The Cutting Edge: Challenges in Medical and Surgical Therapeutics REPORT OF A CASEA 41-year-old African American woman with a 14-year history of systemic lupus erythematosus (SLE) presented with exquisitely painful stellate ulcers with surrounding livedo reticularis on both shins in April 2006. In addition to smallvessel involvement, her connective tissue disease was characterized by pulmonary fibrosis, pulmonary hypertension requiring continuous oxygen supplementation, Raynaud phenomenon,andchronicrightpoplitealdeepvenousthrombosis. Her medications included prednisone (5 mg/d), methotrexate (12.5 mg/wk), folic acid, hydroxychloroquine, pentoxyphilline, coumadin, budesonide inhaler, fluticasone inhaler, fexofenadine, erythropoietin, sildenafil, amlodipine, gabapentin, acetaminophen-codeine, tramadol hydrochloride, famciclovir, tolterodine, calcium supplement, vitamin E supplement, alendronate, and esomeprazole. The results of laboratory tests were remarkable for the following values: hemoglobin, 8.8 g/dL (to convert to grams per liter, multiply by 10.

This article reviews the post-Freudian psychoanalytic literature that focuses on child sexual abuse. Most of the articles reviewed are case presentations; there is little new theoretical work and few empirical studies. The present review focuses on the nature and effects of abuse; the parental dynamics in incestuous families; treatment issues and outcomes; and theory. The review results in the following observations: (a) Father-daughter incest is the form of abuse most frequently indicated in these articles; (b) little literature exists on the abuse of boys; (c) the effects of sexual abuse are often serious and enduring; (d) little literature exists on treatment issues, specifically whether and how analysis should be modified with the sexually abused population; (e) there is no consensus about what is curative; and (f) treatment outcomes vary widely. Although contributions to the psychoanalytic literature on child sexual abuse have increased dramatically in the last 10 years, further investigation is indicated. The article concludes with a discussion of some areas for additional work.The subject of child sexual abuse has played a pivotal and provocative role in the history of psychoanalytic thought. Freud's "seduction theory" acknowledged the pervasiveness of sexual abuse; however, Freud had great difficulty reconciling this theory with his evolving concept of the child's inner fantasy life (Freud, 1905a(Freud, , 1905b. Thus, by the turn of the century, memories of seduction were conceptualized largely as fantasy instead of actual trauma, and the theory of psychosexual development-crucial to Freud's subsequent work and the cornerstone of classical analysis-was born. Although Freud apparently retained a belief in the reality of sexual trauma, the motivation was shifted from adults to the seductive behavior of the child.Literature detailing the seduction theory and the shift to the theory of Requests for reprints should be sent to Elizabeth Krimendahl Wolf, MA,

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Nijmegen breakage syndrome (NBS) is a rare DNA repair disorder caused by mutations in the NBS-1 gene (8q21). Patients with this autosomal recessive condition have characteristic facial features, microcephaly present at birth, immunodeficiency, predisposition to malignancy, ionizing radiation hypersensitivity, and growth retardation. We report a 12-year-old boy with NBS associated with porokeratosis; to our knowledge this association has not previously been reported.