doi: 10.1001/archderm.1995.01690150014001
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archderm.1995.01690150016002
Abstract On August 14, 1994, the Broward County Public Health Unit of the Florida Department of Health and Rehabilitative Services was notified of three children from Pompano Beach who were hospitalized with encephalitis attributed to cat scratch disease (CSD). All three children (aged 5, 6, and 11 years) were previously healthy and had no histories of seizure disorders or diagnoses of CSD. This report summarizes the investigation of these cases. On August 12 and 13, during a 26-hour period, each child entered the emergency department of the same hospital with sudden onset of generalized seizures, coma, and respiratory depression requiring intubation and assisted ventilation. Two of the children had focal lymphadenopathy (axillary and epitrochlear) on admission; cervical lymphadenopathy developed in the third child during hospitalization. Clinical examinations and laboratory tests ruled out some causes of encephalopathy, including viral infections (e.g., herpes simplex and arboviruses), metabolic disorders, and toxic ingestions. On September References 1. Zangwill KM, Hamilton DH, Perkins BA, et al. Cat scratch disease in Connecticut: epidemiology, risk factors, and evaluation of a new diagnostic test . N Engl J Med 1993;329:8-13.Crossref 2. Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection: a new zoonosis with the domestic cat as reservoir . JAMA 1994;271: 531-5.Crossref 3. Carithers HA, Margileth AM. Cat-scratch disease . Am J Dis Child 1991;145:98-101.Crossref 4. Regnery R, Martin M, Olson J. Naturally occurring Rochalimaea henselae infections in domestic cats . Lancet 1992;340:557-8.Crossref 5. Childs JE, Rooney JA, Cooper JL, Olson JG, Regnery RL. Epidemiologic observations on infection with Rochalimaea species among cats living in Baltimore , Md. J Am Vet Med Assoc 1994; 204:1775-8.
doi: 10.1001/archderm.1995.01690150025005
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The aim of the above authors is primarily to encourage the reader to think about physical signs as the basic approach to make a dermatologie diagnosis. This has been the traditional teaching approach for students, residents, and fellows throughout their dermatologie training in an associated dermatologie training program. There are 20 chapters that address the basic morphologic appearance of lesions and describe the shapes of lesions and geographic patterns of skin diseases as well as the colors of lesions and the skin, especially hyperpigmentation and hypopigmentation. The regional distribution of skin diseases are demonstrated by clinical photographs presented in color; there are no graphic anatomic figures to demonstrate the regional distribution of the more common dermatoses. The diagnostic significance of scales and crusts, plaques, papules and nodules, eruptions that are macular and papular or macular, ulcers, blisters and vesicles, pustules, excoriations, itch and the associated eczematization, wheals, and erythema are presented. Disorders of the vascular system, hair, and nails
doi: 10.1001/archderm.1995.01690150025004
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The book Clinical Photomedicine has the goal of integrating clinical and scientific photomedicine in a format suitable for the practicing clinician. Overall, the text does an outstanding job in achieving this objective. Clinical Photomedicine has six sections covering the basic science of photomedicine, acute and chronic effects of light on normal skin, photoimmunology, photosensitivity diseases, photoprotection, and the use of light in therapy. The list of contributors reads like a who's who in the field of photomedicine. The authors have written a book that is clinically relevant and yet touches on many exciting areas of research and controversy that exist in photodermatology. Additionally, the book has good figures and clinical color photographs. Dermatologists at various stages in their careers will find this book useful. Difficult principles and nomenclature are made understandable for the novice, while the text retains sufficient ''meat'' to satisfy the needs of individuals experienced in the field
doi: 10.1001/archderm.1995.01690150025003
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Cutaneous Surgery provides an encyclopedic review of basic surgical fundamentals and procedures, discusses many areas of recent research, and explains advancements in cutaneous surgery. Each chapter is authored by a different expert, which provides a more comprehensive and diverse range of experience and technique than might be gained through a single author with a geographically limited patient population. For the beginning cutaneous surgeon, well-written chapters on surgical anatomy, preoperative patient evaluation and preparation, and recognition and management of office medical and surgical emergencies serve to establish a solid framework for learning the surgical procedures that follow. The text is accompanied by excellent illustrations, and the authors use a basic, step-by-step approach for presentation of procedures. Experienced surgeons will value the sections covering the most current and improved techniques of cosmetic surgery and updated modalities for management of malignancies. Throughout the text, the latest research and advances are noted, including a
doi: 10.1001/archderm.1995.01690150026006
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Part of a recent holiday was spent carefully studying the 400 or so pages of text, illustrations, and tables that comprise Disorders of Hair Growth. My time was well spent because this is a very good book. It is good because of the high level of expertise and extensive clinical experience of the several contributors. It is good because of emphasis on practical therapeutics. And it is good because a serious effort was made to include the new biology of the hair follicle. Andrew Messenger's chapter on control of hair growth and pigmentation is a paradigm of understandable molecular biology. Editor and contributor Elise Olsen's chapter on hair loss in children (an incredibly complicated and often arcane subject) is clear, well organized, beautifully tabulated, and comes complete with 226 references. David Whiting's chapter on hair shaft defects is simply the best there is. The final chapter, Wesley Wilborn's contribution on
Walsh, Douglas S.;Dunn, Cary L.;Konzelman, Joseph;Sau, Purnima;James, William D.
doi: 10.1001/archderm.1995.01690150029007
Abstract REPORT OF A CASE A 36-year-old woman presented with an 11-year history of chronic, painful biopsy-proven oral, vaginal, and vulvar erosive lichen planus (LP) complicated by vaginal stenosis and labial adhesions. She reported no remissions despite therapeutic trials of high-potency topical, oral, and intralesional steroids, isotretinoin, etretinate, and griseofulvin. Surgical procedures to release the labia and repeated vaginal dilatations were only temporarily successful. Pain, bleeding, and decreased vaginal orifice size prohibited sexual intercourse for 1 year. Her mother has suffered from biopsy-proven oral, vaginal, and vulvar erosive LP for 20 years. The patient's sister, brother, and grandmother also suffer from persistent oral ulcerative disease.Intense erythema of the attached upper and lower facial and lingual gingiva was present. Irregular 2- to 3-cm erosions on the buccal mucosa were present with white reticulated plaques noted on the left lower side. Pelvic examination revealed a narrow vaginal orifice. The mucosal lining of References 1. Lee MS, Wakefield PE, Konzelman JL, James WD. Oral insertable prosthetic device as an aid in treating oral ulcers . Arch Dermatol. 1991;127:479-480.Crossref 2. Altman J, Perry HO. The variations and course of lichen planus . Arch Dermatol. 1961;84:179-191.Crossref 3. Silverman S, Gorsky MA, Lozado-Nur F. A prospective follow-up study of 570 patients with oral lichen planus: persistence, remission, and malignant association . Oral Surg. 1985;60:30-34.Crossref 4. Crotty CF, Su WPD, Winkelmann RK. Ulcerative lichen planus: follow-up of surgical excision and grafting . Arch Dermatol. 1980;116:1252-1256.Crossref 5. Pelisse M. The vulvo-vaginal-gingival syndrome . Int J Dermatol. 1989;28:381-384.Crossref 6. Mahood JM. Familial lichen planus: a report of nine cases from four families with a brief review of the literature . Arch Dermatol. 1983;119:292-294.Crossref 7. Itin P, Surber C, Buchner S. Lack of effect after local treatment with a new cyclosporin formulation in recalcitrant erosive oral lichen planus . Dermatology . 1992;185:262-265.Crossref 8. Eisen D, Ellis CN, Duell EA, Griffiths CEM, Voorhees JJ. Effect of topical cyclosporine rinse on oral lichen planus: a double blind analysis . N Engl J Med. 1990;323:290-294.Crossref 9. Pelisse M, Boisnic S, Moyal-Barracco M, Szpiglas H, Reigneau O, Frances C. Treatment of vulvo-vaginal erosive lichen planus with topical cyclosporin . In: Program and abstracts of the International Society for the Study of Vulvar Disease, 11th World Congress; September 1991; Oxford, England. 10. Smith KJ, Konzelman JL, Lombardo FA, et al. Iontophoresis of vinblastine into normal skin and for treatment of Kaposi's sarcoma in human immunodeficiency virus—positive patients . Arch Dermatol. 1992;128:1365-1370.Crossref 11. Sloan JB, Keyoumars S. Iontophoresis in dermatology . J Am Acad Dermatol. 1986;15:671-684.Crossref 12. Singh J, Roberts MS. Transdermal delivery of drugs by iontophoresis: a review . Drug Des Deliv. 1989;4:1-12.Crossref 13. Robinson JR, Longer MA, Veillard M. Bioadhesive polymers for controlled drug delivery . Ann N Y Acad Sci. 1987;507:307-314.Crossref 14. Bachmann GA, Notelovitz M, Gonzalez SJ, Thompson C, Morecraft BA. Vaginal dryness in menopausal women: clinical characteristics and nonhormonal treatment . Clin Prac Sex . 1992;7:1-8. 15. Ziny MA, Shiao-Yu L. Double-blind study of the comparative effects of two gels on the vaginal pH in postmenopausal women . Today Ther Trend . 1991; 8:65-72.
doi: 10.1001/archderm.1995.01690150036008
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Dermatopathology Self-assessment Workshop. On October 7, 1995, The Cleveland (Ohio) Clinic Foundation will offer this workshop, directed by Wilma F. Bergfeld, MD. For information, contact Wilma F. Bergfeld, MD, Department of Dermatology A61, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; telephone: (216) 444-5722; fax: (216) 444-5448. Fundamentals of Mohs Surgery. ''Fundamentals of Mohs Surgery'' will be held in San Diego, Calif, from March 24 through 26, 1995. Sponsored by the American Society for Mohs Surgery, the course will be an intensive, 3-day didactic and hands-on training course designed to provide participants with the basic knowledge and skills to begin practicing Mohs surgery. The meeting is expected to be approved for 18 hours of Category 1 credit. For further information, please contact course directors Ken Gross, MD, or Howard Steinman, MD, at The American Society for Mohs Surgery, c/o Department of Dermatology, University of California-Irvine Medical Center, 101
Cuozzo, Daniel W.;Aaronson, Barry;Benson, Paul M.;Sau, Purnima
doi: 10.1001/archderm.1995.01690150039009
Abstract A 68-year-old white man with undifferentiated acute myelocytic leukemia demonstrated residual leukemia 2 weeks after initial induction chemotherapy with cytarabine and daunorubicin and was receiving a second course of the same agents during his first induction. Amphotericin B (0.5 mg/kg) was added to ceftazidine, gentamicin, and vancomycin on the ninth day of treatment because of persistent neutropenic fevers (leukocytes, 0.3×109/L [normal, 4.8×109/L]), with negative blood and urine cultures. Throughout this postinduction period, the patient was receiving twice daily injections of 5000 U of heparin subcutaneously to the abdominal wall for deep-vein thrombosis prophylaxis. On the 15th day after the second treatment, a large, irregular, slightly tender, ecchymotic lesion was noted on the left side of the abdomen at the site of the heparin injections. The platelet count was 23×109/L (normal, 130×109/L). Physical examination revealed a large ecchymotic lesion in the periumbilical area References 1. DiMagno EP. Pancreatitis . In: Kelley WN, DeVita VT, DuPont HL, et al, eds. Textbook of Internal Medicine . Philadelphia, Pa: JB Lippincott; 1992:531-537. 2. Hall JC, McConahay D, Gibson D, Crockett J, Conn R. Heparin necrosis: an anticoagulation syndrome . JAMA . 1980;244:1831-1832.Crossref 3. Shelley WB, Sayen JJ. Heparin necrosis: an anticoagulant-induced cutaneous infarct . J Am Acad Dermatol. 1982;7:674-677.Crossref 4. Tuneu A, Moreno A, de Moragas JM. Cutaneous reactions secondary to heparin injections . J Am Acad Dermatol. 1985;12:1072-1077.Crossref 5. Rongioletti F, Pisani S, Ciaccio M, Rebora A. Skin necrosis due to intravenous heparin . Dermatologica . 1989;178:47-50.Crossref 6. Weiner CI, Diaconis JN. Primary abdominal wall abscess diagnosed by ultrasound . Arch Surg. 1975;110:341-342.Crossref 7. Adams JT. Abdominal wall, omentum, mesentery, and retroperitoneum . In: Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery . New York, NY: McGraw-Hill International Book Co; 1994:1491-1524. 8. Yeh HC, Rabinowitz JG. Ultrasonography and computed tomography of inflammatory abdominal wall lesions . Radiology . 1982;144:859-863.Crossref 9. Taylor RH, McNicol MW. Ultrasound in the diagnosis of two unusual tuberculous abscesses . Br J Surg. 1980;67:556.Crossref 10. Majewski JA. Rectus sheath abscess . South Med J. 1986;79:1311.Crossref 11. Silliman CC, Lawellin DW, Lohr JA, Rodgers BM, Donowitz LG. Paecilomyces lilacinus infection in a child with chronic granulomatous disease . J Infect. 1992; 24:191-195.Crossref 12. Nguyen KT, Sauerbrei EE, Lewandowski BJ, Nolan RL. The abdominal wall . In: Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic Ultrasound . St Louis, Mo: Mosby—Year Book; 1991:354-364. 13. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 14. Hopper KD, Smazal SF, Ghaed N. CT and ultrasonic evaluation of rectus sheath hematoma: a complication of anticoagulant therapy . Milit Med. 1983;148:447-449.
Dummer, Wolfgang;Blaheta, Hans-Jürgen;Bastian, Boris C.;Schenk, Tamara;Bröcker, Eva-Bettina;Remy, Wolfgang
doi: 10.1001/archderm.1995.01690150043010
Abstract Background and Design: Previous studies have referred to the value of epiluminescence microscopy in the differential diagnosis of pigmented skin lesions and to the possibility of preoperative tumor thickness measurement in malignant melanoma by high-frequency ultrasound. Both noninvasive methods have been combined in this study. The question of improved diagnostic accuracy was discussed. Previously proposed epiluminescence microscopic characteristics of 508 melanocytic lesions and sonographic characteristics of 792 skin tumors were investigated for their sensitivity and specificity. The tumor thickness of 108 malignant melanomas was measured sonographically. Results: Black dots, irregular pigment network, and grayish-blue areas have been shown to be the most sensitive characteristics, whereas pseudopods, grayish-blue areas, and a whitish veil have been shown to be the most specific epiluminescence microscopic features for malignant melanoma. Sonography alone cannot reliably distinguish between different skin tumors. Preoperatively, the tumor thickness of 85% of the melanomas was assessed correctly concerning the pT stage. Conclusions: A 20-MHz ultrasound, in addition to epiluminescence microscopy, may improve the diagnostic accuracy by delivering information about depth and topographic location of skin tumors, but cannot give highly specific information about tissue dignity. It is a reliable tool for tumor thickness measurement for surgical planning.(Arch Dermatol. 1995;131:279-285) References 1. Grin CM, Kopf AW, Welkowich B, Bart RS, Levenstein MJ. Accuracy in the clinical diagnosis of malignant melanoma . Arch Dermatol. 1990;126:763-766.Crossref 2. Steiner A, Pehamberger H, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions, II: diagnosis of small pigmented skin lesions and early detection of malignant melanoma . J Am Acad Dermatol. 1987;17:584-591.Crossref 3. Kreusch J, Rassner G. Strukturanalyse melanozytischer Pigmentmale durch Auflichtmikroskopie . Hautarzt. 1990;41:27-33. 4. Braun-Falco 0, Stolz W, Bilek P, Merkle T, Landthaler M. Das Dermatoskop: eine Vereinfachung der Auflichtmikroskopie von pigmentierten Hautveränderungen . Hautarzt. 1990;41:131-136. 5. Dummer W, Doehnel KA, Remy W. Videomikroskopie in der Differentialdiagnose von Hauttumoren und der sekundären Prävention des malignen Melanoms . Hautarzt. 1993;44:772-776. 6. Kenet OR, Kang S, Kenet B, Fitzpatrick TB, Sober AJ, Barnhill RL. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy . Arch Dermatol. 1993;129:157-174.Crossref 7. Goldman L. Some investigative studies of pigmented nevi with cutaneous microscopy . J Invest Dermatol. 1951;16:407-410. 8. MacKie RM. An aid to the preoperative assessment of pigmented lesions of the skin . Br J Dermatol. 1971;85:232-238.Crossref 9. Fritsch P, Pechlaner R. Differentiation of benign from melanocytic lesions using incident light microscopy . In: Ackermann AB, ed. Pathology of Malignant Melanoma . New York, NY: Masson Publishing USA Inc; 1981:301-312. 10. Bahmer FA, Fritsch P, Kreusch J, et al. Terminology in surface microscopy . J Am Acad Dermatol. 1990;23(pt (1) ):1159-1162.Crossref 11. Alexander H, Miller DL. Determining skin thickness with pulsed ultrasound . J Invest Dermatol. 1979;72:17-19.Crossref 12. Hoffmann K, El-Gammal S, Matthes U, Altmeyer P. Sonographie der Haut in der präoperativen Diagnostik . Z Hautkr. 1989;64:851-858. 13. Pawlak FM, Hoffmann K, El-Gammal S, Altmeyer P. Three-dimensional reconstruction of serial ultrasound images of the skin . In: Altmeyer P, El-Gammal S, Hoffmann K, eds. Ultrasound in Dermatology . New York, NY: Springer Publishing Co Inc; 1991:385-396. 14. Gassenmaier G, Kiesewetter F, Schell H, Zinner M. Value of high resolution ultrasound in determination of vertical tumor thickness in malignant melanoma of the skin . Hautarzt. 1990;41:360-364. 15. Soyer HP, Smolle J, Hodl S, Pachernegg H, Kerl H. Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors . Am J Dermatopathol. 1989;11:1-10.Crossref 16. Remy W, Doehnel KA. Das flexible elektronische Mikroskop . Dtsch Dermatol. 1991;1:65-67. 17. Kreusch J, Rassner G. Standardisierte auflichtmikroskopische Unterscheidung melanozytischer und nichtmelanozytischer Pigmentmale . Hautarzt 1991;42: 77-88. 18. Hoffmann K, El-Gammal S, Winkler K, Jung J, Pistorius K, Altmeyer P. Skin tumors in high-frequency ultrasound . In: Altmeyer P, El-Gammal S, Hoffmann K, eds. Ultrasound in Dermatology . New York, NY: Springer Publishing Co Inc; 1991:181-201. 19. Schulz H. Maligne Melanome in der Auflichtmikroskopie . Hautarzt. 1994;45: 15-19.Crossref 20. Steiner A, Binder M, Schemper M, Wolff K, Pehamberger H. Statistical evaluation of epiluminescence microscopy criteria for melanocytic pigmented skin lesions . J Am Acad Dermatol. 1993;29:581-588.Crossref 21. Kreusch J, Rassner G, Trahn C, Pietsch-Breitfeld B, Henke D, Selbmann HK. Epiluminescence microscopy: a score of morphological features to identify malignant melanoma . Pigment Cell Res. 1992;17( (suppl 2) ):295-298. 22. Orfanos CE, Jung EG, Rassner G, Wolff H, Garbe C. Stellungnahme und Empfehlungen der Komission malignes Melanom der Deutschen Gesellschafr zur Diagnostik, Behandlung und Nachsorge des malignen Melanoms der Haut . Hautarzt. 1994;45:285-291.Crossref
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