A Case of Pleomorphic Dermal Sarcoma: Giant Exophytic Tumor of the Medial Canthus.

We present the case of a 99-year-old Caucasian female who was referred for treatment of a painless, 8.0 cm × 7.8 cm exophytic, pedunculated, ulcerated tumor of the left medial canthus. Pathology showed spindled, oval, and polygonal cells with pleomorphic nuclei. Many multinuclear giant cells and mitotic figures were also noted. The tumor was highlighted with CD10, showed focal positivity with actin, desmin, and CD68, and had increased Ki67 immunohistochemical staining. The tumor was negative for pancytokeratin, CK5/6, p63, MART-1/MelanA, S100, Sox10, p40, CD34, and CD23. Based on clinicopathologic correlation, the diagnosis of pleomorphic dermal sarcoma (PDS) was made. Pleomorphic dermal sarcoma (PDS) refers to a deep, histologically high-grade tumor that often resembles other tumors clinically and histologically. As PDS is frequently aggressive and related to adverse outcomes, it is important to recognize its distinguishing features in comparison to other similar entities, including atypical fibroxanthoma (AFX) and pleomorphic leiomyosarcoma (PLMS). To our knowledge, there is only one other reported case in the literature of PDS occurring on the eye. By reviewing and understanding characteristic etiologies, locations of presentation, histopathological features, and management techniques, pathologists can make a more accurate diagnosis and dermatologists can provide more effective patient care in a timely manner.

Case Report: Idiopathic Subcutaneous Thrombotic Vasculopathy.

Lower extremity ulcers have significant morbidity, with treatment determined by the underlying disorder. Reported is a 32-year-old female presenting with small skin nodules and bruises across her legs 4 weeks following her second COVID vaccination. These lesions progressed into large, necrotic ulcers over several months. Initial work-up showed widespread pannicular thrombotic vasculopathy with ischemic skin necrosis. The tissue was negative for calcification on Von Kossa histochemistry, and a working diagnosis of subcutaneous thrombotic vasculopathy was suggested. The ulcers progressed despite treatments with corticosteroids, therapeutic anticoagulation, intravenous immunoglobulin, plasmapheresis, sodium thiosulfate, wound care, and repeat debridement. Later debridement specimens demonstrated rare vascular and pannicular calcifications. This finding supports the hypothesis that subcutaneous thrombotic vasculopathy is a precursor to calciphylaxis, the patient's current working diagnosis. However, based on the patient's entire clinical picture, a definitive diagnosis has yet to be found. This report highlights the challenges of working with rare diseases and the importance of multidisciplinary cooperation.

Patients Frequently Overestimate Their Comprehension of Common Mohs Micrographic Surgery Terms: A Cross-Sectional Survey.

BACKGROUND: Patients who understand their diagnosis and treatment are more likely to be satisfied with their care and more compliant with treatment. Dermatologic surgery is a specialized field with associated jargon that many patients may not understand. OBJECTIVE: The aim of the study was to assess patient understanding of dermatology medical terminology. METHODS: This was a single-blinded study conducted with patients 18 years and older from an academic dermatology clinic surveying patients on 12 terms that are frequently used in dermatologic surgery. Participants rated their level of confidence in their understanding of each term using a 5-point Likert scale, followed by explaining the definition of the term. 3 blinded physicians graded each participant’s definition using a 5-point scale of accuracy of understanding, designed to mimic the Likert scale. RESULTS: A total of 200 respondents completed the survey (96% response rate). The average term perceived understanding was 3.90 ±0.66, the average term accuracy was 3.26±0.93. Patients overestimated their understanding 44% of the time, and underestimated their knowledge 17% of the time. The terms with the lowest respondent confidence were the terms secondary intention, Mohs, and flaps. The terms with the lowest respondent accuracy was secondary intention, defect, and Mohs surgery. CONCLUSION: There is a gap in knowledge in commonly used dermatologic surgery terms among patients. Certain demographics appear to be more at risk for not understanding medical jargon or overestimating their understanding of terms. Obtaining these patient demographics may help to identify patients needing additional education regarding dermatologic surgery. J Drugs Dermatol. 2021;20(11):1252-1254. doi:10.36849/JDD.6174.

Plasmacytoid dendritic cells in keratoacanthoma and squamous cell carcinoma: A blinded study of CD123 as a diagnostic marker.

BACKGROUND: Histopathologic distinction between keratoacanthoma (KA) and squamous cell carcinoma (SCC) is challenging. We surmised that a discriminatory immunostain would be clinically meaningful. Previous investigators have found CD123-positive plasmacytoid dendritic cells (PDCs) are more prominent in KA than SCC. We sought to determine if CD123 immunostaining might have value as a diagnostic test for distinguishing KA from SCC. METHODS: We used blinded, semi-automated image analysis to compare CD123 expression in 66 KAs and 63 SCCs in a tissue microarray. RESULTS: PDCs were present in both KA and SCC. Mean PDC frequency was higher in KA than SCC (14.2 vs 11.2 mean cells/0.0945 square mm) but the difference was not statistically significant (P = 0.1240). There was no significant difference in mean PDC cluster frequency, mean intratumoral PDC frequency, or the percentage of PDCs as proportion of the total mononuclear inflammatory cell infiltrate between KA and SCC. CONCLUSION: CD123 immunostaining is not a clinically useful test for distinguishing KA from SCC.

Structural, biomechanical and hemodynamic assessment of the bladder wall in healthy subjects.

AIM: The aim of this study was to apply and evaluate three ultrasound methods to measure the bladder wall in a healthy population using high-resolution applications and to establish reference points and baselines for future research into lower urinary tract diseases, specifically to understand how lower urinary tract disorders affect the bladder wall and to find objective, non-invasive diagnostic tests. METHODS: The study was conducted on 116 healthy volunteers aged 19-79 years old with approximately 10 participants in each decade group. RESULTS: The following bladder parameters were recorded and measured using a GE LOGIQ E9 XDclear 2.0 ultrasound machine (GE Healthcare, Wauwatosa, WI, USA):Full bladder wall thickness (BWT) and each of three bladder wall layers thickness (BWLT) - serosa, detrusor and mucosa;Shear Wave Velocity (SWV) in m/s, using 2D Shear Wave Elastography (2D-SWE); andBladder wall blood circulation (Resistive Index, RI), using Duplex Doppler ultrasound.All of the above measurements were recorded at three different urine filling volumes: V0 (20-50 mL), V2 (180-200 mL) and V4 (380-400 mL) with ten repeats for each measured parameter. As expected, BWT and BWLT correlated inversely with increasing bladder volume. While there are no large differences in the healthy bladders of men compared with women, or with age, some small, but statistically significant, differences revealed. BWT at V0 is greater in men, as is the detrusor thickness at VO, but there are no differences at other volumes or for other layers. There is a small, but statistically significant thickening of BWT and detrusor layer and increase in SWV with age in men at V0. SWE showed increase in SWV measured at 400 mL bladder volume across all gender and age groups. There was no change in bladder wall vessels RI with age, between gender groups or increasing bladder volume. CONCLUSION: We used three ultrasound applications to obtain bladder wall reference data in healthy individuals and investigated the relationships between BWT, BWLT, SWV, RI and gender, age at three bladder volumes, for further studies into identifying and diagnosing different urinary bladder disorders. With further research, ultrasound could be used as a diagnostic test to differentiate bladder pathology in clinical practice.

Chronic Nasolabial Fold Seborrheic Dermatitis Successfully Controlled With Crisaborole.

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Parenteral nutrition--ascites with acute renal failure as a complication from an umbilical venous catheter in an extremely low birth weight infant.

Umbilical venous catheters (UVCs) are frequently used in the neonatal intensive care setting and play a crucial role in the management of extremely low birth weight (ELBW) infants. One very rare complication reported is parenteral nutrition (PN) ascites secondary to vessel perforation or hepatic erosion by PN at the tip of malpositioned UVCs with various hepatic lesions. We describe a case of early onset PN ascites with no obvious associated hepatic lesion but complicated by pre-renal acute renal failure in an ELBW infant with the tip positioned between the 10th and 11th thoracic vertebrae.

A flavonol glycoside, isolated from roots of Panax notoginseng, reduces amyloid-beta-induced neurotoxicity in cultured neurons: signaling transduction and drug development for Alzheimer's disease.

A Radix Notoginseng flavonol glycoside (RNFG), quercetin 3-O-beta-D-xylopyranosyl-beta-D-galactopyranoside, was isolated from roots of Panax notoginseng. Among different biological properties tested, RNFG possessed a strong activity in preventing amyloid-beta (Abeta)-induced cell death. In an in vitro assay, RNFG inhibited the aggregation of Abeta in a dose-dependent manner. Moreover, application of RNFG in cultured cortical neurons, or PC12 cells, reduced the Abeta-induced cell death in time- and dose-dependent manners, with the suppression of Abeta-induced DNA fragmentation and caspase-3 activation. In cultured neurons, the pre-treatment of RNFG abolished the increase of Ca(2+) mobilization triggered by Abeta. The neuroprotective properties of RNFG required a specific sugar attachment within the main chemical backbone because the flavonol backbone by itself did not show any protective effect. In memory impairment experiments using the passive avoidance task, the administration of RNFG reduced brain damage in scopolamine-treated rats. These results therefore reveal a novel function of Radix Notoginseng and its flavonol glycoside that could be very useful in developing food supplements for the prevention, or potential treatment, of Alzheimer's disease.

Unusually late presentation of lactobezoar leading to necrotising enterocolitis in an extremely low birthweight infant.

The present report concerns a case of unusually late presentation of lactobezoar, or inspissated milk curd obstruction, leading to necrotising enterocolitis (NEC) in an extremely low birthweight (ELBW) boy infant, born at 26 weeks gestation with a birth weight of 750 g. He deteriorated acutely on day 84 of postnatal age (corrected age 38 weeks) needing intermittent positive pressure ventilation (IPPV). Over the next 3 days he developed signs of NEC, though a radiograph showed no diagnostic features. In view of increasing abdominal distension, silent abdomen and increasing ventilatory requirements, an emergency exploratory laparotomy was performed. The laparotomy revealed inspissated milk curd obstruction in the terminal ileum. There was also a small area of NEC at the ileocaecal valve. A limited hemicolectomy was performed with creation of an ileostomy and mucous fistula. Following this procedure his clinical status improved. Feeds were reintroduced after 7 days and he was on full enteral feeds by 14 days.

Bis(7)-tacrine, a promising anti-Alzheimer's dimer, affords dose- and time-dependent neuroprotection against transient focal cerebral ischemia.

Bis(7)-tacrine, a promising anti-Alzheimer's dimer, has been shown to have multiple neuroprotective activities in vitro. Here, we investigate whether bis(7)-tacrine attenuates focal cerebral ischemic impairment in vivo. Cerebral ischemia was induced in Sprague-Dawley rats by transient (2h) middle cerebral artery occlusion (MCAO) followed by 24h of reperfusion. Bis(7)-tacrine administered intraperitoneally 15 min after ischemia dose-dependently improved neurological behavior deficits and reduced both cerebral infarct volume and edema. The TUNEL staining assay showed that bis(7)-tacrine attenuated neuronal apoptosis in the penumbral region. Compared with that for memantine, a moderately effective N-methyl-d-aspartate (NMDA) receptor antagonist with a similar affinity and potency to bis(7)-tacrine in blocking NMDA receptors, the therapeutic window for bis(7)-tacrine was wider and lasted up to 6h after the onset of ischemia. Bis(7)-tacrine did not affect physiological parameters or regional cerebral blood flow during either the occlusion period or the early reperfusion stage. In conclusion, bis(7)-tacrine dose- and time-dependently protected against acute focal cerebral ischemic insults, possibly through the drug's anti-apoptotic effects during multiple events in the ischemic cascade.

Measurement of attitudes toward obese people among a Canadian sample of men and women.

A new scale for examining attitudes toward obese people had 44 items selected from previously published scales designed to indicate attitudes toward obese people. Reliability analysis yielded a Cronbach coefficient alpha of .92 for the total sample. A factor analysis yielded four factors. Employing the Body Mass Index as an indicator of obesity, the attitudes of 239 men and women were examined. Women were significantly more positive than men in their attitude toward obese people. When examining Body Mass Index as a factor, comparisons of obese and nonobese women indicated obese women were more positive on the Diet and Exercise factor of the scale. Suggestions for improvement and research are offered.