LICHEN PLANUS SUBTROPICUS: DIRECT IMMUNOFLUORESCENCE FINDINGS AND THERAPEUTIC RESPONSE TO HYDROXYCHLOROQUINE

A 32-year-old black woman presented with the complained of a l-year history of asymptomatic “dark areas” on her face and neck. New lesions developed throughout this time and, once present, slowly increased in size and persisted. She denied systemic symptoms, including arthralgias and myalgias. Her occupation as a real estate agent involved frequent outdoor work. The family history was noncontributory. On physical examination there were multiple hyperpig-mented round-to-oval macules and papules measuring from 0.5 to 2.0 cm in diameter and located over the photoexposed lateral aspects of the face and neck (Figs. 1 and 2). New lesions were papules characterized by a subtle, raised “thread-like” border (Fig. 1, arrow). Older lesions were mac-ular, some with a slightly atrophic, hypopigmented center (Fig. 1, Flesh-colored polygonal papules were present in the V-shaped area on the anterior neck (Fig. 2). The remainder of the cutaneous examination, including the oral mucosa, was unremarkable. Histopathologic examination of a flesh-colored papule viewed on low power revealed a bandlike lymphohistiocytic infiltrate that focally obscured the dermoepidermal junction. Numerous homogenous eosinophilic bodies (Civatte bodies, cytoid bodies, apoptotic cells) and scattered melanophages were identified. In addition, there was epidermal hyperplasia, overlying orthokeratosis, and V-shaped hyper-granulosis. The rete was jagged and possessed a slightly eosinophilic hue (Fig. 3). Hyperpigmented, oval macules had a more patchy lichenoid infiltrate, less epidermal hyperplasia, but possessed a greater number of melanophages in the papillary dermis than new lesions. Periodic acid-Schiff (PAS) stained sections of either type of specimen were negative for basement membrane thickening and also negative for dermal mucin using the colloidal iron reagent. No deposits of immunoglobulin or complement were identified at the dermoepidermal junction by direct immunofluorescence microscopy, but numerous immunoglobulin-coated cytoid bodies were present. Laboratory testing was significant for a negative antinu-clear antibody (ANA) reaction and RPR. A complete blood cell count, results of serum chemistry, and the angiotensin converting enzyme level were within normal limits. Chest roentgenogram revealed no active cardiopulmonary disease. Based on the distinctive histopathology and the impressive, characteristic clinical presentation, the diagnosis of lichen planus subtropicus was made. Therapy with hydroxy-chloroquine 200 mg per day, topical hydrocortisone valerate 0.2% cream b.i.d. to inflammatory lesions, 3% hydroquinone solution b.i.d. to hyperpigmented lesions, and photoprotection were initiated. Partial resolution of the lichenoid lesions has occurred, new lesions have ceased to appear, and the hyperpigmentation has slightly improved.     

Efficacy of lumiracoxib in relieving pain associated with knee osteoarthritis: a 6‐week,randomized, double‐blind,parallel‐group study

Aim: The aim of the current study was to assess the efficacy, safety, and tolerability of lumiracoxib 200 mg once daily (o.d.) in relieving osteoarthritis (OA) knee pain in patients in China, Taiwan, and South Korea. Methods: Patients of either sex (aged ≥ 18 years) with symptomatic, primary OA of the knee for ≥ 3 months were eligible for inclusion if they had OA pain intensity of ≥ 40 mm (100 mm visual analogue scale [VAS]) in the target knee joint during the previous 24 h. Patients were required to undergo regular non‐steroidal anti‐inflammatory drug therapy for ≥ 6 weeks. After 3–7 days of screening, patients were randomized (1 : 1) to receive either lumiracoxib 200 mg o.d. or celecoxib 200 mg o.d. The primary efficacy comparison between the study groups was overall OA pain intensity (VAS) in the target knee after 6 weeks of treatment. Results: The mean overall OA pain intensity (VAS) in the target knee after 6 weeks decreased from 60.6 mm to 35.7 mm and 60.5 mm to 36.1 mm in the lumiracoxib and celecoxib groups, respectively. Both study groups showed similar results in terms of improvement in both patient's and physician's global assessment of disease activity and functional health status. The percentage of adverse events (AEs) in the lumiracoxib and celecoxib groups (40.3% and 37.9%, respectively) was similar, as was the proportion of treatment‐related AEs (21.0% and 18.2%, respectively). Conclusions: Lumiracoxib 200 mg o.d. provided effective and well‐tolerated pain relief similar to that achieved with celecoxib 200 mg o.d. in knee OA patients.     

Multicenter Evaluation of Fixed-Wire PTCA Catheters with Modified Distal Tips: Initial and 2-Month Follow-Up Results

Lesions in the distal portion of coronary arteries are technological challenges with currently available percutaneous transluminal coronary angioplasty (PTCA) equipment. A study was performed at multiple centers to determine if new "fixed-wire" devices with a modified distal tip (a 2-cm flexible tip and 1-cm standard tip) would be useful in these situations. Three hundred twenty-three patients were included in the study, 75% male, mean age 63 ± 11 years. Four hundred ninety-three lesions were attempted; the overall success rate was 85%. Forty-six (14.2%) clinical complications occurred including: 5 deaths (1.1%); 2 nonfatal myocardial infarctions (0.6%); and 6 emergency coronary artery bypass grafting procedures (2.6%). A device malfunction was noted in 32 patients (9.9%), and included: 8 balloon ruptures or perforations (2.0%); 6 bent or damaged tips (1.9%); and 4 shaft/manifold leaks (1.2%). Two-month follow-up assessment for restenosis was done in 352 of 371 (95%) patients and at that time 89% were asymptomatic, had a negative functional test, or patent PTCA site by angiography. The new fixed-wire PTCA catheters with 1- and 2-cm flexible tips hold promise for dilating lesions in distal locations with an acceptable rate of complications. Additional investigation is needed to determine their role in the treatment of coronary artery disease with PTCA.     

Demonstration of the Feasibility of Implantation of a Skeletal Muscle Pulse Generator for Fecal Incontinence in a Patient with an Implanted Unipolar DDD Pacemaker

Electromagnetic fields and myopotentials from skeletal muscle may interfere with the function of a cardiac pacemaker. A 65-year-old woman with a unipolar DDD cardiac pacemaker underwent dynamic graciloplasty (transposition of the gracilis muscle around the anal canal and subsequent implantation of a bipolar pulse generator to stimulate the gracilis muscle), for the treatment of fecal incontinence. This gracilis pulse generator is turned "off" with an external magnet to allow defecation. Appropriate functioning of these two pulse generators (the cardiac pacemaker and the gracilis pulse generator) was tested during implantation of the gracilis pulse generator and afterwards. It was demonstrated that the combination could be used safely in this patient.