Virus‐Associated Trichodysplasia Spinulosa

A 46‐year‐old hepatitis C‐positive African American woman presented with a several month history of worsening, well‐marginated, erythematous, dusky plaques on the dorsum of her feet and ankles. After an initial skin biopsy showed spongiotic dermatitis, she was treated with emollients, high potency topical steroids, and keratolytics, all of which were of no benefit. A punch biopsy from the dorsum of her foot showed acanthosis, individual keratinocyte necrosis, confluent upper epidermal necrosis, and a superficial and deep perivascular lymphocytic infiltrate. Given the patient's positive hepatitis C status and clinicopathological correlation, a diagnosis of necrolytic acral erythema was rendered. Empiric therapy with oral zinc sulfate was initiated despite a normal plasma zinc level, and the skin lesions resolved with post‐inflammatory hyperpigmentation. Necrolytic acral erythema, considered one of the necrolytic erythemas, is a cutaneous manifestation of hepatitis C virus infection. A total of nine cases have been reported in the literature, seven from Egypt and two from the United States. All reported patients have been hepatitis C positive. This case represents the third reported patient from the US with necrolytic acral erythema.     

Cytomegalovirus infection and disease in renal transplant patients treated with cyclosporin: A prospective study

Abstract. In this prospective study, the incidence of cytomegalovirus (CMV) infection and CMV disease was determined in 175 renal transplant recipients on cyclosporin and low-dose prednisone. CMV infection occurred in 51. 4% of the patients, CMV disease in 13. 7%. The major manifestations of CMV disease were fever of unknown origin and leukopenia. In the group with CMV infection, there was an increased occurrence of rejection (60% in infected vs 27% in noninfected patients). In most patients (41/54), the rejection preceded the CMV infection. CMV infection did not lead to a decreased graft survival. There was no close time relationship between the onset of clinical symptoms of CMV disease and the laboratory confirmation of CMV infection. A subgroup of patients at risk for the development of severe CMV disease could not be identified.     

Influence of Body Size on Clinical Outcome in Patients Undergoing Coronary Surgery with or Without Cardiopulmonary Bypass

Aim: Saphenous vein (SV) is the most commonly used conduit in bypass procedures but has a one‐year occlusion rate of 15‐30%. A new ‘no‐touch’ technique where the SV is harvested with a cushion of surrounding tissue with no distension has led to improved early patency rates of 5% at 18‐months. Nitric oxide (NO), synthesised by nitric oxide synthase (NOS) has properties beneficial to graft patency. Our aim was to study the distribution of NOS in SV harvested by this technique and the effect of distension and removal of perivascular tissue on NOS content of SV. Methods: Following ethical committee approval and patients' informed consent, SVs were harvested from ten patients undergoing coronary artery bypass grafting. A segment of vein was harvested by the conventional technique (surrounding tissue stripped and vein distended with saline); another part was stripped but not distended (‘control’) and the remaining parts harvested by the ‘no‐touch’ technique. Samples of each segment were taken and transverse sections prepared for NOS identification using ³[H]L‐N^G nitroarginine (NO Arg) autoradiography and NADPH‐diaphorase histochemistry. NOS isoforms were studied using standard immunohistochemistry. Endothelial cells and nerves were also identified using immunohistochemistry with CD31 and NF200 respecitvely, to confirm sources of NOS. Morphometric analysis of NADPH‐diaphorase staining was carried out to study tissue NOS content. Results: NO Arg binding representing NOS was preserved on the lumen of ‘no‐touch’ vessels whilst that on conventional and control vessels was reduced. NOS was also localised to the medial smooth muscle cells of all vein segments and to the intact adventitia of ‘no‐touch’ segments. This was confirmed by NADPH‐diaphorase staining, which revealed a mean reduction of NOS by 19.5% (p < 0.05, ANOVA) in control segments due to stripping of surrounding tissue alone and a reduction of 35.5% (p < 0.01, AVNOVA) in conventional segments due to stripping and distension, compared to ‘no‐touch’ segments. Adventitial NOS sources in ‘no‐touch’ vessels corresponded to vasa vasorum and paravascular nerves. All three NOS isoforms contributed to the preserved NOS in ‘no‐touch’ vessels. Conclusions: Apart from preserved lumenal NOS, NOS sources are also located in the media and adventitia of SV grafts. These are reduced by both adventitial damage and vein distension during conventional vein harvesting. The ‘no‐touch’ technique avoids these procedures, preserving NOS sources. This may result in improved NO availability in SV harvested by this technique, contributing to the improved patency rates reported.     

Fatal bronchospasm after oral ingestion of isphagula

We report the case of a 40-year-old asthmatic who suffered fatal bronchospasm following oral injestion of a laxative containing isphagula.     

A case of neurofibromatosis associated with a coronary artery aneurysm and myocardial infarction

A case of myocardial infarction secondary to thrombosis of a coronary artery aneurysm in a patient with neurofibromatosis is presented. The vascular manifestations of neurofibromatosis, and the associated clinical sequelae, are reviewed.