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Biomedical subjects

R K Winkelmann

Publications and source records attributed to R K Winkelmann.

At least 73 records · Page 4Linked to original sources
PubMed1990

The pathology of the autologous serum skin test response in chronic urticaria resembles IgE-mediated late-phase reactions.

The wheal-and-flare response to intradermal autologous serum in chronic urticaria offers a model for study of the pathogenesis of the disorder. Serial biopsies of autologous serum induced wheals were performed in 5 chronic urticaria patients to assess the evolution of the cellular inflammatory response and to look for evidence of mast cell degranulation. Perivascular neutrophils and eosinophils were seen as early as 30 min, becoming more intense and diffuse over 2 h. T lymphocyte numbers were increased by 2 h, CD4+ cells outnumbering CD8+ cells at 24 h. By 48 h, the neutrophils were clearing, but eosinophils and lymphocytes persisted. The histology of compound 48/80-induced wheals was similar to serum-induced wheals, but there was little or no response to physiological saline (0.16 M). Stainable mast cells were reduced in compound 48/80- and serum-induced wheals when compared to saline skin tests. Mast cell granules appeared swollen and had lost their characteristic lamellar substructure on electron microscopy of a serum-induced wheal biopsied at 10 min. Eosinophil degranulation was also observed at 2 h. The resemblance of the inflammation to the late phase of IgE-mediated immediate hypersensitivity reactions in atopics supports the concept that a circulating factor causes mast cell degranulation in chronic urticaria and may be important in the pathogenesis of the disorder.

Aged↗
PubMed1989

Clinicopathologic spectrum of cutaneous manifestations in systemic follicular lymphoma. A study of 11 patients.

Follicular lymphoma is rarely diagnosed on the basis of only a cutaneous biopsy. Eleven patients with primary follicular lymphoma of lymph nodes who developed skin lesions were studied. Skin lesions involved the scalp, head and neck, trunk, and buttocks and were small cleaved cell type in four cases, large cell type in three cases, and mixed type in four cases. The follicular pattern with a bottom-heavy distribution was identified in only six of the 11 cases. One case showed a nodular, perivascular pattern in the deep dermis and subcutaneous tissue. Four cases were characterized by a diffuse pattern of lymphocytic infiltrate. One patient with a diffuse pattern had an isolated subepidermal band of lymphoma cells representing primary cutaneous T-cell lymphoma. Cutaneous involvement by lymphoma previously diagnosed as low-grade (follicular growth pattern) transformed to higher grade disease in five of ten asynchronous cases. The 5-year survival rate was 60% among the transformed cases and 100% among the nontransformed cases. Extranodal cutaneous involvement in follicular lymphoma occurred in 3.8% of cases. The correct histologic diagnosis in a skin biopsy specimen can be established in cases with a follicular pattern (60%) with conventional histologic criteria such as redundancy of follicles, uniformity of follicular center cell composition, lack of interspersed phagocytic histiocytes, and absence of immunosecretory cellular elements such as plasma cells and immunoblasts.

Adult↗
PubMed1989

Blue nevus and nevus of Ota associated with dural melanoma.

A 41-year-old woman with a complex congenital nevus that possessed features of both a blue nevus and a nevus of Ota is described. She was found to have melanotic hyperpigmentation of the underlying subcutaneous tissue and dura mater. Two separate melanomas developed in the tissues underlying her nevus (one in the subcutaneous tissue and another intracranially, arising from the dura).

Adult↗
PubMed1989

Sweating patterns in atopic dermatitis patients.

Postganglionic sweat output in ten patients with atopic dermatitis was determined by a quantitative sudomotor axon reflex test in which the output results from axon reflex stimulation by acetylcholine iontophoresis. All measurements were obtained from normal skin on the volar aspect of the left wrist and dorsal aspect of the left foot of the atopic patients. Latency, sweat volume, and dynamic sweat pattern were variables included in the study. An abnormal value or configuration was found in nine of the ten patients studied. Seven of the ten patients had abnormal sweat output values. Atopic patients have abnormal sweating patterns, which may be inherently responsible for or related to their disorder.

Acetylcholine↗
PubMed1989

Superficial granulomatous pyoderma: clinicopathologic spectrum.

Superficial granulomatous pyoderma is a form of pyoderma gangrenosum characterized by superficial ulceration and a chronic course. Histopathologic examination shows a granulomatous response. We report two new cases of superficial granulomatous pyoderma in detail and briefly review the clinical data of five previous cases included in a recent series. These lesions typically begin as single furunculoid papules that most commonly occur on the trunk and that may arise at sites of surgical treatment or other pathergic stimuli. The lesions progress to superficial ulcers with a relatively clean base and vegetative borders. Tetracycline, minocycline, sulfapyridine, dapsone, and intralesionally administered corticosteroids have been effective anti-inflammatory agents, producing healing and allowing avoidance of the use of systemic corticosteroids in the management of most patients with superficial granulomatous pyoderma.

Adult↗
PubMed1989

Cutaneous gangrene, vascular calcification, and hyperparathyroidism.

We describe the development of necrotic ulcers with underlying vascular calcification in a 72-year-old man who had chronic renal failure. These lesions had surrounding ecchymoses. The patient had a normal serum calcium concentration, an elevated parathyroid hormone level, and findings consistent with a parathyroid adenoma on ultrasonography. We consider this another case of a characteristic cutaneous syndrome secondary to underlying vascular calcification and hyperparathyroidism.

Aged↗
PubMed1989

Generalized granuloma annulare: histopathology and immunopathology. Systematic review of 100 cases and comparison with localized granuloma annulare.

Some form of collagen alteration (necrobiosis) was observed in 53% of patients with generalized granuloma annulare and in 79% of patients with localized granuloma annulare. Fragmentation of collagen bundles was the most common single type of collagen abnormality in both groups. Collagen sclerosis, accompanied by a strong palisading pattern of histiocytes, was more frequent in localized granuloma annulare. Results of microdroplet lipid staining were positive in 80% of annulare cases and 39.3% of nonannulare cases of generalized granuloma annulare. Inflammatory cells were confined to peripheral perivascular lymphocytes; bandlike granuloma below the epidermis was observed. Positive results of direct immunofluorescence tests in 12 of 23 patients with generalized granuloma annulare suggested that fibrin deposition in areas of altered collagen is less frequent in the generalized than in the localized form, a possible reflection of the lower rate of histologic collagen alteration in that group. Lymphohistiocytic granuloma with various degrees of collagen degeneration, microdroplet lipid accumulation, and mucin deposition form the basic pathologic description of granuloma annulare.

Collagen↗
PubMed1989

Generalized granuloma annulare: clinical and laboratory findings in 100 patients.

Clinical and laboratory records of 100 biopsy-proved cases of generalized granuloma annulare seen at the Mayo Clinic between 1966 and 1986 were reviewed. The skin eruption involved predominantly annular lesions in 67 patients and predominantly nonannular papules in 33. The ratio of female-to-male patients was 2.9:1 in the annular group and 1.4:1 in the nonannular group. The mean age at onset was 51.7 years. The eruption was symptomatic in 34 patients, and specific precipitating factors could be implicated in 16 patients. No consistently associated systemic disorders were identified. Diabetes mellitus was diagnosed in 21% of our referral group of generalized granuloma annulare cases, compared with 9.7% in 1350 cases of localized granuloma annulare and 10.3% in 1383 cases of all forms of granuloma annulare seen at the Mayo Clinic in the same period. Serum lipid abnormalities were more common in the generalized annular group. Follow-up data indicated a chronic, relapsing course in most patients.

Adolescent↗
PubMed1989

Unilesional mycosis fungoides: a distinct entity.

Four cases of solitary lesions showing the histologic features of mycosis fungoides are described. Three patients had an erythematous scaling plaque, whereas the fourth had a solitary nodule. The lesion was located on the arm in two patients, on the foot in one patient, and on the back in one patient. No preceding factors were noted, and no lymphadenopathy or other significant illness was found on examination. Histologic examination demonstrated features of a cutaneous T cell lymphoma with epidermotropism. Monoclonal markers on frozen and paraffin sections revealed a predominant T cell infiltrate. Three patients were treated with local excision. The remaining patient was treated with radiotherapy. The lesions have not recurred, and no new lesions have developed after individual follow-up of 7 months, 7 1/2 months, 13 years, and 18 years. These cases appear to be unique reports of solitary mycosis fungoides behaving in a biologically benign manner. The relationship to Woringer-Kolopp disease and lymphomatoid papulosis is discussed.

Aged↗
PubMed1989

Histiocytic cytophagic panniculitis.

Nineteen cases of histiocytic cytophagic panniculitis from our institution and from the literature were reviewed for their clinical and histopathologic features. All patients had cutaneous involvement consisting of cutaneous nodules and plaques that occasionally were ecchymotic and ulcerated and were characterized by infiltration of the subcutaneous tissue by large, benign histiocytes with cytophagic features. Thirteen of the patients had died (nine with hemorrhagic complications), four patients had a benign course with remission of the disease, and two patients responded to aggressive polychemotherapy. Immunohistochemical studies of paraffin-embedded tissue, performed in five cases, revealed a large number of infiltrating T cells in the subcutaneous inflammatory lesions.

Adult↗
PubMed1989

Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients.

We studied the clinical, microbiologic, and histopathologic findings from 14 patients with necrotizing fasciitis; also tissue obtained at autopsy was available from six patients. In all cases, material cultured was positive for multiple organisms, including Clostridia and fungi; organisms were identified by histochemical staining of tissue sections in 12 of 14 cases. The histologic pattern comprised edema, necrosis, and inflammation of skin, subcutaneous fat, and fascial tissue. Hyalin necrosis of sweat glands was observed in five patients. Thrombosis of vessels at all levels was a prominent feature, suggesting that study of coagulation factors may be important. Diagnosis may be confirmed by the histologic picture; however, microbiologic material is essential to guide therapy.

Adult↗
PubMed1989

Eruptive histiocytoma.

A case of adult cutaneous eruptive histiocytoma is reported. The lesions showed self-healing capacity in a 9-year period. Electron microscopic studies revealed comma-shaped bodies and multiple melanosomes in the cytoplasm of some cells. Normolipemic xanthelasma was present, and the patient had polyclonal gammopathy and hypocomplementemia. Resolution of the lesions produced pigmented atrophic macules. Generalized eruptive histiocytoma and benign cephalic histiocytosis could be forms of the same non-X histiocytosis.

Aged↗
PubMed1989

Evidence for eosinophil degranulation with deposition of granule major basic protein in solar urticaria.

Multiple sequential biopsy specimens of wheals elicited by a solar simulator in four patients with severe solar urticaria were studied with the use of indirect immunofluorescence for eosinophil granule major basic protein. Examination of control biopsy specimens from normal, unstimulated skin did not show eosinophils or major basic protein deposition. Five minutes after solar simulation, eosinophils were observed in vessels in the dermis, and 2 hours later there was marked tissue eosinophilia. Extracellular major basic protein was extensively deposited in the dermis at 2 and 24 hours, suggesting eosinophil degranulation. Thus evolution of the solar urticaria wheal is accompanied by infiltration of eosinophils and neutrophils and by tissue deposition of the eosinophil major basic protein, suggesting eosinophil degranulation.

Blood Proteins↗
PubMed1989

Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases.

We reviewed 62 cases (26 men and 36 women, median age 55 years) of previously diagnosed lichenoid dermatitis and correlated the histologic and immunodermatologic findings with the clinical diagnosis and course. The clinical diagnostic groups were contact dermatitis (6 cases), drug eruption (14), lupus erythematosus (6), lichen planus (3), cutaneous T cell lymphoma (3), chronic dermatitis or neurodermatitis (19), and miscellaneous dermatologic disorders (11). With the use of individual histologic features, a correlation with specific clinical conditions was possible, and the clinical groups of dermatitis, drug eruption, lupus erythematosus or lichen planus, and T cell infiltration could be selected histologically. Direct immunofluorescence studies were of most help in the diagnosis of lupus erythematosus and atypical lichen planus, but these studies should be performed in all cases involving lichenoid inflammation. Although previously the nonspecific term lichenoid dermatitis was used to classify the histologic features in these cases, we found that by careful correlation of histologic, immunodermatologic, and clinical features, we were often able to provide a specific diagnosis.

Adolescent↗
PubMed1989

Subcutaneous xanthogranulomatosis: an inflammatory non-X histiocytic syndrome (subcutaneous xanthomatosis).

The histopathologic features in four cases of subcutaneous xanthogranuloma were reviewed. All patients were elderly men and no associated diseases or hyperlipidemia were present. The microscopic picture was uniform in seven biopsy specimens: foam cells and masses circumscribed by Touton cells replacing the adipose tissue. Most cells, including foam cells, showed a positive reaction for the macrophage marker MAC387. Diffuse, sparse T cells and focal perivascular B cell nodules were identified. Electron microscopic examination showed histiocytes and lysosome-rich cells with myelin bodies. All patients are alive and well. We believe that we have identified a form of adult subcutaneous xanthogranuloma syndrome that can be initially confusing and lead to overdiagnosis and overtreatment.

Adult↗
PubMed1989

Lipophagic panniculitis of childhood.

The cases of three patients with an atrophic lipophagic granulomatous lipoatrophy are described and compared with 14 similar cases in the literature. In affected children erythematous lesions of the arms and legs usually occur, after which subcutaneous atrophy develops. Fever and edema are common. The histologic feature is a replacement of the fat lobule by lipophagic histiocytes and giant cells. No vasculitis or phlebitis is present. Previously, such cases have been called Weber-Christian disease or Rothmann-Makai syndrome, but they are best characterized by the distinctive clinical lesions, the course, and histologic findings. Corticosteroids apparently have been effective in some patients.

Arm↗