Botanical Briefs: Bloodroot (Sanguinaria canadensis)

Bloodroot (Sanguinaria canadensis) is a plant that historically has been used in medicine for its antimicrobial, antihypertensive, anti-inflammatory, and antineoplastic properties. In dermatology, bloodroot has been utilized for its cytotoxic effects; it has been marketed as black salve as an anticancer treatment, but it does not come without notable toxicities. Unwanted cosmetic outcomes and even irreversible scarring and premalignant conditions have been reported. This article aims to bring awareness to both the therapeutic potential of S canadensis as well as the potential toxicities and risks associated with this North American plant.

Ectopic breasts: familial functional axillary breasts and breast cancer arising in an axillary breast

Supernumerary breasts and nipples are not uncommon and have familial and syndrome associations. Although usually of only cosmetic concern, hormonal changes and inflammatory or neoplastic conditions that affect primary breast tissue also may occur in areas of ectopic breast tissue. We describe cases of familial functional axillary breasts and primary carcinoma of the breast arising in ectopic axillary breast tissue.

Pulmonary cutaneous metastasis: a case report and review of common cutaneous metastases

The literature on cutaneous metastatic disease can be difficult to interpret because of inconsistent study design and analysis among authors. Furthermore, one should be careful when reviewing the statistics in the literature, as reported patient populations tend to vary and are not representative of the whole population. However, certain trends are notable and should be reported. Diagnosis of cutaneous metastatic disease carries a grave prognosis. We describe a patient with pulmonary cutaneous metastasis and provide a review of the literature on nonmelanomatous solid tumor malignancies that most commonly have cutaneous metastases. The review will focus on epidemiology, clinical presentation, histology and immunohistochemical staining, and prognosis and management. The most common cutaneous metastasizing carcinomas--breast, lung, and colorectal cancer--also are discussed.

Viral-associated trichodysplasia in a patient with lymphoma: a case report and review

Viral-associated trichodysplasia is a recently described entity associated with immunosuppression. We describe a 68-year-old man with a history of treated lymphoma who developed numerous, disfiguring, papular and spiny lesions involving most of the central face. Both facial and body alopecia was noted. Histopathologic findings of a facial papule showed dramatic alterations of the hair bulbs, including bulbar distention, lack of hair shaft formation and a marked expansion of inner root sheath type epithelium. These findings were identical to those of previously described cases, so electron microscopy was performed. Numerous intranuclear virus particles were identified. Shortly after the diagnosis of trichodysplasia was made, the patient was found to have a relapse of his lymphoma, which may represent the source of his immunosuppression. Based on his skin biopsy findings, successful antiviral therapy was initiated. This case and a review of previously reported cases are discussed in this study.

Military aviators with mitral valve prolapse: long-term follow-up and aeromedical endpoints

INTRODUCTION

Mitral valve prolapse (MVP) is a disqualifying condition for USAF aviators. Trained USAF aviators, and in recent years flying training applicants, may be granted waiver for initial or continued flying duties following extensive, periodic evaluation. This study examines the usefulness of the various tests performed in that evaluation process and provides long-term follow-up from 404 USAF flyers with MVP.

METHODS

We retrospectively reviewed 2-dimensional echocardiography, Holter monitoring, treadmill exercise, thallium imaging, coronary fluoroscopy, cardiac catheterization, and centrifuge testing results from 404 military aviators evaluated at the Aeromedical Consultation Service between 1 January 1972 and 31 October 1993. Follow-up was achieved through questionnaires (91%) and death certificates, etc.

RESULTS

Mean follow-up was 8.6 yr (range 1-21 yr). Age at study entry was 21 to 64 yr (mean = 36 yr). The occurrence rate for suddenly incapacitating events (sudden cardiac death, syncope, pre-syncope, and cerebral ischemic episodes) was 0.32%/yr.

CONCLUSIONS

Echocardiographic MVP in military aviators is associated with a low but statistically increased prevalence of "incapacitating" aeromedical events. Univariate predictors of adverse outcome included study entry with an enlarged left ventricle or left atrium, cardiovascular symptoms or findings, or MVP with thickened leaflets. Evaluation of coronary artery disease (CAD) in this population, absent specific indicators of CAD risk, is not indicated.

Self-treatment of a basal cell carcinoma with "black and yellow salve"

Patients may seek "alternative" or "non-traditional" therapies for dermatologic problems, frequently in search of a miraculous cure. However, many of these medicaments contain unknown compounds with questionable benefit and a potential for significant harm. We describe a patient who developed a large ulceration on her nose after applying "black and yellow salves" obtained from Mexico in an attempt to self-treat a basal cell carcinoma.

Giant right plantar keloid treated with excision and tissue-engineered allograft

Plantar keloids are a management problem as a result of the pain and mechanic restriction with ambulation. We present the treatment of a patient with a particularly large plantar keloid that was refractory to multiple excisions, adjunctive intralesional steroids, and radiation therapy, who was successfully treated with excision, intralesional steroids, and tissue-engineered allograft placement.

Erythema dyschromicum perstans: a case report and review

Erythema dyschromicum perstans (EDP) is an acquired ashy dermatosis characterized by patches of blue-gray pigmentation over the trunk, extremities, and neck. These pigmentary changes may become chronic and disfiguring. At present, the etiology of EDP remains unclear, and there is no single established therapy. We describe a 21-year-old Hispanic man with extensive patches of EDP who improved with oral corticosteroid therapy.

Diabetes mellitus, advances and their implications for aerospace medicine

The authors describe a case of Type 1 diabetes mellitus (insulin dependent) in a 34-year-old fighter pilot, which included a 15-month remission ("honeymoon period"). The pathogenesis, characteristics, diagnosis, evaluation, and the aeromedical implications of Type 1 diabetes are discussed. The use of C-peptide values in accessing beta cell function is also discussed. The risk of poorly controlled diabetes, diabetic ketoacidosis, and visual acuity fluctuations were major reasons to disqualify this individual when in remission. The importance of determining the type of diabetes for prognosis and aeromedical disposition is stressed.