Eosinophilic fasciitis associated with hypereosinophilia, abnormal bone-marrow karyotype and inversion of chromosome 5.

We report the case of a male patient presenting with eosinophilia, pulmonary oedema and eosinophilic fasciitis (EF). He had the classic clinical appearance and magnetic resonance imaging of EF. Cytogenetic analysis of the bone marrow revealed a previously undescribed pericentric inversion of chromosome 5. Overall, the presentation was consistent with a diagnosis of chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS). Dermatologists should consult a haematologist in cases of EF, in order to rule out possible haematological malignancies.

Calcific panniculitis in adult-onset dermatomyositis.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy associated with characteristic cutaneous features. Panniculitis is a rarely reported clinical finding in this condition. This report describes two cases of adult-onset DM complicated by severe calcific panniculitis. In both cases, the associated pain and loss of function seemed to be best managed on combination anti-malarial therapy with mepacrine and hydroxychloroquine.

Acquired reactive perforating collagenosis: four patients with a giant variant treated with allopurinol.

Reactive perforating collagenosis (RPC) is one of the four essential acquired perforating dermatoses. The condition is characterized by the transepidermal elimination of altered collagen. This paper describes four patients with a giant variant of RPC which has not previously been documented. Three of the patients had associated diabetes mellitus and one had chronic renal failure secondary to fetal scarring. Three of the four patients had a significant improvement in their lesions and symptoms following treatment with allopurinol.

Sexual activity, fertility and contraceptive use in middle-aged and older men: Men in Australia, Telephone Survey (MATeS).

BACKGROUND: With limited information regarding fertility and sexual activity in the older population, men's behaviour, attitudes and concerns were explored in a representative population of middle-aged and older men using the Men in Australia, Telephone Survey (MATeS). METHODS: A stratified random national sample of 5990 men participated in a standardized computer-assisted telephone interview. Equal numbers in the age strata 40-49, 50-59, 60-69 and >or=70 years were surveyed with findings census-standardized to the national population. Broad aspects of men's health and well-being, including reproductive health, were explored. RESULTS: The majority of men were sexually active in the last 12 months (age-standardized proportion, 78.3%) with approximately 37% of men aged >or=70 years still continuing sexual activity. Overall, 12.2% of men had never fathered children, of whom most (7.7%) had chosen not to have children. Questioning on failed attempts to produce a pregnancy suggested an involuntary infertility rate of 7.6%. The age-standardized vasectomy rate was 25.1%, with 5.6% of vasectomized men having no children. Although 9.2% of vasectomized men regretted sterilization, only 1.4% had undergone vasectomy reversal. CONCLUSIONS: Continuing sexual activity, fertility and contraception needs in middle-aged and older men suggests that education and service delivery must be more appropriately directed to an ageing population.

Diffuse hypertrichosis and faun-tail naevus as cutaneous markers of spinal dysraphism.

We describe two cases of spinal dysraphism where detection of the cutaneous signs - namely a faun-tail naevus and diffuse hypertrichosis - led to early recognition of the occult neurological abnormalities and institution of corrective surgery. The dermatologist may be the first physician to observe these skin changes and an early neurosurgical referral can prevent subsequent neurological complications.

Sweet's syndrome in association with generalized granuloma annulare in a patient with previous breast carcinoma.

We describe a case of Sweet's syndrome in association with generalized granuloma annulare (GA) which presented 3 years after a diagnosis of breast carcinoma. Both Sweet's syndrome and generalized GA have been described independently in association with breast carcinoma but have never been described together. Both conditions appeared to respond to oral clofazimine.

Cyclosporin for atopic dermatitis in children.

This paper details a UK consensus conference held in London in April 2000 to establish guidelines for the use of cyclosporin A for atopic dermatitis in children. It should be reserved for the severest refractory atopic dermatitis. In view of its potential toxicity, careful monitoring is mandatory, in particular blood pressure and renal function.

Split skin grafts in the treatment of pyoderma gangrenosum. A report of four cases.

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon necrotising, non-infective ulceration of the skin. The management of PG is aimed at limiting tissue destruction, promoting the healing of the wound, and providing an acceptable cosmetic result. However, skin grafting is normally avoided because of the potential risk of pathergy-the localization of skin damaged by trauma. REPORT: We describe the use of split skin grafts in the management of ulcerative pyoderma gangrenosum in 4 patients. RESULTS: Our cases demonstrate that split skin grafts are a useful treatment modality in patients with ulcerative PG, producing a good cosmetic result. One case illustrates the importance of ensuring the disease is quiescent prior to grafting, to avoid pathergy. The other cases emphasise the need for prolonged immunosuppressive therapy to minimise the chance of reactivation of the disease process. CONCLUSION: Our preliminary experience of 4 cases of ulcerative PG indicates that split skin grafts have a role to play in its management. The ultimate cosmetic result is considered to be superior to allowing the wound to heal by secondary intention. To limit the risk of pathergy developing, our experience suggests a role for prolonged courses of immunosuppressive therapy. The most effective dose and duration of immunosuppressive therapy in patients with PG treated with split skin grafts remains to be determined. A controlled study would be of benefit to compare it with other current treatment options.

Semen storage for special purposes at Monash IVF from 1977 to 1997.

OBJECTIVE: To review 20 years of experience with sperm storage before vasectomy or before chemotherapy and/or radiation therapy (medical storage), and to evaluate its usefulness. DESIGN: Retrospective data analysis. SETTING: University-affiliated reproductive medicine clinic. PATIENT(S): Two hundred fifty-six men who underwent vasectomy and 258 men who underwent chemotherapy and/or radiation therapy. INTERVENTION(S): Review of patient clinical notes. MAIN OUTCOME MEASURE(S): The subsequent use of cryostored sperm and the number of pregnancies that resulted. RESULT(S): Only 4 of the 256 men who underwent vasectomy returned for treatment, and three pregnancies were achieved. Eighteen of the 258 men who underwent chemotherapy and/or radiation therapy returned for treatment, and six pregnancies were achieved. CONCLUSION(S): Only a small proportion of men (2%) returned to use their cryostored specimens after vasectomy, and pregnancy was achieved in most cases. Seven percent of men returned to use their specimens after chemotherapy and/or radiation therapy, and pregnancy was achieved in only one third of cases.

Lack of c-kit mutation in familial urticaria pigmentosa.

Somatic mutations within c-kit have been reported in individuals with mastocytoses, including urticaria pigmentosa (UP). We have identified three siblings with UP. We aimed to determine whether the c-kit proto-oncogene was playing a part in the aetiology of UP in these three siblings. Using seven microsatellite repeat markers spanning an 8-cM interval encompassing the c-kit gene we followed the transmission of the c-kit gene in this family. Furthermore, single-strand conformation polymorphism analysis was used to scan exon 17 of the c-kit gene for mutations in genomic DNA of all family members and somatic DNA extracted from skin of the eldest affected sibling, the proband. No mutations were found in exon 17 in either genomic DNA of all family members or somatic DNA of the proband. Patients with UP have been shown to possess somatic mutations of the c-kit gene. However, this locus has been excluded as playing a part in the three siblings examined here in whom a second gene locus must be determining their UP. Therefore, this study emphasizes genetic heterogeneity in UP. Future study to identify primary molecular determinants of UP should include affected sib-pair studies.