C.T.K. Khoo

Angiolymphoid hyperplasia with eosinophilia associated with tetanus toxoid vaccination

Three cases of angiolymphoid hyperplasia with eosinophilia are reported at the site of tetanus toxoid vaccination. All presented as nodules on the upper arm, a known adverse effect of the vaccine following superficial inoculation. Histologically the nodules showed numerous small and medium sized vessels, some lined by hyperplastic endothelial cells with perivascular lymphocytic cuffing and an inflammatory infiltrate of plasma cells, eosinophils and scattered mast cells. Lymphoid follicles replete with germinal centres were identified in the dermis and subcutaneous tissue. Immunostaining revealed a polytypic lymphoplasmacytic infiltrate and a curious IgE reticulated pattern within the germinal centres, a feature described in both Kimuras disease and angiolymphoid hyperplasia. The present study suggests that atopic reaction to tetanus toxoid may be an aetiological factor in some cases of angiolymphoid hyperplasia.

Correction of developmental breast abnormalities with a permanent expander/implant

Patients with developmental breast abnormalities often present to the plastic surgeon at a young age. We report our experience with 4 cases of unilateral breast abnormality (3 hypoplastic and 1 tuberous) treated with a Becker permanent expander/implant. Our approach is to insert the expander/implant, expand intermittently to keep pace with growth of the other breast and remove the filling valve under local anaesthesia on maturity. The techniques and advantages of this approach are illustrated and discussed.

Tumour thickness in malignant melanoma: the limitations of frozen section.

This paper reports a prospective study to compare maximal tumour thickness values of the same lesion obtained by frozen and paraffin sections in 20 patients with malignant melanoma over a one-year period. Significant differences were found between tumour thickness values obtained by frozen section and paraffin section. There was no constant relationship between the two sets of values. As present prognostic and therapeutic criteria are based on tumour thickness measurements obtained from paraffin sections, we recommend that clinical decisions should not be based on results obtained from frozen sections.

No sense; no sensibility--a tale of two adult hairdrier burns.

Hot air burns resulting from hairdriers held against the skin are rare. The largest published clinical series relates to burns in children injured by the use of hairdriers at home. Adults are assumed not to be at risk because the pain associated with thermal injury would normally stimulate acute action to prevent further skin damage. We present two adult patients in whom the normal protective mechanisms were inactive. There was loss of consciousness resulting from an epileptic fit in one case, and the local absence of sensation in a flap used to reconstruct a breast after mastectomy, in the other. The temperatures generated by hairdriers were experimentally assessed and the results are reviewed. We emphasize that hairdriers are a potentially dangerous source of hot air and can cause burns.

Median cleft of the upper lip in association with bilateral hexadactyly and accessory toes

Abstract Median clefts of the upper lip are rare. A case is described in which a median cleft of the upper lip was associated with symmetrical bimanual hexadactyly and bilateral accessory toes. A thorough search of the literature has revealed two similar cases and it is suggested that the association is sufficiently constant to form a recognisable syndrome.

Rhinophyma in a negro: Case report

A case of rhinophyma in a negro patient is reported. The cause of rhinophyma and its association with acne rosacea is discussed. It is suggested that racial factors may be relevant in this incompletely understood condition.

The control of carotid arterial haemorrhage in head and neck surgery by balloon catheter tamponade and detachable balloon embolisation

Radical surgery in the neck is hazardous after irradiation. Rupture of the carotid artery may lead to uncontrollable haemorrhage. Reported mortality rates following this serious complication are between 18% and 50% (Heller and Strong, 1979). We describe a simple method for controlling acute carotid haemorrhage using a standard Fogarty biliary catheter, with selective detachable balloon embolisation for permanent occlusion of the carotid artery.

Subtotal premaxillectomy; a salvage procedure in selected cases of bilateral cleft lip and palate

Subtotal premaxillectomy with preservation of the posterior plate of the premaxilla and the premaxillary-vomerine suture line was carried out in six selected cases of severe bilateral cleft lip and palate between the ages of four and eight years. The long term results are shown and it is concluded that although the procedure does not seem to affect mid-facial growth adversely, it should be reserved for very selective cases and only as a last resort.

The pathogenicity of coagulase negative staphylococcus in the presence of silicone rubber implants

Coagulase negative staphylococci have long been thought to be harmless skin commensals. However they are now recognised as important pathogens in patients who have undergone insertion of prosthetic devices. We present three patients with infection following the insertion of silicone polymer prostheses, in whom a coagulase negative staphylococcus was the pathogen. All responded to antibiotic treatment. It is important to alert the bacteriologist to the presence of an implanted prosthesis when wound swabs are sent from an area showing clinical signs of infection. The coagulase negative staphylococci may otherwise be regarded falsely as merely skin contaminants.

A simple modification of the pin-prick test for the assessment of burn depth in children

The clinical assessment of burn depth can be particularly difficult in children. A new technique is described for applying the pin-prick test in children. It is simple to perform, causes no distress, and has consistently given reliable results. A personal series of 196 cases is presented, with a 95 per cent diagnostic accuracy.