A case report of dyshidrotic bullous pemphigoid developing after partial anterior circulation ischaemic stroke.

Dyshidrotic bullous pemphigoid is a rare form of bullous pemphigoid that affects predominantly a patient's hands and feet. It has been associated in the literature with neurologic, psychiatric and cerebrovascular disorders. We present an interesting case of this rare skin condition developing in a patient following a diagnosis of partial anterior circulation stroke.

Poliosis circumscripta unmasking a scalp melanoma.

A 28-year-old man presented with a 1-year history of a localized patch of grey hair and an underlying darkly pigmented lesion on his right occipital area. Clinical appearance revealed poliosis overlying an asymmetrical plaque with variable degrees of brown pigmentation and white discolouration. Owing to the suspicious nature of the lesion, excision with a 2 mm margin was performed. Histology revealed an invasive melanoma with extensive regression and prominent involvement of multiple hair follicles. Scalp melanoma with associated poliosis is extremely rare, and has only been reported once in the literature to date. There have been two reports in the opthalmology literature regarding eyelash poliosis associated with orbital melanoma. The pathogenesis of poliosis still remains unclear. This is the second reported case of poliosis circmscripta unmasking a scalp melanoma, and highlights the importance of being vigilant when examining patients with poliosis of the scalp.

Social partnering significantly reduced rapid eye movement sleep fragmentation in fear-conditioned, stress-sensitive Wistar-Kyoto rats.

Negative emotionality affects sleep-wake behavior in humans and rodents, and the Wistar-Kyoto (WKY) rat strain is known for its stress-sensitive phenotype. Analyzing rapid eye movement sleep (REMS) microarchitecture by separating REMS into single (siREMS; inter-REM episode interval>3 min) and sequential (seqREMS; interval≤3 min) episodes, we previously reported that cued fear conditioning (CFC) increased REMS fragmentation in WKY compared to Wistar rats by increasing the number of seqREMS episodes. Since social support affects fear responsiveness in humans, we hypothesized that social interaction with a naive partner would affect the sleep-wake response to CFC in WKY rats. Thus, male WKY rats were assigned to either the social support or the social isolation group. Animals were fear-conditioned to 10 tones (800 Hz, 90 dB, 5 s), each co-terminating with a mild foot shock (1.0 mA, 0.5 s), at 30-s intervals. All subjects underwent a tone-only test both 24 h (Day 1) and again two weeks (Day 14) later. Social partnering was achieved by providing the fear-conditioned rat with 30 min of interaction with its naive partner immediately after CFC and during the tone presentations on Day 1 and Day 14. The results indicate that while CFC increased freezing behavior in socially isolated WKY rats, it increased grooming behavior in socially partnered rats. Socially partnered rats had increased sleep efficiency during the light phase and spent less time in NREMS during the dark phase. The number of siREMS episodes increased during both the light and dark phases in partnered rats, and the number of seqREMS episodes increased in socially isolated rats. Our findings suggest that social partnering may protect WKY rats from the REMS fragmentation that is observed following CFC in isolation.

Gallbladder sarcoma: a clinicopathological study of seven cases from the UK and Austria with emphasis on morphological subtypes.

BACKGROUND: Primary sarcoma of the gallbladder (PGBS) is rare, with only 40 cases reported in the literature. Most of these have been diagnosed as leiomyosarcoma. We aimed to evaluate the histological features of a case series of this rare tumor and correlate these with clinical features. DESIGN: Cases recorded as "gallbladder sarcoma" from different institutes were reviewed and the clinicopathological features of these cases were recorded. Only primary gallbladder wall mesenchymal tumors were included. Epithelial tumors, mixed tumors (carcinosarcoma or sarcomatoid carcinoma), and tumors extending into the gallbladder from the abdomen or sarcoma with other known primaries were specifically excluded. RESULT: PGBS occurred in one male and six females with a median age of 70 (range 64-82) years. Patients presented with acute or chronic cholecystitis, abdominal pain, weight loss, and pruritus. They were generally found to have elevated alkaline phosphatase and bilirubin, and leukocytosis. Tumors ranged from 1.1 to 4 cm with a median size of 3 cm. Most PGBS arose in the body but one arose in the fundus. All tumors were associated with ulcerated mucosa. Based on morphological and immunohistochemical features of the PGBS, there were three myxofibrosarcomas (malignant fibrous histiocytoma, MFH, storiform pleomorphic), one leiomyosarcoma (LMS), one angiosarcoma (AS), and two liposarcomas (LS). All patients received cholecystectomy and three received adjuvant chemotherapy. Follow-up revealed that six patients died of the disease 6 weeks to 2 years after diagnosis and one died of unrelated causes. CONCLUSION: PGBS are rare and mainly occur in the gallbladder body in middle-aged females. They generally present with acute cholecystitis and have a very poor prognosis. A variety of sarcoma types are found with MFH being the predominant variant.

Superficial acral fibromyxoma: a clinicopathological study of new 41 cases from the U.K.: should myxoma (NOS) and fibroma (NOS) continue as part of 21st-century reporting?

BACKGROUND: Superficial acral fibromyxoma (SAF) remains poorly recognized by general pathologists and dermatopathologists, partly attributable to its relatively uncommon occurrence and recent documentation. OBJECTIVES: To examine a series of SAF and document the U.K. experience with this new entity. METHODS: We reviewed 771 tumours reported between 1970 and 2006 in seven different U.K. hospitals and coded as myxoma, not otherwise specified (NOS), fibroma (NOS) or dermatofibroma (NOS) presenting at acral sites. Forty-one cases of SAF were studied. RESULTS: The patients comprised 27 men and 14 women, age range 19-91 years (mean 50, median 47), presenting with a solitary mass or nodule with a mean size of 1.92 cm. The common clinical sites were the toes (n=29) and fingers (n=11) as well as the palm (n=1), with more than 75% of cases close to or involving the nail bed. All cases presented with a painless mass except for four cases where pain was the presenting complaint. A history of trauma was reported in only two cases. Histologically, all cases presented as proliferation of spindle-shaped and/or stellate cells with a storiform and fascicular pattern embedded in a fibromyxoid/collagenous stroma with conspicuous mast cells. Multinucleated cells were observed (n=22), increased number of blood vessels in the stroma and extravasation of red blood cells (n=4). The characteristic immunophenotype was CD34+, CD99+/-, epithelial membrane antigen+ focally/-, S100-, desmin-, smooth muscle actin-, HMB45- and cytokeratin-. CONCLUSIONS: We describe a large series of 41 cases of SAF showing that it is a distinct entity with typical clinical, histological and immunohistochemical features. Follow-up was available only in 12 patients, precluding a firm comment on recurrence. However, complete excision and follow-up review is recommended.

Photoilluminated riboflavin/riboflavin-Cu(II) inactivates trypsin: Cu(II) tilts the balance.

Riboflavin (RF) upon irradiation with fluorescent light generates reactive oxygen species like superoxide anion, singlet and triplet oxygen, flavin radicals and substantial amounts of hydrogen peroxide (H2O2). H2O2 can freely penetrate cell membrane and react with a transition metal ion like Cu(ll), generating hydroxyl radical via the modified metal-catalyzed Haber-Weiss reaction. Earlier, it was reported that trypsin-chymotrypsin mixture served as an indirect antioxidant and decreased free radical generation. Thus, in the present study, we used photoilluminated RF as a source of ROS to investigate the effect of free radicals on the activity of trypsin. We also compared the damaging effect of photoilluminated RF and RF-Cu(ll) system using trypsin as a target molecule. RF caused fragmentation of trypsin and the effect was further enhanced, when Cu(II) was added to the reaction. Results obtained with various ROS scavengers suggested that superoxide radical, singlet and triplet oxygen were predominantly responsible for trypsin damage caused by photoilluminated RF. On the other hand, when Cu(ll) was added to the reaction, hydroxyl radical was mainly responsible for trypsin damage. A mechanism of generation of various ROS in the reaction is also proposed. Trypsin did not show any antioxidant effect with RF alone or with RF-Cu(II) combination.

Epidemiology and outcome of bacterial meningitis in Canadian children: 1998-1999.

BACKGROUND: The introduction of Hemophilus influenzae type b (Hib) conjugate vaccine as part of the routine childhood vaccination schedule in Canada has resulted in a dramatic reduction in the cases of Hib meningitis. We describe the epidemiology and outcome of bacterial meningitis in Canadian children six years after the introduction of Hib conjugate vaccine and prior to the introduction of the conjugate Streptococcus pneumoniae vaccine. METHODS: A retrospective chart review from January 1998 to December 1999 of children with meningitis identified at eight Canadian tertiary care children's hospitals belonging to the PICNIC network. RESULTS: Bacterial meningitis was documented in 104 (11%) of 970 children presenting with meningitis. The most common isolated organisms were: Streptococcus pneumoniae (54%), group B streptococci (13%), and Neisseria meningitidis (11%). The mean age was 2.2 +/- 3.5 yr. Forty seven percent of the children required admission to Intensive Care Unit (ICU), and 19% required artificial ventilation. Sequelae were documented among 32 children (31%) prior to discharge and there were 6 (5.6%) deaths attributable to meningitis and sepsis. CONCLUSIONS: Bacterial meningitis is an important cause of morbidity in Canadian children with S. pneumoniae replacing H. influenzae as the leading potentially vaccine preventable cause. Despite proper initiation of antimicrobial therapy, meningitis results in great morbidity and mortality in children in Canada.

Percutaneous diffusion of cefalexin, sulfamethoxazole and diphenhydramine from ointments.

The effects of ointment base, drug concentration, and the presence of surfactant on the diffusion of cefalexin, sulfamethoxazole and diphenhydramine through excised mouse skin were studied. The total amount of diffused drug per ml against time and against the square root of time as plotted for the evaluation of results. As was expected from theory, a linear relationship was obtained for each drug when the square root of time was employed. The effect of the vehicle on the release of cefalexin was in the following decreasing order: o/w emulsion greater than water-soluble greater than hydrophilic greater than oleaginous greater than w/o emulsion base. That on the release of sulfamethoxazole was in the order: water-soluble greater than o/w emulsion greater than w/o emulsion = oleaginous = hydrophilic. The order in case of diphenhydramine was as follows: o/w emulsion greater than water-soluble greater than hydrophilic greater than oleaginous = w/o emulsion. The increase in drug concentration or the addition of a surfactant has caused an increase in the diffusion rate of each of the drugs.