Median raphe cysts of the penis.

The occurrence of a ventral cystic lesion of the penis should alert the clinician to the diagnosis of a median raphe cyst. The lesions, which are most common near the glans penis, may occur anywhere from the urethral meatus to the anus. Cysts of the median raphe represent defects in the embryologic development of the genitalia and are usually lined by entodermal epithelium. Surgical excision is the treatment of choice.

Experimental aural cholesteatoma causing bone resorption.

A series of experiments were carried out on 55 guinea pigs in four groups to study the conditions fostering bone resorbin epidermal cysts. The first group had free grafts of canal wall skin applied to the cochlea with and without talc application. The second group had canal skin flaps applied to the cochlea with and without subsequent talc application. The third group had talc applied either to the tympanic membrane or on the cochlea. The fourth group had a canal skin flap inserted into a mucosal pocket in the bulla. The animals were killed three to four months after surgery and the temporal bones were prepared for histology. Epidermal cysts were found at the cochlea in 8 of 55 animals. Cochlear fistulas were found in 6 of 55 animals. The fistulas were associated with epidermal cysts in three cases, otitis media in two cases, and talc granuloma in one case. These experiments show that migrating skin attached to a source of epithelium is capable of inducing bone resorption. Chronic foreign body granulomas and chronic sepsis are also capable of resorbing bone. These three conditions all produce a layer of undifferentiated connective tissue containing chronic inflammatory cells lying against the resorbing bone.

Once-weekly fluconazole (450 mg) for 4, 6, or 9 months of treatment for distal subungual onychomycosis of the toenail.

BACKGROUND: Fluconazole is a bis-triazole antifungal agent approved for the treatment of oropharyngeal, esophageal, and vaginal candidiasis, serious systemic candidal infections, and cryptococcal meningitis. OBJECTIVE: The purpose of this study was to evaluate three different durations of once-weekly fluconazole for the treatment of onychomycosis of the toenail caused by dermatophytes. METHODS: In a multicenter, randomized, double-blind, parallel, placebo-controlled trial, 384 patients with distal subungual onychomycosis of the toenail received fluconazole, 450 mg once weekly, or placebo for 4, 6, or 9 months. For inclusion, patients were required to have mycologically confirmed distal subungual onychomycosis of the toenail with a large toenail at least 25% clinically affected but having at least 2 mm of healthy nail between the nail fold and the proximal onychomycotic border. Efficacy was assessed by clinical and mycologic (microscopic and microbiologic) measures at screening, at every treatment visit starting at month 3, and at months 2, 4, and 6 after therapy. Observed or volunteered adverse events were recorded and classified at all visits. RESULTS: At the end of treatment, very significantly superior clinical and mycologic results were achieved in all fluconazole groups compared with placebo (p=0.0001). This superiority was largely maintained over 6 months of follow-up. The clinical and mycologic responses of the 9-month treatment duration were significantly superior to the 4- and 6-month durations. Similar percentages of patients in the fluconazole and placebo groups reported adverse experiences for all three durations of the study. CONCLUSION: Results of this study support the efficacy and safety of fluconazole in the treatment of distal subungual onychomycosis of the toenail.