The Perlman syndrome: familial renal dysplasia with Wilms tumor, fetal gigantism and multiple congenital anomalies. 1984

INTRODUCTION

The ensuing paper by Professor Giovanni Neri and colleagues was originally published in 1984, American Journal of Medical Genetics 19:195–207. The original article described a new family with a condition that the authors designated as the Perlman syndrome. This disorder, while uncommon, is an important multiple congenital anomaly and dysplasia syndrome; the causative gene was recently identified. This paper is a seminal work and is graciously republished by Wiley-Blackwell in the Special Festschrift issue honoring Professor Neri. We describe a familial syndrome of renal dysplasia, Wilms tumor, hyperplasia of the endocrine pancreas, fetal gigantism, multiple congenital anomalies and mental retardation. This condition was previously described by Perlman et al. [1973, 1975] and we propose to call it the "Perlman syndrome." It appears to be transmitted as an autosomal recessive trait. The possible relationships between dysplasia, neoplasia and malformation are discussed.

A novel germline PIGA mutation in Ferro-Cerebro-Cutaneous syndrome: a neurodegenerative X-linked epileptic encephalopathy with systemic iron-overload

Three related males presented with a newly recognized x-linked syndrome associated with neurodegeneration, cutaneous abnormalities, and systemic iron overload. Linkage studies demonstrated that they shared a haplotype on Xp21.3-Xp22.2 and exome sequencing was used to identify candidate variants. Of the segregating variants, only a PIGA mutation segregated with disease in the family. The c.328_330delCCT PIGA variant predicts, p.Leu110del (or c.1030_1032delCTT, p.Leu344del depending on the reference sequence). The unaffected great-grandfather shared his X allele with the proband but he did not have the PIGA mutation, indicating that the mutation arose de novo in his daughter. A single family with a germline PIGA mutation has been reported; affected males had a phenotype characterized by multiple congenital anomalies and severe neurologic impairment resulting in infantile lethality. In contrast, affected boys in the family described here were born without anomalies and were neurologically normal prior to onset of seizures after 6 months of age, with two surviving to the second decade. PIGA encodes an enzyme in the GPI anchor biosynthesis pathway. An affected individual in the family studied here was deficient in GPI anchor proteins on granulocytes but not erythrocytes. In conclusion, the PIGA mutation in this family likely causes a reduction in GPI anchor protein cell surface expression in various cell types, resulting in the observed pleiotropic phenotype involving central nervous system, skin, and iron metabolism.

The benefits of powered liposuction versus traditional liposuction: a paired comparison analysis

BACKGROUND

There is much debate about the safety of liposuction as well as the efficacy and risk:benefit ratio of newer devices used in this procedure.

OBJECTIVE

To determine if there are any benefits in terms of safety and efficacy of power reciprocating cannulas compared to traditional manual liposuction cannulas.

METHODS

Patients served as their own controls in a paired comparison analysis of power liposuction cannulas and traditional liposuction cannulas.

RESULTS

Power cannulas significantly reduced procedure times, intraoperative pain, and surgeon fatigue, and increased the amount of fat aspirated per minute. Power cannulas also decreased postoperative pain, ecchymoses, and edema, as well as resulting in higher patient satisfaction scores.

CONCLUSION

Power liposuction cannulas produce significantly faster recovery times for patients, allow faster procedure times, and reduce surgeon fatigue, resulting in safer and more precise surgery. A lower incidence of touch-up procedures is likely due to these benefits.

Lasers in dermatology: a review

The revolution in laser technology has had a significant impact on medicine in general and dermatology in particular and has piqued the interest of physicians, the lay public, and the media. Advances in laser therapy have dramatically improved the clinicians' ability to treat cosmetic and noncosmetic skin lesions safely and effectively. The number and variety of skin problems amenable to laser treatment continues to grow. We will provide a review of the major cosmetic and therapeutic applications of laser therapy.

Successful treatment of spider leg veins with a high-energy, long-pulse, frequency-doubled neodymium:YAG laser (HELP-G)

BACKGROUND

While sclerotherapy has been the standard treatment for spider leg veins for many years, recent advances have allowed lasers to be considered as a treatment option.

OBJECTIVE

To study the efficacy of a frequency-doubled Nd:YAG laser at 532 nm with a 50 ms pulse width and chill tip device in the treatment of spider leg veins.

METHODS

Forty-six patients with spider leg veins with a diameter of less than 1 mm or 1-2 mm were treated with a frequency-doubled Nd:YAG laser at 532 nm with a pulse width of 50 ms (VersaPulse HELP-G laser) while using a water-cooled chill tip device.

RESULTS

Of patients with veins less than 1 mm in diameter, 60% had greater than 50% clearing after one treatment and 80% had greater than 50% clearing after two treatments. Of patients with veins 1-2 mm in diameter, 39% achieved greater than 50% clearing after one treatment and 67% had greater than 50% clearing after two sessions.

CONCLUSION

Our results suggest that the frequency-doubled Nd:YAG laser with a pulse width of 50 ms and chill tip device offers an excellent alternative to sclerotherapy in the treatment of small spider leg veins.

A novel application of the infrared coagulator in hair transplantation. Significant reduction of width of the donor site wound

BACKGROUND

The infrared coagulator, a by-product of laser technology, has been used in dermatology in a variety of settings. During hair transplantation sessions, we observed a significant reduction of the donor ellipse width while performing hemostasis with the infrared coagulator.

OBJECTIVE

Quantitative assessment of the donor wound width after infrared coagulator use, and correlation to the number of previous transplant sessions and patients' age.

METHODS

Twenty-four patients (22 men, two women) underwent hair transplantation. The infrared coagulator was utilized for hemostasis with a pulse duration of 2.5 seconds.

RESULTS

The infrared coagulator produced an average donor area decrease of 42%, while achieving rapid hemostasis. No correlation was demonstrated to number of previous transplant sessions or patients' age.

CONCLUSIONS

The infrared coagulator significantly decreases the donor wound width while providing hemostasis. Advantages include the potential of larger donor strip harvest, minimal tissue manipulation, and less traumatic closure.

The new fluor-hydroxy pulse peel. A combination of 5-fluorouracil and glycolic acid

BACKGROUND

Chemical peels have become an increasingly popular method to treat a myriad of benign skin disorders. Individually, glycolic acid (GA) and 5-fluorouracil (5-FU) have been proven efficacious in the treatment of actinically damaged skin. However, to our knowledge the literature lacks a study examining the synergistic effects of these two agents in the treatment of actinic keratoses (AKs) and solar damage.

OBJECTIVE

The aim of the study was to determine if a combination of 5-FU and 70% GA, when delivered in pulse doses, would have greater efficacy than using GA alone in destroying precancerous AKs and improving the cosmetic appearance of the skin.

METHODS

A prospective randomized controlled study was designed with 18 subjects who had clinically apparent facial AKs. Each patient was treated with the combination of 5-FU and GA to one half of the face, while GA alone was applied to the other half, in a randomized fashion. A before-treatment count of the number of AKs present on each half of the face was recorded and pretreatment photographs were taken. The solutions were applied weekly to all patients for an 8-week period. A posttreatment count of AKs on each half of the face along with posttreatment photographs followed at 6 months.

RESULTS

The combination of 5-FU and GA cleared 91.94% of AKs at a 6-month follow-up period as compared with 19.67% clearing by GA alone. There were no significant side effects reported with the combination peel.

CONCLUSION

The fluor-hydroxy pulse peel applied in a pulse dose regimen not only provides cosmetic improvement, but more importantly, has a therapeutic effect on ablating premalignant AKs. This therapeutic effect occurs without the usual morbidity associated with using 5-FU alone in a nonpulsed dosage. Additionally, it is evident that the superficial peeling induced by alpha hydroxy acids may improve cosmesis of actinically damaged skin, but the GA alone cannot destroy a significant number of AKs.

Superior results of tibial rodding versus external fixation in grade 3B fractures

From 1987 to 1993, 41 Grade 3B open tibial shaft fractures were treated with the unreamed tibial nail or an external fixator. The method of treatment was left to the choice of the operating surgeon. Three below knee amputations were performed; three patients died; and three were lost to followup. Thirty-two patients were observed until union or for at least 1 year. There were no significant statistical differences between the two groups with respect to fracture type, fracture location, age, gender, or accompanying injuries. The unreamed tibial nail group showed significantly better results regarding time to full weightbearing, number of reoperations, isolated bone grafting, walking range, and average Karlström and Olerud score. Time to bony union, infection, and nonunion were not significantly different between the groups.

Silicone gel sheeting in scar therapy

The purpose of this study was to analyze the efficacy of silicone gel sheeting in the treatment of fresh and long-standing hypertrophic and keloid scars. All subjects applied the gel sheeting in the same fashion and wore it for twelve to twenty-four hours per day for at least two months. After at least six months' follow-up, twenty of thirty-six (56 percent) chronic scars were improved. Eleven of fourteen fresh hypertrophic scars (79 percent) did not recur after surgery during a similar follow-up period. Side effects were minimal. Silicone gel sheeting is safe and effective treatment for hypertrophic and keloid scars. The mechanism of action is not completely understood.

Proximal femoral focal deficiency (PFFD) and fibular A/hypoplasia (FA/H): a model of a developmental field defect

Proximal femoral focal deficiency (PFFD) and fibular a/hypoplasia (FAH) are distinct malformations of the lower limbs. Both can occur as isolated defects or in association with other limb malformations. In fact, fibular defects frequently are present in PFFD, and, conversely, femoral abnormalities can be found in the presence of a typical FAH picture. We report on 5 patients with a variable combination of femoral and fibular defects. In one of them unilateral PFFD was associated with lateral foot defects, in the absence of fibular abnormalities, and with a phenotype similar to that observed in the femoral hypoplasia/unusual face syndrome (FH/UFS). Another patient had isolated PFFD on one side, with controlateral absence of femur, fibula, and tibia. Another patient had a PFFD, fibular hypoplasia, and abnormalities of fibular foot rays, and the last 2 patients, a father and son, had, respectively, bilateral foot malformations plus fibular and tibial hypoplasia in the father and a PFFD in the son. These observations represent a further demonstration of the existence of a fibular developmental field, and contribute to the definition of its spatial boundaries. The variable involvement of elements comprised in the developmental field can be explained by multifactorial etiology.

Atypical facial scarring after isotretinoin therapy in a patient with previous dermabrasion

The increased use of isotretinoin therapy for severe cystic acne has posed new problems for dermatologic surgeons. There have been recent reports in the literature of unexpected "atypical" scarring after dermabrasion in patients who have previously taken isotretinoin. This scarring was considered atypical because it occurred outside the typical "danger zones" (e.g., mandible and malar eminences) where scarring most often occurs after dermabrasion. This is the first reported case of atypical scarring in a patient who began isotretinoin therapy 2 months after dermabrasion.

Pseudopelade of Brocq is lichen planopilaris: report of four cases that support this nosology

Four patients are presented with pseudopelade of Brocq whose symptoms also illustrate the spectrum of symptoms of lichen planus. The literature is reviewed and the clinical and histologic features of pseudopelade of Brocq and lichen planopilaris are described. The literature on pseudopelade of Brocq is confusing and outdated. Since Degos's article in 1954, it has become commonly accepted that pseudopelade of Brocq is a nonspecific cicatricial end stage of scalp diseases resulting in alopecia. We maintain instead that pseudopelade of Brocq and lichen planopilaris are basically the same condition, namely a manifestation of lichen planus.

Successful salvage of an 8-month-old child with an aortoesophageal fistula

Aortoesophageal fistula (AEF) from an impacted esophageal foreign body was first described in 1818 and has been a uniformly fatal condition to this date. We report the salvage of an 8-month-old child with an AEF from ingesting a straight pin. She survived a massive gastrointestinal (GI) bleed and primary esophageal and aortic repairs performed in conjunction with aortic shunting, interposed pleural flap, and a diverting cervical esophagostomy. This represents the first successful outcome of an AEF from a foreign body, many of which have been described in infants and children. History of esophageal foreign body and signal upper GI hemorrhage should mandate aggressive diagnosis and surgical intervention.

Pseudocyst of the auricle: successful treatment with intracartilaginous trichloroacetic acid and button bolsters

Pseudocyst of the auricle is an asymptomatic, noninflammatory cystic swelling that typically involves the anthelix of the ear and results from an accumulation of fluid within an unlined intracartilaginous cavity. We report a patient with a recurrent pseudocyst of the auricle and describe a new surgical technique for treating this condition by applying 50% trichloroacetic acid to the intracartilaginous cavity and utilizing external button bolsters for compressive therapy. This therapeutic approach is simple to perform in the office, results in permanent resolution of the pseudocyst, preserves the normal architecture of the external ear, and provides excellent postoperative and long-term cosmetic results.

A controlled study of the effectiveness of spot dermabrasion ('scarabrasion') on the appearance of surgical scars

We report the results of a controlled study on the use of spot dermabrasion ("scarabrasion") on surgical scars. In a split scar model, linear scars produced by full-thickness surgical excisions on the face, trunk, and extremities were studied in 48 patients. Results of abrasion of the left (top) half of each scar were compared with the untreated right (bottom) half. Although scars were improved at 4 and 6 weeks after injury, a significantly greater number responded to abrasion at 8 weeks (p less than 0.05). All regions of the body showed comparable improvement. The diamond fraise was found to be an effective instrument for scarabrasion.

Linear porokeratosis: successful treatment with diamond fraise dermabrasion

A patient with linear porokeratosis was successfully treated with diamond fraise dermabrasion. Follow-up evaluation revealed an excellent cosmetic result with adequate repigmentation, no scarring, and no recurrence of lesions. Long-term follow-up will be necessary to determine whether dermabrasion treatment of linear porokeratosis provides adequate prophylaxis against the subsequent development of malignancy.

Bacitracin: a unique topical antibiotic sensitizer

Topical bacitracin appears to be unique for the following reasons: (1) It is becoming a frequent sensitizer, particularly when used after surgery. (2) It may cause not only a delayed, eczematous contact dermatitis but an immediate urticarial reaction and, rarely, anaphylactic shock. (3) Positive patch test reactions to bacitracin often do not appear at the usual 48-hour test reading but may be positive when read at 96 hours. (4) Zinc bacitracin and "plain" bacitracin are two forms of topical bacitracin available, with possibly different degrees of sensitizing potential. (5) Bacitracin injected intradermally has been reported to be a histamine-releasing agent. (6) Bacitracin often coreacts but does not cross-react with neomycin. In this presentation we document the clinical and patch test findings of nine patients seen in the past year with allergic contact dermatitis to bacitracin ointment.

The Perlman syndrome: familial renal dysplasia with Wilms tumor, fetal gigantism and multiple congenital anomalies

We describe a familial syndrome of renal dysplasia, Wilms tumor, hyperplasia of the endocrine pancreas, fetal gigantism, multiple congenital anomalies and mental retardation. This condition was previously described by Perlman et al [1973, 1975] and we propose to call it the "Perlman syndrome." It appears to be transmitted as an autosomal recessive trait. The possible relationships between dysplasia, neoplasia and malformation are discussed.