Bronchogenic cyst is a benign congenital developmental abnormality of the embryonic foregut. The most common extrapulmonary location of these lesions is the mediastinum. Over 50 cases of cutaneous bronchogenic cyst were reported in the English literature. Nevertheless, it is poorly recognized by clinicians and is sometimes confused with branchial cyst. In almost all cases the diagnosis is established by histopathologic examination. We report an unusual clinical presentation of bronchogenic cyst in a 4-year-old girl and review the literature. This lesion is four times more common in males than in females. The most common location is the suprasternal notch, followed by the presternal area, neck, and scapula. The characteristic histologic findings are a ciliated pseudostratified epithelial lining with the presence of smooth muscle cells, goblet cells and, less frequently, cartilage. Our review of the clinical and histologic features of all reported cases further delineates this entity and may facilitate its clinical diagnosis. Bronchogenic cyst should be included in the differential diagnosis of congenital cystic and nodular skin lesions on the upper chest, upper back, and neck.

Biopsy, Needle↗

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Calcium channel blockers intake and psoriasis: a case-control study.

In vitro evidence suggests that intracellular calcium metabolism influences keratinocyte differentiation. However, only a few reports have described exacerbation of psoriasis or psoriasiform eruptions due to intake of calcium channel blockers. We conducted a case-control study to evaluate the association between exposure to calcium channel blockers and psoriasis. Data were obtained through a retrospective assessment of the files of 150 patients hospitalized for psoriasis or psoriasiform eruptions and 150 matched control patients. Exposure to calcium channel blockers was recorded in case and control patients. It was found that 13/150 patients hospitalized for psoriasis consumed calcium channel blockers. Calcium channel blockers were associated with precipitation of new-onset psoriasis (n = 2), as well as with the exacerbation of psoriasis (n = 11). The calcium channel blockers were as follows: nifedipine (n = 10), felodipine (n = 2) and amlodipine (n = 1). The median latent period between the beginning of intake of calcium channel blockers and precipitation or exacerbation of psoriasis was 28 months (range 4-143 months). A stepwise multivariate logistic regression analysis demonstrated that intake of calcium channel blockers was significantly associated with psoriasis, as compared to the control group (p = 0.018). Our study implies a possible role of calcium channel blockers as precipitating or exacerbating factors in patients with psoriasis.

Acute Disease↗

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The sign of Leser-Trélat. A cutaneous marker for internal malignancy.

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Adenocarcinoma↗

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Asymptomatic liver injury due to erythromycin stearate.

A 73-year-old woman with rosacea, who had started treatment with erythromycin stearate 2 g/d, developed asymptomatic liver injury. The drug was discontinued and the laboratory findings of liver damage disappeared within 11 days. This is the first report of erythromycin stearate-induced asymptomatic hepatotoxicity.

Aged↗

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Paracervical block with 2-chloroprocaine.

Thirty healthy term gravidas in active labor received a paracervical block (PCB) with the ester-type local anesthetic, 2-chloroprocaine (2CP). Good to excellent pain relief resulted in all but 1 case. The duration of action was short (mean 38.9 min), requiring repeat blocks in 6/30 cases. Fetal heart rate and uterine contractions were electronically monitored, and fetal acid-base status was periodically checked by fetal scalp pH measurements. PCB-related fetal bradycardia was observed in 3 cases, but in only 1 case was PCB the only cause for the bradycardia. Fetal acidosis was not observed. No instance of neonatal depression or acidosis as expressed by the 1- and 5-minute Apgar scores and cord blood acid-base evaluation was observed. No maternal complications were observed. It is concluded that paracervical block using 2CP is an effective though short-acting method of pain relief which, when properly monitored, is safe for both mother and fetus.

Acid-Base Equilibrium↗

PubMedDate not supplied

Umbilical vessels endothelium and vascular reactivity.

In vitro preparations of isolated umbilical vessels are ideal for the study of vasoactive substances. These vessels display vascular reactivity in response to numerous substances, although the mechanism of action of many of these agents is unknown. The present study was undertaken to study the role of the endothelium in the vasoactivity of these preparations, and to examine their cellular integrity. Umbilical artery and vein were studied using conventional isometric techniques, and using high power light microscopy. We found that umbilical vessel rings had no relaxant response to agents believed to release endothelium-derived relaxant factor (EDRF). Mechanical and chemical treatment to remove endothelium did not significantly alter vascular response to known contractile agonists. Cellular morphology is well maintained in ring preparations. Finally, mechanical rubbing of the intima of these rings is more reliable in endothelium removal, as compared to chemical removal with the detergent saponin.

Acetylcholine↗

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Placental transmission and maternal and neonatal elimination of fluroxene.

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Anesthesia, Inhalation↗

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The response of umbilical vessels, with and without vascular endothelium, to local anesthesia in low PO2 and hypercarbia.

BACKGROUND AND OBJECTIVES: Human umbilical vessels are sensitive to local anesthetic agents as well as to a variety of other exogenous and endogenous substances. Changes in blood gases such as hypoxia and hypercarbia may alter these responses. This study examined the effects of local anesthetic agents under these conditions and how the effects are related to the vascular endothelium. METHODS: Veins and arteries, dissected from umbilical cords of healthy newborns, were cross-sectioned to form rings. The rings were mounted in a muscle chamber containing Krebs-Ringer bicarbonate solution that was gassed to approximate control, low PO2 or hypercarbic conditions. Changes in isometric tension were recorded in response to increasing concentrations of bupivacaine (B), lidocaine (L), or 2-chloroprocaine (2-CP). In half the experiments, intimal rubbing was used to remove the endothelium of rings for the purpose of disclosing the role of endothelial-derived factors. RESULTS: The normal contracting (increasing baseline tone) or relaxing (decreasing baseline tone) responses to local anesthesia were unchanged by hypercarbia, but low PO2 suppressed the relaxing effect of 2-CP on arteries. Removal of endothelium enhanced the relaxing effect of 2-CP on arteries, and unmasked a contracting effect of L on arteries. Rubbed vessels, while exposed to low PO2 or hypercarbia, became less responsive to 2-CP. CONCLUSIONS: Changes in the internal environment are capable of altering the response of umbilical vascular smooth muscle to local anesthesia. Additionally, the vascular endothelium appears to influence the degree of response to anesthesia.

Anesthetics, Local↗

PubMedDate not supplied

Transition between solar keratosis and basal cell carcinoma.

Transition from solar keratosis (SK) to squamous cell carcinoma (SCC) is well known and vastly documented. The possible relation between SK and basal cell carcinoma (BCC) is rarely mentioned in the dermatopathological literature. In order to identify the characteristics of the relation between SK and BCC, 40 slides of the head and neck regions in which both SK and BCC had been diagnosed, were retrieved from a collection in the Institute of Pathology of Beilinson Medical Center, seen between 1984 and 1994. Gradual and continuous transition between SK and BCC was found in 15 (37.5%) of these 40 slides. In order to estimate the prevalence of this phenomenon, 73 additional slides, which had been diagnosed as BCC of the head and neck, were re-examined. Atypia of the spinous layer, as an initial marker for the development of SK, was sought in each slide. Revision revealed spinous layer atypia in 26 (35.6%) slides, in addition to the previously diagnosed BCC. In seven (9.6%) the transition between atypical spinous cells and BCC was gradual and continuous. A gradual and continuous transition between SK and BCC can be explained by the presence of pluripotent stem cells in the epidermis. Stem cells, following malignant transformation, may differentiate in different directions, resulting in both SK and BCC.

Basal Cell Carcinoma↗