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Summary Since Wells and Smith first described cases of eosinophilic cellulitis (Wells syndrome; WS) in 1979, it has been noted that some but not all patients with WS present with eosinophilia. In the face of idiopathic persistent eosinophilia patients will also then fall within the hypereosinophilic syndrome (HES), which represents a multifarious spectrum of disorders of varying severity, causes and outcomes. In this article we propose that patients who present within the HES spectrum with cutaneous findings of WS and with no extracutaneous disease be classified as having ‘persistent hypereosinophilia with Wells syndrome’ (PHEWS).

The encapsulation of islets of Langerhans in alginate-poly-1-lysine has been proposed as a method for the immunoprotection of transplanted islets. Although several capsule compositions have been reported, there has been no published study concerning the effect of capsule composition on the severity of the foreign body reaction.Empty capsules were prepared from high mannuronic acid alginate and were coated with: (1) poly-1-lysine alone, (2) poly-1-lysine plus high guluronic acid alginate, or (3) poly-1-lysine plus high mannuronic acid alginate. The capsules were placed in the renal subcapsular space or the peritoneal cavity, and retrieved after three weeks for histological examination. The recipients were WAG/01a, nude (athymic), diabetic BB, and non-diabetes prone BB rats. The severity of reaction to the capsules was determined by measuring the thickness of the pericapsular cell infiltrate or by a scoring system.The severity of the reaction to the capsules was strain-dependent in both the renal an...

A 33-year-old man with recessive dystrophic epidermolysis bullosa presented with a 3-month history of an enlarging mass within scarring on the posterior aspect of the right shoulder. The clinical appearance of the mass with an almost cobbled, verrucous surface, and its rapid evolution suggested the development of a squamous cell carcinoma (SCC) in a chronically scarred site. Histopathological examination of a biopsy taken from the lesion subsequently revealed it to be a verruciform xanthoma. This case shows that benign phenomena can mimic SCC and underlines the need for a biopsy to be taken promptly.

Malignant fibrous histiocytoma of the larynx is a rare entity. It is even more infrequent for the tumour to arise from a specific location on the larynx namely the vocal cords. We report two cases of vocal cord malignant fibrous histiocytoma, one in a 27-year old man who underwent frontal partial laryngectomy, and the other in a 57-year old man who was managed with total laryngectomy. Both patients remain disease-free after 5 years of follow-up. We present a discussion of the available literature on this subject. As these tumours occur very infrequently, no one centre is able to acquire the prerequisite amount of experience to be able to lay down firm scientifically based guidelines on the management of these tumours. It is thus inevitable that whatever evidence we have is purely anecdotal in nature.

A 67-year-old woman presented with a scaly, erythematous plaque, for which a clinical diagnosis of Bowen's disease was made. However, incisional biopsy established the diagnosis of amelanotic superficial spreading malignant melanoma. Biopsy thus avoided the use of inappropriate destructive therapy, such as cryotherapy or cautery. This case illustrates the importance of obtaining a histological diagnosis, prior to treatment, in suspected cases of Bowen's disease.

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented fungi. It is primarily a disease of the tropics and subtropics. It is uncommon in the UK where it may occur as an imported disease. We describe a 42-year-old lady who developed chromoblastomycosis on her right forearm from Cladosporium, after visiting Malta. The lesion resolved after treatment with itraconazole for 6 months. To our knowledge there are no previous reports of chromoblastomycosis from Malta. We review the clinical course, diagnosis and management of this condition.

The encapsulation of islets of Langerhans in alginate-poly-l-lysine has been proposed as a method for the immunoprotection of transplanted islets. Although several capsule compositions have been reported, there has been no published study concerning the effect of capsule composition on the severity of the foreign body reaction. Empty capsules were prepared from high mannuronic acid alginate and were coated with: (1) poly-l-lysine alone, (2) poly-l-lysine plus high guluronic acid alginate, or (3) poly-l-lysine plus high mannuronic acid alginate. The capsules were placed in the renal subcapsular space or the peritoneal cavity, and retrieved after three weeks of histological examination. The recipients were WAG/01a, nude (athymic), diabetic BB, and non-diabetes prone BB rats. The severity of reaction to the capsules was determined by measuring the thickness of the pericapsular cell infiltrate or by a scoring system. The severity of the reaction to the capsules was strain-dependent in both the renal and peritoneal sites, with the BB and nude rats displaying the most severe responses. The degree of response was not affected by capsule composition in the renal subcapsular space, but in the peritoneum, the high mannuronic acid alginate capsules provoked the weakest response, and this type of capsule will be used for future transplantation work. The infiltrating cells were characterised by immunohistochemistry and electron microscopy and found to be mostly fibroblasts and macrophages.

Islets of Langerhans were isolated from WAGola rats and encapsulated in high mannuronic acid sodium alginate droplets. The capsules were completed in the following ways: (a) poly-l-lysine alone, (b) poly-l-lysine plus high guluronic acid alginate, (c) poly-l-lysine plus high mannuronic acid alginate. Islet viability was assessed every 3-4 days over a period of 4 weeks, by a microfluorometric assay using fluorescein diacetate and propidium iodide, and every 7 days by perifusion. The perifusion results were corrected for DNA content to take islet size differences into account. The results from the microfluorometric assay showed a generally high viability of the islets in all groups at each time interval. The perifusion experiments showed that the response time and stimulation indices of the islets was similar in all groups, but the absolute amount of insulin released was slightly lower from encapsulated islets relative to unencapsulated controls. It was concluded that the presence of a capsule, regardless of its composition, did not adversely affect the membrane integrity of the islets, their response time, nor their proportionate increase in insulin release following glucose stimulation. However, the absolute amount of insulin released from encapsulated islets was reduced during perifusion. This reduction was apparent after 1 week in culture, but remained stable thereafter.

The Ames Glucometer II and Boehringer Reflolux II glucose meters were evaluated from the point of view of precision of results, correlation with a reference method, susceptibility to interferences from other monosaccharides and anticoagulants and ease of use. The Boehringer Reflolux II is recommended as the meter of choice.