Sister Mary Joseph's nodule: a case of umbilical cutaneous metastasis with signet ring cell histology.

The metastasis of a visceral malignancy to the umbilicus is known as "Sister Mary Joseph's nodule". It is a rare clinical sign indicating advanced, metastasizing intraabdominal cancer. We report a 50-year-old man who developed metastatic skin cancer in the form of semicircular indurated plaque on top of which was a firm mobile rounded nodule at the umbilical area. Histopathological examination demonstrated diastase-resistant periodic acid-Schiff and mucicarmine positive signet ring cells, suggesting gastric carcinoma. Immunohistochemical staining showed that these cells were positive for cytokeratins and epithelial membrane antigen, suggesting epithelial origin.

Using a 308-nm excimer laser to treat vitiligo in Asians.

BACKGROUND: Current vitiligo therapies require many months of treatment and often result in disappointing outcomes. Treatment with a 308-nm excimer laser has shown promising results in patients with vitiligo. OBJECTIVE: This controlled prospective trial studied the effectiveness of the 308-nm excimer laser for treating vitiligo in Asians. METHODS: Thirty-four patients (14 males and 20 females) with localized vitiligo were enrolled in the study. Vitiligo patches were treated using a 308-nm excimer laser. Lesions were treated twice weekly for 13 weeks. The treatment was started with 50 to 100 mJ/cm2 (according to site) and increased by 50 mJ/cm2 in every session until erythema appeared. Patients were treated for 25 sessions, or until 100% repigmentation, whichever was achieved first. The overall response rate was assessed clinically and by comparison of photographs before and after treatment by two independent investigators. RESULTS: Twenty-nine patients (12 males and 17 females) completed the study. Lesions on the face responded better than elsewhere on the body. The least responsive areas were the hands and feet. The average number of treatment sessions prior to repigmentation was 11. Untreated control patches remained unchanged. In higher skin phototypes the response was more favorable. There was no significant correlation between the age of the patients and their response to treatment. CONCLUSION: The use of the 308-nm excimer laser for the treatment of vitiligo is effective, relatively safe, and more convenient compared to other available modalities of treatment for stable vitiligo with small patches. However, similar to other modalities of treatment, the therapeutic effect is mainly dependent on the location of vitiligo lesions.

Anhidrosis: a clue to an underlying autonomic disorder.

We describe a patient with Ross syndrome who had the classic triad of segmental anhidrosis, tonic pupils and hyporeflexia. Dilute pilocarpine (0.1%) instillation in both eyes revealed parasympathetic denervation hypersensitivity. There was evidence of cardiac dysautonomia in the form of a decrease in heart rate variability with deep breathing and an abnormal Valsalva response. A thermoregulatory sweat test showed the presence of sweating in the right cheek, neck and upper one-third of the left arm and shoulder only. Sympathetic skin responses were absent in the affected segments of the upper limb. Ross syndrome is a degenerative disorder that progressively involves different fibre populations, starting with autonomic fibres and then involving the unmyelinated and myelinated sensory fibres. A careful clinical examination and simple bedside autonomic tests can confirm the diagnosis.