Biomedical subjects
Publications and source records attributed to E Diem.
A female patient with acrodermatitis chronica atrophicans and widespread sclerodermiform skin lesions with a high IgG antibody titer against Borrelia burgdorferi is presented. The rapid improvement after high-dose penicillin G therapy and the course of the Borrelia antibody titer suggest a persistence of the causative organism.
A 65-year-old female patient with pulmonary embolism developed widespread, extremely painful hemorrhagic necroses of the skin and subcutaneous tissue of the lower extremities 5 weeks after initiation of anticoagulation therapy. Due to the clinical and histopathologic findings and the course of the disease, a diagnosis of cholesterol embolization was made. The characteristic features of this clinical entity and differential diagnostic considerations are discussed.
We present two patients with lymphomatoid granulomatosis (LG) which was diagnosed from the histopathology of cutaneous lesions. Combined cytostatic and corticosteroid treatment induced transient, partial remission in one case, but a lethal outcome could not be prevented in either case. Monoclonal-antibody typing of lesional infiltrates indicated that LG is a malignant T-cell lymphoma.
Twenty-one patients with infected burns were treated with 5.2 g Timentin (ticarcillin 5 g + potassium clavulanate 200 mg) three times a day for an average of 8.3 days. Staphylococcus aureus was the commonest pathogen, there being ten cases of septicaemia with this organism and all were cured. Three patients with Pseudomonas aeruginosa septicaemia and infections with methicillin-resistant S. aureus failed. No drug related side effects were noted.
A 42-year-old woman with extensive pemphigus vulgaris failed to respond to high-dosage systemic steroids, immunosuppressive drugs and plasmapheresis. The treatment resulted in severe depression of the immune system, without marked effect on the disease activity. Eleven weeks after onset of disease she died of pneumonia and sepsis.
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Toxic epidermal necrolysis (TEN) has rarely been documented in children. We treated an 8-year-old boy who developed generalized blistering dermatosis after anticonvulsive therapy with diphenylhydantoin. The diagnosis was proved by exfoliative cytology, histology, and electron microscopy. The disease entity and its differentiation from staphylococcal scalded-skin syndrome and toxic shock syndrome are reviewed.
We present an unusual case of pemphigus vegetans (Hallopeau) with widespread, nonblistering gyrate erythematous lesions on the trunk and extremities in addition to typical vegetating lesions in the inguinocrural area. The histopathology which was characterized by eosinophilic spongiosis, as well as immunofluorescence and immunoelectron-microscopic studies indicated that the gyrate erythema (characterized by eosinophilic spongiosis) seen in our patient represented a manifestation of pemphigus. Treatment with retinoids resulted in the prompt disappearance of the gyrate erythemas, and the eosinophils returned to normal. A short-term, low-dose corticosteroid regimen also led to rapid healing of vegetating lesions.
Continuous epidural anesthesia, started 6 h after severe cold injury of the extremities and continued for 3 days, resulted in complete clinical remission of the frozen areas of the feet. In contrast, repeated stellate ganglion block, started 72 h after cold injury, failed to prevent the development of necroses in the frozen parts of the hands, so that plastic surgery was required.
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In a female patient which had been operated shortly after birth because of lumbal myelomeningocele, suddenly trophic ulcera of the toes of her right foot occurred. Rapid healing was achieved after laminectomy and successfull exstirpation of an epidural lipoma and a fibrous band which compressed the cauda equina at the level L4.
In a patient the simultaneous occurrence of lupus vulgaris, lupus carcinoma, metastatic to the regional lymphnodes and glandular tuberculosis is reported.
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This paper deals with the specialised therapeutic needs regarding immediate care, parenteral nutrition and surgery in burned geriatric patients according to the experience gained in the treatment of these patients at the Burns Treatment Division of the Department of Dermatology (I) of the University of Vienna.
The unique coincidence of five dermatological disorders, which occurred in a 39-year-old patient, is discussed. The clinical and laboratory examination did not reveal a common underlying cause. It is hoped this report will stimulate the recognition of other cases and thus aid in determining whether the coincidence of these disorders is a true association of diseases with a common underlying factor or a rare abnormality.
In 5 severely burned women (greater than 25% TBS, II degrees and III degrees burns) the following hormones were investigated by RIA. (1) LH-releasing hormone test in the initial phase of burn shock with 100 gamma 3 LH-RH. (2). Follow-up controls of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (HPRL), oestradiol (E2), progesterone (P) and testosterone (T) in the catabolic and healing phase of burn disease. All women were before onset of burn trauma regularly ovulating. The following preliminary results can be presented: If the burn trauma occurs in the preovulatory phase of the menstrual cycle, there was no ovulation during the time of observation. As a sign of the normal function of the anterior lobe of the pituitary gland all subjects responded with an increase of plasma LH to the stimulation with LH-releasing hormone. The burn trauma interferes with the female endocrine equilibrium by involving hypothalamic centres. Negative feedback mechanisms by the secretion of adrenal hormones and temporary hyperprolactinemic states as a further result are discussed.
The preconditions for the development of systemic mycoses, mainly levuroses, caused by opportunistic organisms are particularly favorable in the severely burned patients: on the one hand as a consequence of suppression of immunity, on the other hand by the overgrowth of these fungi in the digestive tract as a side-effect of the antibacterial chemotherapy which is necessary for the treatment of the original disease. Since such mycoses are usually very severe, mostly life endangering, their prophylaxis and early diagnosis are highly important. The aspects and measurements, most important in this connection, are discussed on the basis of our experience.