Subepidermal calcified nodule presenting as a cutaneous horn: two cases and a review of the literature

Subepidermal calcified nodules are an uncommon subtype of idiopathic calcinosis cutis. Morphologically, this entity typically present as a single, well-circumscribed, white-yellow nodule. Based on clinical appearance alone, subepidermal calcified nodules are frequently misdiagnosed and often requires histological confirmation. We describe two cases of subepidermal calcified nodules presenting atypically as cutaneous horns. Subepidermal calcified nodules presenting as a cutaneous horn has rarely been reported; on review, there are fewer than 10 such cases have been described within the past 30 years. The cases described here illustrate the clinical variety and should increase awareness of subepidermal calcified nodules presented.

Buschke-Ollendorff syndrome and bilateral cutaneous syndactyly

A 3-year-old boy presented with asymptomatic elastomas on the posterior trunk. Radiographic studies revealed osteopoikilosis, confirming the diagnosis of Buschke-Ollendorff syndrome. The patient had a history of bilateral simple cutaneous syndactyly, which has not been previously reported with this condition. Buschke-Ollendorff syndrome is a rare autosomal-dominant disorder characterized by connective tissue nevi and osteopoikilosis. Several associated systemic abnormalities have been reported, but morbidity and mortality are generally not affected.

Treatment of molluscum contagiosum and herpes simplex virus cutaneous infections

Molluscum contagiosum (MC) is a human viral infection contracted by skin-to-skin inoculation, autoinoculation, and fomite inoculation. There are a variety of treatments for MC, including watchful waiting, curettage, cantharidin, cryotherapy, and topical imiquimod. Herpes simplex virus (HSV) infections also have been treated with imiquimod. This article discusses the treatment of MC and HSV infections and reviews the literature.

[The diagnosis of inflammatory muscular and vascular diseases using MRT with STIR sequences]

The role of MRT in the prebiopsy diagnosis of muscular and vascular inflammatory conditions was evaluated prospectively and an optimal method of examination was investigated. 92 patients with a suspected diagnosis of myositis (60 cases) or vasculitis (32 cases) were examined, in each case two extremities were studied using transverse T1 and T2 weighted SE sequences and double echo STIR sequences on a 0.5 Tesla (56 patients) or 1.5 Tesla magnet (36 patients; T5/S15 Gyroscan, Philips). The site of the biopsy depended on the MRT findings. In 41 patients the suspected diagnosis was confirmed histologically, in two patients an infective myositis was diagnosed on clinical grounds despite negative histology. MRT demonstrated muscle oedema in 86% of patients. There were negative findings after immuno-suppressive therapy (two patients), in focal myositis (3 out of 4 patients) and in one of 7 patients with untreated vasculitis. Amongst 49 patients in whom the suspected diagnosis could not be confirmed there was muscle oedema in 11 cases (9 neuropathies out of 22, two myopathies out of 10). Oedema indicated inflammatory muscular or vascular disease with a sensitivity of 97% (except in treated patients and for focal myositis). The number of false negative biopsies can be greatly reduced by the use of MRT.

The epidemiology of medical care utilization by severely-disabled independently-living adults

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

A prospective evaluation of the effect of managed care on medical care utilization among severely disabled independently living adults

We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study group's utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).

[Treatment of mastopathy: the last possible risk]

52 patients with mastopathia were treated with Mastodynon. The drug was given twice daily in a dose of 30 drops over a period of at least three cycles. 24 out of 52 patients had no more pain at all; in 15 patients pain was decreased to a minimum. Mastodynon showed side effects in only four cases where gastric incompatibility was found. Therapy with Mastodynon is an effective alternative to surgical or hormone treatment.

Effects of 5,6 benzo-alphapyrone on traumatic edema due to crush and burn injury

Benzopyrones are a class of drugs which have been used clinically and experimentally in Europe and Australia to reduce tissue swelling caused by high-protein edema states. These drugs are not available nor have they been investigated in the United States. This pilot experiment was designed to determine if one of these compounds, 5,6 benzo-alphapyrone, is effective in reducing traumatic edema from thermal and crush injury.

METHOD

One hind limb of 34 Sprague-Dawley rats was immersed for 30 seconds in 55 degrees C water and the animals divided into three groups as follows: Group I--no treatment; Group II--17 cc saline/kg body weight IP; Group III--25 mg 5,6 benzopyrone in 17 cc saline/kg body weight IP. In another 30 S-D rats, the soft tissue of the posterior aspect on one hind limb was crushed in a Servistor vise (jaws to within 1 mm of each other) for 5 minutes. They were divided into three groups and treated as in the thermal injury group. After 24 hours both limbs were amputated, weighed, dried, and reweighed. Crushed and burned rat hind limbs treated with benzopyrone after injury had significantly greater dry weights (less edema) than did untreated or saline treated limbs. Benzopyrone appears to be effective in reducing edema following crush and thermal injury in this experimental system. Further studies are being conducted to elucidate the mechanism of action of benzopyrones, their potential activity in other postinjury edema, and their effect on tissue survival.

[Two-phase respiration of apnoeic newborn, basic research and clinical value (author's transl)]

Studies on fetal human and calf lungs proved an 1: 2,5 increase rate of the transpulmonary blood-flow after inflation of the alveolar spaces. The extent of the inflation depends on the function pressure X time. Based on the rupture rate of the pulmonary tissue, the factor pressure is limited to 20-30 ch H2O. Consequently the inflation only can be obtained by increasing the factor time. Conditional on the flow resistance in the variably calibrated branches of the pulmonary system, the maximal pressure of 30 cm H2O has to act repeated continuously at least 10 seconds over an endotracheal tubus. Only then even the periphere alveoles will fully be inflated (phase I equals monotone inflation phase). An intermittend pressure breathing of maximal plus 30 cm H2O respectively-30 cm H2O will be supporting. After the total inflation short pressure waves of plus 30 cm H2O in physiological frequency (equals 30/minute) will do for further ventilation of the alveoles (phase II equals rhythmical ventilation phase).