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A series of germanium (Ge)-containing glasses were synthesized based on a starting glass composition of SiO2-ZnO-CaO-SrO-P2O5. Additions of GeO2 (6 and 12 mol%) were incorporated at the expense of SiO2, which retained the amorphous character, and each glass was processed to present similar particle size and surface area. Glass characterization using x-ray photoelectron spectroscopy (XPS) and magic angle spinning nuclear magnetic resonance (MAS-NMR) determined that the addition of GeO2 increased the fraction of lower Q-speciation and subsequently the concentration of non-bridging oxygens (NBO). Glass Polyalkenoate Cements (GPC) were formulated from each glass with 40, 50 and 60 wt% PAA, and presented time dependent solubility profiles (1, 10, 100, 1000 h) for the release of Si4+ (4-140 mg/l), Ca2+ (1-8 mg/l), Zn2+ (<6 mg/l), Sr2+ (2-37 mg/l), PO43- (2-43 mg/l) and Ge4+ (20-911 mg/l) and attained pH values close to 7.5 after 1000 h. Ge-GPCs containing 40 wt% polyacrylic acid (PAA) presented appropriate working time (Tw) and setting times (Ts), and the corresponding compressive strengths ranged from (14-30 MPa). The Ge-GPCs (40, 50 wt%) presented a linear increase (R2-0.99) with respect to time. Simulated Body Fluid (SBF) testing resulted in the Ge-GPCs encouraging the precipitation of crystalline hydroxyapatite on the GPC surface, more evidently after 100 and 1000 h incubation.

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We present a 64-year-old patient with a 9-cm firm, irregular penile mass associated with phimosis, erectile dysfunction, and voiding difficulty. After he reluctantly admitted to multiple penile mineral oil self-injections for enlargement, surgical excision was performed. Pathologic examination was consistent with mineral oil granuloma (paraffinoma). Within several weeks after surgery, his erectile dysfunction and voiding complaints resolved. Paraffinomas have been encountered with the use of various oily substances injected for cosmetic purposes. Despite early warnings, these agents continued to be used to treat conditions ranging from hemorrhoids to wrinkles and even baldness. Fortunately, most of these fads have been abandoned by medical professionals, but the complicating lesions have been documented as having lag times as long as 30 years. Complete surgical excision remains the treatment of choice to prevent recurrence. Increased public awareness is needed for the prevention of this physically and psychologically debilitating problem.

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Little research has been performed to evaluate factors that may exacerbate perineal skin injury in the adult population. But extensive research has been done and knowledge has been gained from studies with diaper dermatitis in infants. Our objectives in writing this article are to define the anatomical area affected, the terms used, and to review the available literature for diaper dermatitis in infants, elucidating the similarities and differences between diaper dermatitis in infants and perineal dermatitis in adults. The six extrinsic environmental factors that have been identified and extensively studied in diaper dermatitis are skin wetness, urine, ammonia, feces, local skin pH and microorganisms. Although the complex interactions of the six factors are still not totally defined, we do know that to prevent perineal skin injury, it is helpful to prevent excessive skin hydration, minimize the interaction of urine and feces, minimize local microorganisms, and maintain skin near its physiologic pH. In general, the six extrinsic factors can be extrapolated and applied to the care of adults. Further research in adult fecal enzymes and pH is still necessary.

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We have studied human Thy-1 and T-cell receptor (TCR) antigen expression in mycosis fungoides and benign inflammatory dermatoses. The study included 24 biopsy specimens from 21 patients with mycosis fungoides (nine patch stage from eight patients, 13 plaque stage from 11 patients, and two tumor stage from two patients), six specimens from five patients with premycotic parapsoriasis (pre-mycosis fungoides), three specimens from three patients with lichen planus, 11 specimens from 11 patients with lupus erythematosus, 13 specimens from 13 patients with dermatitis, six specimens from six patients with drug eruptions, nine normal skin specimens from nine subjects, and three specimens from three patients with small plaque (benign) parapsoriasis. Immunoperoxidase studies using the avidin-biotin complex technique on serial frozen sections were performed. Primary antibodies were anti-human Thy-1, anti-alpha heterodimer of the TCR, anti-beta heterodimer of the TCR, and anti-delta heterodimer of the TCR. An extensive dendritic network of Thy-1+ cells was seen in all cases of mycosis fungoides. Epidermotropic cells were Thy-1 negative, and Thy-1 was expressed perivascularly in normal individuals and patients as previously reported. Epidermal gamma/delta cells were seen only in mycosis fungoides, where up to 60% of the epidermal lymphocytes expressed this TCR. The increased numbers of Thy-1 and gamma/delta T cells in mycosis fungoides were statistically significant when compared with normal skin or benign inflammatory dermatoses. The role of these dendritic dermal Thy-1+ cells and epidermal gamma/delta T cells in mycosis fungoides is unclear. The significant numbers of these potentially immunomodulating cells that were seen suggest that they are involved in the pathogenesis of mycosis fungoides.

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Basal cell carcinoma is the most commonly diagnosed malignant skin tumor. It is found most frequently on sun-exposed skin. There is a higher incidence of basal cell carcinoma in white skin than in black skin. We report the thirteenth case of basal cell carcinoma on the penis. To our knowledge, this is the first reported such case in a black patient.

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A number of surgical modalities, including the CO2 laser, have been advocated for the treatment of rhinophyma. The CO2 laser has been extensively promoted for the management of many skin lesions, including warts, keloids, and various nail problems. In many instances it has been suggested that the CO2 laser holds a distinct advantage over other surgical modalities. Three patients with rhinophyma are presented. Results are compared after treating one half of the nose with biterminal electrocutting current and the other half with the beam of the CO2 laser.

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Reflections from instruments in the surgical field involving the CO2 laser beam present a serious ocular hazard. In addition to the use of plastic or glass protective eyewear, this hazard can be minimized by utilizing anodized instruments and recognizing the specific distances at which various reflections are no longer hazardous depending upon certain variables, including laser output wattage, emergent beam lengths, and surface characteristics of the reflecting instruments.

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Basic surgery of the mouth has been described. Surgery of the anterior one third to one half of the mouth is relatively easy to perform. The patient's medical history, an understanding of the anatomy and histopathology of the oral mucosa, and special instrumentation and techniques are essential to performing oral surgery.

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From Orentreich's initial studies of the donor and recipient dominance of disease and of dermatologic conditions and his translation of those observations into punch-graft hair transplantation, a number of innovations in hair replacement have occurred. Many of these have been modifications and improvements of punch-graft techniques. Others have had major impacts on the treatment of baldness, such as flaps, scalp reduction, and tissue expansion. It is the combination of techniques, especially tissue expansion and punch-graft transplantation, that seems to hold the greatest promise for surgical treatment of baldness. Whether the hair replacement surgeon performs all of these procedures or not, he or she must be aware of the benefits of all of them and take them into consideration in developing a total plan for the individual patient. The hair transplant surgeon must also be aware that procedures desirable during the earlier stages of baldness may need to be modified with other types of surgery later in life as the alopecia becomes more developed, especially in the face of imprecise genetics in male-pattern baldness. The hair replacement surgeon not only must be aware that such modification may be necessary, but also must be knowledgeable about what those options entail. For example, tissue expansion may be a desirable adjunctive treatment with progression of baldness and would be possible if the parietal area has not been extensively harvested for punch grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

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A 70-year-old man presented with an enlarging, recurrent tumor of the left buttock which, on initial biopsies, was interpreted as a histiocytic malignant lymphoma. Further biopsies showed numerous monomorphic, hyperchromatic, noncohesive cells, arranged in compact sheets, throughout the dermis, the fat, and the underlying muscle. Neuron specific enolase stain for neuroendocrine granules was positive. Electron microscopy showed cytoplasmic perinuclear microfilaments and round membrane-bound dense core granules. The histologic, enzymatic, and ultrastructural findings confirmed the diagnosis of Merkel cell carcinoma. Early diagnosis and treatment are imperative for a favorable outcome.

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We reviewed longitudinal nail biopsies performed at Henry Ford Hospital on patients with acquired nail dystrophies to see whether the procedure did, indeed, provide useful diagnostic information and to see which microscopic features were most helpful in histopathologic diagnosis. Clinical diagnoses included psoriasis, lichen planus, Darier's disease, isolated longitudinal defects, and diffuse thickening. We found that clinical diagnosis could be supported by histopathologic findings in eight of twenty cases of acquired nail dystrophy. Specifically, we were able to make a diagnosis of psoriasis in four cases, lichen planus in three cases, and Darier's disease in one case. The other twelve cases showed nonspecific eczematous changes. We conclude that the longitudinal nail biopsy may be a useful diagnostic tool in certain cases of acquired nail dystrophy.

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Chronic skin ulcers, which are frequently located on the lower legs, are a common cause of patient morbidity and incur significant direct and indirect costs in their treatment. The most important process for their development is probably impairment of blood flow to the capillaries and small vessels. Examples of such ulcers are illustrated and some of their causes discussed. The milieu in which chronic skin ulcers develop is usually very different from those conditions in which biosynthetic dressings have been more extensively tested; nonetheless, the use of these dressings to treat such lesions is currently being evaluated. The successful treatment of chronic skin ulcers rests on four basic principles: (1) treatment of pathogenetic mechanisms, (2) correction of physiologic alterations, (3) treatment of contributing factors, such as infection, and (4) additional treatment to promote healing. The use of biosynthetic dressings on chronic skin lesions appears to result in a more rapid epithelialization and a reduction of pain, thereby satisfying the fourth principle. The management of the other principles, as well, is necessary to achieve a maximal rate of healing with chronic skin ulcers.

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Although its etiology remains unknown, evidence has accumulated to support an autoimmune pathogenesis for alopecia areata. Our review summarizes the immunologic data and also examines the role of genetics, atopy, and psychologic stress in this disorder. Until etiology is better understood, treatments for alopecia areata are likely to remain palliative. Nevertheless, newer therapies such as photochemotherapy, topical immunotherapy, and perhaps systemic immunotherapy (e.g., inosiplex) offer new hope for patients with extensive disease.

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A new case of congenital self-healing reticulohistiocytosis was studied with S-100 antibody and electron microscopy. Many tumor cells were S-100-positive and contained Langerhans cell (LC) granules and concentrically laminated dense bodies. Octopus-like bodies and wormlike bodies were also found. The formation of LC granules at the cytomembrane was frequently found, not only between the cytomembrane and its own villi, but also between the cytomembranes of adjoining cells. These findings strongly support the cytomembrane origin of LC granules in general.

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Injectable collagen implant (ICI), a new biomaterial reportedly useful for correction of scars and certain aging skin lines (wrinkles), was recently introduced. The purpose of this paper is to evaluate the safety and efficacy of this product. Data for this study were obtained from a survey which was sent to a group of cutaneous surgeons. They were asked about test site and treatment site reactions and about their satisfaction with ICI. The incidence of adverse reactions is low, and the severity of the reactions does not appear to be serious. The long-term benefit of ICI has not been established.

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