Echographic diagnosis of pretibial myxedema in patients with autoimmune thyroid disease.

In the present study we have evaluated the use of pretibial ultrasound for the diagnosis of pretibial myxedema (PTM). We studied 76 patients, 58 with Graves' disease, 13 with Hashimoto's thyroiditis and five with idiopathic hypothyroidism. Thirty-two normal subjects were also studied as controls. Sixty-four patients had associated ophthalmopathy. The ultrasound scanner was equipped with 10- and 13-MHz probes. Punch biopsies were carried out in 11 patients and tissue sections examined on a light microscope. On clinical examination 21 patients (28%) had suspected PTM. By ultrasound, we measured the thickness of dermis and subcutaneous tissue (D1) and that including only deeper dermis (D2) in normal subjects to define the echographic parameters of normal pretibial skin. We then found increased skin thickness in 25 patients (33%), with mean D1 and D2 values significantly higher than those measured in controls (p < 0.00001). The echographic study was positive in 20 patients with ophthalmopathy (31%). Ultrasound showed increased skin thickness in 16 of 21 patients (76%) with clinically suspected PTM. Histopathological findings confirmed the presence of PTM in all the patients who underwent pretibial skin biopsy. We believe that the measurement of pretibial skin thickness by ultrasound may be useful for revealing the presence of PTM.

[Diabetic bullosis. A case report]. / La bullosis diabeticorum. Segnalazione di un caso clinico.

Bullosis diabeticorum is a very rare complication of diabetes; few more than fifty cases have been reported in literature. We report on an 80-year-old man with non-insulin dependent diabetes mellitus who showed bullosis diabeticorum relapsing at the leg. We describe the cutaneous feature and the procedure carried out. We analyze the different etio-pathogenetic hypothesis and differential diagnosis, that is always by exclusion.

A technique for the biopsy of oral lesions.

BACKGROUND: Biopsy of mucosal lesions can be carried out by means of several methods. OBJECTIVE: To describe a combination technique for the biopsy of mucosal lesions. METHODS: The combined effect of a chalazion forceps with a 4-mm punch allows the physicians to work on a stabilized, bloodless, and therefore simplified field. RESULTS: A preliminary suture with a 4-0 catgut chromic is the key step in assuring a safe post-operative hemostasis. CONCLUSION: This technique allows us to perform accurate and safe oral mucosal biopsies without any major side effects.

Multiple persistent keratoacanthomas: treatment with oral etretinate.

Multiple keratoacanthomas (KAs) of the Ferguson-Smith type represent a rare and distinctive disease for which treatment is difficult and often unrewarding. Two patients with multiple KAs of this variety, who were successfully treated with oral etretinate, are described. Our cases support the conclusion that oral retinoids have to be added to the treatment modalities for this entity. Use of oral retinoids is particularly recommended when the number of lesions is very high or when the development of new lesions is severely disabling.

Sporothricoid mycobacterial infection. A case report.

A case of bilateral, symmetric, sporothricoid granulomas involving the dorsa of fingers and wrists is reported. The culture-proved Mycobacterium marinum skin infection was acquired by a fish-fancier while clearing his aquarium with bare hands. The patient suffered from chronic hand eczema. Treatment with co-trimoxazole was successful.