Deep Granuloma Annulare (Pseudorheumatoid Nodule) in Children: Clinicopathologic Study of 35 Cases

Deep granuloma annulare (DGA) is one of several lesions of skin and superficial soft tissues whose histologic character is a palisading granuloma with a small central focus of necrosis or necrobiosis. Unlike the other palisading necrobiotic lesions, DGA has a predilection for children in the first 5 to 6 years of life. A painless subcutaneous nodule(s) in the lower anterior tibial region or foot and the scalp, typically in the occiput, was the most common presenting feature in this study of 35 cases. Additional or recurrent lesions were reported in approximately 70% of cases with clinical follow-up. All lesions showed the presence of necrobiosis; however, one of the characteristic features was the multinodular character of the predominantly mononuclear cellular aggregates. The presence of vascular spaces at the periphery of the nodular profiles served as a clue to the diagnosis of DGA. The palisading arrangement of the mononuclear cells was evident only in those foci with central necrobiosis. A histiocytic disorder or fibrohistiocytic process was a common consideration in the differential diagnosis, especially in those cases with less apparent foci of necrosis. Palisading histiocytes with prominent eosinophilic cytoplasm and some nuclear atypism were problematic with regard to possible epithelioid sarcoma. Our study failed to identify any underlying or predisposing factors in the development of DGA. Despite the fact that DGA is a well-documented lesion in children, it occurs sufficiently infrequently that it is often not considered clinically when it presents as a subcutaneous mass or masses in a child. Its recognition by the pathologist is especially important as the occurrence of additional lesions in a high proportion of children can be anticipated without undue concern. Received June 16, 1997; accepted October 28, 1997.     

A new method to measure intraosseous pressures

A new technique for measuring intraosseous pressures involves inserting a miniature transducer directly into the intraosseous space. A high-performance, high-fidelity pressure transducer is easy to assemble and insert. The transducer permits dynamic studies of intraosseous pressure during gait, and constitutes a promising tool for detecting changes in intraosseous pressure in osteoarthritis and osteonecrosis.     

Alcohol on wheels

Alcohol misuse remains the single most important contributing factor to road accident deaths and injuries in Australia. The results of compulsory blood alcohol tests on road casualties have shown that probationary licensed drivers have a threefold increased risk of road accident injury compared to fully licensed drivers and are additionally over-represented in alcohol-related crashes. These findings led the Victorian Road Trauma Committee to campaign for a zero blood alcohol limit for learner and probationary drivers and motorcyclists. In May 1984, zero blood alcohol legislation was enacted in Victoria. The present legislation applies to learner and first year probationary licence holders. For the first time we have evidence of a moderate reduction in alcohol-related road trauma in Victoria. Between 1977 and 1983 there has been a significant reduction in the proportion of driver casualties admitted to hospital with illegal blood alcohol concentrations and in the number of driver fatalities with blood alcohol concentrations in excess of 0.15 g%. An evaluation of the following recommended drink driver countermeasures is presented: improved driver education, increased penalties, re-education--rehabilitation programmes for convicted drink drivers, interlock devices and an increase in the legal drinking age.     

NO LINKAGE OR ASSOCIATION OF TELOMERIC AND CENTROMERIC T-CELL RECEPTOR β-CHAIN MARKERS WITH SUSCEPTIBILITY TO TYPE 1 INSULIN-DEPENDENT DIABETES IN HLA-DR4 MULTIPLEX FAMILIES

The T-cell receptor β locus (TCRB) on chromosome 7q35 was studied as a candidate region for genetic susceptibility to type 1 insulin-dependent diabetes (IDDM). A highly polymorphic microsatellite marker mapping to the TCRBV6.7 gene and a TCRB C-region RFLP were used to genotype the members of a total of 21 multiplex IDDM families from two different geographical areas. There was no evidence to support linkage to either of these markers with IDDM, and conventional two-point analysis excluded linkage to the telomeric end of the TCRB complex, in the region of the highly informative TCRBV6.7 marker. There was significant linkage of IDDM to the class II HLA-D locus with significant lod scores >3.0 obtained for the HLA-DRB1 and HLA-DQB1 genes. Affected sib-pair (ASP) and transmission disequilibrium (TDT) association tests confirmed these findings.     

Cytokine gene polymorphism in human disease: on-line databases

The pathologies of many infectious, autoimmune and malignant diseases are influenced by the profiles of cytokine production in pro-inflammatory (TH1) and anti-inflammatory (TH2) T cells. Interindividual differences in cytokine profiles appear to be due, at least in part, to allelic polymorphism within regulatory regions of cytokine gene. Many studies have examined the relationship between cytokine gene polymorphism, cytokine gene expression in vitro, and the susceptibility to and clinical severity of diseases. A review of the findings of these studies is presented. An on-line version featuring appropriate updates is accessible from the World Wide Web site, http://www.pam.bris.ac.uk/services/GAI/cytokine4.htm.