Biomedical subjects
Publications and source records attributed to S Baer.
Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory fibrosing condition of unknown aetiology that involves the nose or larynx producing mucosal thickening and severe obstructive symptoms. We report the first case affecting a male. He presented with nasal obstruction requiring septoplasty. The clinical and histopathological features of the condition are discussed and a comparison is made with the seven previous reported cases.
BACKGROUND: Incidence rates of cutaneous malignant melanoma (CMM) have been increasing for decades among Caucasian populations worldwide. Multiple factors identify persons at increased risk of CMM, including those with a family history of melanoma and those with atypical moles. Approximately 6-12% of melanomas are familial and approximately 12% of patients with familial melanoma have multiple primary melanomas. OBJECTIVE: To report a case of a patient with atypical moles and with 17 multiple primary melanomas. To review the literature on multiple primary melanomas as well as to review the genetics and treatment of melanoma. CONCLUSION: Patients with numerous atypical moles and a family or personal history of melanoma are at greatest risk for developing CMM. Patients from this population tend to develop CMM approximately 10 years earlier than the general population and have an increased risk for developing multiple primary melanomas. Since genetic tests capable of detecting individuals with an inherited susceptibility to CMM are not available, it is important to identify those patients with an increased risk and monitor them closely with regular total-body examinations.
The anatomy of the inframammary fold has been a subject of controversy. This report describes the anatomic location and the histologic structure of the inframammary fold on the basis of caderveric dissections and microscopic examination. Ten breast cadaver dissections were performed on female cadavers (ages 35 to 72). Twenty specimens after en bloc resections of the inframammary fold and subcutaneous tissue, including the pectoralis muscle, were harvested. Specimens were examined for gross collagen stricture by using India ink to highlight the collagenous aspects of the subcutaneous soft-tissue networks. The inframammary fold skin and dermis from the contralateral breast and control samples of skin and dermis from the upper chest and the abdomen were collected for microscopic studies. These samples were stained with Sirius red and examined microscopically by polarized light. On histologic examination, regular arrays of collagen were found running parallel with the inframammary fold, and the control sections showed random patterns of collagen deposition. On gross examination, a condensation of the superficial fascial system was observed. This formed a zone of adherence between the skin and the underlying pectoralis fascia. The conclusion of this study is that the inframammary fold is an intrinsic dermal structure consisting of regular arrays of collagen held in place by a zone of adherence that is a specialized area of the superficial fascial system. The clinical significance of this study is that the intradermal structure of the inframammary fold should be preserved in any breast procedure for natural aesthetic results.
Desmoplastic malignant melanoma is an uncommon neoplasm that presents both as a clinical and diagnostic challenge. Prognosis is frequently adversely affected by misdiagnosis and delayed diagnosis of this tumor, which is often amelanotic. We report a case of an amelanotic desmoplastic malignant melanoma that presented as an erythematous nodular tumor.
BACKGROUND: Controversy exists over the rate of malignant transformation of actinic keratoses (AKs) and, therefore, which treatment is indicated. Furthermore, it is not known to what degree each of the separate clinical subtypes of AKs become malignant. OBJECTIVE: Our purpose was to examine clinically diagnosed hyperkeratotic AKs and classify them histologically. METHODS: Fifty papular hyperkeratotic AKs on the dorsum of the hand, wrist, and arm, less than 1 cm in diameter, were identified in 43 patients. Histologic evaluation was conducted in a blinded fashion by two observers. RESULTS: Histologic examination showed 18 lesions (36%) to be invasive squamous cell carcinoma, whereas another seven (14%) were squamous cell carcinoma in situ. Proliferative AKs were the next most common lesion identified (26%), followed by hypertrophic (10%) and lichenoid (4%) AKs. Basal cell carcinomas (4%) and other benign lesions (6%) comprised the rest of the biopsy specimens. CONCLUSION: It is possible to predict clinically, with greater certainty than previously realized, which AKs have a greater tendency toward malignant change. Clinical hyperkeratotic AKs less than 1 cm in diameter on the dorsum of the hand, wrist, or forearms of white patients have a malignancy rate of 50%. Lesions with this clinical description should be removed by shave biopsy, then by 35% trichloroacetic acid, then liquid nitrogen to a width and depth of 3 mm.
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During a 27-year period 295 patients in Copenhagen County were treated for acute epiglottitis. One hundred and eight-two were adults and 113 were children. Most children were treated by nasotracheal intubation while only a few adults required nasotracheal intubation in order to secure the airway. The incidence of acute epiglottitis in children less than five years old was calculated to be 8.7/100,000 with minor annual variation. Since vaccination against Haemophilus influenzae type b has been implemented in Denmark from May 1993, this figure will probably be markedly reduced, and the disease even may be even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b. It is emphasized that this reduced incidence will make it even more important that each department engaged in the treatment of suspected acute epiglottitis have a departmental protocol for management of the condition, so that the future rarity of acute epiglottitis does not cause the mortality rate to rise.
Two different approaches, i.e. the anterior approach and the combined approach, for en bloc removal of the ethmoidal and ostiomeatal complex are described. In both techniques the contours of the face are completely maintained. Preliminary studies of prevalence of nasal polyps found by using these methods are described.
Ossification of the tympanic membrane after myringoplasty is recorded for the first time. Myringoplasty was performed for closure of a perforation which followed the surgical treatment of otitis media with effusion and had included the insertion of a long-term T-tube.
A deterioration in pulmonary function is a common problem in patients with cystic fibrosis. One strategy which might help to arrest this process is the administration of aminoglycosides by nebulizer in dosages which greatly exceed those which are normally given parenterally. Ten patients (4-19 years of age) with cystic fibrosis underwent evoked response audiometry at regular intervals following a 400 mg dose of nebulized tobramycin; the concentrations of tobramycin in samples of blood taken at the same time intervals were also determined. No significant abnormalities in the audiometric investigations were detected. The relationship between shifts in vestibulocochlear potentials and long-term ototoxic sequelae in patients receiving aminoglycosides via a nebulizer requires further evaluation.
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During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital. Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children. The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis. The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.
A 69-year-old female was admitted because of a febrile state, somnolence, nausea and diarrhea. Addison's disease known to have developed several years earlier after adrenal tuberculosis suggested Addisonian crisis triggered by an acute infection. Therapy with steroids and substitution of electrolytes and fluid led to rapid improvement. Streptococcus bovis was identified as causative agent. The known association of this germ with cancer of the colon led to further investigation which revealed cancer of the sigmoid and incidental cancer of a salpinx. After surgical removal of both cancers, the patient has remained free of complaints under substitution of steroids.
The condition known as ankylosing vertebral hyperostosis or Forestier's disease is described. Eight cases are reviewed where the radiological findings warranted this diagnosis. Their presenting symptoms are summarized as are their responses to treatment. The relevance of this diagnosis is discussed with emphasis being placed on the importance of thorough investigation of these patients. In those for whom no other cause has been found for their symptoms, the various therapeutic options are outlined with the possible complications.
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