Granulomatous pigmented purpuric dermatosis.

The granulomatous variant of the pigmented purpuric dermatoses (PPDs) is a rare and infrequently described condition, with a total of 16 cases published to date. We report a case of granulomatous PPD in a 59-year-old white woman who demonstrated involvement of the arms, legs, chest and back with concurrent hyperlipidaemia. Histopathological examination revealed a lymphohistiocytic infiltrate obscuring the dermoepidermal junction, and loose granuloma formation in the superficial dermis, with extravasated erythrocytes. Other conditions within the differential diagnosis such as atypical infection, papular sarcoidosis and generalized granuloma annulare were excluded on clinical and histological grounds. Our patient represents the ninth patient reported to have granulomatous PPD with coexisting hyperlipidaemia, and the fifth patient with granulomatous PPD and a lichenoid infiltrate.

Factors predicting the sentinel node metastases in T1 breast cancer tumor: an analysis of 1416 cases.

AIM: To determine the factors associated with the metastatic involvement of sentinel lymph node (SLN) biopsy in patients with early breast cancer. STUDY DESIGN: This was a retrospective study of patients with T1 invasive breast cancer who underwent SLN biopsy at Claudius Regaud Institute between January 2001 and September 2008. RESULTS: 1416 patients were recruited into this study. SLN metastases were detected in 368 patients (26%). Younger age, tumor size and location, histological type, nuclear grade, and lymphovascular invasion appear to be significant risk factors of SNL involvement. In multivariate analysis, tumor size, tumor location, histological type and lymphovascular invasion are significant factors. When the tumor size is >20 mm, the OR is 6.6 compared to a T1a tumor (3.145-14.175, p<0.001, confidence interval 95%). When the tumor is found in the inner quadrant, the risk of SLN involvement is reduced compared to external locations with an OR of 0.53 (0.409-0.709, p<0.001, confidence interval 95%). Non-ductal/lobular compared to infiltrative ductal cancer have a lower risk of SLN involvement with an OR of 0.423 (0.193-0.927, p<0.03, confidence interval 95%). Lymphovascular invasion increase the risk of positive SLN with an OR of 2.8 (1.9-4.1, p<0.001, confidence interval 95%). CONCLUSION: It appears reasonable to avoid axillary lymph node dissection in older patients with T1a tumors of good histopathological type and in the absence of lymphovascular invasion.

Technique for making flexible impression trays for the microstomic patient.

This impression technique can be used for patients in whom routine use of stock impression trays is hindered by microstomia. Putty wash material can be manipulated with minimal effort and time. Placing the completed preliminary impression in a free-flowing mix of dental stone stabilizes the impression material and facilitates boxing and pouring of the impression. The resultant preliminary casts can then be used for diagnostic purposes and for making rigid sectional trays for final impressions.

Enhanced retention for the distal extension-base removable partial denture using a heat-cured resilient soft liner.

Replacement of the conventional heat-cured acrylic resin with a soft durable liner in the retromylohyoid eminence areas allows the patient to manipulate the distal extension-base mandibular RPD into place without traumatizing the soft tissue. With maximum coverage of the edentulous ridges, the semiflexible flange minimizes food entrapment and improves the retention and stability of the RPD. The procedure can be accomplished during the initial processing of the RPD or when relining the prosthesis. We have also used the technique for overdentures and for improving retention in the maxillary anterior extension-base RPD where anterior clasping was not esthetic or was insufficient.

An alternative to conventional overdenture attachments with Molloplast-B: a technique.

The use of Molloplast-B within the abutments of mandibular overdentures is an easy and inexpensive method for increasing retention and stability of dentures. The use of a retentive area prepared in natural tooth structure increases retentive capabilities for the overdenture patient. Unlike some silicone denture liners, Molloplast-B has shown an inhibitory effect to the growth of Candida albicans. Molloplast-B can be used in the conventional overdenture method or as described for an immediate overdenture. This type of overdenture can be relined easily to adjust for changes in mouth architecture. How well this material will retain its shape and consistency needs to be observed.