LeGrand N. Denslow: Pioneer in dermatology or charlatan?

LeGrand N. Denslow (1852-1918) was a pioneer of American dermatology and one of its most controversial figures. His professional career revolved around the cities of New York; St. Paul; Minnesota; and London, England. In 1885, he became professor of skin diseases and genitourinary surgery, and secretary of the St. Paul Medical College, thus making him one of the earliest dermatologists to practice in the state of Minnesota. In 1908, Denslow created a sensation in the news media when he announced, in a paper read before the New York Academy of Medicine, that he had cured patients suffering from tabes dorsalis by treating various abnormalities that he had found in their urethras. Although some American physicians hailed Denslow's "cure" as a major advance in the treatment of tabetic patients, other physicians denounced his treatments as being worthless or, at best, providing minimal and transient symptomatic benefits. This contribution presents the highlights of Denslow's personal life and professional career. It also describes his urologic treatment of tabes dorsalis and the controversy that surrounded it.

Blemished noses in the art of three masters: Ghirlandaio, Rembrandt, and Warhol.

Blemished noses are portrayed in the paintings of such noted artists as Ghirlandaio, Rembrandt, and Andy Warhol. Sometimes, the deformity results from a skin disorder such as rhinophyma as in Ghirlandaio's An Old Man and his Grandson or a saddle nose deformity from congenital syphilis as in Rembrandt's Portrait of Gerard de Lairesse. Andy Warhol's Before and After portrays a large nose before and after cosmetic surgery. This contribution explores some of the lessons that can be learned, both artistically and medically, from these famous works of art.

Syphilis: A great imitator.

Despite advances in the control, diagnosis, and treatment of syphilis, its recognition is ill- understood or often not considered by dermatologists and other physicians who either have little specialized training in the minutiae of sexually transmitted infections (STIs) or whose dermatologic practice is only occasionally consulted by individuals from communities where STIs are prevalent. Our aim is to highlight contemporary ideas and findings on syphilis so that not only is an accurate diagnosis of syphilis made and recognized treatment given, but also necessary measures, such as counseling to exclude other STIs and to prevent reinfection, partner notification, and public health epidemiology as for any other infectious disease, are not forgotten. For syphilis, like human immunodeficiency virus (HIV) infection, not only is the biomedical aspect important, but also are the social and psychologic components.

Changing patterns and progress in venereology.

This paper provides a summary of the philosophy of modern concepts on venereology, the control and treatment of sexually transmitted infections (STIs). There is a basis in professional education, based on evidence based medicine. From that follows a much wider dissemination to the public on the personal and community aspects of STIs. The World Wide Web has had profound effects on rapid developments in this field. STIs are more frequent in some groups in the general population. Epidemiological trends in STIs from the United States and Europe are described. Interventions to prevent the spread of STIs not only by changing personal preventive behavior but through research based on applied medical science, such as developments in chemotherapy and vaccines, already efficacious to prevent hepatitis A and B and some genital human papilloma virus infections, should be pursued. Venereology, as a major component of dermatovenereology, not only encompasses all of pathology, internal medicine, and therapeutics, but also, most importantly, sexual behavior and its consequences as part of humanity. It also has a major role in community medicine and public health, where the world of medicine meets politics and the media. Sexually transmitted infections have always affected human beings. If STIs are not prevented, not only are there the immediate consequences requiring medical intervention, but also long term results of chronic morbidity, such as infertility in women and congenital syphilis, and in some instances, such as syphilis, viral hepatitis, genital human papilloma virus infection and its neoplastic sequaelae, and HIV/AIDS, an early death.

Sexually transmitted penile amoebiasis in Iran: a case series.

OBJECTIVES: Four cases of penile amoebiasis (PA) presenting as genital ulceration seen among men who practiced unprotected insertive anal intercourse in Tehran are described. METHODS: PA was confirmed by observation of motile trophozoites of Entamoeba histolytica from lesions examined by wet mount microscopy. RESULTS: Ulcers were solitary, painful, irregular, discharging and increasing in size. Three heterosexuals and one bisexual had practised insertive anal intercourse in the 2 weeks before diagnosis. Bilateral inguinal lymphadenitis occurred in one case. Direct examination of lesions was positive for the presence of amoebic trophozoites. Complete resolution occurred after treatment with oral metronidazole 800 mg three times daily for 7-10 days. CONCLUSIONS: Clinicians need to be aware of cutaneous amoebiasis in sexually active men who practice unprotected insertive anal sex where intestinal amoebiasis is endemic. Wet mount microscopy is a rapid and useful diagnostic test.

The role of condom use in sexually transmitted disease prevention: facts and controversies.

The role of the condom, as a protective prophylactic device, is one of the most important tools, if used appropriately, against the spread of sexually transmitted diseases and HIV/AIDS. It should be used by every man, worldwide, who is having casual penetrative sex. The word condom is derived from the Latin condere. This contribution describes its history from the first descriptions in English in the 18th century through rapid improvements in manufacture after the commercial cultivation of rubber. The age-old phony arguments against its use by men are noted. Recent studies of its acceptability to women are described, as well as the introduction of the female condom.

Endoscopic ultrasound-guided fine needle aspiration biopsy of the intrapancreatic accessory spleen: a report of 2 cases.

BACKGROUND: Intrapancreatic accessory spleen (IPAS) can pose a challenge in the diagnostic workup by mimicking a pancreatic neoplasm. Reports of IPAS identified by endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) are scant in the literature, and increased recognition of this benign entity may reduce misdiagnosis and unnecessary surgical intervention. Here we report 2 cases of IPAS diagnosed by EUS-guided FNA biopsy. CASES: Each patient underwent computed tomographic evaluation for abdominal pain; it revealed a mass or thickening within the tail of the pancreas. Both patients were referred for EUS-guided FNA to further characterize their pancreatic lesions. In both cases, the cytomorphologic appearance of smears and cell blocks demonstrated aggregates of benign splenic tissue characteristic of both white and red pulp. Rare fragments of pancreatic acinar tissue were also identified. One cell block demonstrated benign splenic and pancreatic parenchyma immediately adjacent to one another without an apparent intervening capsule. CONCLUSION: IPAS can be diagnosed by FNA biopsy. Definitive tissue diagnosis in these 2 cases avoided not only unnecessary surgical intervention but also the need for consideration of a "watch and wait" strategy with further imaging and possible additional biopsy attempts.

Extranodal follicular dendritic cell sarcoma.

Extranodal follicular dendritic cell sarcoma is a rare tumor of follicular dendritic cells that can occur in a wide variety of sites. Although fairly well characterized histologically, with a distinct immunophenotype, it remains under-recognized, with as many as one third of cases initially misdiagnosed. This is often due to a failure to consider the entity. Patients with this tumor may have a worse prognosis than originally described. Prompted by a recent case at our institution, we briefly review the clinical features, etiology, histologic, and cytologic appearance of the tumor, as well as the ancillary studies useful in resolving diagnostic issues, primarily in an attempt to increase recognition of this rare neoplasm.

Use of the ThinPrep method in bile duct brushings: analysis of morphologic parameters associated with malignancy and determination of interobserver reliability.

Recent work suggests the ThinPrep method can improve diagnostic sensitivity and accuracy in bile duct brushings. However, the proportion of atypical and suspicious diagnoses remains high. The aim of this study was to identify the most useful morphologic features in ThinPrep bile duct cytology and evaluate interobserver reliability. We evaluated 100 bile duct brushings prepared by ThinPrep, all with either histology or long term clinical follow-up (55 malignant, 45 benign). Morphologic features were evaluated by four experienced cytopathologists blind to clinical information and follow-up diagnoses. These features included cellularity, blood or diathesis, mitoses, inflammation, three-dimensional groups, discohesive atypical cells, macronucleoli, well-defined cytoplasmic borders, and nuclear features of malignancy (nuclear membrance irregularity, chromatin clumping). The data were analyzed by intraclass correlation (ICC) and stepwise multiple logistic regression. Reviewers showed unanimous agreement in 29% of cases, one degree of disagreement in 58% of cases, and full disagreement in 13% of cases. Of benign cases, 38% were thought to be diagnostic of malignancy by at least one of the four reviewers. Sensitivity for the morphologic parameters varied from 18 to 67%; the highest sensitivity was for discohesive atypical cells, well-defined cytoplasmic borders, nuclear features of malignancy, and cellularity (67, 62, 51 and 46%, respectively). Specificity of parameters varied from 16 to 100%; the highest specificity was for mitoses, three-dimensional groups, nuclear features of malignancy, and macronucleoli (100, 98, 93, and 93%, respectively). Interobserver reliability (ICC) was very good for specimen cellularity (0.72) and nuclear features of malignancy (0.60). In logistic regression analysis, only nuclear features of malignancy and increasing patient age separated benign from malignant. On ThinPrep bile duct brushings, nuclear features of malignancy are most useful in distinguishing benign from malignant, and interobserver reliability for this parameter is very good. Discohesive atypical cells show moderate sensitivity and specificity, while three dimensional clusters and macronucleoli are specific but not sensitive for malignancy, and are not significant in multivariate logistic regression models. The relatively high proportion of benign cases thought to be diagnostic of malignancy by at least one reviewer argues for a consensus approach to this diagnosis.

Genital human papilloma virus infection: advances in prevention for the long-term good of all.

The wonderful thing about being a physician, even an ordinary dogsbody of one, is that we live in a world in which almost every week scientists, researchers, and clinicians taking part in well-conducted trials usually backed by private capital and the pharmaceutical industry manage to perfect advances that will ultimately benefit not just our patients but the families and society in which our patients live. That is, of course, if we bother, even in the usual way of busy practitioners, skimming through medical journals or glancing at progress from Web sources. Most of us do not do so as well as we would like, but merely by reading this article, education somehow touches us. (Damn, there goes an interruption; we have just been jolted out of our thoughts!).

A global look at sexually transmitted infections.

This paper will give a resume of many of the important factors, which form the immense problems in sexually transmitted infections in the world in 2007. STI is the term used to include sexually transmitted diseases and HIV/AIDS. It aims to enlighten both the specialist dermato-venereologist as well as all interested readers.

Sexually transmitted infections-microbial infections, 2007 update.

Human sexual behavior required for the continuation of humankind nevertheless has its downsides, among them sexually transmitted infections (STIs). The treatment of microbial STIs is challenging but not in itself essentially very difficult. Controlling STIs, on the other hand, is like the task of Sisyphus, a king in Greek mythology who was forced forever to roll a block of stone to the top of a steep hill, only to see it roll back to the valley, where he started the toilsome task again. This is how many a venereologist must view the day's practice, supervising patients with STIs. Yes, there are newcomers, many of them very young, but there are many others, the recidivists, whom the physician and health care staff know only too well. "You don't mind seeing me again, doc. You (collectively) were so good to me last time"--as though catching a chlamydial infection 3 or 4 times, gonorrhea 20 or 30 times, and syphilis on occasion were badges of virility or part of life's natural progression. This is the pattern of STIs in 2007.