Red Streaks Research Articles

292 Deletion of RNA-Binding Protein HuR in Intestinal Epithelial Cells Delays Mucosal Repair After Ischemia/Reperfusion-Induced Injury

Acute gut mucosal injury occurs commonly during critical pathological conditions, leading to mucosal hemorrhage, epithelial barrier dysfunction, and the translocation of luminal toxic substances and bacteria to the blood stream, but the exact mechanism underlying mucosal injury/repair are still obscure. RNA-binding proteins (RBPs) posttranscriptionally regulate gene expression and are implicated in many aspects of pathophysiology. HuR is among the most prominent sequence-specific RBP and has emerged as a master regulator of the maintenance of the homeostasis of gut mucosa. Our previous studies show that HuR regulates intestinal epithelial cell proliferation and apoptosis, but the exact role of HuR in gut mucosal repair after injury remains unknown. This study tested the hypothesis that HuR plays a role in intestinal mucosal repair after ischemia/reperfusion (I/R)-induced Injury.Methods: Studies were conducted in our recently generating intestinal epithelial tissue-specific HuR knockout (IE-HuR-/-) mice and wild-type littermates. Mucosal injury was induced by exposed to 30min of mesenteric ischemia, followed by 2-h reperfusion. Barrier function was detected by paracellular tracer flux assay using FITC-dextran. Results: The mucosa of the animals subjected to mesenteric I/R displayed signs of remarkable damage. Macroscopically, the intestines of the animals exposed to I/R exhibited swollen and edematous with areas of red streaks in both littermates and IE-HuR-/animals. Microscopic analysis showed that there were severed damages in the small intestinal mucosa as indicated by sloughed cells, denuded villi with dilated capillaries, and frank hemorrhage. Although there were no significant differences in the injury scores between littermates and IE-HuR-/mice when measured immediately after I/R, HuR deletion delayed the process of early mucosal repair after I/Rinduced injury. The mucosal surface remained discontinuous, showing sloughed cells and debris in IE-HuR-/mice (injury score: 3.3 ± 0.12) 6 h after I/R, whereas the mucosa in littermates was almost completely recovered (0.2 ± 0.03). Both littermate and IE-HuR-/mice exhibited significant gut barrier dysfunction after I/R-induced injury, but increased levels of gut permeability in IE-HuR-/mice were much greater than those observed in littermates. The recovery of gut barrier function after I/R was also inhibited by HuR deletion. Moreover, expression of the Wnt co-receptor LRP6 and ARP2 in the intestinal mucosa of HuR-/mice decreased dramatically, which are necessary for normal mucosal repair after injury. Conclusions: These results indicate that 1) HuR is crucial for maintenance of normal gut mucosal epithelial integrity and 2) HuR deletion in intestinal epithelial cells delays mucosal repair and represses the recovery of gut barrier function after I/R-induced mucosal injury.

The reason for red streaks on dermoscopy in the distal part of a subungual hemorrhage.

The reason for red streaks on dermoscopy in the distal part of a subungual hemorrhage.

What’s My Line? Red Streaks in Pediatric Patients

What’s My Line? Red Streaks in Pediatric Patients

FIRE BLIGHT: FIRST REPORT IN LATIUM, ITALY

Fire blight, caused by Erwinia amylovora, a major pathogen of pome fruits and many ornamentals, included in the EPPO A2 list of quarantine organism, was detected in 1990 in the main pome fruit-growing areas of Italy, including Emilia-Romagna where, since 1994, it spread rapidly causing epidemic outbreaks in 1997-1998. In October 2012, during the official monitoring made by the regional Plant Protection Service (PPS), a sample was collected in a nursery in Viterbo province (Latium, central Italy) from a quince plant showing shoot tips withered in the typical 'shepherd’s crook', blackish-brown discoloration of the cortex which, when removed, disclosed the typical red streaks. Following isolation on nutrient sucrose agar (NSA) levan-positive colonies were obtained and purified. The bacterial isolates did not produce fluorescent pigment on CSGA, induced hypersensitive response in tobacco leaves and were oxidase-negative. One isolate (CRA-PAV 1751) was lyophilized and conserved. Specific PCR protocols (Bereswill et al., 1992; Llop et al., 2000; Taylor et al., 2001) yielded amplicons of the expected size. Rep-PCR (using BOX and ERIC primers) fingerprinting pattern was similar to that of the reference strain OMP-BO 1077/7. Pathogenicity tests on immature pear fruits and re-isolation were performed successfully. This is the first report of E. amylovora from Latium, which was declared as "protected zone" by EU Directive 2000/29/EC. Following our finding, the regional PPS has adopted all the measures required by the Ministerial Decree 10/9/99 No. 356, to restrain the spread of the pathogen. This highlights the importance of healthy nursery productions, especially for pathogens like E. amylovora for which prevention is the main control strategy, given that no effective chemical or integrated control methods are available.

First Report of Sugarcane Leaf Scald in Gabon Caused by a Highly Virulent and Aggressive Strain of Xanthomonas albilineans.

During a disease inspection at the sugarcane estate SUCAF near Franceville, Gabon, in March 2011, 0.5 to 1 cm wide chlorotic stripes covered with many small red streaks were observed on sugarcane (Saccharum spp.) leaves of a single plant of cultivar R581. After removal of the leaves covering the base of the stalks, abnormal development of basal side shoots was also observed. Transversal sections of a diseased stalk showed reddening of the vessels near the nodes. Circular, convex, smooth, shiny, translucent, non-mucoid, honey-yellow pigmented bacterial colonies were isolated from stalk pieces and side shoots on XAS selective agar medium (1). The nucleotide sequence of the 16S-23S internal transcribed spacer (ITS) of a representative colony was shown to be 100% identical to the 16S-23S ITS sequence from the genome of Xanthomonas albilineans strain GPE PC73 (GenBank: FP565176.1). This strain from Gabon was named GAB266. Sugarcane stalks of greenhouse grown cultivar CP68-1026 were inoculated with X. albilineans strains XaFL07-1 from Florida, GPE PC73 from Guadeloupe, and GAB266. Five stalks were inoculated by the modified decapitation method (3) with each strain or with a water control. One month post-inoculation (MPI), white pencil lines and severe necrosis were observed on leaves inoculated with strains XaFL07-1 and GPE PC73, and no disease symptoms appeared on non-inoculated leaves that developed 2 to 3 MPI. These results are in agreement with those generally obtained after inoculation of susceptible sugarcane cultivars with X. albilineans strains from various geographical locations under greenhouse conditions (Rott, unpublished results). In contrast, 1 MPI, only discrete white to red pencil lines were observed along with necrosis on leaves inoculated with strain GAB266, and by 2 to 3 MPI, all five inoculated plants were wilted. The pathogen was successfully reisolated by the stalk blot inoculation technique (3) with XAS medium, from all five inoculated stalks and from 98 of 114 internodes. In a second greenhouse experiment, the same three strains of X. albilineans were inoculated as described above into five sugarcane cultivars differing in resistance to leaf scald in Guadeloupe (2) (CP68-1026, highly susceptible; B69566, susceptible; R570, tolerant; B8008, resistant; Co6415, highly resistant). The same symptoms as those described above were again observed on inoculated leaves of the five sugarcane cultivars 1 MPI. Strains XaFL07-1 and GPE PC73 produced occasionally a single pencil line on non-inoculated leaves 2 to 3 MPI, but only strain GAB266 caused leaf scalding and/or plant death 2 to 3 MPI: cultivar CP68-1026 (5 of 5 plants), B69566 (5 of 5 plants), R570 (4 of 5 plants), B8008 (5 of 5 plants), and only non-inoculated leaves of cultivar Co6415 remained symptomless (5 plants). Strain GAB266 from Gabon appeared, therefore, more virulent and aggressive than the two strains of X. albilineans from Florida and Guadeloupe. To our knowledge, this is the first report of leaf scald of sugarcane in Gabon and the first description of an unusual highly virulent and aggressive strain of X. albilineans. A large-scale survey needs to be undertaken to determine the distribution of leaf scald disease and this new pathotype/race of X. albilineans in Gabon and other geographical locations.

Finding the Silver Lining: Hair, (Mixed) Race, and Identity Politics in Toni and Slade Morrison’s Little Cloud and Lady Wind

Finding the Silver Lining:Hair, (Mixed) Race, and Identity Politics in Toni and Slade Morrison’s Little Cloud and Lady Wind Sika A. Dagbovie-Mullins (bio) raincloudswe arenaturenaturenaturenatural!!!black people, we raincloudscloser to the sun and full of life. —Marvin Wyche Jr., “We Rainclouds” (1974) As a little girl I dreamed freely, often on the top step of the back porch—morning, noon, sunset, deep twilight. I loved clouds, I loved red streaks in the sky. I loved the gold worlds I saw in the sky. Gods and little girls, angels and heroes and future lovers labored there, in misty glory or sharp grandeur. —Gwendolyn Brooks, Report from Part One (1972) In Happy to Be Nappy (1999), bell hooks describes black girls’ unprocessed hair as “soft like cotton, flower petal billowy soft, full of frizz and fuzz.” In addition to being described as puffy, spongy, kinky, crinkly, wooly or cotton-like, “natural” unprocessed hair is often associated with clouds. “Flower petal billowy soft” immediately evokes the image of lightness but also brings to mind billow clouds, layers of water vapor that create fluffy wave-like patterns in the sky. The trope of black-hair-as-clouds is especially noticeable in descriptions of black hair in twentieth-century [End Page 173] African American literature. In Jessie Redmon Fauset’s “Double Trouble” (1923), Angelique shakes her “short, black, rather wiry hair til it misted like a cloud” (32); Fran Ross’s mixed race protagonist in Oreo (1974) is told: “Kinky hair—like that beautiful fuzzy cloud you have—is not really kinky” (49); in Paule Marshall’s Praisesong for the Widow (1983), Avey Johnson’s daughter’s hair “had stood massed like a raincloud about to make good its threat” (13); in Dorothy West’s The Wedding (1995), Clark Cole thinks of his mistress: “There is no beauty like that of a brown skinned woman when she is beautiful: the velvet skin, the dark hair like a cloud” (97); and in John Edgar Wideman’s Hiding Place (1998), Tommy’s hair is described as, “[c]ombed so high it’s a cloud over his head, a bushy cloud making him taller than his brothers” (77). Toni and Slade Morrison’s children’s book Little Cloud and Lady Wind (2010), illustrated by Sean Qualls, focuses on a young female cloud whose image appears as a black or biracial girl; she sports a giant blue Afro (cloud), striking feature and a continuation of the hair/cloud analogy. In fact, some of Morrison’s novels also equate African American hair with clouds. In Tar Baby after Jadine complains about the effect of the island’s foggy weather on her hair, “[s]he pressed her hair down with both palms, but as soon as she removed them her hair sprang back into a rain cloud” (Morrison, Tar Baby 64) and in Love, the narrator, L, describes the transition black hair goes through when wet as she recounts the actions of a woman on the beach: “Her hair, flat when she went in [the water] rose up slowly and took on the shape of the clouds dragging the moon” (Morrison, Love 106). Little Cloud’s hair and her lavender tan skin act as racial signifiers in this children’s book about independence, belonging, and community. In the beginning of the story, Little Cloud separates from the other clouds, “not wanting to blend into a group and lose her freedom, [but] not wanting to frighten the earth” (Toni and Slade Morrison). A visit from Lady Wind shows Little Cloud that her cloud duties of providing mist and dew are important, teaching her to respect both her individuality and restoring her place in the sky community. The story is reminiscent of Eric Carle’s Little Cloud (1996), which also features a “Little Cloud” that chooses independence: “The clouds pushed upward and away. Little Cloud pushed downward and touched the tops of horses and trees” (Carle). Toni and Slade Morrison’s book seems to signify on this Little Cloud predecessor who does not take a human form (and thus remains a white cloud). On one level, Little Cloud and Lady Wind encourages children to...

Superficial Lymphangitis after Insect Bite

A 10-year-old girl was referred to our department for the evaluation of a ‘bizarre’ pruritic linear eruption of the anterior wall of the trunk that appeared 1 day after an insect bite on the abdomen. Physical examination showed 2 bilateral and symmetric red streaks starting from round erythematous macule of the abdomen and extending toward the axillary folds, disposed in a V-shaped fashion (Figure 1). Neither fever nor lymph node enlargement were present. Dermoscopy of the main erythematous macule showed the presence of a centered hemorrhagic and crusted punctum (Figure 2), compatible with the insect bite.

Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: A multicenter prospective study

Endoscopic features corresponding to pathological findings in the Sydney System have not been identified, and endoscopic diagnosis of chronic gastritis has not yet been established. To establish the diagnosis of Helicobacter pylori (H. pylori) infection in gastric mucosa by endoscopic features, a prospective multicenter study was carried out. Two hundred and ninety-seven registered patients from 24 facilities between March 2008 and February 2009 were enrolled. Association between endoscopic findings (conventional findings and indigocarmine contrast (IC) method findings) and diagnosis of H. pylori infection made by microscopic observation of biopsy specimens was investigated in the corpus and antrum and their diagnostic accuracies were investigated. Two hundred and seventy-five patients were analyzed. The area under the receiver operating characteristic (ROC) curve for H. pylori infection of conventional endoscopy was 0.811 in thecorpus and 0.707 in the antrum (P = 0.006). Evaluation of diffuse redness, spotty redness and mucosal swelling by conventional endoscopy and swelling of areae gastricae by the indigocarmine contrast (IC) method were useful for diagnosing H. pylori infection. Regular arrangement of collecting venules (RAC) in the angle, fundic gland polyposis, hemorrhagic erosion and bleeding spot in the corpus and red streaks, and erosions (flat, raised, hemorrhagic and bleeding spot) in the antrum may be used as diagnostic features suggesting negative H. pylori infection. It is suggested that endoscopic diagnosis of H. pylori infection in gastric mucosa by conventional endoscopy and the IC method is mostly possible.

Topical preparations for preventing stretch marks in pregnancy.

Striae gravidarum (stretch marks developing during pregnancy) occur in 50% to 90% of women. They appear as red or purple lines or streaks that fade slowly to leave pale lines or marks on the skin. The abdomen, breasts and thighs are commonly affected. The exact cause of stretch marks is unclear and no preparation has yet been shown to be effective in preventing the development of stretch marks. They are a source of significant anxiety for women, impacting on their quality of life. To assess the effects of topical preparations on the prevention of stretch marks in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011) and reference lists of retrieved reports. We included randomised controlled trials and quasi-randomised controlled trials comparing topical preparations (with active ingredients) with other topical preparations (with active ingredients), with a placebo (that is, preparations without active ingredients) or with no treatment for the prevention of stretch marks in pregnant women. Three review authors independently assessed trial eligibility and trial quality, and extracted data. Data were checked for accuracy. The primary outcome was the presence of stretch marks and the secondary outcome was the severity of stretch marks. We included six trials involving 800 women. Of the six trials, we judged the risk of bias for three as 'low risk' for random sequence generation, blinding of participants and personnel, blinding of outcome assessment, completeness of outcome data and selective reporting.There was no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received a placebo or no treatment (average risk ratio (RR) 0.74; 95% confidence interval (CI) 0.53 to 1.03; five trials, 474 women; random-effects model, Tau² = 0.09, I² = 65%) (Analysis 1.1).Results were consistent with the main effects when we performed a sensitivity analysis excluding studies judged to be at high risk of bias for random sequence generation, allocation concealment or more than 20% missing data for a given outcome (average RR 0.81; 95% CI 0.60 to 1.10; four trials, 424 women; random-effects model, Tau² = 0.05, I² = 57%).The was no statistically significant average mean difference in the severity of stretch marks (standardised mean difference (SMD) -0.31; 95% CI -1.06 to 0.44; two trials, 255 women; Tau² = 0.26, I² = 87%).There was no statistically significant difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received other topical preparations with active ingredients (average RR 0.51; 95% CI 0.16 to 1.60; two trials, 305 women; Tau² = 0.53, I² = 74%). There was no statistically significant difference in the severity of stretch marks (mean difference (MD) -0.20; 95% CI -0.53 to 0.13; one trial, 206 women; heterogeneity not applicable). We found no high-quality evidence to support the use of any of the topical preparations in the prevention of stretch marks during pregnancy. There is a clear need for robust, methodologically rigorous randomised trials involving larger sample sizes to evaluate the effects of topical preparations on the development of stretch marks in pregnancy. In addition, it is important that preparations commonly used by women to prevent and treat stretch marks are evaluated within the context of robust, methodologically rigorous and adequately powered randomised trials.

Betta mahachaiensis, a new species of bubble-nesting fighting fish (Teleostei: Osphronemidae) from Samut Sakhon Province, Thailand

Betta mahachaiensis, a new species of fighting fish belonging to the Betta splendens group, is described. The fish inhabitsspecifically sites with brackish water and nipa palms in the Samut Sakhon Province, Thailand. It is distinguishable from othermembers of the B. splendens group in having an iridescent green/bluish-green appearance on the brown-to-black bodybackground. The opercular membrane has brown-to-black colour without red streaks or patches. The opercle has two paralleliridescent green or bluish-green vertical bars. Its dorsal, caudal, and anal fin rays are brown to black, contrasting with theiridescent green or bluish-green of the interradial membrane. Black transverse bars are present on at least the proximal two-thirds of the dorsal fin, but not on the caudal fin. The colour of the pelvic fins is brown to black with an iridescent green/ bluish-green front margin and a white tip. Females possess similar characters but are less colourful than males.

Raberite, Tl5Ag4As6SbS15, a new Tl-bearing sulfosalt from Lengenbach quarry, Binn valley, Switzerland: description and crystal structure

AbstractRaberite, ideally Tl5Ag4As6SbS15, is a new mineral from Lengenbach quarry in the Binn Valley, Valais, Switzerland. It occurs very rarely as euhedral crystals up to 150 m m across associated with yellow needle-like smithite, realgar, hatchite and probable trechmannite, edenharterite, jentschite and two unidentified sulfosalts. Raberite is opaque with a metallic lustre and has a dark brown–red streak. It is brittle with a Vickers hardness (VHN10) of 52 kg mm–2 (range 50–55) corresponding to a Mohs hardness of 2½–3. In reflected light raberite is moderately bireflectant and very weakly pleochroic from light grey to a slightly greenish grey. It is very weakly anisotropic with greyish to light blue rotation tints between crossed polars. Internal reflections are absent. Reflectance percentages for the four COM wavelengths [listed as Rmin, Rmax, (λ)] are 30.6, 31.8 (471.1 nm), 28.1, 29.3 (548.3 nm), 27.1, 28.0 (586.6 nm), and 25.8, 26.9 (652.3 nm).Raberite is triclinic, space group P1, with a = 8.920(1), b = 9.429(1), c = 20.062(3) Å, α = 79.66(1), β = 88.84(1), γ = 62.72(1)º, V = 1471.6(4) Å3 and Z = 2. The crystal structure [R1 = 0.0827 for 2110 reflections with I > 2σ(I)] consists of columns of nine-coordinate Tl atoms forming irregular polyhedra extending along [001] and forming sheets parallel to (010). The columns are decorated by cornersharing MS3 pyramids (M = As, Sb) and linked by AgS3 triangles. Of the seven M positions, one is dominated by Sb and the others by As; the mean M-S bond distances reflect As ↔ Sb substitution at these sites.The eight strongest lines in the powder diffraction pattern [dcalc in Å (I) (hkl)] are: 3.580 (100) (13); 3.506 (58) (23); 3.281 (73) (006); 3.017 (54) (3); 3.001 (98) (133); 2.657 (51) (226); 2.636 (46) (300); 2.591 (57) (330). A mean of 9 electron microprobe analyses gave Tl 39.55(13), Ag 18.42(8), Cu 0.06(2), As 17.08(7), Sb 5.61(6), S 19.15(11); total 99.87 wt.%, which corresponds to Tl4.85Ag4.28Cu0.02As5.72Sb1.16S14.97 with 31 atoms per formula unit. The new mineral has been approved by the IMA-CNMNC Commission (IMA 2012-017) and is named for Thomas Raber, an expert on Lengenbach minerals.

Pregnancy‐associated acquired arteriovenous malformation of the nail unit: a novel cause of localized erythronychia

Localized longitudinal erythronychia describes a solitary red streak limited to a single nail unit. Localized longitudinal erythronychia can be caused by both benign and malignant entities. Most commonly, the cause is a benign process, such as an onychopapilloma. We report a case of an acquired subungual arteriovenous malformation that presented as localized longitudinal erythronychia during pregnancy. To our knowledge, this is the first report of localized longitudinal erythronychia arising from a pregnancy-associated arteriovenous malformation of the nail unit.

Boundary zone between northern and southern pig-tailed macaques and their morphological differences

Based on previous conflicting reports that the two forms of pig-tailed macaque (northern and southern) exist as separate species, subspecies, or forms, and that their boundary zone lies in Thailand, a survey of the distribution range and morphology of pig-tailed macaques in Thailand was conducted during 2003-2010. We first conducted a questionnaire survey. Questionnaires were sent to 7,410 subdistricts throughout Thailand. We then traveled to 72 of the 123 subdistricts reporting the presence of pig-tailed macaques. However, due to a lack of reports of the presence of free-ranging pig-tailed macaques living south of the Isthmus of Kra, a survey of pet pig-tailed macaques was also conducted during 16-24 September 2011. Furthermore, 35 wild northern pig-tailed macaques inhabiting northern Thailand (13°13'N, 101°03'E) were temporarily caught and their morphological characters were measured and then compared to those of the southern form captured from Sumatra, Indonesia. Although largely allopatric, the ranges of the northern and southern pig-tailed macaques in Thailand were found to have a partially sympatric boundary at the Surat Thani-Krabi depression (8-9°30'N). Morphologically, these two forms were very distinctive, with different morphological characters such as the crown patch, the white color of the triangle above the eyes, the red streak at the external rim of the eyes, pelage color, ischial callosity, tail length and carriage, facial height, and limb length in both sexes, and patterns of sex skin swelling and reddening in females. These differences in morphological characters between the northern and southern forms should help settle the problems of their taxonomy.

Recent developments in gastroesophageal reflux disease and Barrett's esophagus: ANNO 2012

The incidence of gastroesophageal reflux disease (GERD) and esophageal columnar metaplasia is rising worldwide. Both mechanical and functional factors perturb the double sphincter barrier at the esophagogastric junction (EGJ). Discovery of the acid pocket is fundamental in understanding postprandial acid reflux. Adding impedencemetry to pH measurements allows detection of non-acid or weakly acidic reflux. Histologic and endoscopic injury of the squamous mucosa rises from dilation of the intercellular spaces, papillary extension, accentuated intrapapillary looping, red streaks, erosive tissue loss, etc., graded with the Los Angeles system. Seventy percent of patients have no recognizable abnormalities (non-erosive or neGERD). Treatment of GERD mainly relates to the control of acid secretion but a revival of alginate/antacid obliterating the acid pocket is to be expected. Weaker heartburn control in neGERD is a misnomer because most studies included patients with no evidence of reflux disease. Traditional (delayed-release) proton pump inhibitors (PPIs) are powerful suppressors of acid secretion but do have limitations such as gradual build up of acid control, weak control of nocturnal acid recovery, possibility of rebound, occasional need for dose escalation, etc. Barrett's esophagus (BE) is endoscopically diagnosed also in the absence of intestinal metaplasia. A prerequisite is the precise location of the EGJ (proximal end of gastric folds, esophageal sphincter pinch, distal extent of palisade vessels). BE is graded with the Prague C & M system. Barrett's cancer develops usually via low-grade and high-grade dysplasia. Endoscopic examination may indicate suspicious areas, amenable for targeted biopsy. Otherwise, four quadrant biopsies are obtained when searching for neoplasia. Low-grade dysplasia, especially when it is multifocal and p53 positive, high-grade dysplasia and mucosal cancer should be treated with endoscopic resection of the target area, followed by radiofrequency ablation of the adjacent non-neoplastic columnar mucosa, followed with powerful acid suppressant therapy. The long-term results of the combination of resection and ablation are exiting and at least comparable to surgical resection.

An investigation of striae distensae using reflectance confocal microscopy

Striae distensae, otherwise known as stretch marks, are white or red scar-like streaks on the skin. Although they are not associated with adverse health outcomes, striae are associated with significant cosmetic morbidity. While they have been well characterised histopathologically, a non-invasive method of microscopic lesion assessment of striae would be welcome. To gain insight into the small-scale morphological features associated with striae we undertook an in vivo investigation of nine patients with striae alba and one with striae rubra utilising reflectance confocal microscopy (RCM). Here we demonstrate that features known to be present using light microscopy, such as parallel collagen bundles in the dermis, and some features that are not well recognised by light microscopy, including distortion of dermal papillae, are demonstrable using RCM. Characterising the features of early and established striae distensae with confocal microscopy is an important foundation for future work. The potential ability to reliably identify the earliest pathological changes in skin in early lesions or before clinically manifest striae develop--a task facilitated by our findings--will increase the understanding of their pathogenesis and will have significant practical utility in monitoring the impact of future preventative interventions.

Acute lymphangitis in a preschool child: A case report

A 3-year old preschool boy presented with a pruritic red streak at the dorsum of his right foot traveling upward from the affected site which was red and swollen. Insect sting was the more likely trigger which had caused the cellulitis and subsequently the acute lymphangitis. IeJSME 2012 6(2): 46-48

A New Variety ofMusa itinerans(Musaceae) in Taiwan

Musa itinerans Cheesman var. formosana (Warb.) Häkkinen & C. L. Yeh is one of the three wild bananas in Taiwan and represents the taxon previously recognized as M. formosana (Warb. ex Schum.) Hayata [≡ M. basjoo Siebold & Zucc. ex Iinuma var. formosana (Warb. ex Schum.) S. S. Ying]. The gross morphology of M. itinerans var. formosana is stable. Some populations without variegation on the pericarps and the bracts of male buds were mainly found in a restricted area of northeast Taiwan. The morphological characteristics of the nonvariegated populations are otherwise similar to those of M. itinerans var. formosana. Their principal distinction is based on the absence of the purplish red streaking on both the pericarps and the male, fertile bracts. This character of nonvariegation is stable across the taxon's habitat and as cultivated through a 9-year period of observation. From molecular evidence, the DNA sequence for the ITS region of ribosomal DNA (rDNA) is highly similar in both populations. The nonvariegated population is herein segregated as the new variety, M. itinerans var. kavalanensis H. L. Chiu, C. T. Shii & T. Y. A. Yang. Photos for the three varietal taxa, M. itinerans var. chinensis, variety formosana, and variety kavalanensis, and a key to Taiwanese wild bananas are also provided.

Longitudinal Erythronychia

Longitudinal erythronychia is a linear red band on the nail plate that originates at the proximal nail fold, traverses the lunula, and extends to the free edge of the nail plate. Longitudinal erythronychia is classified based upon the number of nails affected and the number of red streaks present on each nail as follows: type Ia (monodactylous - single band), type Ib (monodactylous - bifid bands), type IIa (polydactylous - single band), and type IIb (polydactylous - multiple bands). Associated morphologic findings that can be present at the distal tip of the nail with longitudinal erythronychia include fragility, onycholysis, splinter hemorrhage, splitting, subungual keratosis, thinning, and V-shaped nick. Some patients with longitudinal erythronychia seek medical evaluation because of pain in the associated distal digit; however, the linear red nail plate dyschromia is often asymptomatic and the individual is concerned about the cosmetic appearance or distal nail fragility. Longitudinal erythronychia can be a clinical manifestation of an underlying local or systemic condition. Benign tumors (glomus tumor, onychopapilloma, and warty dyskeratoma), malignant neoplasms (malignant melanoma and squamous cell carcinoma), and other conditions (hemiplegia and postsurgical scar) can be associated with monodactylous longitudinal erythronychia or it may be idiopathic or the initial stage of polydactylous longitudinal erythronychia-associated systemic conditions. Polydactylous longitudinal erythronychia is most commonly reported in patients with Darier disease (keratosis follicularis); other associated conditions include acantholytic dyskeratotic epidermal nevus, acantholytic epidermolysis bullosa, acrokeratosis verruciformis of Hopf, amyloidosis, graft-versus-host disease, lichen planus, and pseudobulbar syndrome. Polydactylous longitudinal erythronychia has also been observed as an idiopathic finding. Biopsy of the nail matrix and nail bed may be necessary to establish the diagnosis of a longitudinal erythronychia-associated condition. Indeed, a biopsy should be seriously considered in patients aged more than 50 years who present with a monodactylous longitudinal red band to exclude squamous cell carcinoma. Treatment of longitudinal erythronychia depends on the etiology. For patients with longitudinal erythronychia-associated discomfort or severe nail splitting, a surgical excision may provide not only the underlying diagnosis of the nail dyschromia, but also relief of related symptoms.

Endoscopic treatment of antral vascular ectasia – nationwide multicenter survey. APC or ligation?

Introduction: Antral vascular ectasia is type of gastic vascular malformations, which can lead even to chronic iron-definciency anaemia or severe acute blood loss. About 30% of it can be observed in patients with liver cirrhosis, but there are a lot of other associated diseases (mainly autoimmune diseases) as well. The classic „watermelon“ type forms red streaking of the antrum with convergence at the pylorus with visible small, tortous vessels, but the diffuse form is similar to the antral gastritis. The severity of the disease is not associated with portal hypertension even in patients with cirrhosis. Effective medical treatment does not exist, therefore various endoscopic treatment modalities can be used. Aim: We sent a questionnary to major hungarian endoscopic centers to get information about endoscopic treatment of this rare entity. Patients & methods: We got data of 37 evaluable patients from 7 centers. 56% of them were women, the mean age was 67.2 (32–85) years. Liver cirrhosis was the underlying disease in 21 (56.8%) patients. Watermelon type was observed in 60% of all cases, while the occurence of diffuse form varied markedly between centers (0–70%). 30 patients were treated exclusively by argon plasma coagulation (APC), 6 patients were treated by ligation therapy (1 after unsuccessful APC therapies) and one patient had to be operated on in acute settings. Patients in APC group were treated at median 3 (1–20) sessions, the median number of ligation therapy was 1.5 (1–4). Results: In APC group two patients died, both due to hepatic coma, in 1 patient acute TIPS insertion had to be performed due to uncontrollable bleeding, but in the majority of remaining patients the intensity of blood loss, the need for further blood transfusion and hospitalisation decreased in followed ones. In 6 patients treated by ligation therapy 5 cases were evidently successfull with no further blood transfusion and hospitalisation in the follow up period of 3–24 months. Conclusion: The endoscopic treatment of antral vascular ectasia can be successfull for long term in majority of cases using APC or ligation therapy. Ligation therapy seems to be superior and more cost effective, but it needs further confirmation in larger group of patients.

Is a Red Umbilical Cord a Sign of Umbilical Venous Congestion?: A Case Report

Postnatal examination of fetal appendages is important because this information may help predict perinatal outcome. We present a case of a red streak along the entire umbilical vein after a cesarean section due to non-reassuring fetal status. The pathological findings revealed an umbilical cord with dilated vascular changes and mild funisitis. Because the dilated change was intense in the umbilical vein, the red streak of the umbilical cord was caused by venous congestion. Moreover, we considered that the umbilical venous congestion was due to increased resistance in the fetal intra-abdominal umbilical vein, which was associated with the non-reassuring fetal status.