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Background Primary cutaneous γ/δ T-cell lymphoma ( PCGD- TCL) is aggressive and has a poor prognosis. In contrast, subcutaneous panniculitis-like T-cell lymphoma ( SPTCL) of the α/β T-cell receptor phenotype is known to follow an indolent course and have a more favourable prognosis. In the past, PCGD- TCL and SPTCL were often considered to be a manifestation of the same disease, and aggressive systemic polychemotherapy has commonly been the first-line therapy for both. Given the understanding that SPTCL is a separate and less aggressive entity, clinical data exclusively evaluating the efficacy of conservative treatment in SPTCL are needed. Objectives To assess the overall clinical response to systemic corticosteroids in the treatment of SPTCL. Methods This was a retrospective cross-sectional study based on a patient data repository from two tertiary care university hospitals in Zürich (Switzerland) and Tübingen (Germany). The repository spanned 13 years. Results In four of the five patients (80%) with SPTCL, treatment with systemic corticosteroids induced a complete remission. Conclusions Systemic corticosteroids may be an excellent first-line single-agent therapy for SPTCL. [ABSTRACT FROM AUTHOR]

We conducted a longitudinal cohort study on the quality of life of infertile male patients measured at baseline and after 5 years with a specific quality of life instrument for male patients who are involuntarily childless. It was distributed to patients who were seen at the andrology and gynaecology clinics for infertility diagnoses and treatment. At baseline (T1), 275 patients took part in the study. A subset of these patients (N = 133) had released two semen samples, and the results of the semen analysis had been communicated to them before they received the questionnaire. Semen quality of this subset was assessed according to WHO recommendations. After 5 years (T2), the questionnaires were mailed again and were sent back by N = 101 patients. No significant quality of life difference was found between the semen quality groups. After 5 years, an improvement was found for the dimensions 'desire for a child' [mean score 1.92 (T1) versus 1.72 (T2)] and 'gender identity' [mean score 1.56 (T1) versus 1.42 (T2)] while no change was found for 'partnership' and 'psychological well-being'. We did not find significant differences between patients who had fathered a child in the meantime and patients who did not become fathers. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of whole-body magnetic resonance imaging (MRI) in detecting musculoskeletal involvement in patients with systemic scleroderma and musculoskeletal symptoms.Methods: Eighteen consecutive patients (8 men, 10 women) with systemic scleroderma (median age 46 years) presenting with musculoskeletal complaints underwent whole-body MRI at 1.5 T. Images were evaluated for abnormal signal intensity and/or thickening of subcutaneous fatty tissue septa, muscular fasciae, intramuscular perifascial septa, muscle signal intensity and articular or tendon sheath synovial abnormalities on STIR and post-gadolinium scans. Additionally, C-reactive protein, creatinine kinase and the modified Rodnan skin score were determined.Results: MRI indicated evidence of fasciitis, articular synovial inflammation, and subcutaneous thickening in 16 (89 %) patients. MRI findings were compatible with myopathy or myositis in 14 (78 %) patients, tenosynovitis in 11 (61 %) patients and enthesitis in 10 (56 %) patients. Typically, these manifestations were distributed symmetrically and mostly generalised. We only found few correlations with modified Rodnan skin score, C-reactive protein and creatinine kinase.Conclusion: In patients with systemic scleroderma experiencing musculoskeletal symptoms, whole-body MRI is able to detect involvement of muscles, fasciae, joints and entheses more confidently compared with clinical and laboratory parameters. [ABSTRACT FROM AUTHOR]

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0-4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0-2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS. [ABSTRACT FROM AUTHOR]

Mycophenolate mofetil (MMF) is an immunosuppressive agent that has been shown to be effective in transplant patients. Some case reports and pilot studies have suggested efficacy against systemic lupus erythematosus (LE), particularly in the case of lupus nephritis. Reports on MMF treatment of skin manifestations of LE are still anecdotal. We report two cases with extensive skin lesions owing to subacute cutaneous LE (SCLE). Both patients had been treated with azathioprine and antimalarials without effect. Finally both patients were given highly dosed glucocorticosteroids, which were also ineffective but led to vertebral fractures because of long-term steroid treatment in one patient and steroid-induced psychosis in the other. MMF 2 g daily caused the skin manifestations to disappear within a few weeks in both patients. One patient was followed up for more than 24 months, and showed good toleration of MMF treatment. The skin remained stable over this period when at least 1 g MMF per day was administered. In conclusion, MMF appears to be an attractive treatment option in skin manifestations of SCLE, and seems to be beneficial for patients with steroid-refractory lesions that are also resistant to treatment with immunosuppressants or antimalarials. The observations suggest that further evaluation of this route in randomized controlled trials is warranted. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a case of a 38-year-old Caucasian woman diagnosed with generalized cutaneous infection due to Trichophyton rubrum associated with ichthyosis vulgaris and atopy.

Musculoskeletal involvement, often unrecognized, is common in patients with limited scleroderma, and it may be identified with magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Clarifies comments on a case arterial embolization (AE) after injection of hyaluronic acid. Application of dermal fillers only by trained physicians who know the potential risk of AE; Documentation of delayed reactions.

Presents a letter to the editor of the periodical 'International Journal of Impotence Research' regarding the use of prostaglandin E[sub1] ethyl ester as an agent for topical penile therapy. Study sample of 17 men with more than six months' history of erectile dysfunction; Local tolerability and efficacy; Dose-dependent increase in erectile function during the titration period.

Reports on a case of cholesterol embolism which causes leg ulcers. Diagnosis; Abnormalities accompanying leg ulcers; Use of warfarin in treatment.

Reports on a case of arterial embolization caused by injection of hyaluronic acid. Symptoms and treatment procedures; Medical opinion on the cases; Theoretical significance to dermatology.

For currently presented anatomical coracoclavicular ligament repairs issues such as autologous tendon graft versus synthetic suture augmentation and the optimum fixation strategies for both types of reconstruction are not solved. The purpose of the study was to compare the biomechanical properties of different tendon graft repairs to the characteristics of a synthetic polyester augmentation. Four anatomical coracoclavicular ligament repairs were biomechanically tested: 5 mm coracoclavicular tendon loop with suture fixation, tendon loop with flip button fixation, tendon loop with interference screw fixation versus a double 1.0-mm polyester repair with flip button fixation. The biomechanical testing included cyclic superio-inferior loading and a subsequent load to failure protocol. The ultimate failure loads were significantly higher for the double polyester/flip button repair (927 N) compared to all tendon repair techniques (maximum 640 N). In contrast the stiffness level was higher for the tendon repairs compared to the polyester/flip button repair (68.7 N/mm) but strongly dependent on the fixation technique (interference screw 97.2 N/mm, flip button 84.9 N/mm, side to side suture 60.9 N/mm). A synthetic coracoclavicular augmentation using a polyester suture provides adequate structural properties compared to a tendon repair. Therefore the decision for a tendon graft should be made by the necessity of a biologic substrate rather than by the assumption of a biomechanical advantage. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented entitled "Dapsone in the management of insect bite-like reaction in a patient with chronic lymphocytic leukaemia," published within the issue.

BACKGROUND: Studies have suggested that double-bundle anterior cruciate ligament reconstruction may restore intact knee kinematics better than single-bundle anterior cruciate ligament reconstruction. Although the tunnel position of the femoral anteromedial bundle is well established, the effects of different posterolateral bundle positions on knee kinematics are unknown. HYPOTHESIS: Double-bundle anterior cruciate ligament reconstruction with an anatomical (shallow) femoral posterolateral bundle tunnel placement will restore knee kinematics more closely than will a nonanatomical (deep) femoral posterolateral bundle tunnel position. STUDY DESIGN: Controlled laboratory study. METHODS: In 12 human cadaveric knees, the kinematics of the intact knee, anterior cruciate ligament-deficient knee, and double-bundle anterior cruciate ligament-reconstructed knees with nonanatomical femoral posterolateral tunnel placement and anatomical posterolateral bundle placement were determined in response to a 134-N anterior tibial load and a combined rotatory load of 10 N x m valgus and 4 N x m internal tibial rotation using a robotic/universal force moment sensor testing system. Statistical analyses were performed using a 2-way analysis of variance test. RESULTS: Double-bundle anterior cruciate ligament reconstruction with nonanatomical posterolateral bundle placement showed significantly higher anterior tibial translation under anterior tibial and combined rotatory load than did the intact knee at 0 degrees and 30 degrees of knee flexion (P < .05). Reconstruction with an anatomical posterolateral tunnel placement restored the intact knee kinematics and showed significantly lower anterior tibial translation under anterior tibial and combined rotatory load when compared with reconstruction with nonanatomical posterolateral placement (P < .05). CONCLUSION: Double-bundle anterior cruciate ligament reconstruction using the anatomical posterolateral bundle tunnel position restores the intact knee kinematics. A nonanatomical posterolateral bundle position results in rotatory instability. CLINICAL RELEVANCE: Double-bundle anterior cruciate ligament reconstruction should be performed using anatomical tunnel placement of the anteromedial and posterolateral bundles. Nonanatomical double-bundle reconstruction may fail to show any clinical superiority to single-bundle reconstruction and should be avoided. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Severe exacerbation of chronic plaque psoriasis following initially effective therapy with efalizumab: clinical characterization and therapeutic management."

Summary: Metastases from uveal melanoma are often confined to the liver. Palliative hepatic chemoembolization has been considered to be a reasonable treatment approach. We enrolled 14 patients with hepatic metastases from uveal melanoma into a pilot trial of transarterial chemoembolization (TACE). All patients received additional systemic immuno-chemotherapy or best supportive care. In 31 procedures 100mg/m2 of cisplatine was continuously infused by means of a power injector preceding embolization by manual injection of polyvinyl alcohol particles. In three procedures cisplatine was replaced by 200mg/m2 carboplatine because of increased serum creatinine levels. Tumor response was evaluated using RECIST criteria. Fourteen patients received 34 TACE''s (mean: 2.4 treatments). Eight patients (57%) achieved partial response (PR), four patients (29%) had stable disease and two patients (14%) tumor progression. Median time to progression was 8.5 months (5–35 months). Median survival after first TACE was 14.5 months in responders compared to 10 months in non-responders (p =0.18, not significant) and 11.5 months (3–69 months) in all patients. In seven patients with metastases occupying less than 25% of liver volume median survival was 17 months compared to 11 months in seven patients with tumor involvement of more than 25% (p =0.02) with partial response rate of 86% and 29%, respectively. TACE of liver metastases from uveal melanoma is well tolerated and may prolong survival in patients with limited tumor extension. [Copyright &y& Elsevier]