INTRADERMAL NODULAR FASCIITIS PRESENTING AS AN EYELID MASS

Background. Nodular fasciitis is a fibroblastic proliferation in which nodules, most commonly appearing on the extremities, develop suddenly and rapidly. Although excisional biopsy is curative, the nodules will often resolve spontaneously; however, the histologic appearance of a pleomorphic spindle cell neoplasm with frequent mitotic figures may raise concern of a more malignant neoplasm and lead to unnecessary and overly aggressive therapy. Methods. A case of nodular fasciitis presenting in an unusual location, intradermally at the lateral canthus, is discussed. Results. Review of the recent literature from other disciplines reveals new insights into the etiology and diagnostic options (fine needle aspiration, tomography, other imaging techniques) for this puzzling disease. Conclusions. When nodular fasciitis occurs in an unusual location, such as on the head and neck or at an intradermal location, it will not present as the deep, mobile, nontender nodule described in the dermatologic literature. Fine-needle aspiration and modern imaging techniques may help in the diagnosis and prevent unnecessary surgery for a self-limited condition.     

Anthralin Therapy for Alopecia Areata

Topical anthralin application producing a brisk irritant contact dermatitis has been reported to have therapeutic benefit in alopecia areata. A pilot clinical study was undertaken to determine whether topical anthralin application in doses low enough to produce only minimal contact dermatitis would produce a similar therapeutic response. None of the patients in the study received any benefit from this low-dose regimen. If anthralin is of benefit in the therapy of alopecia areata, a significant irritant contact dermatitis is apparently required.     

Techniques for Reconstruction of Perialar and Perialar-Nasal Ala Combined Defects

BACKGROUND: The nasal ala and perialar areas involve junctions with the nose, cheeks, and lips. Following Mohs surgery, defects in this area often extend across one or more creases or folds, thus requiring repair of more than one reconstructive subunit. OBJECTIVE: Our goal is to present various reconstructive techniques required to obtain aesthetic results. METHODS: Defects and reconstructions will be illustrated to demonstrate techniques and results. Emphasis will be on selection of techniques and documentation of results. RESULTS: Examples include various flap procedures (advancement, rotation, pedicle, interpolation, transposition), full-thickness and composite grafting, second intention healing, and combinations thereof. CONCLUSIONS: Thoughtful application of the various techniques will help to maximally camouflage scars and avoid maneuvers which would result in bridging and/or blunting of creases and folds.     

Adult acquired antral web

Summary Gastric antral webs in adults have been considered to be either congenital or acquired lesions. We present the first radiographically documented progression from a normal antrum to the development of an antral ulcer followed by healing with web formation.In a single study we feel that irregularity of the web and deformity or eccentricity of the antrum favor an acquired rather than a congenital web. Obtaining prior radiographs as well as follow-up examinations may be the only way to prove associa tion with peptic disease.The figures shown are published with permission from the Armed Forces Institute of Pathology.     

Computer-enhanced thallium scintigrams in asymptomatic men with abnormal exercise tests

The use of treadmill testing in asymptomatic patients and those with an atypical chest pain syndrome is increasing, yet the proportion of false positive stress electrocardiograms increases as the prevalence of disease decreases. To determine the diagnostic accuracy of computer-enhanced thallium perfusion scintigraphy in this subgroup of patients, multigated thallium scans were obtained after peak exercise and 3 or 4 hours after exercise and the raw images enhanced by a computer before interpretations were made. The patient group consisted of 191 asymptomatic U.S. Air Force aircrewmen who had an abnormal exercise electrocardiogram. Of these, 135 had normal coronary angiographic findings, 15 had sub-critical coronary stenosis (less than 50 percent diameter narrowing) and 41 had significant coronary artery disease.

Use of computer-enhancement resulted in only four false positive and two false negative scintigrams. The small subgroup with subcritical coronary disease had equivocal results on thallium scintigraphy, 10 men having abnormal scans and 5 showing no defects. The clinical significance of such subcritical disease is unclear, but it can be detected with thallium scintigraphy.

Thallium scintigrams that have been enhanced by readily available computer techniques are an accurate diagnostic tool even in asymptomatic patients with an easily interpretable abnormal maximal stress electrocardiogram. Thallium scans can be effectively used in counseling asymptomatic patients on the likelihood of their having coronary artery disease.