ABSTRACT
Vitiligo is a disease of melanocytes characterized by achromic lesions in the skin, affecting the epidermis and the pilosebaceous follicle. We performed an ultrastructural analysis of biopsy specimens from four patients with noninflammatory, stable vitiligo of long duration (three had generalized vitiligo and one had segmental vitiligo). The samples were taken from the oldest achromic lesions, and the biopsy sites were far from normal skin. In all cases we noted alterations in keratinocytes, Langerhans cells, and melanocytes. We also found lymphocytes in the epidermis, and these cells and macrophages were noted in the dermis. The basal membrane disappeared at some points, and sometimes it was possible to see dermal cells with processes that engulfed either granular material or vesicles of epidermal origin in such areas. Our studies suggest that even in stable vitiligo, achromia implies intense cytologic activity, probably involving cell-mediated cytotoxicity, and ultrastructural findings resemble those of a lichenoid reaction.
Subject(s)
Microscopy, Electron/methods , Vitiligo/pathology , Adult , Female , Humans , Keratinocytes/ultrastructure , Langerhans Cells/ultrastructure , Male , Melanocytes/ultrastructure , Middle AgedABSTRACT
Presentamos el caso de una mujer de 58 años tratada en el Servicio de Cardiología por múltiples infartos del miocardio asociados a hipertensión arterial desde 1992. En octubre 2000 presentó una úlcera de la pierna de tipo arteriosclerótica. La paciente era muy delgada, con desnutrición severa, historia de alcoholismo y fumadora. En los exámenes de laboratorio se encontró una elevación plasmática de homocisteína con valores que oscilaban entre 50 a 60 umoI/I ) (v.n: 5 a 15 umoI/I). El estudio básico de la hemostasis mostró diversas anormalidades, pues estaba en tratamiento con fármacos hipotensores y anticoagulantes (heparina, ticlopidina, dipiridamol). Fue tratada con Vitamina B1 (600 mg/d), B6 (600 mg/d), B12 (5000 mcg/d) y ácido fólico 40 mg/d durante varios meses, logró una mejoría de los niveles de homocisteína a cifras entre 20 y 25 umoI/I. A los 11 meses se observó una curación de su úlcera de la pierna. La causa principal de su úlcera arterial fué el trastorno metabólico de la homocisteína dañando directamente, y por varios mecanismos fisiopatológicos, todos los elementos de la pared arterial, especialmente la célula endotelial, a lo que se sumó la hipertensión arterial. Sugerimos que ésta no fue el elemento fundamental para la formación de la úlcera, pues apareció bajo el control de los fármacos hipotensores y anticoagulantes. Posiblemente los altos valores plasmáticos de homocisteina fueron secundarios a la severa alteración metabólica acompañante (AU)
Subject(s)
Female , Middle Aged , Humans , Atherosclerosis/complications , Leg Ulcer/etiology , Hyperhomocysteinemia/diagnosis , Leg Ulcer/drug therapy , Homocysteine/metabolism , Hyperhomocysteinemia/complications , Anticoagulants/therapeutic use , Thiamine/therapeutic use , Riboflavin/therapeutic use , Hypertension/drug therapy , Hypertension/complicationsSubject(s)
Foot Dermatoses/etiology , Hand Dermatoses/etiology , Keratosis/etiology , Adolescent , Adult , Aged , Diagnosis, Differential , Female , Foot Dermatoses/diagnosis , Foot Dermatoses/pathology , Hand Dermatoses/diagnosis , Hand Dermatoses/pathology , Humans , Keratosis/diagnosis , Keratosis/pathology , Male , Middle Aged , SyndromeSubject(s)
Ganglia/pathology , Melanoma/pathology , Peripheral Nervous System Neoplasms/secondary , Skin Neoplasms/pathology , Adult , Clavicle , Female , Humans , Melanoma/surgery , Neoplasm Staging , Organotechnetium Compounds , Peripheral Nervous System Neoplasms/diagnostic imaging , Radionuclide Imaging , Radiopharmaceuticals , Skin Neoplasms/surgery , Time FactorsABSTRACT
We describe several members of a family with Van der Woude syndrome, a genetic and congenital malformation syndrome with autosomal dominant inheritance and 70% to 80% penetrance with variable expressivity. It is characterized by clinical signs localized to the face, such as bilateral or unilateral pits on conical elevations in babies or extensive depressions in adults, both in the vermilion border of the lower lip, with cleft lip, with or without cleft palate and uvula. Small accessory or heterotopic salivary glands empty into sinuses or fistulas in the lips. This eight member family had various clinical signs of the condition. All had cleft lip and palate. We studied the major characteristics of the eight patients and describe histopathologic and immunohistochemical features.
Subject(s)
Cleft Lip/genetics , Diseases in Twins , Lip/abnormalities , Female , Humans , Infant , Lip/pathology , Pedigree , SyndromeABSTRACT
BACKGROUND: Several conservative and surgical treatment methods have been demonstrated to be useful in the management of lymphedema. METHODS: In a patient with an enormous lymphedema of the leg, we first used complex decongestive physiotherapy as proposed by Földi et al. in 1989, and then followed it with surgery. RESULTS: Satisfactory results were obtained in a short period of time and were maintained during the 2-year follow-up. CONCLUSIONS: We recommend a combined medical, surgical, and physiotherapeutic approach in patients with marked lymphedema.
Subject(s)
Lymphedema/drug therapy , Lymphedema/surgery , Combined Modality Therapy , Elephantiasis/pathology , Female , Follow-Up Studies , Humans , Leg , Lymphedema/pathology , Middle Aged , Treatment OutcomeABSTRACT
Ten patients with chronic purpuric and pigmented angiodermatitis in the extremities and two patients with acute and disseminated eczematoid-like purpura angiodermatitis were studied with current hemostasis parameters: (1) platelet aggregation, (2) platelet circulating aggregates, (3) clotting factor measurements and high molecular weight kininogen (HMWK) in their coagulation fraction. The results showed: (1) reactional thrombocytosis with morphologic changes; (2) increased levels of platelet circulating aggregates; (3) increased response of platelet aggregation to different agonists, especially at very low doses, and also when we used washed platelets resuspended in normal plasma; (4) delayed activation of the contact system; (5) decrease of the activity of the fibrinolysis activators; and (6) diminished function activity of the HMWK coagulation fraction. As a physiopathogenic hypothesis in these patients, there is a cutaneous pathology that could be entailed to these hematologic alterations of the platelet-HMWK-endothelial cells-kinins-coagulation-fibrinolysis system.
Subject(s)
Hemostasis/physiology , Platelet Aggregation/physiology , Purpura/blood , Adult , Blood Coagulation Factors/analysis , Blood Coagulation Tests , Female , Humans , Kininogens/metabolism , Male , Middle Aged , Platelet CountABSTRACT
A new case of fibrous hamartoma of infancy is described as a benign but persistent soft-tissue tumor that appears during the first 2 years of life, as a rare condition. The histopathological study shows the three characteristic elements: fibrous, uni-locular adipose tissue and mixoid mesenchymal tissue. The histogenesis of this peculiar tumor is discussed.
Subject(s)
Hamartoma/pathology , Shoulder , Soft Tissue Neoplasms/pathology , Female , Humans , InfantABSTRACT
A male patient of 52 years old is studied with an scabiei by Sarcoptes scabiei v. hominis. After a month the patient developed a clinic and histopathologic generalized granuloma annulare. With the specific local treatment of his scabiei, the disease was cured in 7 days. After this treatment, the generalized granuloma annulare disappeared within 2 months. Due to the sequence of both diseases and the way in which they disappeared after local therapy, we suggest that the antigens of the scabies are the ones responsible for the granulomatous lesions. We concluded this since once the antigens have disappeared, the immunologic mechanisms depending on the interactions of lymphocyte T-macrophage which form the granuloma are interrupted. Since the patient is homosexual, we studied the HIV antibodies which were negatives in several opportunities. Nevertheless, an immune disbalance which could be the coadjuvant factor was founded. With this case we show that specific exogens may cause a generalized granuloma annulare.
Subject(s)
Granuloma/immunology , Scabies/complications , Skin Diseases/immunology , Granuloma/pathology , Humans , Male , Middle Aged , Skin Diseases/pathologyABSTRACT
We studied a white skin type 3 male patient aged 68 years old with a paraneoplastic acrokeratosis of Bazex, suffering from an oesophagus neoplasm. Cutaneous manifestations preceded in months the cancer. Dermatosis affected fingers of hands and feet, soles, nose and helix. Black melanic hyperpigmentation was the first cutaneous sign and were followed by an hyperkeratosis, becoming the most clinical characteristic of the syndrome. The sequence of these signs induces us to suggest that hormonal factors elaborated by the tumoral cells are the ones responsible for the pigmentary changes since they appeared before the hyperkeratosis.
Subject(s)
Acrodermatitis/complications , Keratosis/complications , Paraneoplastic Syndromes/complications , Pigmentation Disorders/complications , Aged , Facial Dermatoses/complications , Foot Dermatoses/complications , Hand Dermatoses/complications , Humans , MaleABSTRACT
The number of scratching episodes and average frequency with which they started during each sleep stage as well as the effects of nighttime pruritus on objective sleep parameters in nine children with atopic dermatitis were assessed in the sleep laboratory. Scratching episodes occurred during rapid eye movement (REM) sleep and non-REM (NREM) sleep. The largest average frequency corresponded to stage 1, followed by stage 2, REM sleep, stage 4, and stage 3. Sleep maintenance was markedly altered. Total sleep time decrease was related mainly to smaller amounts of stage 4 NREM sleep. REM sleep percentage of total sleep time was increased as compared with normal children of the same age. Furthermore, in six of nine patients REM sleep latency was found to be decreased.
Subject(s)
Dermatitis, Atopic/physiopathology , Electroencephalography , Pruritus/physiopathology , Sleep Stages/physiology , Sleep Wake Disorders/physiopathology , Adolescent , Cerebral Cortex/physiopathology , Child , Child, Preschool , Evoked Potentials , Female , Humans , Male , Reaction Time/physiology , Sleep, REM/physiology , Wakefulness/physiologyABSTRACT
Four cases of "connective naevus" have been revised in a family, mother and her two daughters and son. The histology shows as principal characteristic hyperplasia, thickness and crossing disposition of elastic fibers, forming an image similar to the one of an "elastic naevus". Because of its familiar features and the absence of osteopoikilosis, we postulate a frustrate form of the Buschke-Ollendorf syndrome.
Subject(s)
Elastic Tissue/pathology , Nevus/genetics , Skin Neoplasms/genetics , Adolescent , Adult , Child , Female , Humans , Male , Neoplasms, Multiple Primary/genetics , Nevus/pathology , Osteopoikilosis/genetics , Osteopoikilosis/pathology , Skin Neoplasms/pathology , SyndromeABSTRACT
Se realizó un estudio retrospectivo para conocer la asociación entre liquen plano, hepatitis crónica y cirrosis. Se analizaron 11280 historias del Hospital de Clíncias (Montevideo). La incidencia de liquen plano fue de 108/11280 casos (0,95%. de hepatitis crónica 183/11280 casos (1,62%) y cirrosis 260/11280 casos (2,30%). Un único paciente tenía liquen plano y hepatitis crónica (chi cuadrado 0,328) y 2 pacientes liquen plano y cirrosis (chi cuadrado 0,099). Ambas asociaciones no son de significación estadística. Los resultados sugieren que la presentación clínica entre estas afecciones es casual (AU)
Subject(s)
Humans , Lichen Planus , Hepatitis, Chronic , Liver Cirrhosis , Retrospective StudiesABSTRACT
Se realizó un estudio retrospectivo para conocer la asociación entre liquen plano, hepatitis crónica y cirrosis. Se analizaron 11280 historias del Hospital de Clíncias (Montevideo). La incidencia de liquen plano fue de 108/11280 casos (0,95%. de hepatitis crónica 183/11280 casos (1,62%) y cirrosis 260/11280 casos (2,30%). Un único paciente tenía liquen plano y hepatitis crónica (chi cuadrado 0,328) y 2 pacientes liquen plano y cirrosis (chi cuadrado 0,099). Ambas asociaciones no son de significación estadística. Los resultados sugieren que la presentación clínica entre estas afecciones es casual
Subject(s)
Humans , Hepatitis, Chronic , Lichen Planus , Liver Cirrhosis , Retrospective StudiesABSTRACT
Estudios clínicos y la función in vitro del neutrófilo fueron estudiados en 10 pacientes con acné vulgar y lesiones inflamatorias severas tratados con isotretinoína (134-cis-retinoide). Luego de 12 semanas de tratamiento se observó la mejoria clínica de las lesiones. Al inicio se comprobó en todos los pacientes una depresión de las funciones quimiotácticas, prueba NAT y actividad lisosómica, que fueron más evidentes cuando se inclcuyó suero autólogo en estas pruebas. Luego de 8 semanas de tratamiento la función quimiotáctica y la prueba NAT aumentaron significativamente. En cambio, la actividad lisosómica aumentó significativamente luego de 12 semanas de tratamiento. La mejoría de la función in vitro se evidencío también en las pruebas con suero autológo. Los autores sugieren que la isotretinoína posee múltiples acciones locales y sistémicas, en particular la disminución del Priopionibacterium acnes con la subsequente disminución de las respuestas inmunes específicas e inespecíficas (AU)
