Spindle-cell non-pleomorphic atypical fibroxanthoma: analysis of a series and delineation of a distinctive variant

Atypical fibroxanthoma is a bizarre, cytologically malignant but usually clinically benign, lesion which typically arises in sun-damaged skin of the head and neck region in the elderly. Classically, its morphology is said to represent the dermal counterpart of pleomorphic malignant fibrous histiocytoma. We have identified 10 cases of a more monomorphic spindle-celled, fascicular variant which, paradoxically, was often mistaken for a clinically malignant lesion because it lacked the pleomorphism of conventional atypical fibroxanthoma. These tumours all arose in the head and neck region as polypoid lesions in the elderly. The tumours were confined to the dermis, often had an epidermal collarette, showed an eosinophilic fascicular morphology and were highly mitotic. All 10 were vimentin positive and five showed very focal actin positivity. Desmin, keratin and S-100 protein were negative in all cases. The clinical course was benign in all cases, justifying their accurate recognition. The principal differential diagnoses are spindle cell squamous carcinoma, spindle cell melanoma and leiomyosarcoma. Immunohistochemistry plays a key role in this distinction.     

New method to identify nociceptor units innervating glabrous skin of the human hand

Summary A new technique is described for detecting nociceptor activity in microelectrode recordings from cutaneous fascicles of the human median nerve. The search strategy involves combined intraneural microstimulation and microneurographic recording in intrafascicular sites, where a critically low electrical stimulus amplitude evokes a threshold sensation of pain. From the subject's projection of pain to a small area of skin, the experimenter is guided to receptive fields of recordable nociceptor units. This technique has allowed, for the first time, to identify and study receptive properties of very high threshold nociceptors with A and C fibres in the glabrous skin of the human hand.     

Examination of the Short-Term Efficacy of a Parent-Based Intervention to Prevent Skin Cancer

The research evaluated an intervention strategy designed to prevent skin cancer in young adolescents. The intervention used parents as change agents to effectively communicate the risks of skin cancer and encourage their children to avoid high-risk sun-related behaviors while increasing positive sun-safe behaviors. Three hundred and forty parents in two regions of the United States were educated about the dangers of risky sun behaviors and how to convey information about skin cancer prevention to their children. Parents were then encouraged to talk with their children about these issues over a 1-month period prior to the onset of summer. Following this time period, children whose parents received and implemented the intervention materials were compared with a control sample of 129 children. These two groups were matched on age, gender, and school on number of sunburns and sunburn severity, attitudes and beliefs, and sunbathing behavior. Children in the treatment condition differed significantly from controls in the predicted directions on all outcome variables. The findings are discussed in terms of reducing skin cancer risk behaviors of children via parent-based intervention approaches.     

Determination of body heat storage in clothing: calorimetry versus thermometry

Two methods of estimating body heat storage were compared under differing conditions of clothing, training, and acclimation to heat. Six male subjects underwent 8 weeks of physical training [60–80% of maximal aerobic power ( ) for 30–45 min · day–, 3–4 days · week^–1 at < 25 °C dry bulb (db)] followed by 6 consecutive days of heat acclimation (45–55% for 60 min · day^–1 at 40°C db, 30% relative humidity)]. Nine other male subjects underwent corresponding periods of control observation followed by heat acclimation. Before and after each treatment, subjects walked continuously on a treadmill (1.34 m · s^–1, 2% grade) in a climatic chamber (40°C db, 30% relative humidity) for an average of 118 min (range 92–120 min) when wearing normal light combat clothing and for an average of 50 min (range 32–68 min) when wearing protective clothing resistant to nuclear, biological, and chemical agents. The heat storage was determined calorimetrically (by the balance of heat gains and losses) and thermometrically [by the conventional equations, using one or two set(s) of relative weightings for the rectal temperature (T _re) to mean skin temperature _sk of 4:1 and 4:1, 2:1 and 4:1, or 2:1 and 9:1 in thermoneutral and hot environments, respectively]. _sk was calculated from 12-site measurements, weighted according to the regional distribution of body surface area and the first eigenvectors of principal component analysis. There were only minor differences (< 5%) between the heat storage values calculated by given weighting factors forT _re and _sk, whether the individual coefficients were derived from estimates of regional surface area or principal component methodologies. When wearing normal clothing, no significant differences were found between the two estimates of heat storage (calorimetry vs thermometry with an invariant relative weighting of 4:1) in any experimental condition, with one specific exception: when wearing protective clothing, thermometry underestimated the heat storage by 24–31%. This underestimation was attenuated by using two sets of relative weightings of 2: 1 and 4: 1 or 2: 1 and 9: 1. The results suggest that when subjects wearing protective clothing are transferred from thermoneutral to hot environments, the accuracy of thermometric estimates of heat storage can be improved by using two sets of weighting factors forT _re and _sk     

Long-term evaluation of usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics

A variety of adverse reactions to local anesthetics has been described, some of which are thought to be allergic. Different protocols of prick and intradermal skin tests as well as subcutaneous challenge tests are used to select a local anesthetic which can safely be used. Their long-term effectiveness has not yet been assessed. Twenty-eight patients with a history of adverse reaction to local anesthetics were evaluated over a 3-year period. Loss of consciousness occurred in eight patients, skin reaction in nine, and vagal symptoms in eight. Various reactions were recorded in the remaining three patients. Rapid spontaneous recovery was the rule, suggesting that immediate allergic reaction and, in particular, anaphylactic reaction were unlikely. Investigation allowed the selection of a tolerated anesthetic in all cases. Reexposure occurred in 19 patients 16–50 months after evaluation and 6.8 ± 5.5 years after the first reaction. No patient presented a second reaction. In conclusion, adverse reactions to local anesthetics seem to be, in most cases, not allergic in nature. Evaluation protocols are effective in selecting an agent susceptible to tolerance, but are time consuming. However, they probably contribute to an important reassurance effect that is likely to increase tolerance to subsequent local anesthetic administration. Simplification of the protocols and better patient selection are proposed.     

Laterality of Body Focus and Digital Skin Temperature in Patients with Raynaud''s Disease

The purpose of the present study was to assess the relationship between lateralization of body image and right versus left vasomotor activity. Fifteen right-handed female patients suffering from idiopathic Raynaud's disease demonstrated a relationship between the extent of right lateralization of body image and bilateral digital skin temperature during a controlled temperature stress test. In addition, subjects showing a reliable right side awareness demonstrated more unilateral vasospastic attacks in their right hand than their left hand white subjects showing no clear right lateralization by body image reported more left hand attacks than right hand attacks. These results were taken as consistent with previous work on the relationship between skin conductance and lateralization of body image.     

Predictors of sunbathing and sunscreen use in college undergraduates

Sunbathing and sunscreen use, as well as related intentions, attitudes, beliefs, and knowledge, were assessed in 90 Southern Appalachian undergraduates. A large majority (75%) reported sunbathing, with more than half reporting sun lamp use. A slight majority (56.7%) reported some use of sunscreen. Subjects reporting an intention to tan spent more time sunbathing, both outside and under a sun lamp. Individuals reporting a sun protection intention had lighter tans and spent less time sunbathing. Sunbathing was predicted by perceptions of sunbathing as relaxing, while sun lamp use was predicted by more positive views of suntatns. Sunscreen use was predicted by more positive sun protection attitudes and less negative sunscreen attitudes.     

Report on two patients with Costello syndrome and sialuria

We report on 2 unrelated patients with Costello syndrome. The first is a 5-year-old girl with “coarse” face, nasal papillomata, redundant skin of feet and hands, hyperextensible hand and finger joints, curly hair, feeding problems due to oral motor apraxia, growth and psychomotor retardation. The second is a 3-year-old boy with “coarse” face, loose skin on hands and feet, curly hair, oral motor apraxia, severe growth and psychomotor retardation. In both patients urine sialic acid levels were found to be repeatedly high. The meaning of this biochemical abnormality is discussed. © 1993 Wiley-Liss, Inc.     

CORRELATION OF SKIN POTENTIAL AND SKIN RESISTANCE MEASURES

Simultaneous measurements of skin potential (SP) and skin resistance (SR) obtained from 20 male and 20 female adult subjects during 2 sessions held 2 to 9 days apart were used in studying (1) the correlation of change measurements and prestimulus level in the two measures, and (2) the amount of correlation between SP and SR using both simple difference and residual change scores in which the regression of poststimulus values on initial level (prestimulus) has been controlled. Correlations within Ss and correlations among Ss showed large individual variability, correlation differences between males and females, and high correlation between SP and SR change scores. Although the law of initial value (LIV) seemed to have little applicability to the measurement of electrodermal responses, the results underscored the need to control for contamination of change measures by initial level regardless of direction.     

Lamellar cells of sensory receptors and perineural cells of nerve endings of pig skin contain cytokeratins

Summary The lamellar cells of the sensory corpuscles of the pig dermis must be considered to be epithelial cells as they contain cytokeratins. The cytokeratins detected are similar to those found in simple epithelia. Moreover, lamellar cells are embedded in an extracellular matrix reminiscent of the basement membrane of epithelium since it contains laminin and collagen IV. The perineural cells surrounding the nerves of pig dermis present the same features.These results suggest that lamellar cells and perineural cells have the same origin. The nature of the lamellar and perineural cells of the rabbit or human dermis is not as clear since cytokeratins were not detected in those cells. These results, together with recent observations on Merkel cells, may indicate that epithelio-neuronal junctions are a general feature of cutaneous sensory receptors.