Extensive unilateral atrophoderma vermiculatum associated with ipsilateral congenital cataract.

Atrophoderma vermiculatum (AV) is a rare follicular dermatosis presenting with 'wormeaten' or 'honeycomb' atrophy, usually on the cheeks and sometimes extending to the preauricular areas and forehead. It predominantly affects children and follows a slowly progressive course. The treatment of AV is challenging. We describe a rare case of unilateral AV in a young boy. The scarring in AV is characteristically limited to the face, but our patient had lesions extending to the concha auriculae and the neck. He also had an ipsilateral congenital cataract. Such an association has only been reported once before in the literature.

Omenn's syndrome: lessons from a red baby.

Exfoliative dermatitis and erythroderma in infancy are rare. Clinicians need to be alert to the possible diagnosis of Omenn's syndrome (OS), a rare form of combined immunodeficiency in infants presenting with exfoliative dermatitis, erythroderma, recurrent infections, eosinophilia and raised IgE. OS is fatal unless treated by bone-marrow transplantation (BMT). We describe a 3-week-old girl who presented with a widespread scaly erythematous rash and stomatitis, and was initially treated for presumed atopic eczema and primary herpes stomatitis. Aged 3 months, she developed erythroderma, diarrhoea and hepatosplenomegaly associated with eosinophilia, raised serum IgE and low IgG, IgA and IgM levels, abnormal lymphocyte populations and skin histology, consistent with a diagnosis of OS. She remains well 16 months after a human leucocyte antigen-matched bone-marrow transplant from an unrelated donor.

Disseminated cutaneous Mycobacterium chelonae infection with multidrug resistance in a patient with panuveitis.

We report the case of a 43-year-old immunosuppressed woman who presented with cellulitis of the lower limbs and multiple widespread subcutaneous nodules in a sporotrichoid distribution. Microbiological findings from skin biopsy confirmed Mycobacterium chelonae infection.

Subacute cutaneous lupus erythematosus presenting as erythroderma.

Erythrodema secondary to subacute cutaneous lupus erythematosus (SCLE) is rare. We report a 61-year-old man presenting with erythroderma secondary to SCLE. During erythrodermic phase our patient still had few annular and polycyclic lesions characteristic of SCLE. He was successfully treated with topical and oral corticosteriods.

Metals, boron, and selenium in Neosho Madtom habitats in the Neosho River in Kansas, U.S.A.

In 1991 and 1992 we determined the levels of metals, arsenic, boron, and selenium in the Neosho River drainage in southeastern Kansas, the primary habitat for the threatened Neosho madtom (Noturus placidus). We evaluated concentrations in sediments, mussels (Quadrula pustulosa and Q. metanevra), and fish (Percina phoxocephala, Cyprinus carpio, and Ictiobus bubalus) from three sites on the Neosho River and one site on the Cottonwood River. We also evaluated contaminant concentrations in C. carpio composite samples collected by the Kansas Department of Health and Environment (KDHE) at two additional locations on the Neosho River in 1990-92. Sediments were contaminated by lead. Concentrations of selenium, boron, and most metals in mussels were low to normal for biota. Arsenic levels in mussels and fish suggest low-level contamination of biota. Aluminum, barium, manganese and strontium concentrations were much higher in mussels than in fish. Five fish composite samples had cadmium concentrations that indicate chronic deleterious effects on biota. Lead concentrations in six fish samples were elevated. Mercury concentrations in most large fish composites exceeded concentration for protection of animals that might consume them. We believe that reductions in cadmium, lead, and mercury contamination, in particular, would benefit aquatic life in the river.

Juvenile colloid milium associated with ligneous conjunctivitis: report of a case and review of the literature.

Juvenile colloid milium is an extremely rare skin condition with an onset prior to puberty; it can be distinguished histologically from the adult form. We report a case of juvenile colloid milium associated with ligneous conjunctivitis and gingival deposits of an amyloid-like homogenous eosinophilic material. We hypothesize that all three of these are the same pathological process occurring at different sites and review the literature on these associations.

Basal cell carcinomas cause little handicap.

Basal cell carcinoma (BCC) is the most common type of skin cancer and the incidence of BCC is expected to rise, with increased demand on dermatology resources. Little is known of the effect on people's lives of having skin cancer. The aim of this study was to quantify the handicap caused gy basal cell carcinomas before and after therapy. Forty-four patients (22 males, mean age = 65 yrs, range = 35-81 yrs) with 48 BCCs were recruited and 37 patients completed the study. Each patient completed the UK Sickness Impact Profile (UKSIP) and the Dermatology Life Quality Index (DLQI) at the initial visit to the dermatology clinic, 1 week after treatment and 3 months after treatment. Lesions had been present for a mean of 25 months (range = 1-240 months), their mean diameter was 9.6mm (range = 3-35mm) and the sites were head and neck (79%), trunk (17%) and limbs (4%). There was no relationship between the quality of life score and size of lesion. Overall the scores at presentation were very low, rising 1 week after treatment and falling to below the initial scores at 3 months (mean UKSIP 0.4%, 0.7%, 0.13%; mean DLQI 5.3% 8.7%, 1.2%). BCCs cause little handicap. This may explain the delay in seeking medical attention and should be considered in planning public health education about BCCs.

Cutaneous scleroderma in association with carcinoid syndrome.

A case of scleroderma in a woman with carcinoid syndrome is described and the similarities between our case and those in the literature are reviewed. The carcinoid tumours were all of midgut origin and liver metastases were present. All subsequently developed fibrotic heart disease and none had clinical features or autoantibodies suggestive of systemic sclerosis. The association between carcinoid syndrome and particular features of scleroderma is likely to be more than fortuitous.

Cowpox infection causing a generalized eruption in a patient with atopic dermatitis.

We report a patient with a history of atopic dermatitis who developed a generalized eruption due to cowpox infection. The infection was probably acquired from the patient's cat. This is the first report from Britain of cowpox causing Kaposi's varicelliform eruption in a patient with atopic dermatitis.

Mu- and kappa-opiate receptor control of prolactin secretion in rats: ontogeny and interaction with serotonin.

The present study explores developmental changes in mu- and kappa-opiate receptor control of PRL secretion. The ontogeny of mu- and kappa-receptor function was determined by assessing the PRL response to the mu-agonist sufentanil (SUF) and the kappa-agonist U50488 in 5-, 10-, 15-, 20-, and 60-day-old rats. Both mu- and kappa-agonists stimulated PRL secretion at all ages. The selectivity of the mu- and kappa-agonists was confirmed by selective blockade with their respective antagonists (beta-funaltrexamine and nor-binaltorphimine). Serotonin mediation of opiate-induced changes in PRL secretion was explored across ontogeny by testing cyproheptadine (CYPRO) blockade of agonist responses in 5-, 10-, 20-, and 60-day-old rats. CYPRO attenuated the PRL response to the mu-agonist SUF in 20- and 60-day-old rats, but not in the 5- or 10-day-old pups. CYPRO did not block the kappa-agonist U50488 at any age. Similarly, pretreatment with parachlorophenylalaine lowered the PRL response to SUF in 60-day-old rats, but not in 10-day-old rats. These results support previous reports of a serotonin-mediated mu control of PRL secretion that develops by day 20 and a kappa control of PRL secretion that is independent of serotonin at all ages. These findings also suggest that a previously reported serotonin-independent mu-receptor-mediated control of PRL secretion can be stimulated early in ontogeny.

Ontogeny of mu- and kappa-opiate receptor control of the hypothalamo-pituitary-adrenal axis in rats.

The purpose of the present study was to determine the relative ontogeny of mu- and kappa-opiate receptor control of the hypothalamo-pituitary-adrenal (HPA) axis in rats. The ability of the mu-agonist morphine and the kappa-agonist U-50,488 to stimulate the HPA axis was determined by evaluating ACTH and corticosterone (CS) secretion in developing rat pups. Morphine elicited marked rises in both ACTH and CS secretion in 10-day-old rats, and these increases were maximal from 30-60 min after drug administration. Both morphine and U50,488H caused a dose-related rise in CS secretion that was blocked by the synthetic glucocorticoid dexamethasone. The mu-opiate antagonist beta-funaltrexamine blocked the morphine-induced rise in CS secretion, and the kappa-antagonist norbinaltorphimine blocked the action of U50,488H. While a maximal dose of U50,488H (1 mg/kg) elicited a significant rise in CS secretion as early as postnatal day 2, significant effects of a maximal dose of morphine (5 mg/kg) were not observed until day 5. The effects of both drugs were significantly blunted during the stress-hyporesponsive period from days 5-15. The results of this study demonstrate that significant opiate receptor control of HPA function can be demonstrated early in postnatal development, even before the onset of the stress-hyporesponsive period. In addition, these data suggest that kappa-receptor control is functional before mu-receptor control of HPA function.

Familial multiple blue naevi.

Blue naevi are benign melanocytic neoplasms. They are usually solitary blue or blue-black nodules or plaques. Multiple blue naevi have been reported rarely and there is one report of familial solitary blue naevus. However, familial multiple blue naevi have not been reported previously. We report the case of a family with multiple blue naevi occurring in three generations with an autosomal-dominant inheritance pattern.