The spectrum of Reiter's disease.
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Biomedical subjects
Publications and source records attributed to J P Callen.
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Dermatitis herpetiformis has been associated with a variety of thyroid abnormalties. A case of thyrotoxicosis in a patient with pre-existing dermatitis herpetiformis is reported. Thyroid antibodies were present in the serum. This may suggest an immunologic relationship between dermatitis herpetiformis and thyroid disorders, that may be more than fortuitous.
A case of Kaposi's sarcoma is presented in which extensive diagnostic studies failed to detect the cardiac, pulmonary, intestinal and nodal involvement that was found to be present at autopsy.
Both the skin and the eye are easily accessible structures which may reflect systemic disorders. Certain systemic conditions frequently involve the oculocutaneous structures and will be discussed herein. The practitioner must be aware of these disorders, and the interrelationship of the skin and the eye.
Malignant melanoma (MM) is an important cutaneous neoplasm. In classic cases, histologic levels of tumor invasion have been used as indicators of prognosis. Recent research suggests that vertical tumor thickness may be an equally valuable guide to prognosis and also to therapy. The standard surgical approach of wide excision and regional lymph node dissection may not be mandatory for all patients with MM. Regional perfusion of accessible primary tumors as an adjunct to surgery has yielded encouraging results. Immunotherapy of MM alone and in combination with chemotherapy may improve the poor outlook for disseminated MM.
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A time-space aggregate of Hodgkin's disease was observed in a small town. A large elevator for the storage of navy beans was located in the residential area of the town. Lymphocytes of town residents compared to those of non-residents showed increased levels of transformations when challenged with extracts of navy beans. A phytohaemagglutinin from navy beans with the ability to stimulate lymphocytes was isolated and characterized. A hypothesis concerning a connection between this cluster of Hodgkin's disease and the abnormal lymphocyte responses to navy-bean phytohaemagglutinin is discussed.
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Polymyositis is an idiopathic progressive muscle disease. Occasionally, sarcoidosis can be associated with a polymyositis-like picture, both clinically and on laboratory investigation. However, serial sections of muscle biopsies will usually demonstrate sarcoid granulomas. A case of sarcoidosis that began as polymyositis with diffuse interstitial pneumonitis is presented.
Cutaneous manifestations of histoplasmosis may be divided into primary and secondary lesions. Primary cutaneous histoplasmosis is rare; to our knowledge, there are only three reported cases in the literature. Secondary cutaneous histoplasmosis develops during the course of disseminated disease. An isolated nodule of the hand was the initially appearing sign of recurrent disseminated disease in our patient. Because of the extreme rarity of primary cutaneous histoplasmosis, cutaneous lesions that are proven to be due to histoplasmosis should alert the physician to the presence of disseminated disease.
Erythema multiforme (EM) is clinically characterized by a "minor" form and a "major" form. The latter is known as the Stevens-Johnson syndrome. Infections (particularly herpes simplex and Mycoplasma pneumoniae) and drugs seem to predispose toward the development of EM. The pathogenesis is poorly understood. The treatment is supportive. Prognosis varies with the severity of the eruption. Recurrences are commonly seen.
Granulomatous hepatitis has been associated with many conditions, including chronic ulcerative colitis and sulfonamide therapy. We report a patient with ulcerative colitis in whom hepatic granulomatosis was associated with salicylazosulfapyridine (Azulfidine). Sulfonamides should be considered a possible cause of hepatotoxicity when used therapeutically in inflammatory bowel disease.
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Squamous cell carcinoma of the skin is not an uncommon problem. It is often accompanied or preceded by actinic keratoses, arsenical keratoses, or other skin cancers. The most common cause is exposure to sunlight. This paper will deal with squamous cell cancer of the skin and actinic keratoses.
Although bullous pemphigoid is a disease associated with autoantibodies, it rarely has been associated with other diseases associated with autoimmune phenomena. We report the occurrence of bullous pemphigoid, pernicious anemia, and rheumatoid arthritis in a patient.
Systemic complications of drugs commonly prescribed by dermatologists fortunately are uncommon. Nevertheless, it is extremely important that the dermatologist be aware of medical contraindications to the use of these agents, as well as their potential systemic side effects. These considerations for methotrexate, sulfones, tetracyclines, and corticosteroids are reviewed.