Successful treatment of three cases of primary extramammary Paget’s disease of the vulva with Imiquimod – proposal of a therapeutic schedule

Background/aim Extramammary Paget‘s disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland‐bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget‘s disease. Methods Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. Results Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. Conclusion Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.     

Population Mobility and Epidemiology of Chronic Bronchitis in Connecticut

The distribution of chronic bronchitis was studied in southern Connecticut by administering a standardized questionnaire on respiratory symptoms to 424 persons (249 men and 175 women). Eighteen men (8.8%) and 22 women (10.3%) were found to have this disease, and smokers were affected far more frequently than former smokers or nonsmokers. Among the chronic bronchitics a statistically significant association was observed between severity of symptoms and migration from urban areas, those with severe symptoms being the most likely to have left these areas in recent years. The need is therefore emphasized of taking length of residence into account in surveys which are concerned with the relationship between chronic bronchitis and urban air pollution.     

Right aortic arch,bilateral ductus arteriosus,and anomalous origin of left pulmonary artery from innominate artery in a fetus with normal intracardiac anatomy

Right aortic arch (RAA) with right ductus arteriosus (RDA) is one of the least frequently diagnosed cardiac abnormalities prenatally. We describe here a case of RAA, bilateral ductus arteriosus (BDA), and anomalous origin of left pulmonary artery from innominate artery in a fetus with normal intracardiac anatomy.     

The use of Fogs' test to assess associated movements in Parkinsonism,dystonia, and controls

The Fogs' test elicits non‐homologous associated movements which reflect underlying pathology or immaturity of the CNS, but has not been thoroughly studied. We filmed participants performing a modified Fogs' test and developed a reliable scoring system for the associated movements. We assessed scores in healthy controls of all ages and compared scores in dystonia and parkinsonism to age similar controls. Associated movements were marked in children, lessened as they matured into adults, and then increased in old age. Associated movements were marked in dystonia but not in parkinsonism. Our scoring system showed robust inter‐ and intra‐rater reliability. The Fogs' test is a reliable addition to the clinical examination that can be used to screen for both normal and abnormal neurological status. We suggest a potential neural pathway via cervical‐lumbosacral connections within the spinal cord which are modulated by propriospinal and cerebral input. © 2010 Movement Disorder Society