Tamale foot: deposit of acid mucopolysaccharides in the synovial sheaths of extensor tendons of the foot, resembling tendinitis, in a patient with juvenile ankylosing spondylitis.

We describe a clinical case of juvenile ankylosing spondylitis (AS) that developed "pseudo-chronic tendinitis" of the foot. A 20-year-old male patient had HLA-B27 positive juvenile AS since he was 13 years old. At the age of 19 he presented chronic pain in the dorsum of the left foot. Examination disclosed an increased volume of the tarsal dorsum, with rubbery consistency, with no evidence of venous or lymphatic insufficiency, godette, or inflammation in laboratory tests, giving the foot the appearance of a tamale. Synovectomy of the foot extensor tendon sheath was followed by relief of pain and swelling. Histopathological study showed a deposit of acid mucopolysaccharides (MPS) with no inflammatory cell infiltrate. Tamale foot in juvenile AS may develop as a consequence of acid MPS deposit with no evidence of synovial inflammation. The good response to synovectomy suggests this is the preferred treatment for tamale foot.

Prognostic significance of cutaneous depigmentation in Mexican patients with malignant melanoma.

BACKGROUND: The clinical significance of cutaneous depigmentary phenomena in patients with malignant melanoma is not clear. There are two varieties: 1) vitiligo (VIT), and 2) leukoderma acquisitum centrifugum (LAC). METHODS: In order to evaluate the outcome of our patients with malignant melanoma and skin depigmentation (VIT or LAC), the patients in this study with this association were retrospectively reviewed and compared with the total melanoma patients at the Oncology Hospital and the XXI Century National Medical Center of the Mexican Social Security Institute in Mexico City. RESULTS: Nine cases were found from 1985-1995. There were eight women and one man, their mean age was 63 years. Six melanomas were located in the foot, one in the leg, one in the anus and one in the neck. All were Clark's levels III, IV or V, and their mean tumor thickness was 5.7 mm. Four out of nine patients had regional lymph node metastasis. Six melanomas were associated with VIT and three with LAC. Three patients developed the depigmentation after chemo- or chemoimmunotherapy. All nine patients are alive (100%) with a mean follow-up of 55 months (9-141), eight out of nine have no evidence of tumor. CONCLUSIONS: From these data it may be concluded that the study patients with malignant melanoma and VIT or LAC have a higher-than-expected survival according to their prognostic factors. Therefore, the presence of the depigmentation phenomena must be looked for intentionally.

Antigen induced eosinophilia protects gerbils (Meriones unguiculatus) against experimental amebic abscess of the liver.

While the normal human eosinophil is destroyed in vitro by virulent Entamoeba histolytica, notwithstanding the presence of antibodies and complement, activated eosinophils promptly destroy the parasite even though succumbing in the process as well. To study the possible in vivo participation of eosinophils in invasive amebiasis, we compared the induction of experimental amebic abscess of the liver (EAAL) in gerbils (Meriones unguiculatus) previously made eosinophilic (532 +/- 80 eosinophils/mm3) through Toxocara canis antigen injection and normal control gerbils (101 +/- 15 eosinophils/mm3). Shortly (6 and 24 h) after intraportal injection of 10(5) virulent E. histolytica, the ratio of gerbils with EAAL, as well as the number and size of the abscesses was comparable in eosinophilic and control gerbils. At 96 h post-inoculation, the ratio of animals with EAAL was still the same in both groups, yet number and size of abscesses were significantly (p < 0.05) smaller in eosinophilic gerbils. The actuarial EAAL survival curve up to 45 days post-amebic inoculation was significantly (p < 0.05) shifted to the right in eosinophilic gerbils. No significant changes in IL-5 levels were recorded throughout these experiments. The results suggest that antigen-induced eosinophilia may exert a protective effect against EAAL in gerbils. It is speculated that a less overwhelming EAAL strategy--more akin to human amebic abscesses--may reveal this protective effect more clearly.

Giant congenital juvenile xanthogranuloma.

Congenital giant juvenile xanthogranuloma is an uncommon lesion that apparently has benign biologic behavior in most reported patients. In one of our three patients it was necessary to perform histochemical reactions with CD 1 (-), MAC 387, and electron microscopy to rule out Langerhans cell histiocytosis. The other patients had a typical histologic picture, with foamy histiocytes and Touton cells in association with lymphocytes and eosinophils. Comments about treatment are also made.

[Hodgkin's disease with the nephrotic syndrome. A case report]. / Enfermedad de Hodgkin con síndrome nefrótico. Informe de un caso.

It is presented a child with Hodgkin's disease which at diagnosis present associated at nephrotic syndrome. Male of nine years old which present a ganglionic growing of left jugular chain of one year evolution without systemic symptoms and anasarca. Were underwent a ganglionic biopsy with histopathology report of Hodgkin's disease mixed cellular variety and renal biopsy with histopathology report of minimal change disease. The patient present remission of nephrotic syndrome in simultaneous form at the control of the disease. In the reported cases of nephrotic syndrome associated with Hodgkin's disease it not clear the physiopathology. In this patient were realized immunologic studies of renal tissues to treat to find a possible mechanism of action of the neoplastic cells on the basal glomerular membrane but we can not found.

Vascular changes in cutaneous neurofibromas.

A variety of vascular changes has been associated with neurofibromatosis, and morphological alterations of arteries have been described previously. However, little attention has been paid to structural modifications of the microvasculature in neurofibromas themselves. Small vessels of 10 cutaneous neurofibromas, excised from patients with neurofibromatosis, were studied by using transmission electron microscopy and compared with normal skin vessels. The major alterations were: (1) increased thickness of the cytoplasm of endothelial cells which send numerous long processes to the lumen and, in some instances, obliterate it; (2) larger numbers of endothelial cell processes on the abluminal surface which are apposed to pericyte processes; (3) increased amounts of filaments and free ribosomes in the cytoplasm of endothelial cells, and (4) abundant pericytes with bundles of cytoplasmic filaments and many small subplasmalemmal densities. Mitotic figures were not seen in any of the vascular elements. These changes were interpreted to be the result of a generalized malformative process of blood vessels in neurofibromas rather than a consequence of the action of a tumor angiogenesis factor.

Occupationally induced psoriasis.

Psoriasis of the hands may be triggered by work, especially in occupations involving physical trauma or contact with irritants. When limited to the hands and in absence of other typical lesions, diagnosis can be difficult particularly when coexisting with contact eczema. It is necessary to establish diagnostic criteria which help to establish a relationship between clinical manifestations and noxious stimuli at work. Prevention should be directed to early identification of cases and adequate preemployment physical examinations in order to avoid permanent disability.

[Diffuse malignant lymphoma with small cleaved cells preceded by erythroderma with non-caseous granulomatous infiltration of the skin and leukemoid reaction]. / Linfoma maligno, difuso, de células pequeñas hendidas, precedido por eritrodermia con infiltración granulomatosa no caseosa de la piel y reacción leucemoide.

This is a description of a case in a man who developed non-Hodgkin lymphoma of small cleaved cells preceded by erythroderma with leukemoid reaction. Non- caseous granulomas with Langhans' cells were found in the skin biopsy. The etiologic agent was not identified until the neoplasia that killed him was demonstrated. Autopsy study showed lymphomatous infiltration in all ganglionaries groups, the skin, lungs, kidney, liver, spleen, adrenal glands and bone marrow. One of the interesting aspects of the case in the tissue reaction to the neoplastic process, a fact already described but rarely observed.

Occupational dermatitis from IPPD in tires.

A tire assembler developed contact dermatitis from IPPD, a rubber antioxidant. The lichenoid clinical pattern corresponded histologically to lichenified dermatitis. Tire assemblers appear to acquire contact dermatitis to this aromatic amine more frequently than any other workers in the tire manufacturing industry. Possible adjuvant factors and preventive measures are discussed.

Leucodermia por paraterbutilfenol.Padecimiento profesional generalizado? / Leukoderma due to paratertiarybutylphenol. A generalized professional disease?

Se informan 12 casos de leucodermia en bajadores dedicados a la sintesis de paraterbutilfenol. Se estudian macroscopicamente y ultramicroscopicamente las lesiones dermicas y se investigan, en detalle, las posibles repercusiones generales. Se comparan con hallazgos similares en otros paises y se proponen algunas hipotesis sobre el mecanismo patogenico para basar las medidas terapeuticas y profilacticas idoneas

Estudios del musculo estriado en la espondilitis anquilosante / Study on striated muscle in ankylosing spondylitis

Se llevo al cabo un estudio morfologico de biopsias de musculo, de 15 pacientes con espondilitis anquilosante. El proposito fue obtener una mejor definicion del tipo de anormalidades musculares presentes en esta enfermedad. La historia clinica de los pacientes no revelo dados de dano muscular. Los estudios de microscopia optica e histoquimica no revelaron alteraciones. Con el microscopio electronico se encontro desorganizacion de las miofibrillas, asi como acumulacion de glucogeno en ocho de los pacientes. Hubo engrosamiento de la membrana basal de los capilares musculares en siete casos. Solamente una biopsia fue considerada como normal. Aunque no hubo correlacion entre los cambios musculares y las manifestaciones clinicas, las alteraciones del musculo deben considerarse parte del cuadro de espondilitis anquilosante

Skin immunoflorescence in patients with systemic lupus erythematosus, SLE. Relationship between the immunohistochemical pattern and systemic activity.

19 SLE patients between 12 and 18 years of age were studied. In all cases a renal histological study was performed and patients received prednisone daily or on alternate days; 10 also received azathioprine. Patients were hospitalized for disease activity assessment from the clinical and biochemical standpoints. A healthy skin biopsy was simultaneously performed in the antero external face of the forearm and the fragment was subject to direct immunofluorescence study. IgG, IgM or C3 granular deposits were fund in six patients (33 per cent). Presence, type and intensity of deposits were related with other clinical and biochemical activity aspects, type of nephropathy, evolution and treatment time, and none was statistically significant. We can conclude that immune deposits in the skin of SLE patients can be useful as an auxiliary method for the diagnosis of this disease not having a relationship with the type and severity of the nephropathy or clinical activity of the disease.

[Study of the pathogenicity of Conidiobolus coronatus in experimental animals]. / Estudio de la patogenicidad de Conidiobolus coronatus en animales de experimentacion.

The pathogenicity of a strain of Conidiobulus coronatus isolated from Aenolamia postica was investigated in 152 mice, 42 guinea pigs and 47 hamsters. Four routes of inoculation were used: intraperitoneal, subcutaneous, intratracheal and scarification in the oral mucosa. Each animal was inoculated 3 times at 3 week intervals. Animals were sacrificed at 1, 8, 15, 45 of 225 days after the first inoculation. Observations of macroscopic lesions (nodules, abscesses, adhesions, etc.) direct examinations, cultures and histopathological studies of different tissues were performed. The aforementioned lesions of tissue were the most frequently found and all of them were resolved by spontaneous cure. The animals inoculated intraperitoneally and subcutaneouslly presented the highest number of postive results. The histopathological features at the 1st and 8th days after inoculation showed an acute inflamatory infiltrate with well preserved fungus filaments; at the 15th day granulomas with giant cells were observed containing fragmented and disintegrated fungal hyphae; at the 45th and 225th days a fibrosis reaction was observed and no fungal filaments, could be found. In no animal was rhinoentomophthoromycosis never reproduced, and according to these results it is considered that either this strain is not a pathogen or its pathogenicity is very low.