated parameters, the inflammatory reaction must be caused by the method of contraception.