- Email: [email protected]
Congenital smooth muscle hamartoma
Volume 14 Number 4 April, 1986
Correspondence
some expense and inconvenience to themselves. For this reason, I am puzzled by the fact that those who ask for reprints think that they should receive them as an inalienable right. The author is not only required to purchase, store, and retrieve articles at considerable expense but is also expected to bear the costs of postage, envelopes, and clerical services that are generated by such a mailing. Clearly, the ethics and etiquette associated with this process should be revised. I think it would be entirely appropriate to expect those who request a reprint to enclose a self-addressed, stamped envelope in order to divide the costs of the entire process in a more equitable manner. (except of course for international mailings, in which case return postage could not be provided). If such a revision in our code of conduct is not forthcoming soon, I expect that we will see the words "reprints not available" printed on the first page of an increasing number of journal articles. Daniel E. Gormley, M.D. 412 West Carroll, Suite 207 Glendora, CA 91740 Reprints not available.
Reply To the Editor: Dr. Gormley has not considered our foreign colleagues, many of whom do not have ready access to copy machines. I have friends in Europe who send reprints only to those who live in Third World countries. Stephenl. Katz, M.D. NCl-National Institutes of Health Dermatology Branch, Bldg. 10, Rm. 12N238 Bethesda, MD 20205
Congenital smooth muscle hamartoma To the Editor: We were delighted to read the very well illustrated paper on congenital smooth muscle hamartoma by Berger and Levin (J AM ACAD DERMATOL 11:709-712, 1984). We presented cases of congenital smooth muscle hamartoma only 3 months earlier. 1 We observed in our nursery three cases proved by biopsy and two others clinically suspected as congenital smooth muscle hamartoma. After their publication we learned of other similar cases by personal communication. Our contention is that congenital smooth muscle hamartoma is not as rare as suggested by Berger and
691
Levin's paper. The calculated incidence of proved cases in our nursery is I :2,700 newborn infants (6 cases of congenital smooth muscle hamartoma· in a total of 16,068 deliveries within 4 years). It is present at birth, usually as a single lesion, with many possible different locations (e.g., thighs) and is benign without association of any systematic disturbances. A. Metzker, M.D., and P. Merlob, M.D. Department of Pediatric Dermatology and Neonatology Beilinson Medical Center, Petah Tiqva, Israel REFERENCE I. Metzker A, AmiI' J, Rotem A, Merlob P: Congenital smooth muscle hamartoma of the skin. Pediatr Del'matol 2:45-48, 1984.
Treatment of brown recluse spider bites To the Editor: The diagnosis and treatment of brown recluse spider bites (Loxosceles reclusa), as discussed in nondennatologic journals, may be of interest. '·1 The astute clinician is often faced with deciding whether a lesion is a brown recluse bite, what acceptable treatments are available, and which have the least morbidity and maximum efficacy. There are no accepted clinical criteria to diagnose brown recluse bites when the spider is either not properly identified or in vitro lymphocyte transformation tests 8 are not available. Because many bites are truly unremarkable,9 some authors prefer no treatment. Since there is little morbidity, intralesional or systemic corticosteroids with or without antibiotics have been used to treat brown recluse bites. The aggressive approach to brown recluse bites is to excise the "bite site" in the first 96 hours. 10 We have also observed that brown recluse bites often are not serious and heal without incident. However, some severe bites have delayed wound healing, 1-7 repeatedly reject skin grafts, produce recurrent, pyoderma gangrenosum-like lesions, 5 and perhaps cause deep vein thrombosis. * What then is the best treatment for brown recluse bites? When should physicians be conservative and when should they be aggressive? Serious' 'bites" and their imitators, such as gangrene and skin necrosis caused by microorganisms, drugs, and infarction, are usually obvious in the first 24 to 48 hours and need medically but not surgically aggressive, closely monitored treatment. All suspected, early brown recluse bites (less than 24 hours) should be eval*Rees RS, King LE JR; Clinical observation.
Correspondence
some expense and inconvenience to themselves. For this reason, I am puzzled by the fact that those who ask for reprints think that they should receive them as an inalienable right. The author is not only required to purchase, store, and retrieve articles at considerable expense but is also expected to bear the costs of postage, envelopes, and clerical services that are generated by such a mailing. Clearly, the ethics and etiquette associated with this process should be revised. I think it would be entirely appropriate to expect those who request a reprint to enclose a self-addressed, stamped envelope in order to divide the costs of the entire process in a more equitable manner. (except of course for international mailings, in which case return postage could not be provided). If such a revision in our code of conduct is not forthcoming soon, I expect that we will see the words "reprints not available" printed on the first page of an increasing number of journal articles. Daniel E. Gormley, M.D. 412 West Carroll, Suite 207 Glendora, CA 91740 Reprints not available.
Reply To the Editor: Dr. Gormley has not considered our foreign colleagues, many of whom do not have ready access to copy machines. I have friends in Europe who send reprints only to those who live in Third World countries. Stephenl. Katz, M.D. NCl-National Institutes of Health Dermatology Branch, Bldg. 10, Rm. 12N238 Bethesda, MD 20205
Congenital smooth muscle hamartoma To the Editor: We were delighted to read the very well illustrated paper on congenital smooth muscle hamartoma by Berger and Levin (J AM ACAD DERMATOL 11:709-712, 1984). We presented cases of congenital smooth muscle hamartoma only 3 months earlier. 1 We observed in our nursery three cases proved by biopsy and two others clinically suspected as congenital smooth muscle hamartoma. After their publication we learned of other similar cases by personal communication. Our contention is that congenital smooth muscle hamartoma is not as rare as suggested by Berger and
691
Levin's paper. The calculated incidence of proved cases in our nursery is I :2,700 newborn infants (6 cases of congenital smooth muscle hamartoma· in a total of 16,068 deliveries within 4 years). It is present at birth, usually as a single lesion, with many possible different locations (e.g., thighs) and is benign without association of any systematic disturbances. A. Metzker, M.D., and P. Merlob, M.D. Department of Pediatric Dermatology and Neonatology Beilinson Medical Center, Petah Tiqva, Israel REFERENCE I. Metzker A, AmiI' J, Rotem A, Merlob P: Congenital smooth muscle hamartoma of the skin. Pediatr Del'matol 2:45-48, 1984.
Treatment of brown recluse spider bites To the Editor: The diagnosis and treatment of brown recluse spider bites (Loxosceles reclusa), as discussed in nondennatologic journals, may be of interest. '·1 The astute clinician is often faced with deciding whether a lesion is a brown recluse bite, what acceptable treatments are available, and which have the least morbidity and maximum efficacy. There are no accepted clinical criteria to diagnose brown recluse bites when the spider is either not properly identified or in vitro lymphocyte transformation tests 8 are not available. Because many bites are truly unremarkable,9 some authors prefer no treatment. Since there is little morbidity, intralesional or systemic corticosteroids with or without antibiotics have been used to treat brown recluse bites. The aggressive approach to brown recluse bites is to excise the "bite site" in the first 96 hours. 10 We have also observed that brown recluse bites often are not serious and heal without incident. However, some severe bites have delayed wound healing, 1-7 repeatedly reject skin grafts, produce recurrent, pyoderma gangrenosum-like lesions, 5 and perhaps cause deep vein thrombosis. * What then is the best treatment for brown recluse bites? When should physicians be conservative and when should they be aggressive? Serious' 'bites" and their imitators, such as gangrene and skin necrosis caused by microorganisms, drugs, and infarction, are usually obvious in the first 24 to 48 hours and need medically but not surgically aggressive, closely monitored treatment. All suspected, early brown recluse bites (less than 24 hours) should be eval*Rees RS, King LE JR; Clinical observation.