Idiopathic eruptive macular pigmentation with papillomatosis (IEMPP): A controversial entity

A 19-year-old man with a 6-month history of progressive development of hyperpigmented, velvety plaques on the face and body. A diagnosis of idiopathic eruptive macular pigmentation with papillomatosis (IEMPP) was determined. This entity is discussed.

Danazol-induced Stevens-Johnson syndrome in a patient with systemic lupus erythematosus

A patient with Stevens-Johnson syndrome related to danazol is presented.

Psoriasiform dermatitis in a case of newly diagnosed locally advanced pyriform sinus tumour: Bazex syndrome revisited

Acrokeratosis paraneoplastica of Bazex is a rare but important paraneoplastic dermatosis, usually manifesting as psoriasiform rashes over the acral sites. It often precedes diagnosis of the associated malignancy, usually that of upper aerodigestive tract squamous cell carcinoma. We present the case of a patient with a newly diagnosed pyriform sinus tumour and associated acrokeratosis paraneoplastica. To the best of our knowledge, this is the first reported case in the local literature.

A cured patient who came back for consultation: neuropathic scrotal pruritus relieved after ipsilateral inguinal hernia repair

When no demonstrable cause is uncovered after excluding inflammatory dermatosis, infectious disease or a manifestation of anorectal disease, anogenital pruritus is often described as 'idiopathic'. Lumbosacral radiculopathy was described by Cohen et al. as one of the possible causes of 'idiopathic' anogenital pruritus. We report a case of a patient with chronic pruritus of the right scrotum that was relieved immediately post-ipsilateral inguinal hernia repair. This is, to the best of our knowledge, the first case of neuropathic scrotal pruritus secondary to direct nerve compression by an inguinal hernia. We propose that a proper examination for the presence of inguinal hernia be performed in the work-up for scrotal pruritus.

A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization

OBJECTIVE

High anterior resection (HAR) for colorectal cancer is traditionally performed with routine mobilization of the splenic flexure. This is a retrospective review of mortality and morbidity following HAR in which the splenic flexure has been preserved.

METHOD

From a prospective database, all patients who had undergone elective HAR for colorectal cancer between 1999 and 2005 were identified. Morbidity, mortality, pathology and survival data for patients having HAR with and without splenic flexure mobilization were analysed.

RESULTS

A total of 707 patients were identified. Five hundred and thirty-one had HAR with preservation of the splenic flexure. In these patients outcome was: anastomotic leak (0.4%), wound infection (3.6%), anastomotic stricture (0.4%) and 30-day mortality (0.9%). No statistical significant difference was found for postoperative morbidity (P = 0.1926), 30-day mortality (P =0.3285), lymph node harvest (P = 0.2127) or survival (P = 0.1457) compared with patients in whom the splenic flexure was mobilized. Longitudinal resection margins were greater following HAR with splenic flexure mobilization (P < 0.0001).

CONCLUSION

No morbidity, oncological or survival disadvantage in performing splenic flexure preserving HAR was found.

Imaging of painful solitary lesions of the sacrum

In patients with sacral pain, the painful symptoms may be caused by a variety of bony and soft tissue lesions. Benign lesions include giant cell tumour, neurogenic tumour, insufficiency fracture, infection and giant bone island. Malignant lesions include primary bone tumours, Ewing sarcoma, plasmacytoma, lymphoma and chordoma. Soft tissue tumours adjacent to or involving the sacrum may cause painful symptoms. A multimodality approach to imaging is required for full assessment of these lesions. This pictorial essay describes a range of common solitary sacral lesions that may cause pain, with emphasis on imaging features.

Magnetic resonance imaging appearances of fibrous dysplasia

Fibrous dysplasia is a developmental disorder in which normal bone marrow is replaced by fibro-osseous tissue. The radiographic, CT and scintigraphic appearances of this condition are well known. The MRI appearances of fibrous dysplasia have not been widely published. The lesions are largely isointense with areas of hypointensity on T(1) weighted images and appear heterogeneously hyperintense on T(2) weighted images. The enhancement pattern is patchy central, rim, homogeneous, or a combination. The MRI features reflect the variable tissue components of this entity. This pictorial review aims at highlighting the MRI appearances, with pathological correlation.

Radiologists' detection of mammographic abnormalities with and without a computer-aided detection system

The aim of this study was to to evaluate the role of a computer-aided program (CAD) in assisting detection of mammographic lesions by radiologists not specifically trained in mammography and its potential utility in breast screening. Mammograms were evaluated by radiologists not specifically trained in mammography first without, and then with, the CAD. Finally, the mammograms were evaluated by experienced mammographers who formed the reference standard. Two hundred and ninety four breasts were studied. In 257 breasts (87.4%), the CAD system did not help with the detection of abnormalities. It assisted radiologists in detecting abnormalities in 21 breasts (7.1%) with potential for detecting abnormalities in a further 13 breasts (4.4%). Only in three cases (1%) did it cause confusion in interpretation. There is overall increased sensitivity in detecting mammographic abnormalities with the aid of the CAD system from 74.4 to 87.2%, which is statistically significant. However, it failed to detect suspicious abnormalities in 71 breasts (24.1%). The CAD system improved detection of suspicious mammographic abnormalities by radiologists who are not specifically trained in mammography. However, there is also a substantial failure to detect suspicious mammographic features that cautions against over-reliance on the system, emphasizing its role as a second reader at best.

Clinics in diagnostic imaging (77). Pes anserine bursitis

Many cystic lesions occur around the knee and may produce overlapping clinical features, rendering the clinical diagnosis difficult. A 50-year-old woman presented with a soft tissue swelling on the medial aspect of her right knee. The diagnosis of pes anserine bursitis was made, based on typical MR imaging features. Cystic masses occurring in and around the knee, such as bursae and recesses, meniscal and ganglion cysts, and benign and malignant soft tissue masses that may mimic cysts, are classified and described. The role of MR imaging in making an accurate diagnosis and distinguishing among the various masses is discussed.

Direct somatic embryogenesis, plant regeneration and in vitro flowering in rapid-cycling Brassica napus

 A simple method to induce somatic embryogenesis from seeds of rapid-cycling Brassica napus is described. Seedlings cultured on Murashige and Skoog (MS) basal medium produced somatic embryos directly on hypocotyls and cotyledons after 2 to 3 subcultures onto the same medium. A low pH of the medium (3.5-5) was more conducive to somatic embryogenesis than a higher pH (6 and 7). Embryogenic potential of the seeds was inversely correlated to seed age: about 41-68% of immature seeds between the ages of 14 and 28 days after pollination (DAP) formed somatic embryos compared to 0-11% of the seeds obtained 29-37 DAP. About 54% of the somatic embryos produced secondary embryos after subculturing onto the same medium. The embryogenic potential of the cultures has been maintained on MS basal medium for 2 years (12 generations) without diminution. Up to 75% of the secondary embryos developed into plantlets on MS medium enriched with 10^-6  M zeatin, and 40% of these produced flowers when transferred to an optimised flower-induction medium. Viable seeds were produced in self-pollinated in vitro flowers.

When to worry about spider bites. Inaccurate diagnosis can have serious, even fatal, consequences

Almost all species of spiders are capable of biting people, but the bites of only a few are medically significant. Physicians need to be able to recognize the clinical signs and symptoms of common venomous spider bites and administer appropriate therapy. This may be difficult, since the offending spider is rarely seen or recovered for identification. Knowledge of life cycles, habits, and toxicity of venomous spiders enables physicians to provide more comprehensive medical care of bite victims. It is hoped that study of immunologic mechanisms and inflammation mediators will lead to the development of new treatments.