The concern of sexuality should be integrated into the regular consultations of these patients. The strong association between sexual health and subjective wellbeing emphasises the need for diagnosis and, if necessary, treatment of these problems.

Smoking and varicocele are frequent findings in the medical history and physical examination of patients attending andrological outpatient departments. However, data about their influence on human semen parameters, such as sperm concentration and motility, are contradictory. Therefore, the purpose of this study was to examine sperm function (acrosin activity and induction of the acrosome reaction) in smokers (n = 30) and varicocele patients (n = 30) compared with normal fertile donors (n = 20). The acrosome reaction was detected by triple staining after 3 h of incubation at 37 degrees C, followed by treatment with 0.1% dimethylsulphoxide (spontaneous acrosome reaction) and 10 microM calcium ionophore A23187 (induced acrosome reaction) for 1 h at 37 degrees C. Acrosin activity was measured by gelatinolysis. The diameters around the sperm heads after gelatinolysis and the percentages of spermatozoa showing halo formations were evaluated. The inducibility of the acrosome reaction was significantly lower in semen samples from smokers than in those from the fertile group (7.1 +/- 3.2 versus 11.2 +/- 4.0%, P < 0.01), whereas no statistically significant difference was demonstrated in spermatozoa from patients with varicocele (9.3 +/- 4.3%). Both the percentages of spermatozoa with halo formation (53.3 +/- 20.0 versus 76.6 +/- 13.6%, P < 0.05) and the halo diameters (16.1 +/- 6.6 versus 31.0 +/- 14.5 microns, P < 0.001) were significantly lower in the varicocele group than in the samples from fertile men. These data suggest that smoking and varicocele affect sperm function, and that the standard semen parameters alone are insufficient to evaluate the influence of both factors on human male fertility.

Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath-PUVA and cream-PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking clinical improvement with a medium-dose UVA1 phototherapy (single dose, 50 J/cm(2); 35 treatments).

that GPs find it difficult to recognize skin cancer and prioritize referrals. Limited urgent capacity is filled with routine referrals at the expense of delaying detection of skin cancer from nonurgent referrals. Dermatologists must therefore pay particular attention to nonurgent referrals to ensure that these referrals are assigned equal priority.In summary, skin cancers are referred urgently and nonurgently by GPs. The urgency assigned to the referral influences the waiting time. Administrative streamlining helps to meet the 2-week target for urgent referrals but further resources are needed so that nonurgent referrals can be seen more quickly. SIR, Granuloma faciale (eosinophilicum) is a rare granulomatous inflammation of the skin usually presenting as infiltrated multiloculated reddish nodes of the face, although there have been several reports of similar lesions in extrafacial localizations. 1-3 The aetiopathogenesis of this condition is not clear, and several hypotheses including cutaneous vasculitis have been proposed. 4 A histological hallmark of the disease is the infiltration of numerous eosinophilic granulocytes together with macrophages and lymphocytes in a typical granulomatous pattern. 5 We have analysed the cellular infiltrate and cytokine production in two patients presenting with granuloma faciale (eosinophilicum).Patient 1 was a 44-year-old white man who described slowly progressive dark red papules and plaques arising at the cheeks and ear lobes for at least 10 years (Fig. 1A). He had undergone several treatments including local steroid injections, cryosurgery and dapsone before being transferred to our department. After informed consent was obtained, a biopsy was taken from an untreated newly developing lesion at his left ear lobe.Patient 2 was a 67-year-old white woman who presented with a 5-year history of continuously growing firm red plaques at both cheeks and the forehead. The skin lesions were painless and had inconstantly increased in size. At initial presentation we saw multiple painless red nodules of 1-2 cm diameter with a tender consistency located at the forehead and both cheeks (Fig. 1E). After informed consent was obtained, two biopsies were taken from different skin lesions and were split for (immuno)histology and molecular biology.Routine haematoxylin and eosin staining in both patients showed subcutaneous granuloma formation with multinucleated giant cells surrounded by lymphocytes and a prominent infiltration of granulocytes among which eosinophils clearly dominated (Fig. 1B,F). The histological picture and the clinical appearance were consistent with facial granuloma.Immunohistochemistry showed a dominant recruitment of CD4+ T cells among the infiltrating lymphocytes (Fig. 1C,G) and only a weak staining for CD8 (data not shown), a result which confirmed previous investigations 6 (all antibodies from Dako, Hamburg, Germany).We next searched for an explanation for the parallel infiltration of CD4+ T cells and the infiltration of numerous eosinophils into the skin. A major cyto...

No abstract