Sea urchin spines in the stratum corneum: an early finding related to trauma

Penetrating trauma from sea urchin (Echinoidea) spines has been shown to cause numerous cutaneous reactions, ranging from initial pain that rapidly dissipates and resolves to chronic inflammation and formation of characteristic sea urchin granulomas. Many of these skin‐colored or violaceous papules and nodules form weeks to months after injury, and may be surgically excised. Histopathologic examination commonly shows well‐defined granulomas, the majority of which represent sarcoidal‐type granulomas. Other microscopic patterns, such as foreign body reactions and chronic inflammation, have also been shown. Retained spine fragments are birefringent on polarized microscopic examination and are most likely found in the dermal layer. Herein, we describe a case of traumatic sea urchin cutaneous injury with a unique early cutaneous trauma reaction in a young male who lived in Hawaii. Histopathologic exam was significant for retained spines in the layer of the stratum corneum, but no signs of granulomatous inflammation were observed. This case report emphasizes the unique features of our case and reviews the common clinical and histopathologic features of sea urchin cutaneous reactions.     

Treatment of Umbilical Granuloma in Infants With Topical Application of Common Salt: A Scoping Review

BackgroundCommon salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma.MethodsA literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords ‘umbilical granuloma’ and ‘salt treatment’ to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study.ResultsTwenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences.ConclusionTopical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic.Level of EvidenceI.     

长骨嗜酸性肉芽肿的影像诊断

目的 探讨长骨嗜酸性肉芽肿的影像学特征.方法 回顾性分析经病理证实长骨嗜酸性肉芽肿患者的影像学资料.结果 16例患者共检查出病灶21处,其中股骨有12处病灶,胫骨5处,腓骨2处,桡骨2处.影像学表现主要为骨质破坏、皮质改变、骨膜反应、软组织肿块.结论 长骨嗜酸性肉芽肿的影像学表现具有一定的特征性,结合X线平片和CT、MRI,可提高对该病的影像学诊断能力.     

Large pediatric sphenoid sinus cholesterol granuloma: Case report and review of the literature

Cholesterol granulomas are rare lesions in the paranasal sinuses, especially in children. Symptoms are nonspecific depending on the localization and extent of the mass. In a 6-year-old boy who presented with a headache and proptosis, computed tomography and magnetic resonance imaging showed a large expansile mass in the nasal cavity. The patient was started on intravenous antibiotics with no improvement. Following endoscopic biopsy, the mass was removed. Pathological findings were consistent with a cholesterol granuloma. Good clinical outcomes can be obtained with proper imaging studies. Endoscopic sinus surgical techniques allow the surgeon to clear and drain the affected sinus cavity.     

基质金属蛋白酶-1和8在根尖肉芽肿中的表达及意义

目的：探讨基质金属蛋白酶-1（MMP-1）和8（MMP-8）的表达水平与根尖肉芽肿的关系及意义。方法：采用免疫组化方法,检测了20例根尖肉芽肿和20例正常根尖组织中MMP-1和MMP-8的表达水平,并用独立样本t检验分析MMP-1和MMP-8的表达水平与根尖肉芽肿的关系。结果：MMP-1和MMP-8在根尖肉芽肿组织中均有表达,且表达的阳性细胞数高于正常组,差异具有统计学意义（P〈0.05）。结论：MMP-1和MMP-8可能参与了根尖肉芽肿的发病过程。     

The hypereosinophilic syndromes: current concepts and treatments

The hypereosinophilic syndromes (HES) encompass a spectrum of diseases that have increased blood eosinophils and tissue damage in common. The clinical manifestations are protean and may involve any organ system, but especially the skin. Our understanding of these diseases has drastically changed over the past 15 years, along with new classifications that characterize patients with marked eosinophilia. One HES variant, myeloproliferative, is actually chronic eosinophilic leukaemia with a unique genetic marker, FIP1L1-PDGFRA . Such patients are well-controlled by administration of the kinase inhibitor, imatinib, and remissions appear durable with continued imatinib therapy. FIP1L1-PDGFRA is expressed in several cell lineages, thus explaining increases in neutrophils and mast cells in HES. The lymphocytic HES variant is associated with T-cell clones producing interleukin-5 (IL-5) and can evolve into lymphoma. While myeloproliferative and lymphocytic HES are well established and permit elimination of the term, idiopathic, to these varieties, most HES patients do not fall into these categories and are classified as complex (using the 2006 Workshop Report). A recent study showed that a monoclonal antibody to IL-5, mepolizumab, reduced glucocorticoid therapy in HES patients who did not possess the FIP1L1-PDGFRA mutation while controlling eosinophilia and preventing recurrence or progression of tissue damage. These advances augur well for continued progress in the understanding and treatment of HES.