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Necrolytic migratory erythema and glucagon cell tumour of the pancreas: the glucagonoma syndrome. Report of two cases.

Two cases of necrolytic migratory erythema are described. Both patients also suffered from anaemia, weight loss, hypersedimentation and carbohydrate intolerance. A solitary pancreatic tumour was found in both cases-- at autopsy in one and at laparotomy in the other. Microscopic examination of skin biopsies showed necrolysis of superficial epidermis. Both patients had extremely elevated plasma concentrations of pancreatic glucagon. By means of specific staining and immunofluorescence techniques the tumours were shown to consist of glucagon-containing alpha2-cells. It is concluded that these patients suffered from the newly described glucagonoma syndrome.

Adenoma, Islet Cell↗

[11 cases of erythema multiforme. The etiological correlations and therapy].

Erythema multiforme (EM) is characterised by a polymorphous eruptive complex which many involve the cutis and oral, genital and conjunctival mucous. Its etiopathogenesis is unclear: it is thought to be associated with various viral or bacterial infective agents (herpes virus, Coxsackie virus, mycoplasmas, etc.), numerous drugs, physical therapy, systemic pathologies of various types. The authors report their experience in relation to 11 patients suffering from EM; the clinical characteristics of each case are reported, together with the course of disease, and the diagnostic and therapeutic protocol adopted. The discussion examines the possible cause of disease: in 5 patients the etiology was traced back to viral infections (4 herpes and 1 coxsackie) and to the administration of drugs in the remaining cases (4 in relation to anti-phlogistic agents and 2 regarding antibiotics).

Adolescent↗

Erythema infectiosum and other parvovirus B19 infections.

The human parvovirus B19 has been identified as the causative agent in several diseases, including the benign childhood condition erythema infectiosum (fifth disease), a polyarthropathy that occurs in adults, aplastic crisis and hydrops fetalis. The virus has also been associated with numerous other hematologic, neurologic and rheumatic conditions. Except for the potential of neonatal death due to fetal hydrops, the prognosis of patients with parvovirus infection is generally good. The diagnosis of B19 infection may be established on clinical grounds but often requires confirmation with serum antibody testing. Treatment strategies may include supportive care, analgesic medications, transfusions with red blood cells or administration of intravenous immunoglobulin, depending on the clinical circumstances.

Animals↗

[Circumscribed erythema after cardiac pacemaker implantation].

The pathological reactions of the tissue under the picture of a circumscriptive erythema above the pacemaker-pouch of a 35-year-old patient was noticed and documented for more than 10 years. Repeated appearance of a painful and fluctuating swelling above the silicone-containing implant, as well as non-symptomatic intervals during times without application of silicone-material led to the assumption of an allergic contact dermatitis to the silicone components of the pacemaker. However, patch-testing of the pacemaker's constituents remained negative and could not verify this supposition. The diagnosis of a foreign-body-reaction was histologically set up. In its progress a stenosis of vessels as well as an activation of the T-cell-system can follow. Therefore, it might be possible that different factors meshing with each other can modify the cause-consequence-structure and can lead to the erythematic changes.

Adult↗

[Erythema dischromicum perstans (ashy dermatosis). Report of two cases].

Clinical, histological and ultrastructural investigations of two cases of Erythema Dischromicum Perstans (EDP) are reported. EDP is a chronic pigmented lesion of the skin, and its etiology is still unknown. The reported cases showed clinical and ultrastructural differences from what already described in the literature. EDP is also difficult to differentiate from other cutaneous pigmented lesions: clinical and morphologic differences and/or similarities are therefore discussed and compared. The usefulness for a correct diagnosis of the co-existence of optical and ultrastructural lesions which are not pathognomonic per se, is also stressed.

Adult↗

[Paraneoplastic erythema associated with a carcinoma of the cervix. Our experience].

The authors report a case of bullous erythema observed in a young woman affected with II B stage carcinoma of the cervix, whose clinical course was likely to be a paraneoplastic lesion. The aim of the report is to outline such a rare association between a dermatologic pattern and a gynecologic tumor and to synthesize the literature's data concerning this matter.

Adult↗

[Erythema infectiosum in pregnancy. A follow-up of children after 2 years].

During an epidemic of erythema infectiosum in Norway 1984-86, infection with human parvovirus B19 was diagnosed in 22 pregnant women by detection of specific IgM antibodies. Information about the outcome of pregnancy was obtained in 19 cases. 17 women delivered live babies. In two cases, spontaneous abortion occurred in week 16 of the pregnancy. In 11 cases, cord blood and serum samples were obtained from the children at an age of between six and 15 months. No specific IgM antibodies were found in cord blood. Clinical information on 16 children at two years of age revealed normal growth and development in 15 cases. One child was hyperactive and showed delayed language development. B19 IgG antibodies were detected in three children with normal growth and development. According to our findings, there was no association between infection with human parvovirus B19 in pregnancy and congenital abnormalities.

Child Development↗

[Acral erythema after allogeneic graft of the bone marrow].

Acral erythema (AE) is a painful, erythematous bullous eruption of the palms and soles which is chemotherapy-induced. To the numerous chemotherapies which induce AE we must add, perhaps, a new drug, Vépéside. AE is followed by graft-versus-host-disease in all patients receiving bone marrow transplantation. AE and early GVH disease being very similar, we discuss the differential diagnosis which can be very difficult.

Acrodermatitis↗

[Squamous erythema annulare centrifugum].

A case of squamous erythema annulare centrifugum has been observed. It was characterized by striking clinical features and peculiar histological findings, including necrosis of keratinocytes. A search for causative factors was negative. Treatment with tar ointment (Brocq) rapidly resulted in dramatic healing of the lesions; however, the usual features of annular psoriasis were absent in our case.

Erythema↗

[Erythema nodosum in pediatric patients. A study of 22 cases].

In this study we report the cases of 22 pediatric patients with nodal erythema. The predominance of this condition in male patients was clear. Etiological factors were determined in 77% of the patients. In our series, the principal cause was tuberculosis (36%). We would like to point out the etiological diversity in this small series of children: streptococcal infection, gastrointestinal infection with Salmonella enteritidis or Campylobacter jejuni, cat scratch disease, infectious mononucleosis, chronic hepatitis B, Crohn's disease and pharmacological (amoxycillin). In 22% of the cases no cause was found.

Adolescent↗

[Epidemiologic characteristics and serologic findings in erythema migrans].

Our three-year research covered 417 patients with erythema migrans, of both sexes and all age groups. Among them 87.3% had a history of tick bite. Average attachment of tick to a patients skin was two days. Diameter of erythematous lesions was 1-50 cm (with an average of 15.1 cm). Magnitude of the lesion does not correlate with the further development of the Lyme disease. IFA test detected antibodies against Borreliae burgdorferi in 27.0% of our patients.

Adult↗

Erythema migrans. Rash as key to early diagnosis of Lyme disease.

The presence of erythema migrans offers physicians the best opportunity for diagnosis and treatment of Lyme disease. Serologic testing has poor sensitivity in patients with early disease. Therefore, aggressive antibiotic treatment initiated solely on the basis of clinical findings is appropriate. A number of recently studied regimens have shown success against the infection.

Anti-Bacterial Agents↗

[Erythema chronicum migrans (Lyme's disease). Clinico-epidemiologic study of 10 cases].

Migratory Chronic Erythema (MCE), which is the distinctive and diagnostic lesion of Lyme's disease, could manifest itself under different clinical manifestations. Following a clinical and a epidemiological point of view 10 cases of MCE, diagnosed during the last three years, have been studied and described. Its wide variability of the clinical manifestations is underlined, with a mean incubation period of 5.6 days between the onset of cutaneous symptoms and the tick bite. The zones mainly affected were lower limbs followed by trunk and neck. Size of lesion varied from 5 to 30 cm, with a mean of 13 cm. In two patients satellite cutaneous lesions were observed and six showed extra-cutaneous signs. Only in four patients antibodies against Borrelia burgdorferi were detected. Regarding epidemiology we did not found differences between the sexes, or by living on an urban or rural area. The tick bite was referred in half of the cases, 30% of the patients have a job related with wood, forest, farming or cattle. The season in which MCE was most frequent was spring-beginning of summer and end of summer-beginning of autumn. All patients responded to the therapy with tetracyclines and/or macrolides.

Adolescent↗

Erythema formation in magnesium-deficient albino rats. A non-invasive model for the screening of anti-inflammatory agents and oral mineral supplements.

The enteral bioavailability of magnesium firmly bound to a fire-proof, inert SiO2-Al2O3 matrix (ground magnesia boats) was studied in magnesium-deficient albino Sprague-Dawley rats, with and without blocking gastric hydrochloric acid secretion with omeprazole. Magnesium was absorbed, although to a small degree, also at anacidity. Pronounced erythema, developing after only some days in hypomagnesemic hypercalcemic rats, are proposed as a non-invasive model for the screening of antiinflammatory substances. Using this model significant protective effects were proven for cromoglycate, polyenthylene glycol 400, and omeprazole; the latter, however, seems more likely to act via a magnesium-sparing mechanism.

Animals↗

Correlation between TNF production, increase of plasma C-reactive protein level and suppression of T lymphocyte response to concanavalin A during erythema nodosum leprosum.

The complex symptoms observed in lepromatous leprosy patients with reactive episodes of the erythema nodosum leprosum (ENL) type are associated with different serum components actively participating in the acute inflammatory reaction. Among them are the tumor necrosis factor (TNF) and the acute-phase protein C-reactive protein (CRP). TNF and CRP were found at significantly more elevated concentrations in the serum of patients with ENL, with a positive correlation of about 95% when compared with patients with nonreactive lepromatous leprosy (L) or tuberculoid leprosy (T) or with control individuals. Furthermore, in another series of experiments CRP had a specific and significant suppressive action on concanavalin A (ConA)-induced lymphoproliferation in cultures from patients and controls, the reduction being more marked (75%) in patients with ENL. By extrapolation from its known actions, production of TNF may have a number of potential consequences for the immunobiology of ENL. Thus, TNF may cause direct injury to compromised cells, facilitating mononuclear cell activation and production of cytokines such as interleukin-1 and interleukin-6, and upregulating hepatocyte expression of CRP. Both CRP and TNF in high serum concentrations have the ability to enhance the acute inflammatory process in ENL, favoring increased macrophage activation and phagoctyosis, and contributing to the elimination of damaged cells and bacilli, as well as in the reduction of T-suppressor cells, with a consequent improvement in the immunologic response of ENL patients.

Adolescent↗