A unique biphasic variant of cutaneous fibrous histiocytoma with a storiform pattern and intralesional pigmented melanocytes: "storiform melano-fibrous histiocytoma"

Dermatofibromas (cutaneous fibrous histiocytomas) are common cutaneous neoplasms of mesenchymal origin. They are often associated with epidermal hyperplasia and increased basal layer pigmentation. There have been reports of a spectrum of melanocytic lesions associated with dermatofibromas ranging from junctional nevi to malignant melanomas, some of which may be coincidentally associated. We report a case of a long-standing storiform fibrohistiocytic lesion devoid of cytological atypia, lacking extension into subcutaneous fat, not demonstrating the t(17;22) DFSP translocation yet showing diffuse and strong CD34 immunoreactivity and containing pigmented spindle shaped melanocytic cells admixed with the fibrohistiocytic component. This case raises a nosological debate given the histological, immunophenotypic and cytogenetic findings.     

Antioxidant supplementation in pregnant women with low antioxidant status

Aim: The aim of this study was to investigate the benefit of antioxidant supplementation in a cohort of women with low antioxidant status and determine the changes in cell-free mRNA. Material and Methods: This study was a randomized, placebo-controlled trial of 8-12 weeks' pregnant women who had low antioxidant status treated with either antioxidants or control diets daily until 2 weeks' postpartum. The primary end-point was the risk of pre-eclampsia and the secondary end-point was the changes of angiogenic and anti-oxidant mRNA markers related to the outcome (ClinicalTrial.gov, number NCT01232205). Results: There were 110 women enrolled in the study, randomly assigned to the supplementation (n?=?52) and control group (n?=?58). The overall rate of pre-eclampsia was 8.7% (nine subjects). There were significant differences (P?=?0.034) between the supplementation and control group in the incidence of pre-eclampsia (2.0% [one case] and 14.5% [eight cases], respectively) and mRNA level of superoxide-dismutase, heme oxygenase-1, vascular endothelial growth factor receptor-1, endoglin and placental growth factor after supplementation. Conclusion: Supplementation of women with low antioxidant status with micronutrients containing antioxidants during early gestation might reduce the risk of pre-eclampsia.     

Stress involvement as trigger factor in different skin conditions

Dermatological conditions are intimately related to stress. There was a great interest in this field in the last years. Stress could be involved as a trigger factor for a lot of cutaneous diseases: alopecia areata, psoriasis, vitiligo, lichen planus, acne, atopic dermatitis, urticaria. For other conditions: seborrheic dermatitis, hyperhydrosis, herpes, pemphigus, a.s.o, there are anecdotal notices. On the other hand, the skin disease itself could induce a secondary stress for the patient, influencing his quality of life. The stress per se is less important than the "perceived stress", the patient's perception of the stressful situation. This perception could be influenced by the psychological state of the patient. Anxiety, depression could change the perception of the event. It is important to take care of these aspects during the consultation. A good cooperation with psychiatrist or/and psychologist could improve the results, besides the specific therapy.     

Voluntary work, demographic, social and economic features and health self-perception by elderly people from Porto Alegre (Brazil)

The objective of this cross-sectional, comparative study was to describe the demographic, socioeconomic and health characteristics of elderly voluntary workers of a Non-governmental organization of Porto Alegre, and investigate the influence of voluntary work and the referred characteristics on the subjects' self-perception of health, compared to a paired group of elderly individuals who did not perform any voluntary work. Through interviews it was found that 87.4% of the elderly voluntary workers were women, with complete secondary education, had their own income and followed a religion and a healthy lifestyle. The comparison of data from both groups showed that self-perception of great health was more common among voluntary workers (30.5% compared to 6.1%, p = 0.054). Multivariate analysis revealed that performing voluntary work and having fewer diseases influenced the individuals' having a positive self-perception of their health (p < 0.05). Study results support the hypothesis that voluntary work may be a mechanism of health promotion among the elderly.     

Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing

Purpose

To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks.

Methods

A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF).

Results

The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF.

Conclusion

After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.     

Cellular neurothekeoma with a plexiform morphology: a case report with a discussion of the plexiform lesions of the skin

Neurothekeoma is a rare benign dermal lesion that is commonly seen in children and teenagers. Despite its name, the true nature of this lesion is uncertain and controversial, particularly after the emergence of the cellular (spindle/epithelioid) variant. We describe the histological and immunohistochemical findings of a right thigh skin lesion in an 11-year-old girl. It consists of a dermal ill-defined plexiform mass composed of nests and fascicles of spindle cells with pale eosinophilic cytoplasm that lie within a sclerotic stroma. The immunohistochemistry shows diffuse reactivity to CD68, matrix metalloproteinase-II, CD10 and PGP9.5 with focal reactivity to CD57 and CD34. The lesion is negative for S100, factor XIIIa, smooth muscle markers and melanocytic markers. The features are compatible with a cellular variant of neurothekeoma with plexiform pattern that also exhibits an unusual pattern of fibrohistiocytic phenotype. Although such a lesion is benign, it has a wide but important differential diagnoses that are reviewed briefly together with a brief discussion about the origin of this rare entity.     

Real-time neuronavigation with high-quality 3D ultrasound SonoWand in pediatric neurosurgery

Intraoperative ultrasound (IOUS) serves as a basic imaging tool in neurosurgery. However, its low quality and difficulty in interpreting the images make its use as a resection control tool and navigation system cumbersome. We present our experience using a high-resolution 3D IOUS system combined with a navigation system in pediatric cranial surgery. We retrospectively reviewed 16 pediatric neurosurgical procedures in which a high-resolution 3D IOUS combined with a navigation system was used. The system enables basic navigation based on preoperative computed tomography or magnetic resonance imaging scans. In addition, IOUS images serve as a data set for updated intraoperative navigation. The indications for IOUS were preoperative navigation to define the skin incision and exact craniotomy site, and for real-time neuronavigation and resection control during tumor removal. The added time per case was short and no technical difficulties were encountered. High-resolution 3D IOUS combined with navigation systems has advantages for the pediatric neurosurgical population, including both real-time basic navigation and improved resection control.