Search PubMed⌕ Search

Biomedical subjects

J Baral

Publications and source records attributed to J Baral.

At least 19 recordsLinked to original sources

Photoinduced dermal pigmentation in patients taking tricyclic antidepressants: histology, electron microscopy, and energy dispersive spectroscopy.

Two patients had been taking long-term tricyclic antidepressant therapy. Each developed a blue to slate-gray hyperpigmentation in sun-exposed areas. On histologic examination there were refractile golden brown granules free in the dermis along collagen bundles. Similar pigment was present in macrophages and along the basement membrane zone. The granules stained for melanin, but not for iron, and were bleached by the permanganate method. Electron microscopy showed varying size and shaped electron-dense granules within lysosomes and free in the dermis, which, in unstained sections, showed a less dense peripheral halo. This peripheral halo was also evident on light microscopy. Energy dispersive spectroscopy showed these granules to be rich in copper and sulfur (elements present in tyrosinase and pheomelanin, respectively). We believe that this represents a drug-melanosome complex, which is most likely caused by chronic photoactivation.

Antidepressive Agents, Tricyclic↗

[Treatment with stents in the upper gastrointestinal tract].

A wide range of therapeutic methods for treatment of malignant and benign stenoses of the upper gastrointestinal tract is at one's disposal with esophageal mechanical dilatation, laser therapy, insertion of plastic tubes and stent implantation. It has become routine to insert flexible metal stents in the treatment of esophageal carcinoma and tracheoesophageal fistula. Case reports exist describing the use of flexible metal stents in complicated benign esophageal stenoses of stomach and duodenum. Until January 1997 we implanted 18 stents (7 Z-stents[Wilson and Cook], 4 covered and 4 uncovered Ultraflex stents [Boston Scientific], 3 Endocoil stents [Instent]) in 15 patients. We treated patients with esophageal carcinoma, recurrent stenoses after gastrectomy and tracheoesophageal fistula. They were followed by questionnaires. Four days after stent implantation 50% of the patients were able to consume normal solid food, the other half semisolids. The main problem was the stent migration (28%). The decisive factors for stent migration were the quality of surface of the stent and its position in the gastroesophageal junction. The stents which were dislocated in the stomach could easily be extracted endoscopically. The endoscopic extraction of a dislocated Z-stent in the small bowel was impossible. The high rate of stent dislocation (20-30%) in distal stent position (gastroesophageal junction) is not to be tolerated with respect to the purchase price.

Adult↗

[Endoscopic palliation of malignant esophageal stenoses].

The choice of the appropriate endoscopic procedure for treating a malignant esophageal obstruction depends on the tumor localisation, the tumor configuration, on specific patient data and last but not least on the technical possibilities of the hospital involved. Successfully performed is the mechanical dilatation, the tube insertion and stent implantation, the laser therapy, the argon plasma coagulation and the local sclerotherapy. The procedures differ in rate of complication, long term palliation and the improvement of dysphagia. In a case discussion we demonstrate that in the wide range of disease and patient specific facts that have to be dealt with, only the combined use of different endoscopic procedures will lead to the best results.

Carcinoma, Squamous Cell↗

Tar melanosis.

Explore the source record for details and available documents.

Humans↗

Lymphomatoid papulosis with antigen deletion and clonal rearrangement in a 4-year-old boy.

Lymphomatoid papulosis (LyP) is rarely seen in children. We report a case of LyP in a 4-year-old boy in whom immunopathologic studies demonstrated T cell antigen deletions. In contrast to all but two previous reports, a T suppressor (CD-8) phenotype was predominant. Southern blot analysis of DNA isolated from a typical skin lesion indicated a clonal rearrangement of the T cell receptor beta gene. Because of a 10% frequency of malignant lymphomas in patients with LyP, long-term observation is crucial, especially in children. We recommend routine clonal rearrangement studies for aid in diagnosis and follow-up, and as possible prognostic indicators in children with this condition.

Antigens, CD↗