Biomedical subjects
Publications and source records attributed to J W Dijkstra.
Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus. Because histoplasmosis is usually a self-limited disease in the majority of cases, treatment often is not needed in the normal host. However, severe cases of acute pulmonary histoplasmosis require therapy. Amphotericin B is considered the treatment of choice.
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A newcomer in the cosmetic market, the tan accelerator, has stimulated much publicity in recent months. We studied the effects of two brands of this product, used according to package instructions, in eighteen healthy volunteers. Readings at 24, 72, 96 hours, and 1 week failed to show augmented tanning. Our study contradicts the companies' claims of efficacy.
Two patients with the clinical and histopathologic findings of eosinophilic cellulitis are presented. In one patient there was a definite relationship between upper respiratory tract infection and flare-ups of eosinophilic cellulitis. This patient's condition was superimposed on a long history of chronic urticaria. In the other patient a relationship to recurrent sinusitis was possible but not definite. There were no other contributory underlying skin diseases in either patient. Eosinophilic cellulitis is not likely a disease entity as such but, instead, represents a severe urticarial hypersensitivity reaction to various stimuli. Collagen alteration by eosinophil granules results in flame figure formation and a granulomatous response, which may explain the prolonged persistence of the lesions.
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A patient with "classical" lymphomatoid papulosis is described in whom self-healing tumorous lesions occurred. Histologic, immunologic, enzyme histochemical and ultrastructural studies were performed. The atypical cells were found to be of monocyte-macrophage origin. The infiltrate also contained a variable number of suppressor-cytotoxic T-lymphocytes, depending on the stage of the tumorous lesions. The number of IgA positive B-lymphocytes in the peripheral blood was increased. The findings indicate that "classical" lymphomatoid papulosis is not a cutaneous T-cell lymphoma, but is the expression of an abnormal, immune reaction in the skin.
Lumbar puncture was performed in 18 patients with latent syphilis to rule out asymptomatic neurosyphilis. In seven patients the CSF findings were abnormal. The parameters used in CSF were cell count, total protein, immunoglobulins (IgG, IgA, IgM), IgG index, and serologic tests for syphilis (VDRL, Kolmer, RPCF and FTA-ABS, including monospecific IgG and IgM conjugates). In three patients, the CSF findings 7-10 months after treatment are also given. Penicillin levels in serum and CSF were determined in two patients after aqueous procaine penicillin G im with and without oral probenecid. The effect of blood contamination on the differentiation between normal and abnormal CSF may not be significant.
This report describes the immunofluorescence (IF) findings in sequential skin biopsies and serum obtained during a follow-up study of a patient who developed pemphigus lesions after D-penicillamine treatment of arthritis. The distribution in the skin of IgG, IgM and C3 varied with the date, type and site of the biopsy sample. Thus IF patterns showed features of (a) pemphigus vulgaris, (b) pemphigus foliaceus and (c) pemphigus erythematosus. Indirect IF examination indicated the presence of circulating intercellular epithelial antibody of both the IgG and IgM class.
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Transesophageal echocardiography (TEE) was performed within 24 hours after cardiac catheterization in 45 patients for assessment of native mitral valvular regurgitation. Color flow mapping was used in evaluating systolic regurgitant jet sizes. A jet demonstrated by TEE was 96% sensitive and 44% specific for angiographic mitral regurgitation. The presence of angiographic mitral regurgitation was best predicted by (single measurement) (1) a holosystolic jet, (2) a jet length greater than 2.5 cm, and (3) a jet area greater than 2 cm2. Severe angiographic mitral regurgitation (grades 3 and 4) was best predicted by (single measurement) (1) a jet area greater than 5 cm2, and (2) a jet length greater than 4 cm. It is concluded that the assessment of angiographic mitral regurgitation by TEE is improved by the measurement of these jet parameters, which have a high sensitivity and higher specificity than the presence of a jet alone. Furthermore, with TEE one is able to differentiate severe (grades 3 and 4) from absent or mild mitral regurgitation (grades 0, 1, and 2).
A significant proportion of vitiligo patients are children. Systemic PUVA therapy, the most consistently effective and practical therapy for this disease, has not been recommended in pediatric patients because of concerns regarding potential long-term side effects. We report a 9-year-old Caucasian girl with progressive vitiligo who was successfully treated with bath PUVA. This form of PUVA therapy may provide a wider margin of safety, in that less exposure to ultraviolet A (UVA) radiation is required and systemic absorption of psoralen is minimal.
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