[Thirty years of methotrexate treatment for psoriasis].
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Biomedical subjects
Publications and source records attributed to M Lotem.
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Familial lichen planus (FLP) was observed to have developed within a period of 3 years in 2 sisters as well as in the son of one of the women. In contrast to typical FLP, the eruption was generalized in only 1 of these patients; no atypical forms were observed; the response to topical treatment with steroids was rapid, and the relapses were few and mild. Previous reports of familial cases of lichen planus as well as the long interval between onset of the disease in the affected members of the family speak in favor of a genetic predisposition. HLA typing revealed HLA DR in all 3 patients. There was no increased incidence of HLA B7, HLA A3 or HLA A28.
A 69-year-old man developed a generalized pustular drug rash 2 weeks after starting on hydroxychloroquine sulfate (HCQ) medication. This form of drug eruption had not previously been attributed to HCQ, although a diagnosis of pustular psoriasis cannot be ruled out.
A search for possible lithogenous factors was under-taken in a group of 42 lichen planus (LP) patients (15 with urolithiasis and 27 without). Normal mean values of calcium, phosphorus, uric acid and creatinine were found in the serum and in the 24-hour urine collection. However, 9 patients (21%) manifested laboratory deviations consisting of hyperuricemia, hyperuricosuria or hypercalciuria, or combinations of the three. The prevalence of hyperuricemia among LP patients was greater than in matched controls and vis-à-vis the recorded prevalence of hyperuricemia in the general population and in other calcium stone formers. These findings may suggest involvement of metabolic defects in LP.
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Impetigo herpetiformis is a rare pustular disorder that primarily affects pregnant women. Clinically and histologically it bears some resemblance to pustular psoriasis. This similarity has led authors to name the disease "the pustular psoriasis of pregnancy." A case is described that demonstrates the characteristic features of impetigo herpetiformis, as compared with pustular psoriasis, and emphasizes the need to preserve it as a separate entity.
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A superficial pustular eruption with acute onset has been reported in patients with acne vulgaris receiving systemic antibiotic treatment. In all past cases the causative micro-organism was found to be a gram-negative bacterium. This case report describes a similar clinical picture under the same circumstances, in which the bacterium incriminated was a coagulase-negative Staphylococcus.
The medical reasons for rejection among 3,000 consecutive applicants for flight training were evaluated, and the effectiveness of the screening process determined by reviewing subsequent medical wastage occurring during flight training. Of the 46 cadets who left the course because of medical reasons, 8 withheld information which would have led to their rejection on the original screening examination (epilepsy 1, recurrent syncope 1, migraine headache 2, Crohn's disease 1, asthma 1, chronic knee pain 1, and chronic recurrent headaches 1). There were also two errors in medical processing. The other 36 cases could not have been predicted by current screening procedures. We conclude that the major deficiency in our screening process is the concealment or withholding of information by candidates for flight training.
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Two cases of ossicles in human menisci are added to the list of 18 previously reported cases. The points of interest in these cases are that in both cases multiple ossicles were incorporated in the posterior horns of the semilunar cartilages--2 in the first case and 7 in the second. In a 16-year-old girl, the posterior horn of the meniscus was torn longitudinally in the shape of a "Y" and each part of the bifurcated meniscus housed an ossicle. Arthrotomy had been performed twice without successful removal of the ossicles. In a 39-year-old woman, all 7 ossicles were incorporated in the posterior horn of the meniscus.
Rupture of ten major tendons occurred in 7 out of a total of 50 renal patients treated by chronic hemodialysis, in two renal units. The rupture occurred spontaneously without any special strain. Rupture was complete in five tendons and imcomplete in the other five. In 2 cases, rupture occurred simultaneously in both quadriceps tendons. In 1 case a single quadriceps and a triceps brachii tendon were affected together. In 3 cases one quadriceps tendon was affected and in the last case, one triceps brachii tendon alone was ruptured. All the patients suffered from long-standing renal disease with severe secondary hyperparathyroidism. We are anable to explain the high incidence (15%) of this complication in our area. No local factors were found in our study.
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