Ab-Interno Trabeculotomy

The Trabectome (NeoMedix Corporation, San Juan Capistrano, CA, USA) is a US Food and Drug Administration—approved surgical device which removes a segment of the trabecular meshwork and the inner wall of the Schlemm’s canal using an ab-interno approach, enhancing aqueous outflow via increased access to the Schlemm’s canal and the collector channels. This is a bleb-less procedure which spares the conjunctiva, hence does not adversely affect the outcome of subsequent conventional glaucoma filtration surgeries. Multiple studies have shown that Trabectome surgery results in a reduction in IOP and the number of ocular hypotensive agents, though the efficacy is modest compared with conventional filtration surgery. The safety profile of Trabectome surgery is favorable compared with conventional glaucoma surgery, with the most common complication being intraoperative and postoperative bleeding. Additional research is required to understand how the efficacy of Trabectome surgery can be maximized.

Hollywood Horsemen and Horsewomen

Among the Hollywood luminaries who found success as Thoroughbred owners were Fred Astaire, Betty Grable, and Bing Crosby. Astaire was more than smitten with the sport, having discovered the pleasures of betting on the ponies when performing in London’s West End. He quickly gravitated to ownership and achieved his greatest success in California with Triplicate, winner of the Hollywood Derby at Hollywood Park and the San Juan Capistrano Handicap at Santa Anita. The highest-paid actress in Hollywood in the mid-1940s, Betty Grable, in partnership with her trumpet-playing husband Harry James, owned major stakes winners Big Noise and James Session, who ran for them in the Kentucky Derby. After selling his interest in Del Mar, Crosby concentrated on racing in Europe, where he was co-owner of Meadow Court, who would win the Irish Derby and the King George VI and Queen Elizabeth Diamond Stakes.

Pityriasis lichenoides et varioliformis acuta in skin of color: new observations by dermoscopy

Background: Pityriasis lichenoides is an uncommon skin disease that presents in three different forms: pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC) and febrile ulceronecrotic-Mucha-Habermann disease. These represent a spectrum of a disease. PLEVA presents as skin eruption of multiple, small, red papules that develop into polymorphic lesions with periods of varying remissions, as well as possible sequels of hyper/hypopigmentation and varicella-like scars. Diagnosis of this condition is mainly clinical, and sometimes clinical differentiation from other conditions may be a difficult task that often requires histological analysis. In this study, PLEVA lesions were examined by dermoscopy, and the significance of specific dermoscopic findings was investigated in order to facilitate their differentiation from other inflammatory conditions. Objectives: To evaluate dermoscopic patterns in PLEVA and to correlate these patterns with histopathology. Materials and methods: The study was conducted at S. Nijalingappa Medical College, Bagalkot. It was an observational case series study and patients were selected randomly. Ethical clearance and informed consent were obtained. PLEVA lesions in early and late phases were evaluated. A manual DermLite 3 (3Gen, San Juan Capistrano, CA) dermoscope attached to a Sony (Cyber Shot DSC-W800, Sony Electronics Inc., San Diego, California, USA, digital, 14 mega pixels) camera was employed. Histopathology was done to confirm the diagnosis. Data was collected and analyzed. Results were statistically described in terms of frequencies and types of dermoscopic patterns. Results: There was a total of 14 patients; 8 males and 6 females. Mean age of patients was 19 years. Mean duration of disease was 7 months. Dermoscopy in early-phase lesions revealed amorphous brownish areas around the hair follicles, dotted vessels, and scaling. Dermoscopy in late-phase lesions showed whitish-structureless areas and central white crust within whitish-structureless rim with scale, focal bluish-grayish areas or centrifugal strands irregularly distributed along the periphery and yellow structures. Red dots and hemorrhage were seen at the center and glomerular vessels at the periphery. Conclusion: PLEVA demonstrates specific dermoscopic patterns that correlate well with histologic changes. New dermoscopic findings are described. Thus, dermoscopy is a good diagnostic tool in the clinical diagnosis of PLEVA.

Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis—results of a prospective study including data of potassium hydroxide (KOH) and culture examination

Background: Onychomycosis is the most common nail disease, representing 50% of cases affecting the nail apparatus. The diagnosis is made by clinical examination along with the KOH exam of the nail and culture of the sample. However, not all dermatologists have access to a mycology lab. Objective: To determine the correlation between KOH examination and dermoscopic patterns in patients with clinical diagnosis of onychomycosis. Patients/Methods: A descriptive, open, observational, prospective, cross-sectional study of 178 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermoscopy with a DermLite PHOTO dermatoscope (3Gen, San Juan Capistrano, CA, USA), KOH assessment and culture analysis. The most frequent dermoscopic patterns were identified and their correlation with the clinical subtype of onychomycosis was analyzed. Results: The study included 178 patients with clinical suspicion of onychomycosis. Of these, 155 (87.1%) had positive direct KOH examination for onychomycosis. Eighty-seven patients (56.13%) presented with clinical onychomycosis pattern of total dystrophic onychomycosis (TDO), 67 (43.23%) with distal lateral subungual onychomycosis (DLSO), 1 (0.65%) with trachyonychia). Dermoscopic patterns of onychomycosis showed the following frequencies: the spiked pattern was present in 22 patients (14.19%), longitudinal striae pattern in 51 patients (32.9%) and linear edge pattern in 21 patients (13.55%). We identified a pattern described as “distal irregular termination” in 41 patients with TDO and 26 with DLSO. Conclusions: This is the fist study conducted in a Mexican population that uses dermoscopy as a diagnostic tool along with the KOH examination for the diagnosis of onychomycosis. Dermoscopy may be used as an important diagnostic tool when evaluating nail disease. However, it should not be used as the only diagnostic criteria for onychomycosis.

Locating Absence: The Forgotten Presence of Monjeríos in Alta California Missions

This article examines how California's historic mission sites represent the Native American women who worked in the missions and who were sequestered there in monjeríos (chaperoned dormitories for unmarried women). Three missions (San Luis Rey, San Juan Capistrano, and La Purísima Concepción) provide case histories of mission interpretations in which these women were completely absent, represented by signage only, or brought to visitors' attention through a recreated monjerio. However, even in the latter model, their lives are not fully represented: the monjerios were sites of punishment, a fact recorded in mission-era reports and letters but not indicated in the exhibit space.