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At least 1,099 records · Page 61Linked to original sources

Cogan's syndrome. An unusual etiology of urticarial vasculitis.

We report the case of an 18-year-old black woman with urticarial vasculitis, vestibuloauditory dysfunction and superficial keratitis. Oral steroid therapy was effective in reducing most clinical manifestations with high-dosage dependency. However, only intravenous pulses of methylprednisolone allowed slight improvement of hearing. In this case, we emphasize urticarial vasculitis as a new manifestation of atypical Cogan's syndrome. A significant titer of Chalmydia trachomatis antibodies was found in our patient: their role in the pathogenesis of Cogan's syndrome is discussed.

Adolescent↗

Atrophie blanche. A clinicopathological study of 27 patients.

Twenty seven patients (8 males and 19 females) with atrophie blanche were observed in the past 7-years. The mean age at onset was 32 years (ranging from 23 years to 57 years) and 19 years (ranging from 11 years to 36 years) for male and female patient, respectively. The mean disease duration was 2.5 years (ranging from 2 months to 16 years) prior to their consultation. Sixty-three percent of them had summer exacerbation. Four patients had essential cryoglobulinemia, one of whom also developed bilateral iliofemoral artery stenosis one year later. Twelve patients also manifested concurrent purpura pigmentosa chronica (PPC)-like lesions. The observation of the natural course and clinical morphology, being divided into white atrophy-predominant and ulcer-predominant type, led to the impression that atrophie blanche and livedo vasculitis are synonyms with the same disease spectrum. Furthermore, white atrophy is not ulcer scars but lesions de novo suggesting dermal vasculopathy. An attempt was made to explain the uniqueness of clinical morphology. First line treatment included local wound care, bed rest and low-dose aspirin plus dipyridamole. Thirteen patients responded to these treatment either at the first attack or the recurrent episodes. Heparin (5000 units subcutaneous injection once daily) was effective for control of intractable painful ulceration in active stage in 70% of the remaining patients.

Adolescent↗

[Treatment of infected pseudarthroses of the tibia complicated by defects of soft tissues].

On the basis of experience in the treatment of 51 patients with infected false joints of the tibia the authors conclude that local circulatory disorders play the decisive role in the genesis of nonunion of the fracture. The recommended methods for removal of the soft tissue defect by various types of pedicled skin grafts in combination with fixation of the fragments and plastic repair, in some cases, of the false joint zone with demineralized bone allografts made it possible to remove the inflammatory process radically and achieve consolidation in 94% of patients who were operated on.

Adolescent↗

Vaginal ulcerations due to lithium carbonate therapy.

A twenty-nine-year-old woman who had been taking lithium carbonate for seven years experienced ulcerated lesions of the vaginal mucosa and acneiform eruption on both thighs. Histopathologic appearance of the skin biopsy specimens was consistent with lichenoid cutaneous changes. The cutaneous lesions cleared when use of the drug was discontinued.

Acne Vulgaris↗

The swollen leg.

Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg.

Arteriovenous Fistula↗

Post-cardiac transplant reactivation of Chagas' disease diagnosed by skin biopsy.

Reactivation of Chagas' disease in immuno-compromised hosts may represent a recognizable clinical syndrome that can be diagnosed by examination of skin biopsy specimens of characteristic lesions resembling ordinary bacterial cellulitis. This syndrome appears to result in significant morbidity, which can be avoided with the institution of prophylactic therapy for Chagas' disease. An awareness of this complication of immunosuppression is of paramount importance for the thousands of asymptomatic persons infected with Chagas' disease currently living in the United States and abroad.

Adult↗

[Effect of hemodynamic disorders on the course of erysipelas of the lower extremities].

The indices of peripheral circulation in 45 patients with erysipelas of the lower extremities were studied by means of Doppler ultrasound, sonography and tetrapolar rheography in dynamics. It was established that in stable disorders in venous blood flow, disease recurrency developed 2 times more often than in patients with normalized circulation.

Adult↗

[Lucilia sericata infestation of the skin openings for the bone traction device in lengthening of the tibia: apropos of a case].

Fly larvae are responsible for animal disease well known by veterinarians. However, their finding in humans in nontropical countries is a rarity. Recently, we have found several larvae of Lucilia sericata in an achondroplastic child during the phase of lengthening of both tibiae with osteotax. We think that the myasis diagnosed in our patient is the first such case reported in the literature. For the time being, it should be considered a fortuitous finding and not as a complication of surgery.

Adolescent↗

[Tuberculosis cutis luposa gigantea with Mycobacterium bovis detection].

In an 80-year-old woman, retired farmworker, we observed lupus vulgaris extending over more than half of her leg. The extreme size of the affected area made us talk of a giant form in this case. Bacteriological investigation revealed Mycobacterium bovis. The minimal amount of tuberculin required to induce a positive intradermal reaction was 10 IU (GT Behring). Another case with similar dimensions (reported by Christiansen in 1967) had been caused by Mycobacterium avium and developed over a period of at least 5 years. The vast cutaneous affection of our patient, in contrast, had developed within only one year, starting from a brownish macula of the size of a palm on her upper leg. This macula - presumably the manifestation of quiescent lupus vulgaris - had not changed for more than 40 years. This late exacerbation of post-primary tuberculosis might have been favored by the patient's reduced immunologic resistance on account of her advanced age. In addition, local cofactors - namely ankylosis of her knee and contact eczematous dermatitis - have to be considered. In accordance with the resistogram, the disease responded to monotherapy with isoniazide.

Aged↗

[Mycetoma].

Mycetoma is a variety of deep mycoses. The endemic centres are situated in the countries with tropic or subtropic climate. In diagnosis, the important place belongs to microbiological, histological and roentgenological investigations. Surgical treatment supposes the radical removal of a pathological focus in aiming at preservation of the weight-bearing surface of an extremity. In intact skin, the subcutaneous incision of the mycous infiltrate is performed. The extensive soft tissue defects, especially at the region of joints, require primary or secondary autodermoplasty. The medicamentous treatment of fungal mycetomas is ineffective. The positive effect of Ketocanazole (Nizoral) before the operation was noted.

Adult↗