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Systemic and cutaneous side effects observed in some workers of a company producing synthetic corticosteroids are described. The production process and the results of clinical and laboratory investigations are shown. A high incidence of skin and internal disorders (erythema, telangiectasia, acne, purpuric lesions and inhibition of the pituitary-adrenal axis) were found.
Ectopic production of adrenocorticotrophic hormone (ACTH) usually results in hypokalemic myopathy but is occasionally associated with florid Cushing's syndrome. We present a patient with Cushing's syndrome associated with a small-cell undifferentiated lung carcinoma. We describe the skin changes observed in this patient and review the cutaneous manifestation of Cushing's syndrome, and present current knowledge of the effects of glucocorticoids on the skin.
Purpura refers to pigmented eruptions that are recognized dermatologically. Their clinical appearance is valuable in identifying an appropriate etiology. The author discusses this entity and reviews differential diagnoses.
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Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint can result in significant pain and instability. Patients with this injury have severe difficulties with pinching and grasping objects. Avulsions of this collateral ligament from the proximal phalanx and midsubstance tears provide the usual mechanisms of injury. Complete ruptures usually require surgical treatment. Cast immobilization is usually satisfactory for partial tears.
We studied 20 patients in which a variety of erosive gastritis is described. We named it petechial erosive gastritis. We have to bring up that its sequence is due to the presence of the petechiae in the center of the mucosal area. Then in degrees of higher intensity erosions occur also at the center of the area mucosa. Occasionally the erosions meet, become larger and may bleed. An endoscopic classification of petechial erosive gastritis is established it rates mild, moderate, severe and hemorrhagic degrees. Even if the histopathologic study does not keep a strict correspondence with the severity of endoscopic observation of the lesions, it is possible to separate easily a petechial stage from an erosive stage. Demonstration of these lesions at their sequence from petechial to bleeding erosion constitutes an important contribution to the study of acute gastric lesions and it might open a way to a better study of the alterations of the irrigation of the gastric mucosa and the etiology of erosive lesions and acute ulcer.
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Skin and soft tissue necrosis is a rare complication of anticoagulation therapy. Two patients who exhibited the spectrum of this disorder are described. The clinical features, etiology, pathophysiology, and treatment of coumarin skin necrosis are outlined, and the English-language literature is reviewed.
We report a serial case study of 20 patients presenting scrotal contusions and for whom an emergency scrotal ultrasonography was performed. This investigation is not a luxury. It was a useful confirmation diagnostic tool for hematocele in 1/3 of cases (7/20) as well as for the detection of associated epididymal and or testicular lesions. In 2/3 of cases (13/20) it detected lesions unsuspected by clinical examination so that a therapeutic decision was taken promptly. Scrotal echography is therefore a useful emergency tool not for major trauma where the surgical decision is evident, but for apparently benign trauma where the clinical examination is currently deficient and needs provided a trained ultrasonography operator is available.
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Immunologic and immunofluorescent profiles of two patients with the Gardner-Diamond syndrome are described. During the time ecchymoses were present, both patients had decreased serum complement levels; when the lesions healed, the serum complement level returned to normal. One patient had associated angioimmunoblastic lymphadenopathy and subepidermal deposits of immunoglobulin IgM at the basement membrane of ecchymotic skin. The other patient had a normal immunofluorescent pattern. Both patients had increased B-cell counts. The association of immunologic and immunofluorescent findings in patients with the Gardner-Diamond syndrome is suggestive and deserves further study.
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Three cases of ecchymotic cellulitis in 7 to 11 month old infants are reported. Haemophilus influenzae was isolated from blood in two cases. Ecchymotic cellulitis in infants should, in the first place, evoke an Haemophilus influenzae infection. Bacteremia being frequent in this condition, blood cultures should be performed.
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