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CASE FOR DIAGNOSIS: SCLERODERMA? PRESENTED BY ROBERT L. DAY, M.D. The patient, a 22-year-old white housewife, was first seen on February 9, 1959, with the complaint of a tender area on the left chest, first noted three and one-half years ago, immediately following birth of a baby. It began as a whitish pruritic area immediately below the left breast. The spot enlarged only slightly, and other similar areas developed nearby. In the past year the area has become reddened and exquisitely tender. She thinks there is some "caved-in" appearances to the central portion. In the last year she has developed a similar smaller area on the left quadrant of the abdomen.Physical findings: There is a 4-inch by 12-inch area of dusky-red darkening of the skin of the left chest in the inframammary area, distributed over the course of the 6th thoracic nerve, and stops sharply at the midline and

CIRCINATE SARCOID. PRESENTED BY MARJORIE BAUER, M.D. AND (BY INVITATION) ORAN J. SHANNON, M.D. DISCUSSION Edward L. Laden, M.D.: We mentioned under significant personal history that the patient had lived in Florida from birth, and that Australian Pines were prevalent in that area, in order to draw attention to the fact that recent epidemiological studies have indicated a possible etiologic relationship between exposure to certain types of pines and the occurrence of sarcoidosis. In line with this, there is an article which has recently appeared in the literature reporting the occurrence in three Negro sibling children of sarcoidosis. (Kendig, E. L., Jr., and others: New England J. Med. 260:962, 1959). They live in the area of Richmond, Virginia, which, as was mentioned in the article, is an area where these pines grow. There is also a high incidence of known sarcoidosis in this area. It stated that in a population

Cylindroma (Turban Tumors). Presented by Dr. S. W. Becker and (by invitation) Dr. A. Berman.This 44-year-old white man developed four tumors on the scalp at the age of 27. They were called "wens" by his local physician and were excised. He remained free of lesions for approximately two years when, while in New Guinea, new tumors appeared on the scalp and rapidly enlarged. Since then, many new lesions have developed. According to the patient, new lesions continue to appear and existing tumors continue to enlarge.The patient states he has had dengue fever (1942) and malaria (1945). In 1943, a thyroglossal duct cyst was excised. A vasectomy was performed in 1957.No similar lesions of the scalp are known to have occurred in other members of the family, although a 30-year-old brother has "a few little tumors" in the perinasal folds.The significant physical findings are

IN DECEMBER 1944, Andrews, Braestrup and Heisel1 published a study of the exit dose in dermatologic roentgen therapy. This factor was defined as the amount of radiation received by the skin opposite an irradiated surface. Their work suggested that the exit dose was an important reason for the localization of radiodermatitis on the middle part of the face, hands and feet following low voltage roentgen therapy. Since this paper was presented chiefly from an experimental point of view, the purpose of the present study is to show the clinical significance of the exit dose. Tables are included which set forth the exit dose values at various kilovoltages commonly used in the treatment of simple inflammatory dermatoses. It is in these diseases that fractional dosage is repeated on extensive areas. When this radiation is used on the face and extremities the exit dose becomes an important consideration.Numerous reviews of

A CASE FOR DIAGNOSIS (GRANULOMA). PRESENTED BY WALTER NICKEL, M.D., AND (BY INVITATION) R. B. PAPPENFORT, M.D. This 6-month-old Negro boy was born without complications. He was immediately examined by a pediatrician, who noticed no abnormalities other than an umbilical hernia and recalls no unusual appearance to the penis and scrotum. However, the mother noticed the slow evolution of an enlarging and thickened scrotum. At 3 months of age the mother felt "lumps" in the scrotum; it has become nodular and thickened, though at times the mother thinks it may be more soft and slightly smaller.The patient has developed properly and has been healthy as far as is known.Family history reveals the patient to be the youngest of three healthy siblings. There have been no congenital abnormalities among parents, relatives, or grandparents. There is no history of tuberculosis, venereal disease, or diabetes.Examination: The scrotum is enlarged, markedly