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Journal of the American Academy of
The first pat ient was 57 years old when seen and had burned his legs 37 years previously . Several calcium
part icles were removed f rom the ulcer and then it healed. A second patient seen by them was 36 years of age. This pat ient had burned his legs at the age of 9 and had deve loped mul t ip le ulcers on the burn site. Approx- imate ly eleven pieces of calcium were removed from the ulcer. 4
Hogan and Conway a descr ibed a 58-year-old woman with th i rd-degree burns oll the lower back, buttocks, and poster ior aspect o f the thigh. She had burned her- self at the age of 8. She developed an ulcer in the burn scar that was treated b y excis ion and grafting 15 years prior to being seen by them. She consulted them be- cause o f sinus tract format ion over the left ischial tuberosi ty and the r ight buttock. X-ray examination showed calcif ication in the affected area. The area was excised and the wound healed. Hogan and Conway referred to four other cases in the li terature in which bone format ion occurred in burn scars that had occurred
30 to 38 years previously . In our case we thought tha t local injection of triam-
c inolone might help heal the ulcer. The rationale for this is that it m a y inhibit f ibroblast act iv i ty and decrease inf lammat ion. 6 However , it was not effective.
The patient did not want to have the smaller calcium particle excised from her leg and thus it was left intact in the burn scar. It is very possible that at some later date this particle will cause another ulcer to form.
Ralph J. Coskey, M.D. 23133 Orchard Lake Rd., Farmington, 341 48024
Amir H. Mehregan, M.D. 1314 N. Macomb, Box 360, Monroe, MI 48161
REFERENCES l. Raimer SS, Archer ME, Jofizzo JL: Metastatic calcinosis
cutis. Cutis 32:463-483, 1983. 2. Redmond WJ, Baker SR: Keloidal calcification. Arch
Dermatol 119:270-272, 1983. 3. Mehregan AH: Calcinosis cutis. A review of the clinical
forms and report of 75 cases. Semin Dermat 3:53-61, 1984.
4. Beninson J, Morales A: Subcutaneous calcification in leg ulcers. Arch Dermatol 90:314-318, 1964.
5. Hogan VM, Conway H: Calcification in burn scars. Plast Reconstr Surg 33:559-563, 1964.
6. Lee SS, Felsenstein J, Tanzer FR: Calcinosis cutis cir- cumscripta. Treatment with intralesional corticosteroid. Arch Dermatol 114:1080-1081, 1978.
Tubulo-interstitial disease in lupus nephritis. A morphometric study
Magil A B , Ty le r M: His topa thology 8:81-87, 1984
To test the hypothesis that the damage in lupus nephritis is due directly to the deposition of immune complexes, these pathologists studied forty-three selected samples of kidney. They conclude that the hypothesis is not sustained, but that other mechanisms must account for the morphologic destruc- tion seen in these kidneys.
Myocardial depression in streptococcal cellulitis
Edwards JD, Schofield PM: Br Med J [Clin Res]
Streptococcal cellulitis can be a remarkably risky disease, as in this case of a woman who developed the infection after a minor laceration near the knee. Profound hypotension was sustained for 4 days, and the methods of inotropic support are described. She recovered.
Treatment of condylomata acuminata with the carbon dioxide laser
Grundsell H, Larsson G, Bekassy Z: Br J Obstet Gynaecol 91:193-196, 1984
Perhaps the most expensive treatment of condylomata acuminata, the laser, was credited with the cure of 91% of these gynecologic warts, but the follow-up extended to 33 months. A good study of the natural history of condyloma is lacking.
A double blind trial of H1 and H2 receptor antagonists in the treatment of atopic dermatitis
Frosch PJ, Schwanitz HJ, Macher E: Arch Dermatol Res 276:36-40, 1984
In this tidy study of chIorpheniramine and cimetidine in various combinations with placebo, the conclusion follows that the combination of H1 and H2 receptor offers no advan- tage in the treatment of atopic dermatitis.