Purpose. Primary acquired melanosis (PAM) is the name applied to flat, speckled, brown lesions of the conjunctival epithelium. Because there have been reports that many of these lesions progress to melanoma, biopsy of all PAM lesions, regardless of size, is recommended. This study was undertaken to determine the prevalence of PAM, provide a clinical description of the condition, and determine which factors are associated with its presence.Methods. One hundred forty-six consecutive patients, who were outpatients at a corneal and external diseases service, who had no known non-European ancestry, and who were older than 10 years of age underwent careful slit lamp examination.Results. The prevalence of PAM in the study population was 36%. Contrary to earlier reports, PAM is prevalent in young adults as well as in older patients. The presence of PAM was associated with southern European ancestry (P = 0.01), dark brown hair (P = 0.01), facial nevi (P = 0.03), pingueculae or pterygia (P = 0.01), hypertension (P = 0.02), cigarette smoking (P = 0.02), and the absence of ocular surface disease (P = 0.02).Conclusions. Because PAM is common, its transformation to conjunctival melanoma must be extremely rare, and biopsy of all PAM lesions is unwarranted. In the absence of known clinical risk factors for progression to melanoma, interim recommendations are made to perform biopsy only of those lesions that are widespread, large, thickened, dark, palpebral, unusually vascular, or progressive.
The use of theophylline and the β-adrenergic agents in the management of asthma has been widely established throughout the Western world. More recently, anticholinergic drugs have been introduced. Until now, prescribing habits have been determined by the availability of preparations as well as by any real differences in efficacy. The β2 agents which were confined to use in Canada, Europe, and Australasia are now established in the rest of North America. The development of reliable assays for serum theophylline concentrations has produced a large bank of pharmacokinetic data, allowing a more enlightened use of this drug. 1 Weinberger M. Theophylline for the treatment of asthma. J Pediatr. 1978; 92: 1-7 Abstract Full Text PDF PubMed Scopus (54) Google Scholar As experience with this group of drugs widens, new questions are being raised as to advantages of either form of therapy and the safety of combination therapy. More recently, development of ipratropium bromide has reawakened interest in the role of anticholinergic therapy for asthma.
A popliteal cyst, originally called Baker’s cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?
