The case of a 77-year-old man in whom a large digital ulcer with undermined edges was due to cutaneous infection by Cryptococcus neoformans variety neoformans serotype D, probably following direct inoculation, is reported. Long-term steroid treatment for chronic obstructive pulmonary disease may have been a risk factor. A 12-day course of intravenous amphotericin B at a cumulative dose of 750 mg, followed by oral fluconazole at a daily dose of 600 mg for six weeks, resulted in healing of the skin lesion. Manifestations of primary cutaneous cryptococcosis in immunocompetent or immunocompromised patients are reviewed.

The level of urinary carcinoembryogenic antigen (CEA) was evaluated in the diagnosis and follow-up of urothelial carcinoma of the bladder. Urinary CEA concentration, cystoscopic findings and the histopathology of an eventually resected bladder tumour were correlated in 177 cases. The sensitivity proved to be 34%, the specificity 82%. Possible correlations with sex, infection, primary tumour or recurrence, differentiation and invasion of an eventually resected tumour and influence of adjuvant therapy were also evaluated. A comparison was made with the results of other authors and different factors which may influence urinary CEA levels are discussed.

Gallium scintigraphy was performed in 54 consecutive patients hospitalized for exploration of fever or inflammation of unknown origin, in whom thorough initial exploration did not yield any clue. Only in 28 patients (51.8%) could a definite diagnosis be established. The positive gallium scintigraphy results were clinically rated as valuable, questionable or valueless according to their contribution to the diagnosis. Gallium scintigraphy was positive in 22 patients (40%) and deemed valuable in 13 patients (24%). A final diagnosis could be ascertained in 77% of the cases with a positive scintigram. In contrast a cause of fever or inflammation was found only in 34% of the cases with a negative scintigram. Gallium scintigraphy is valuable as an early localizing investigation rather than a last resort test in patients with fever or inflammation of unknown origin. A positive scintigram increases the chances of establishing a final diagnosis.

The development of satellite lesions after removal of a pyogenic granuloma is well known. However, it is unusual to see this complication after the removal of a non-angiomatous lesion. We describe a patient who developed multiple small vascular lesions after excision of a dermal melanocytic naevus on her back; new lesions continued to appear over the next 20 years. Little is known about the pathogenesis of eruptive lesions developing after excision of a primary tumour. Several hypotheses, such as the influence of mechanical forces, abnormalities in the vascular system and the existence of a circulating stimulatory factor, have been suggested.

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