YEW-OO TAN, M.B.B.S., ERCPC, AND SOON-TEE WONC, M.B.B.S., M.R.C.P.A 69-year-old Chinese man, with no past medical illness, presented in July 1989 with a 3-month history of upper abdominal discomfort. Clinical examinations revealed an enlarged palpable liver, 3 cm below the costal margin at the epigastrium. He was not jaundiced and there were no stigmata of chronic liver disease. Initial blood investigations showed urea nitrogen 3.6 mmol per L, Na 138 mmol per L, K 3.8 mmol per L, Cl 105 mmol per L, CO2 20.2 mmol per L, creatinine 83 mmol per L, glucose 4.3 mmol per L, unconjugated bllirubin 10 pimol per L, conjugated bilirubin 0 pmol per L, total protein 70 g per L, albumin 42 g per L, gammaglutamyltransferase 135 U per L, alanine aminotransferase 38 U per L, alkaline phosphatase 94 U per L, lactic acid dehydrogenase 478 U per L, HBsAg was positive and alphafetoprotein was 2.3 pg per L. Ultrasound and computerized tomography (CT) scans showed a hypoechoic lesion measuring 5 cm in diameter, in the left lobe of the liver. A CT-guided fine needle aspiration biopsy revealed a hepatocellular carcinoma. A left bepatectomy and cholecystectomy were performed and histology confirmed a moderately differentiated hepatocellular carcinoma (Fig. 1). Postoperatively, the patient was treated with epirubicin.In September 1991, he was treated for hypertension with enalapril maleate initially and nifedipine later because of a cough with enalapril. He subsequently developed a generalized itch after 4 weeks of nifedipine. The itch continued despite stopping the medication. Liver function tests done then showed no evidence of obstructive jaundice. The total bilirubin was 18 pmol per L, conjugated bilirubin 0 pmol per L, and serum alkaline phosphatase 73 U per L. He was subsequently treated by a private dermatologist for scabies with Eurax cream and topical steroids.Three months later the patient developed severe pruritic nodular eruptions over his hand, trunk, and feet (Fig. 2). Clinical examination revealed erythematous papules with excoriation marks over the involved areas. No jaundice was noted. The dermatologic lesions resembled scabies and he was treated with malathion lotion with no improvement. Skin scrapings for scabies were negative. Biopsies of the skin lesions were performed and a diagnosis of acquired perforated dermatosis was made. The awareness that this

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We report pseudopili annulati for the first time in a dark-haired Chinese girl. The hair was elliptical in shape and twisted along its long axis. The banded or ringed appearance was due to incident light being reflected by the flattened segments. Banding was also noted under polarized light but was not present under transmitted light. Under transmitted light the whole length of the hair appeared dark and the thickness varied at regular intervals, giving rise to fusiform segments due to the twisted nature of the hair shaft. Scanning and transmission electron microscopic examinations revealed no abnormalities in the cuticle and cortex.

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The binding of peroxidase-conjugated Dolichos biflorus (DBA), Triticum vulgaris (WGA), Canavalia ensiformis (Con A), Arachis hypogaea (PNA), Lotus tetragonolobus, and Bandeiraea simplicifolia I (BSAI) to gastrointestinal carcinoid tumours was studied. The results indicate that carcinoid tumour cells express certain carbohydrates similar to those present in the adjacent surface epithelium. The differences in the lectin-binding properties of carcinoid tumours of different sites of the gastrointestinal tract are closely related to the regional differences in the lectin binding of adjacent surface epithelium. These observations therefore form a useful basis for further studies in the application of lectin histochemistry to elucidate the histogenesis of carcinoid tumours.