Temporal artery biopsy in a dermatologic surgery practice.

BACKGROUND: A positive temporal artery biopsy (TAB) is essential to the diagnosis of temporal arteritis. Both this relatively common disease and its prolonged treatment with corticosteroids are associated with serious sequelae. Therefore, accurate and timely diagnosis is critical. The dermatologic surgery literature lacks a description of this straightforward surgical technique, as TABs are most often performed by ophthalmologists. OBJECTIVE: As a service to our rheumatology department we began performing TABs on a same-day on-call basis in July 1996. METHODS: We have performed 45 TABs in a 22-month period using a simple, safe, time-efficient technique. We review the surgical anatomy and danger zone of the temporal region and potential complications. We describe the biopsy technique which aims at safely obtaining a greater than 2 cm segment of a peripheral branch of the superficial temporal artery (STA), identified preoperatively by doppler ultrasonography. RESULTS: The procedure was performed on the day requested in all cases. Intraoperative time ranged from 20 to 40 minutes. TAB established the diagnosis of temporal arteritis in 8 of 44 biopsies (18%) and in 7 of 35 patients (20%), including 1 of 9 patients in whom we performed bilateral TAB. One patient was diagnosed with small-vessel polyarteritis nodosa by TAB. The mean formalin-fixed length of the arterial specimen was 2.2 cm. The length did not vary between positive and negative specimens. There were no complications and the cosmetic results were excellent. CONCLUSION: TAB is a quick, safe, straightforward, and gratifying office procedure which dermatologic surgeons are very qualified to perform.

Ulcerative sarcoidosis. Case report and review of the literature.

BACKGROUND: Sarcoidosis is a chronic granulomatous multisystem disease of unknown origin. Cutaneous manifestations are common but ulcerative skin lesions rarely occur. We report a case of generalized ulcerative sarcoidosis in a patient with fatal multisystem involvement. A review of the literature revealed only 34 other cases of ulcerative sarcoidosis, 5 of which were generalized. We reviewed the clinicopathologic spectrum of the disease and available treatment options. OBSERVATIONS: Ulcerative sarcoidosis affects women (23 of 35 cases) and blacks (18 of 30 cases) most commonly and occurs in young adulthood. Cutaneous sarcoid lesions, including ulcers (11 of 26 cases), were the presenting complaint in 26 of 35 cases. Ulcers developed both de novo and within other sarcoid lesions. The lower extremities were most often involved (29 of 35 cases). A histological diagnosis was made using skin biopsy specimens in all cases. Corticosteroid therapy seems most effective for treatment of ulcerative sarcoidosis, with methotrexate a proven alternative for refractory cases. CONCLUSIONS: Dermatologists most often make the initial diagnosis of sarcoidosis in patients with ulcerative lesions. In the proper clinical setting, a skin biopsy of ulcerative lesions establishes the diagnosis and prompt treatment reduces morbidity.

Chemical stabilization of cartilage matrix.

Severe destruction of articular cartilage in osteoarthritis manifests clinically when repair processes cannot keep up with the catabolic processes. Loss of proteoglycans, which give the tissue its ability to undergo reversible deformation, precedes and probably contributes significantly to breakdown of the matrix in the most superficial layers of articular cartilage. In this study, we have examined the ability of dithiobis[succinimidyl propionate], a bifunctional reagent with a 1.2-nm span that cross-links proteins at lysine amino acid, and poly-L-lysine of high molecular weight (average MW 360,000) to reduce passive loss of proteoglycans and collagen from thin slices (40 and 200 microns) of bovine nasal and human patellar cartilage incubated for 7 days in buffer at 4 degrees C. We present evidence that treatment of thin slices of cartilage with either of these agents is effective in reducing the loss of proteoglycans and collagen from the cartilage matrix and we define conditions (length of treatment and concentrations required) under which the stabilization of the cartilage matrix is optimized. Chemical stabilization of cartilage matrix may become an important modality of treatment in osteoarthritis by protecting the environment around chondrocytes during the repair process.