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Biomedical subjects

M S Stone

Publications and source records attributed to M S Stone.

47 records · Page 3Linked to original sources

Apocrine hidrocystomas of the lids, hypodontia, palmar-plantar hyperkeratosis, and onychodystrophy. A new variant of ectodermal dysplasia.

A fourth case of a newly recognized variant of ectodermal dysplasia is reported. This syndrome is characterized by bilateral apocrine hidrocystomas of the eyelid margins, hypodontia, palmar-plantar hyperkeratosis, and onychodystrophy. To our knowledge, this syndrome, with its striking ocular manifestations, has not been previously documented in the ophthalmic literature.

Aged↗

Acral purpura: an unusual sign of coumarin necrosis.

Coumarin necrosis, a rare complication of coumarin anticoagulation, typically presents with well-defined purpuric patches that progress to bullae formation and necrosis. The vast majority of those affected are women, and most commonly affected sites are the breasts, buttocks, thighs, and abdomen. We present a male patient who manifested a unique reticulated purpura that progressed to bullae formation on the toes of one foot in addition to more classic lesions on the thigh and calf.

Coumarins↗

Psoriasis with pustules and actinic reticuloid.

We describe a patient whose clinical and histopathologic findings were originally interpreted as representative of actinic reticuloid but who later developed psoriasis with pustules. We propose that the original photosensitive eruption could have represented an unusual presentation of photosensitive psoriasis, although koebnerization of psoriasis into areas of photosensitivity remains a definite possibility.

Aged↗

Malignant histiocytosis.

Malignant histiocytosis, also known as histiocytic medullary reticulosis, is a rare neoplasm of malignant histiocytes. Clinical findings include fever, weight loss, hepatosplenomegaly, lymphadenopathy, anemia, thrombocytopenia, and a rapidly worsening course. Approximately 7 percent of patients have skin manifestations early in the course of their disease. In these patients, diagnosis based on examination of a skin biopsy specimen may be crucial. A case of malignant histiocytosis is presented in which the diagnosis was first suggested by findings on the skin biopsy specimen.

Adult↗

Agar disk elution method for susceptibility testing of Mycobacterium marinum and Mycobacterium fortuitum complex to sulfonamides and antibiotics.

An agar disk elution method using round well plates, supplemented Mueller-Hinton agar, and commercial drug disks is described for susceptibility testing of Mycobacterium marinum and the rapidly growing mycobacteria to antibiotics and sulfonamides. By this method, 14 of 14 strains of M. marinum were susceptible to rifampin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole. Identical results were obtained with Middlebrook 7H10 agar and drugs prepared from standard powders. With 58 isolates of Mycobacterium fortuitum and Mycobacterium chelonei, this method had a 92% correlation with broth minimal inhibitory concentration determinations for cefoxitin and greater than 98% for doxycycline, kanamycin, amikacin, and the sulfonamides. Sixty-nine percent of isolates of M. chelonei susceptible to amikacin on supplemented Mueller-Hinton agar were resistant on 7H10 agar, and 15 of 16 M. chelonei isolates susceptible to erythromycin in broth were resistant by disk elution when an endpoint of no growth was used with either agar. The agar disk elution method offers a practical method for testing of most antibacterial agents against these mycobacterial species.

Agar↗

New approaches to the management of severe acute pancreatitis.

A recent experience with seventy-seven patients admitted to Boston City Hospital for acute pancreatitis permitted us to identify thirteen patients (17 per cent) whom we diagnosed as having severe protracted acute pancreatitis. These alcoholic patients obviously had fulminant pancreatitis similar to that reported by others in two instances and pancreatic abscesses in two additional instances, but nine of the patients did not fulfill the criteria usually used by others as a basic for surgical intervention. Specific preoperative diagnosis was obtained in these patients by the aggressive use of endoscopic cannulation of the pancreatic ducts, which documented the presence of surgically correctable lesions. These patients had sustained significant malnutrition, which was corrected only by protracted therapy extending an average of two months and involving all modalities currently available for nutritional support of the severely ill patient. After proper preoperative identification of a specific lesion and correction of the malnutrition, the eleven patients without fulminant disease were operated on with no deaths or significant complication. Nine of the patients had elective procedures, which included six distal pancreatectomies and one total pancreatectomy. Thus, severe protracted acute pancreatitis can be identified, and once categrorized, it can have therapeutic implications.

Acute Disease↗

Spectrum of disease due to rapidly growing mycobacteria.

One hundred twenty-five cases of disease due to rapidly growing mycobacteria were observed over a four-year period. Cutaneous infections accounted for 74 cases (59%). Of these, 40 followed surgical procedures (especially augmentation mammaplasty or median sternotomy), and 34 were due to accidental penetrating trauma. Among the 24 patients with pulmonary disease, the mean age was approximately 60 years, the majority of patients (63%) were women, and most had unilateral noncavitary disease. Other infections included disseminated disease with multiple nodular skin lesions and positive blood cultures, cervical lymphadenitis, keratitis, and endocarditis associated with a prosthetic valve. Infected tissues showed mixed acute and granulomatous inflammation; acid-fast bacilli, when present, occurred in extracellular clumps within microabscesses. Mycobacterium fortuitum and Mycobacterium chelonei were encountered with approximately equal frequency; 80% of isolates of M. chelonei were subspecies abscessus, and 83% of isolates of M. fortuitum were biovariant fortuitum. The outcome in these infections was generally good, although 9% of the patients, including all those with endocarditis, died. Infections due to M. fortuitum and M. chelonei are probably markedly under-diagnosed, and these organisms are capable of causing a wide spectrum of clinical disease.

Adolescent↗

Lupus-type "anticoagulant" in a dog with hemolysis and thrombosis.

A circulating anticoagulant was detected in a 2-year-old Chesapeake Bay Retriever with hemolytic anemia, nephrotic syndrome, thrombocytopenia, polyarthropathy, and pulmonary thromboembolism. A persistent prolongation of the activated partial thromboplastin time (aPTT) was detected, and it did not correct with repeated administration of fresh frozen plasma. The aPTT was still prolonged, with a 1:1 mixture of patient's plasma and normal dog plasma in vitro, suggesting the presence of a circulating inhibitor. Results of assays to characterize the inhibitor were compatible with those described for the lupus anticoagulant in human patients with systemic lupus erythematosus. Paradoxically, patients having the lupus anticoagulant are at increased risk for thrombosis. Pulmonary thromboembolism has been described as a frequent complication of immune-mediated hemolytic anemia in the dog, and the presence of a circulating anticoagulant should be considered as a potential mechanism.

Anemia, Hemolytic↗