These results confirm that topical tacrolimus is an effective treatment for vitiligo. We propose that topical tacrolimus increases IL-10 expression in vitiligo lesions, and thereby inhibits melanocyte destruction triggered by unchecked Th1 pathways in vitiligo.
Purpose:To demonstrate the feasibility of obtaining highquality magnetic resonance (MR) images of the human cervical spinal cord in vivo at a magnetic field strength of 3 T and to optimize the signal contrast between gray matter, white matter, and cerebrospinal fluid (CSF) on 2D gradient recalled echo (GRE) images of the cervical spinal cord. Materials and Methods:Using a custom-built, anatomically molded radio frequency (RF) surface coil, the repetition time and flip angle of a 2D GRE sequence were systematically varied in five volunteers to assess tissue contrast in the cervical spinal cord.Results: The 2D GRE parameters for an optimal balance between gray-white matter and CSF-white matter contrast at 3 T were determined to be a time-to-repetition (TR) of 2000 msec and a flip angle of 45°, with the constant short time-to-echo (TE) of 12 msec used in this study. Excellent tissue contrast and visualization of the internal anatomy of the spinal cord was demonstrated reproducibly in eight subjects using these optimal parameters. Conclusion:This study demonstrates that imaging the cervical spinal cord and delineating internal spinal cord structures such as gray and white matter is feasible at 3 T.
Magnetic resonance images can be used to estimate tissue depth in human faces with precision.
C HRONIC LEG ULCERS are a challenging problem for the dermatologist and nondermatologist physician alike. Identification and treatment of the underlying etiology are very important components of patient management. In the case of chronic leg ulcers in the younger patient population, this approach requires inclusion of a particular group of medical conditions known as the thrombophilias. Although the thrombophilias are easy to overlook as an etiologic factor, identification and correction can improve the patient's outcome. Table 1 outlines the hereditary thrombophilias and other hematologic conditions that have been reported with chronic leg ulcers. Case ReportWe report on a 42-year-old First Nations female with an 18-month history of a right medial ankle ulcer that enlarged over the past year. She was employed at a fast food restaurant as cook and cashier and was on her feet for 8 hours at a time. The patient did not apply compression bandages regularly, as was recommended by her managing physician. Physical examination revealed a 3.5 × 2 cm ulceration with surrounding pigmentation and erythema at the left lateral foot (Figure 1 and Figure 2). Other cutaneous findings included minimal varicosities and atrophie blanche. The ulcer had irregular borders, and the base was granulating. Dorsalis pedis and posterior tibialis pulses were more palpable on the right. Serous discharge was also evident. Finally, the patient complained of pruritus and pain in the region. Previous management consisted of dressing the lesion with silver-impregnated dressing and simple soap and water cleansing. Her past medical history was negative for cardiovascular disease, diabetes, hypertension, and any surgeries or fractures. In terms of family history, she has a brother with leg ulcers and her mother has significant leg varicosities.The laboratory investigations revealed the following: hemoglobin 142 g/L (normal = 120-160 g/L); prothrombin time = 1.0 (normal = 0.8-1.2); white blood cell count = 4.8 × 10 9 /L (normal = 4.0-11.0 10 9 /L); platelets = 242 × 10 9 /L (normal = 140-450 10 9 /L); right ankle to brachial index (ABI) = 1.04 and left ABI = 1.12, and right toe to brachial index (TBI) = 0.59 and left TBI = 0.79.Cryoglobulin screening was negative. Thrombophilia screening was negative for factor V Leiden (FVL) mutation. Protein C was 0.98 U/mL (normal = 0.82-1.74 U/mL), whereas protein S was abnormal at 0.50 U/mL (normal = 0.61-1.51 U/mL). Skin biopsy of the left ankle showed an epidermal erosion with stasis dermatitis-type changes and no evidence of vasculitis.
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