Eosinophilic Fasciitis Presenting as an Ichthyosiform Eruption of the Bilateral Ankles

Eosinophilic fasciitis (EF) is a rare connective tissue disease which closely resembles other scleroderma-like diseases. EF presents with painful swelling and hardening of the distal limbs and is often preceded by a history of strenuous exercise. The marked fascial fibrosis in EF can lead to joint contractures and causes significant morbidity in affected individuals. The authors present a rare case of EF presenting as an ichthyosiform eruption of the bilateral ankles with gradual improvement after the implementation of oral prednisone, hydroxychloroquine, and methotrexate.

Mask-related skin changes among healthcare workers in a community-based hospital

CONTEXT

During the COVID-19 pandemic, dermatologists within the Beaumont Farmington Hills' Dermatology program noticed an increase in conditions associated with mask wearing, such as "maskne" (acne in a mask distribution, thought to be caused by mask wearing), as well as worsening of previously diagnosed dermatologic conditions.

OBJECTIVES

The goal of our study was to explore various factors that impacted mask-related skin changes and how these skin changes affected quality of life.

METHODS

A cross-sectional study was performed. The primary 10-item survey instrument administered was the Dermatology Life Quality Index (DLQI). Respondents were asked a series of 10 additional questions concerning the degree to which abnormal mask-related skin conditions affect their skin symptoms, possible embarrassment/self-consciousness, and perceived impact of mask-related skin changes. A series of descriptive statistics, cross-tabulation charts, and graphical examinations of data was utilized to evaluate sample subgroup and outcome distributional patterns. Pearson r bivariate correlation coefficients between possible collinear predictive measures on the primary study outcome were calculated. A series of simple inferential chi-squared (Χ²) tests of independence were also conducted.

RESULTS

A total of 370 out of 430 (86.0%) Beaumont Health employees noticed some degree of skin changes since the work-hours face mask requirement was instituted, while 378 out of 430 (87.9%) felt that their skin was better when not wearing a mask. The majority of respondents, 283 (65.8%), reported having at least a little symptomatic skin (i.e., itchy, painful, sore, stinging) during the prior week. Furthermore, 72.3% reported that they were at least a little embarrassed or self-conscious of their skin. Chi-squared analysis of composite DLQI score categories by the number of types of masks utilized (Pearson X²=19.0, df=8, p=0.015), and some degree of symptomatic skin (Pearson X²=156.4, df=4, p<0.001) were found to be statistically significant.

CONCLUSIONS

A large number of healthcare workers are affected by mask-related skin changes. Further research should be directed at better understanding how skin changes associated with mask wearing impact one's quality of life and mental health.

Perforating Granuloma Annulare Appearing as a Psoriasiform Lesion

We present a 54-year-old Caucasian female with a history of diabetes mellitus, multiple sclerosis, and ulcerative colitis who presented with nail dystrophy, polyarthralgia in her hands and hips, myalgia, proximal myopathy, dactylitis, and psoriasiform-appearing progressive, painful plaques on the dorsal aspect of her hands. Histologic examination of the lesion from the left index finger revealed an interstitial and necrobiotic granulomatous dermatitis with connective tissue mucin deposition associated with a perivascular lymphoid infiltrate. Additionally, there was focal transepidermal elimination of the necrobiotic material. She was diagnosed with perforating granuloma annulare (PGA). We are unaware of any other cases of PGA in the literature with this presentation.

Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors

Background

Skin cancer is the most prevalent cancer in the United States. Training medical students about the importance of sun-protective behaviors is critical to reducing skin cancer rates. However, minimal research has explored osteopathic medical students' knowledge and behaviors with regard to the sun's effect on skin health.

Objective

To assess first-year osteopathic medical students' knowledge about skin cancer and UV radiation, attitudes toward tanning, and sun-protective behaviors to establish baseline values.

Methods

Using a descriptive, cross-sectional study design, the authors evaluated students' knowledge, attitudes, and behaviors through a quiz.

Results

A total of 121 first-year osteopathic medical students completed the quiz. The mean (SD) score was 74.6% (11.5%). Two-thirds of participants (n=82) correctly identified basal cell carcinoma as the most common skin cancer, and the majority identified the ABCDs (asymmetry, border irregularity, color, and diameter) of melanoma detection (96 [79.3%], 106 [87.6%], 108 [89.3%], and 94 [77.7%], respectively). Most participants were aware that cloud cover and swimming underwater do not provide UV ray protection (121 [100%] and 109 [90.1%], respectively), a fact that is often misconceived. Forty participants (33.1%) usually or always used some form of sun protection when outdoors. Forty-seven participants (38.8%) believed that a tan makes one look healthy, and 43 participants (35.6%) sunbathed with the intention of tanning.

Conclusion

Physicians are uniquely positioned to counsel patients regarding sun-protective behaviors. Thus, a medical school curriculum that includes education about the sun's effect on health is needed for the prevention and early recognition of skin cancer in future patients.

Is diabetes distress on your radar screen?

Diabetes distress, which affects almost half of those with diabetes, contributes to worsening glycemic control. Recognizing and responding to it is essential.

[Choice of the method of cardial correction during selective proximal vagotomy and gastric resection]

The author studied the condition of the esophagogastric junction in 376 patients with gastric and duodenal ulcer before and in the late-term periods after selective proximal vagotomy and distal resection of the stomach performed in combination with antireflux interventions on the cardia (fundoesophagorrhaphy, crurorrhaphy+fundoesophagophrenorrhaphy, fundoplication) or without such interventions. It is shown that reliable correction of the obturator mechanism of the cardia in selective proximal vagotomy may be achieved only by fundoplication. In gastric resection fundoplication is advisable in marked reflux esophagitis, distention of the hiatus esophageus of third degree, hernia of the hiatus esophageus, and cardiac ulcer. In all other patients with distal resection of the stomach crurorrhaphy+fundoesophagophrenorrhaphy is justified as a preventive measure.

[A decade's experience in using transgrastric selective proximal vagotomy]

Under analysis are results of transgastric vagotomy in 211 patients with ulcer disease of the duodenum operated upon at the period from 1979 to 1989. The transgastric selective proximal vagotomy (TSPV) was used in 150 patients, an original authors' extensive TSPV--in 33 patients, combined transgastric vagotomy (CTV)--in 28 patients. Long-term results of TSPV are recognized to be excellent and good in 79.1% of the patients, satisfactory--in 9.8%, unsatisfactory--in 11.1%. An analysis of causes of unsatisfactory results of TSPV is made. Advantages of the method of extensive TSPV were shown. The CTV is thought to be expedient in patients in urgent surgery and in patients with severe coexistent diseases.

[Function of the esophagogastric junction after trans-gastric selective proximal vagotomy]

The influence of transgastric selective proximal vagotomy (TSPV) on the cardia functional state was studied in 120 patients with ulcer disease of the duodenum. It was established that seromyotomy in the zone of cardia and lesser curvature of the stomach when performing TSPV resulted in disturbance of the constrictor-valvar mechanism of the esophago-gastric passage. Fundoesophagography does not allow the insufficient closure of the cardia to be adequately corrected. The significance of fundoplication is stressed in order to restore the mechanism of cardia closure after TSPV.

[Characteristics of acid-producing function of the stomach after transgastric selective proximal vagotomy]

An analysis of results of transgastric selective proximal vagotomy in 90 patients with ulcer disease of the duodenum enabled the authors to conclude that seromyotomy of the lesser curvature of the stomach when performing transgastric selective proximal vagotomy fails to ensure valuable parasympathetic denervation of the zone in question which results in a number of cases in preservation of uninterrupted gastric acid formation of high intensity and in the development of recurrent ulcer.

[Endoscopic evaluation of reflux gastritis in patients operated on for stomach and duodenal ulcers]

An analysis of results of the endoscopic examination of 320 patients who had been subjected to various operations for ulcer disease of the stomach and duodenum has shown that sphincter-preserving operations (selective proximal vagotomy without drainage of the stomach and pylorus-preserving resection of the stomach) in treatment of ulcer disease of the stomach and duodenum with correction of disturbances of duodenal passability is the most reliable method for prevention of duodeno-gastric reflux and reflux-gastritis.

[Gastric emptying in patients with pyloroduodenal ulcers after selective proximal vagotomy]

The method of roentgen planimetry was used in 79 patients with pyloroduodenal ulcer at different terms after selective proximal vagotomy (SPV) with/without draining operations in order to study the rate of emptying the stomach. It was shown that the evacuatory function of the stomach in remote periods after isolated SPV was determined by the state of the closing function of the pylorus, after SPV with drainage of the stomach--by a draining operation. Alterations of the duodenal passage not corrected during operation manifested themselves in remote periods after SPV as slower emptying of the stomach.

Cyclic nucleotides and atherosclerosis: studies in primary culture of human aortic cells

A primary culture of cells derived from uninvolved and atherosclerotic intima of human aorta was used to elucidate the role of cyclic nucleotides in atherogenesis. The cells cultured from fatty streaks and atherosclerotic plaques had a 2- to 8-fold lower cyclic AMP level and a 1.5- to 2-fold higher level of cyclic GMP compared with those of a grossly normal intima. Medial cells cultured from nonlesioned and atherosclerotic aortic segments showed no differences in the cyclic nucleotide concentrations. Reduction of the intracellular cyclic AMP with 2'-deoxyadenosine or a cyclic GMP elevation with its dibutyryl derivative, or liposomes containing cyclic GMP stimulated the uptake of [3H]thymidine and protein synthesis in the cells cultured from unaffected intima. On the contrary, a rise of the intracellular cyclic AMP caused by adenylate cyclase activators, a phosphodiesterase inhibitor, dibutyryl cyclic AMP, and liposomes containing cyclic AMP inhibited cell proliferation and protein synthesis. Elevation of the intracellular cyclic AMP stimulated the hydrolysis of lipids which led to reduction of lipid levels in the cells cultured from atherosclerotic lesions. The results of this study corroborate the existence of a relationship between the alterations of intracellular cyclic nucleotide levels and the metabolic disorders occurring in atherosclerosis.

Evaluation of quantitative parameters of the interaction of antibody-bearing liposomes with target antigens

The model system for the analysis of targeted liposomes is proposed--the layer of protein antigen adsorbed on polystyrene wells. Antibodies were treated with palmitoyl chloride and liposomes were produced by the cholate dialysis method in the presence of the modified protein (7 X 10(-4) mol protein/mol lipid). Affinity of antibody-bearing liposomes to the antigen on the surface of Multiwell plates was studied, and apparent dissociation constant value was estimated: KD was in the range 1.5 to 5 X 10(-9) M liposomes. Sequential transfers of liposomes in antigen-coated plates revealed that the high-affinity fraction of liposomes is adsorbed first. The bound fraction has 1.7-times-higher protein content. For effective in vivo targeting it would be necessary to have high-affinity liposomes and a high concentration of the target antigen.

Estimation of liposome integrity by 1H-NMR spectroscopy

A fast and simple method of 1H-NMR spectroscopic control of liposome membrane integrity is suggested. The method is based on the redistribution of intensities between two singlet 1H-NMR signals--from intraliposomal marker compound (nitrilotriacetic acid sodium salt, 1H-NMR signal at 4 p.p.m.) and from its complex with Eu3+ added to the external medium (NMR signal of the complex at - 1 p.p.m.). The method permits registration of the kinetics of liposome destruction under the action of detergent or serum. It is shown that the presence of cholesterol in the membrane makes it more stable.

Binding of antibodies in liposomes to extracellular matrix antigens

We have incorporated antibodies against fibronectin or laminin into liposomes and studied their interaction with insoluble forms of these antigens. The antibodies, after modification by palmitoylchloride, were incorporated into the lipid bilayer by the cholate dialysis method. The antibodies in the liposomes recognized their specific antigen with little reaction to the alternative attachment protein or to albumin (less than 2%). The binding of antibody-containing liposomes to insoluble antigen was inhibited by soluble antibodies to the respective antigens but not by antibodies to other antigens. The affinity constant of the liposome-antibody complex with the antigen was estimated at 1-10 X 10(-9) M liposomes. Thus, antibodies in liposomes retain their reactivity and specificity, and the reaction constant is comparable to that observed for immune complexes.

[Intramural selective proximal vagotomy]

The intramural selective proximal vagotomy in its extended form was performed in 110 patients with polyroduodenal ulcer. The technique is described. Good functional results were obtained. A conclusion is made that when performing the selective proximal vagotomy a wide mobilization of the terminal portion of the esophagus can be substituted by the circular extramucosal cardiotomy.

[Functional disorders and work capacity after selective proximal vagotomy in duodenal ulcer]

Remote results within the terms of from 1 to 3 years in 60 patients and the working ability in 73 patients subjected to selective proximal vagotomy (SPV) or SPV with drainage of the stomach were studied. Functional disorders were observed much more rarely after the isolated SPV. The use of benzohexasonium and electrostitmulation of the stomach in the early postoperative period allows preventing the development of functional disorders. The SPV ensures an early recovery of the working ability.