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Erythrosis pigmentosa peribuccalis is an infrequent condition, with fewer than 35 cases reported in the literature, that affects mainly women. It presents as small papules that form a hyperpigmented plaque around the mouth and nose. Little is known about the etiology of this condition, its dermoscopic characteristics have not been described, and no effective treatment has been reported. We report a 15-year-old girl with this rare dermatosis who was successfully managed with daily calcipotriol, weekly topical ivermectin, and strict photoprotection. We also describe for the first time the dermoscopic findings of this entity.

Inflammatory breast cancer is an aggressive and infiltrative malignancy that is often misdiagnosed as an infection because of its symptoms and signs of inflammation, delaying proper diagnosis and treatment. We report a case of inflammatory breast cancer showing correlation between dermoscopic and histopathological diagnoses. We highlight the utility of dermoscopy for skin biopsy site selection.

Background/Objective Papular epidermal nevus with skyline basal cell layer (PENS) is a recently described type of epidermal nevus with characteristic histopathologic findings, mainly regular, rectangular acanthosis and a well-demarcated basal cell layer with clear palisading and separation between basal cell nuclei and the first row of Malpighian cell nuclei. Although the first reports described randomly distributed lesions appearing sporadically in otherwise healthy patients, cases of Blaschkoid distribution, lesions associated with extracutaneous manifestations, and familial cases have been reported. Methods We performed a review of the clinical charts of all patients with histologic diagnosis of PENS in our hospital. We evaluated epidemiologic, clinical, and histologic features. We then reviewed the literature with a particular emphasis on the presence or absence of extra-cutaneous associations. Results Three patients with PENS are described. One had a single lesion, one had three lesions, and one, a patient with mild developmental delay, a curved penis, and hypospadias, had multiple lesions. Conclusion The probability of having extracutaneous manifestations is 6.3 times as great in individuals with more than four lesions. Therefore these patients may need closer follow-up.

We determined the influence of oral contraceptives (OC) on the capacity of the endothelium to release tissue-type plasminogen activator (t-PA). Twenty-three healthy premenopausal women were studied: 12 nonusers and 11 users of OC. Net endothelial release rates of t-PA were calculated as the product of the arteriovenous concentration gradient and forearm plasma flow in response to intra-arterial bradykinin (BK: 12.5–50 ng · 100 ml tissue−1· min−1) and sodium nitroprusside (SNP: 1.0–4.0 μg · 100 ml tissue−1· min−1). Net release of t-PA antigen and increment in t-PA activity across the forearm to BK increased ( P < 0.01) in a dose-dependent fashion and to similar extents in the nonusers and users of OC. At the highest BK dose, net release of t-PA antigen was 64.5 ± 8.2 and 66.2 ± 15.4 ng · 100 ml tissue−1· min−1in the nonusers and users of OC, whereas the net increment in t-PA activity was 18.6 ± 3.0 and 16.0 ± 2.0 IU · 100 ml tissue−1· min−1, respectively. There was no effect of SNP on t-PA release in either group. These results indicate that endothelial t-PA release is not altered in premenopausal women who use oral contraception.

Background: Indirect measures of body composition suggest that Hispanic women have an excess prevalence of overweight and obesity compared with white women. Socioeconomic status (SES) is a potentially confounding factor in such studies. Objective: Our aim was to determine whether Hispanic ethnicity is associated with higher total and regional adiposity and lower fat-free mass (FFM) in healthy women across the adult age range. Design: We used a prospective cross-sectional design to examine total and regional body composition in 54 Hispanic women (primarily of Mexican descent) and 56 white women of similar SES. Results: The groups were not significantly different in mean age, body mass, or SES, although the Hispanic women were shorter (P < 0.05). Body mass index (in kg/m 2 ; 25.2 ± 0.5 compared with 23.9 ± 0.5; P < 0.05), percentage body fat (38.4 ± 0.8% compared with 34.9 ± 1.3%: P < 0.05), and total fat mass (25.0 ± I.0 compared with 23.0 ± 1.2 kg; P = 0.10) were or tended to be higher in the Hispanic women. The greater total adiposity of the Hispanic women was primarily the result of higher percentage fat and fat mass in the trunk (P < 0.05); within the trunk region, abdominal and subscapular skinfold thicknesses were 30-40% greater in the Hispanic women (P

Hispanic women may undergo greater age-related reductions in physical functional capacity compared with Caucasian women. If so, a greater rate of decline in muscle strength with age could contribute. We tested this hypothesis in 82 healthy sedentary Caucasian (n = 37) and Hispanic (n = 45) adult women aged 21-78 years of similar socioeconomic status. Absolute one-repetition maximum (1-RM) strength of the knee extensors (KE) declined with advancing age in the Caucasian (r = -.55, p < .01) and Hispanic (r = -.45, p < .01) women; the rates of decline were similar in the two groups (-7% to 8% x decade(-1), p = .60). KE strength normalized for thigh fat-free mass (FFM) also declined with age in the Caucasian (r = .52, p < .01) and Hispanic (r = -.41, p < .01) women, the rates of decline being similar (-6% to 7% x decade(-1), p = .66). For all functional performance tasks (10-m walk, stair ascent, stair descent, and chair stand), performance time increased with advancing age (mean of four tasks vs age: Caucasian, r = .64, p < .01; Hispanic, r = .56, p < .01). Absolute and normalized KE 1-RM were inversely related to the mean time for the four performance tasks (r = -.34 to -.58, all p < .01). Normalized KE 1-RM was the best independent predictor of the age-related decline in task performance in both groups. These cross-sectional findings do not support the hypothesis that Hispanic ethnicity per se is associated with a greater decline in KE strength and performance tasks associated with KE strength in healthy women.

Heart disease is a frequent complication of chronic kidney disease and the major cause of death in patients on renal replacement therapy. The purpose of this study was to evaluate the impact of successful kidney transplantation on systolic and diastolic ventricular dysfunction and pulmonary arterial hypertension in patients with chronic kidney disease (CKD).The study included 35 patients18 years of age with CKD who had successful kidney transplantations. Ventricular function and pulmonary arterial pressure were evaluated by echocardiography before and 1 year after transplant.The mean age of subjects was 40 ± 14 years, and 63% were men. Mean left ventricular ejection fraction (LVEF) was 52 ± 16%. Before transplant, 28 (80%) of the patients had ventricular dysfunction (34.3% diastolic and 45.7% systolic). Pulmonary arterial hypertension was found in 48.6%. Ventricular dysfunction was associated with dialysis of2 years duration before transplant. The LVEF of the entire group increased from 52% to 64% (P.001) by 12 months after kidney transplant. Left ventricular diameters, wall thickness, and pulmonary arterial systolic pressure decreased significantly after transplantation Echocardiograms became normal 1 year after transplant in 8 (66.7%) of the patients with diastolic dysfunction and 9 (56.2%) with systolic dysfunction, and diastolic dysfunction persisted in 5 (31.2%).Because kidney transplantation led to considerable improvement in left ventricular systolic and diastolic function as well as pulmonary arterial pressure of patients with CKD, optimal treatment for dysfunction and transplant as soon as possible is recommended.

We tested the hypothesis that the age-related decline in maximal aerobic capacity, as measured by maximal oxygen uptake (V˙o 2 max), is greater in Hispanic than in Caucasian women. We studied 146 healthy sedentary women aged 20–75 yr: 53 Hispanic (primarily of Mexican descent) and 93 Caucasian (non-Hispanic white). The groups did not differ in mean age, body mass, percent body fat, estimated physical activity-related energy expenditure, or education-based socioeconomic status (SES). During maximal exercise, respiratory exchange ratio, rating of perceived exertion, and percent predicted maximal heart rate were similar across age and ethnicity, suggesting equivalent maximum voluntary efforts in all subjects. V˙o 2 max(ml · kg−1 · min−1) was inversely related to age ( P < 0.01) in Caucasian ( r =−0.68) and Hispanic ( r = −0.61) women. The absolute rate of decline in V˙o 2 maxwith age was the same in the two groups (−0.31 ml · kg−1 · min−1 · yr−1). The relative rate of decline (% from age 25 yr) also was similar in the Caucasian (−9.0%) and Hispanic (−9.2%) women. When subjects of all ages were pooled, mean levels ofV˙o 2 max were similar in the two groups (∼28 ml · kg−1 · min−1). These results, the first to our knowledge in Hispanics, indicate that mean levels of V˙o 2 max, as well as the rate of decline in V˙o 2 max with age, are similar in healthy sedentary Hispanic and Caucasian women of similar SES. Thus it does not appear that Hispanic ethnicity per se modulates maximal aerobic capacity in this population.

Nuclear grade is considered a valuable prognostic factor in mammary carcinomas. Since the histological diagnosis of most of these tumors is made by "non expert" pathologists, it was considered interesting to find out the reproducibility of general pathologists to define the nuclear grade. In order to do this, a series of 15 mammary carcinomas, 10 of them randomly selected and 5 because they were considered difficult to classify for nuclear grade, were examined separately by 10 general pathologists. In a first round of observation, each one of them graded the cases according to their own criteria as used routinely, and for a second round they followed a written guide. An analysis of variance was applied to the data and no significant differences were found between observers, neither in the randomly selected cases nor in the total series. The written guide, surprisingly, instead of lowering the differences, increased them. Analysis of the individual performance of observers showed two of them having a great variation between both rounds of observation, and this was considered to influence the results of the whole group. Interobserver performance to discriminate high grade tumors (G3) from the rest, showed a good correlation in all the participants. These results allow us to conclude that in this series, examined by general pathologists, an acceptable reproducibility was observed, specially when high risk tumors were being identified.

Multiple spiradenoma, trichoepithelioma and traits of cylindroma in three members of a family are studied. The relationships among these tumors are discussed. Spiroadenoma and cynlindroma have shown a close interrelation. Both conditions may exist with multiple lesions in genetic autosomal dominant inherited association with multiple trichoepitelioma.

We report three patients, ages 5 years, 3 years, and 4 days, with umbilical polyps. In the third child the polyp was associated with an umbilical enteric fistula. An umbilical polyp is the result of incomplete closure of the omphalomesenteric duct and becomes apparent after the umbilical cord is detached. It is a reddish tumor of a few millimeters; it seldom bleeds or is exudative. We consider it important to study every case in detail in order to exclude possible underlying embryologic anomalies such as Meckel's diverticulum and umbilical enteric fistula.

Three members of one family with keratoderma Thost-Unna and histopathological picture of epidermolytic hyperkeratosis are reported. Several dermatoses with this abnormality of the keratinization are mentioned and the literature cases with keratoderma are reviewed. The treatment with oral aromatic retinoid though improved the hyperkeratosis, had to be discontinued because the vulnerability of the newly skin. Exhibited erosions with the consequent discomfort. The association of keratoderma with epidermolytic hyperkeratosis would be more frequently observed if the histopathological examination were performed in all cases.

The last 100 patients with malignant melanoma were studied following actual methodology, with these results: mean age at diagnosis was 55.3 years; mean age at the beginning of disease was 51.8 years. Lesions were more frequent in patients with pale skin; there was no predominance of any color of eyes. Forty-nine percent of the patients were referred with a previous nevus which was confirmed only in 7%. One tumor developed on a giant pigmentary congenital nevus. Lesions showed no preponderance in one sex. Four percent of patients had multiple lesions. Familial background was found in 5%. The localization was most often to the head and neck, trunk, and legs. The most frequent types were SSMM and NMM; the first one on trunk and the second one on legs. The SSMM was observed in younger people than NMM. Level IV was seen in the greatest number of cases, with an average thickness of 3.07 mm. In SSMM, level III predominated, while in NMM, level IV predominated. The average thickness of SSMM was 1.82 mm; that of NMM was 6.25 mm. Our data are representative of malignant melanoma in Argentina. Therapy and evolution of lesions will be analyzed with an appropriate long-term follow-up.

A case of achromic lentigo maligna is presented. The rarity and the importance of the differential diagnosis is emphasized.

The case of a 34 years old white female patient with severe bone marrow aplasia is reported. Treated with blood product transfusions, she developed cutaneous lesions consistent with graft versus host reaction. Skin biopsy revealed "satellite-cell" necrosis. The patient condition did not improve with high dose steroid therapy, and a fatal outcome was observed.

Neurotropic melanoma is a variant of desmoplastic melanoma with a distinctive neural or Schwannian appearance of amelanotic spindled melanocytes. We report a 81 years old woman with a neurotropic melanoma on her left superciliary region. The lesion began as a lentigo maligna melanoma, Clark's level V, 4,08 mm. in thickness. The tumor relapsed on seven instances over a follow-up period of five years. Microscopic study showed a spindle cell pattern with marked neurotropism. Patient's general condition is good notwithstanding her evolution and relapses. This type of melanoma usually occurs on the face and, as we observed in our cases, exhibits a marked tendency for peripheral nerve invasion.