Eccrine angiomatous hamartoma: a report of symmetric and painful lesions of the wrists.

Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous lesion histologically defined as a proliferation of eccrine glands within a closely associated vascular stroma. Typically EAH presents as a solitary flesh-colored, hyperhidrotic, painful papule or plaque appearing at birth or during childhood. Only two previously reported cases have been described involving multiple, symmetrically located lesions. The occurrence of knuckle pads in patients with EAH has not been reported. We present an instance of multiple painful EAH lesions occurring symmetrically on the extensor wrists in a 14-year-old girl with knuckle pads.

Idiopathic plantar hidradenitis: a neutrophilic eccrine hidradenitis occurring primarily in children.

Neutrophilic eccrine hidradenitis (NEH) has been described in a variety of clinical settings but is most often seen in leukemic patients receiving chemotherapy. We have recently encountered 6 healthy individuals, of whom 5 were children, who developed NEH localized to the feet. The patients were from 9 to 21 years of age. The presenting complaint was rapid development of tenderness of the feet with varying degrees of morbidity. At clinical evaluation, tender, erythematous papules and nodules were confined to the feet, primarily the plantar surfaces. The major differential diagnoses were erythema nodosum and vasculitis. Laboratory studies were non-contributory. Histologically, the findings were generally similar to those of NEH with certain exceptions, most notably the absence of syringosquamous metaplasia and the presence, in most cases, of neutrophilic abscesses in eccrine coils. Inflammatory and degenerative changes involved primarily the eccrine duct (coiled and dermal), and tended to spare the secretory apparatus. Stains for microorganisms were negative. There were brief recurrences in some of the patients, but those followed over time have remained well. We suggest the term idiopathic plantar hidradenitis for this condition.

Ventriculocoronary connections in hypoplastic right heart syndrome: autopsy serial section study of six cases.

Myocardial sinusoids communicating with the coronary systems occur in pulmonary atresia with intact ventricular septum. To test the hypothesis that the extent of ventriculocoronary connections correlates with the degree of right ventricular outflow obstruction as evidenced by clinical, angiographic and gross anatomic findings, a serial section study of six human autopsy hearts representing a spectrum of hypoplastic right heart was undertaken. Slides were evaluated for the presence and extent of ventriculocoronary connections, associated developmental abnormalities and secondary changes in the ventricular walls. Whereas extensive blind-ended deep sinusoids were a feature of all five cases with unrelieved obstruction, ventriculocoronary connections were identified in three. Changes that suggested ongoing remodeling provide new evidence for the postnatal temporal evolution of these anomalous communications. The regional distribution of myofiber disarray in hypoplastic right heart supports the concept that vascularization parallels myocardial organization in the developing human heart.

Scintigraphic findings in primary amyloidosis of the heart and stomach.

The effectiveness of scintigraphic studies in the study of patients with primary systemic amyloidosis has not been reported previously. This case report describes a patient with the scintigraphic findings of thickened myocardium and delayed gastric emptying, which correlated well with the presence of amyloid deposits in these organs at autopsy. Additionally, the liver and spleen had normal scintigraphic appearances and were free of amyloid at autopsy. Radionuclide studies appear useful in assessing the anatomic and physiologic abnormalities assessed by amyloid deposition.

Effect of proteolytic enzymes on Pneumocystis carinii in rat lung tissue.

Rat lung homogenates heavily infected with Pneumocystis carinii were digested with trypsin and pronase. Pneumocystis carinii cysts were examined by light and electron microscopy, and by an indirect fluorescent antibody (IFA) technique. Cysts digested with trypsin exhibited swelling of their cell wall but stained brightly by IFA; cysts digested with pronase lost their cell wall and ability to stain by IFA. These effects were related to the concentration of the enzyme and duration of exposure. The data suggest that the antigenic determinants of P. carinii cysts reside in the cell wall.