Masson's disease in hand surgery: a clinicopathologic study of four cases.

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumour, is an uncommon benign vascular lesion characterized by small multiple, endothelial-lined, papillary structures with hyaline stalks. It appears to be a reactive condition involving excessive proliferation of endothelial cells in normal blood vessels or in vascular malformations, perhaps in response to blood vessel injury or thrombosis. The lesions are small, superficial, reddish-blue nodules, usually in the head, neck or hand. Distinction from pyogenic granuloma and angiosarcoma usually requires pathological examination. Complete surgical excision is the treatment of choice. Four cases affecting the finger are presented together with histological features.

A case of toxic epidermal necrolysis (ten) with severe chronic ocular complications in a healthy 46-year-old woman.

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a severe drug reaction characterized by extensive destruction of the epidermis and mucosal epithelia. The eyes are typically involved in TEN. The precise pathomechanisms involved remain unknown. We present a case of toxic epidermal necrolysis in a healthy 46-yr-old female patient who had inhaled glycophosphate (herbicide) and was treated with paracetamol, aspirin, and chlorpheniramine. Thirty-five per cent of the skin area was affected by the syndrome, with involvement of conjunctival, gastrointestinal, and respiratory mucous membranes. Topical treatment was performed every day and the patient did not undergo surgery. Complete wound healing was achieved in 47 days. There were acute complications, consisting of infection of the skin areas ( Candida), gastrointestinal bleeding, pleural effusion, and severe ocular mucous membrane damage. The most serious chronic complication was the presence of significant opacity of the corneal epithelium, causing almost complete loss of vision. According to the data in the literature, ocular complications in TEN are frequent and are present in the majority of the patients studied, but are not often severe. Risk factors for the development of ocular complications are not known. Ocular sequelae may appear after the acute period and they can be extremely disabling, even causing almost complete loss of vision. Treatment includes corticosteroids and topical antibiotic therapy in the acute phase and if necessary corneal transplantation in the event of chronic damage to the corneal epithelium.

Induction and secretion of elastinolytic and proteolytic activity in cultures of Paracoccidioides brasiliensis

P. brasiliensis parasitizes various human tissues and proteinases exported by this fungus may allow it to metabolize and invade host tissues. The influence of the culture medium on the production of proteinases by P. brasiliensis isolates was studied and the export of these enzymes was followed as a function of culture time. The fungus was grown in neopeptone, BSA, elastin orcollagen medium. The culture medium was assayed for azocollytic, elastinolytic and caseinolytic activity. Proteolytic activity was also analysed by electrophoresis of the culture medium on gelatin and casein substrate gels. P. brasiliensis expressed relatively high levels of azocoll, elastin and casein degrading activity in all types of medium, except in neopeptone medium. Generally, expression of azocollytic activity peaked during the third week of culture and caseinolytic activity during the fourth week of culture. Azocollytic activity was highest at pH 4.0 and caseinolytic activity at pH 8.0. Elastinolytic activity was also highest at pH 8.0. This activity, as well as the others, may provide the fungus with a source of carbon and nitrogen and may alsobe responsible for the invasion of host tissues, such as pulmonary elastic fiber, by P. brasiliensis.