RESUMO
Three patients, a girl aged 10 and two women aged 59 and 64 years, had erythema multiforme, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), respectively. SJS and TEN are rare illnesses with a high morbidity and mortality. The aetiology is mainly iatrogenic: a hypersensitivity reaction to certain pharmaceutical prescriptions. SJS and TEN should be differentiated from the more frequent erythema multiforme, a self-limiting disease without important residual symptoms, which is usually initiated by infection with herpes simplex virus. SJS and TEN are variants in a spectrum of exfoliative dermatoses with epidermal necrosis. SJS and TEN on the one hand and erythema multiforme on the other can be distinguished on the basis of aetiology, clinical symptoms and histopathology. The distinction can, however, be difficult, notably in the early stages. The girl recovered completely. The first woman was treated with corticosteroids and also recovered; she was thought to have developed the syndrome as a reaction to malarial prophylactics. The third patient died, despite extensive treatment, of multiorgan failure and sloughing of 70% of the skin, probably as a reaction to amoxicillin given for pneumococcal pneumonia.
Assuntos
Eritema Multiforme/diagnóstico , Síndrome de Stevens-Johnson/diagnóstico , Criança , Diagnóstico Diferencial , Eritema Multiforme/patologia , Eritema Multiforme/terapia , Evolução Fatal , Feminino , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Prognóstico , Síndrome de Stevens-Johnson/patologia , Síndrome de Stevens-Johnson/terapiaRESUMO
A malignant eccrine poroma (porocarcinoma) was excised from the right groin of a 78-year-old man.
Assuntos
Acrospiroma/diagnóstico , Neoplasias das Glândulas Sudoríparas/diagnóstico , Acrospiroma/patologia , Acrospiroma/cirurgia , Idoso , Glândulas Écrinas/patologia , Virilha , Humanos , Masculino , Neoplasias das Glândulas Sudoríparas/patologia , Neoplasias das Glândulas Sudoríparas/cirurgiaRESUMO
BACKGROUND: Broad-band UVB phototherapy has appeared to be effective in clearing psoriatic lesions. After the advent of calcipotriol ointment, promising results have been obtained by combining these two therapeutic modalities. Also, an additional effect of narrow-band UVB phototherapy on treatment with calcipotriol ointment has been demonstrated. OBJECTIVE: Our purpose was to compare treatment with low-dose narrow-band UVB phototherapy both with and without calcipotriol ointment. METHODS: We included 53 patients suffering from plaque-type psoriasis. All patients underwent low-dose narrow-band UVB phototherapy. Nearly half of the patients were randomized to apply calcipotriol ointment (50 microg/g) twice daily on the affected skin. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic lesions. RESULTS: In this study we showed that low-dose narrow-band UVB phototherapy is effective in the treatment of psoriasis and that calcipotriol ointment does not improve treatment outcome. CONCLUSION: Calcipotriol ointment does not improve treatment with low-dose narrow-band UVB phototherapy.
Assuntos
Calcitriol/análogos & derivados , Fármacos Dermatológicos/uso terapêutico , Fototerapia , Psoríase/terapia , Adolescente , Adulto , Idoso , Calcitriol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fototerapia/métodos , Psoríase/tratamento farmacológico , Método Simples-Cego , Resultado do TratamentoRESUMO
A 43-year-old woman, born in the Netherlands, developed ulcers on her left foot during a holiday in Gambia and Senegal. She had been bitten bij insects. The ulcers were caused by Corynebacterium diphtheriae. The patient was treated with antibiotics and recovered fully. A grey pseudomembrane covering the ulcer is a characteristic feature of cutaneous diphtheria. The treatment is with antibiotics and, after toxin tests have indicated that the bacterium is toxigenic, with antitoxin. In some cases screening of social contacts is advised.
Assuntos
Corynebacterium diphtheriae/isolamento & purificação , Difteria/microbiologia , Úlcera do Pé/microbiologia , Adulto , Animais , Antibacterianos , Difteria/tratamento farmacológico , Difteria/transmissão , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Mordeduras e Picadas de Insetos/complicações , Insetos VetoresAssuntos
Anti-Inflamatórios/uso terapêutico , Penfigoide Bolhoso/tratamento farmacológico , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Betametasona/administração & dosagem , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Clobetasol/administração & dosagem , Clobetasol/uso terapêutico , Feminino , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-Idade , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/uso terapêuticoRESUMO
We report a case of naevus mucinosus, a recently described condition. Clinically, the lesions presented as unilateral, multiple, firm, 3-5-mm-diameter, coalescent papules in a linear arrangement on the back of a 23-year-old man. Histologically, large amounts of acid mucopolysaccharides (proteoglycans) were demonstrated in the superficial dermis. As far as we are aware, this is the first report of the onset of naevus mucinosus in an adult. Naevus mucinosus appears to be a distinct type of connective tissue naevus which is characterized by an increase in proteoglycans.
Assuntos
Hamartoma/patologia , Proteoglicanas/metabolismo , Dermatopatias/patologia , Adulto , Doenças do Tecido Conjuntivo/patologia , Hamartoma/metabolismo , Humanos , Masculino , Pele/patologiaRESUMO
BACKGROUND: Venous hypertension of the hand is an unusual complication of an arteriovenous shunt in patients receiving dialysis. OBJECTIVE: We investigated whether in venous hypertension of the hand pericapillary cuffs are present and whether they consist of fibrin and other components. METHODS: Biopsy specimens were taken from three patients with a side-to-side shunt and venous hypertension of the hand, from three patients with an end-to-side shunt without venous hypertension, and from three control subjects. The specimens were stained with antibodies against fibrinogen, fibrin, plasminogen activator inhibitor-I, factor VIII-related antigen, and collagen type IV. RESULTS: Pericapillary cuffs consisting of fibrin only were observed in patients with venous hypertension of the hand. In this fibrin network, factor VIII-related antigen and collagen type IV were also present. The finding of plasminogen activator inhibitor-I in the pericapillary cuff in the patient with the most severe signs of venous hypertension may indicate that breakdown of this fibrin cuff is impaired. CONCLUSION: Pericapillary cuffs may be of pathogenetic significance in venous hypertension of the hand.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Mãos/irrigação sanguínea , Diálise Renal/efeitos adversos , Pressão Venosa , Adulto , Idoso , Capilares/química , Colágeno/análise , Feminino , Fibrina/análise , Fibrinogênio/análise , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/análise , Fator de von Willebrand/análiseRESUMO
In and around ulcers complicating the chronic venous insufficiency syndrome and atrophie blanche a pericapillary cuff of fibrinoid material has been described. The aim of the present study was to find out whether pericapillary cuffs are present in atrophie blanche ulcerations, whether they consist of fibrinogen and/or fibrin in comparison to normal controls, and whether this cuff is composed of other components. Skin biopsies from ten patients adjacent to atrophie blanche ulcers, and from ten controls were taken. In all patients pericapillary cuffs consisting of fibrin were found. However, no fibrinogen was found in these cuffs. In the controls no cuffs were found. In this fibrin network factor VIII-related antigen and collagen type IV were also present. The finding of plasminogen activator inhibitor-I in the pericapillary cuff in several cases may indicate that breakdown of this fibrin cuff is impaired. The possible diffusion barrier caused by the pericapillary cuff together with the pattern of vascularization may be an important event in ulcer formation and impaired ulcer healing.
Assuntos
Colágeno/análise , Fibrina/análise , Fibrinogênio/análise , Imunofluorescência , Inativadores de Plasminogênio/análise , Pele/patologia , Úlcera Varicosa/patologia , Insuficiência Venosa/patologia , Fator de von Willebrand/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Hanseníase Virchowiana , Hanseníase Tuberculoide , Adolescente , Adulto , Feminino , HumanosRESUMO
Onto 'activating' surfaces, intact normal plasma deposits an overlapping sequence of proteins, each being desorbed by the next. Ultimately, high molecular weight kininogen (HMK) is deposited unless contact was too short, or space between 2 surfaces too narrow. Thus, injected between a glass slide and a convex lens, intact plasma will leave a disk of HMK with a center of fibrinogen. We describe here how the exchange of proteins on the surface can be demonstrated by staining the adsorbate with a metal oxide suspension. Subsequent flooding of the preparation with more normal plasma causes lift-off of the oxide where underlying fibrinogen is being displaced by the HMK of the newly applied plasma. Kininogen-deficient plasma fails to remove any oxide, while normal plasma can remove nearly all of the oxide and adsorbate, left on glass by HMK-deficient plasma.