Biomedical subjects
Publications and source records attributed to W K Blaylock.
Indurated, erythematous plaques of the left arm and left flank developed in a 69-year-old white man with multiorgan failure from Escherichia coli sepsis. Cutaneous malacoplakia was diagnosed. Intravenous antibiotic therapy resulted in resolution of the malacoplakia and the E. coli sepsis.
Intrauterine-acquired neonatal herpes simplex virus infection is a severe, often life-threatening infection that has a wide spectrum of clinical presentations. We describe a 31-week-gestation male who had a rarely reported epidermolysis bullosa-like clinical presentation. He acquired herpes simplex virus type II in utero secondary to a primary maternal infection that occurred on the knee. A review of the infection, the need for early therapy, and the prognosis are presented.
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The ethmoid air cell labyrinth lies adjacent to the medial orbital wall, extending even beyond the sutures of the ethmoid bone. Its anatomic relationship to the lacrimal sac fossa is important in lacrimal surgery. We evaluated computed tomographic scans of 190 orbits with normal ethmoid anatomy to define the anatomic relationship of anterior ethmoid air cells to the lacrimal sac fossa. In 93% of the orbits, the cells extended anterior to the posterior lacrimal crest, with 40% entering the frontal process of the maxilla. This anatomic relationship may be used to facilitate the osteotomy during dacryocystorhinostomy. During a 10-year period (310 cases), one of us routinely entered the anterior ethmoid air cells to initiate the osteotomy during dacryocystorhinostomy. This technique has helped to avoid lacerations of the nasal mucosa.
Peripheral blood mononuclear cells from 24 patients with mycosis fungoides were used to generate lymphokine activated killer (LAK) cells in vitro by culturing with recombinant interleukin 2. Patients with stage la mycosis fungoides were capable of generating normal levels of LAK cell activity, while patients with more active disease (stages IB to IV) had depressed LAK activity. The ability of these patients' cells to respond in a proliferation assay to various mitogens was similar to that of controls, with the exception of patients in the terminal phase of their illness. Patients with active disease who were unable to generate LAK activity were capable of responding in a proliferation assay to interleukin 2. The results of this study suggest that depressed LAK cell activity in patients with mycosis fungoides may serve as an indicator of a more aggressive disease state.
To investigate the controversy regarding the presence of eosinophils in skin lesions of erythema multiforme, we undertook a retrospective clinicopathologic study of 19 recent cases that fulfilled clinical and histopathologic criteria for the disease. At least a few eosinophils were observed in 13 of 19 cases, and in four cases there were more than three per high-power field, qualifying as "tissue eosinophilia." Immunofluorescence studies in three cases with eosinophils failed to show the linear basement membrane zone fluorescence characteristic of bullous pemphigoid. Giemsa stains revealed that mast cells were present in lesions both with and without eosinophils. The only clinical features that distinguished patients with tissue eosinophilia from those without were an older age of incidence and a longer duration of disease prior to biopsy. Drugs were implicated as a causative factor in some patients both with and without eosinophils, but all four patients with tissue eosinophilia were believed to have drug-induced disease. We conclude that eosinophils do occur in skin lesions of erythema multiforme and are occasionally numerous.
Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.
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