Arteriovenous fistula. Cutaneous manifestations

The association between congenital large-vessel arteriovenous (AV) fistulae of the extremities with Kaposiform acroangiomatosis is well established. Based on pathogenetic considerations, it is likely that many benign, cutaneous angiomatoses represent minute or microscopic AV fistulae. Combined large vessel and small vessel congenital AV fistulae of the extremity would result in the previously mentioned syndrome.     

Cutaneous manifestations of Taxol therapy

Authors report a paediatric patient with thoracic outlet syndrome (TOC) and complete cervical rib. The symptoms at the time of presentation result from pressure on either the subclavian vessels or the lower trunk of the brachial plexus. TOC is infrequent in young people and usually the symptomatology does'nt need a surgical approach. Some Authors affirm that there are necessary impulsive moments like growth, increased muscular mass and rib ossification, decreased elasticity of ligaments, vessels, muscles and nerves, for outcoming the clinical manifestations. Paediatric competention has risen until adolescent age and may be more frequent the observation of this syndrome that present problems of both diagnosis and management.     

Cutaneous manifestations of systemic diseases

Many aspects of dermatologic diagnosis are either of importance or interest to the nondermatologist, and there are many excellent textbooks available for guidance. This article focuses on four categories of conditions that are the source of frequent queries from the primary care setting: (1) common skin diseases that frequently mimic systemic illness, (2) common skin diseases that have important systemic associations, (3) common systemic diseases that have prominent cutaneous findings, and (4) the seldom seen but frequently raised concerns regarding cutaneous signs of internal malignancy.     

Acute exposure to hair bleach causes airway hyperresponsiveness in a rabbit model

Ammonium persulphate (APS) and hydrogen peroxide (H2O2) are used as oxidants in many industrial processes and are the main constituents of standard hair bleaching products. In a previous study, it was demonstrated that aerosols of APS induce alterations in airway responsiveness. The present study examined whether exposure for 4 h to a hair bleach composition (containing APS, potassium persulphate and H2O2) or H2O2 could induce airway hyperresponsiveness and/or an obstructive ventilation pattern in a rabbit model. Exposure to the aerosols altered neither baseline airway resistance, dynamic elastance, slope of inspiratory pressure generation nor arterial blood pressure and blood gas measurements. Similarly to APS, hair bleach aerosols containing > or =10.9 mg x m(-3) persulphate (ammonium and potassium salt) in air and > or =1.36 mg x m(-3) H2O2 in air caused airway hyperresponsiveness to acetylcholine after 4 h of exposure. Aerosolized H2O2 (> or =37 mg x m(-3) in air) did not influence airway responsiveness to acetylcholine. The results demonstrate that hair bleaching products containing persulphates dissolved in H2O2 cause airway hyperresponsiveness to acetylcholine in rabbits.     

Radiation- and chemically-induced respiratory manifestations

There are frequently respiratory complications with cancer particularly in primary lung carcinoma. Among these are bronchopulmonary infections with or without endobronchial obstruction, carcinomatous lymphangitis, thromboembolic disease and haemorrhagic disease as well. Radiotherapy and chemotherapy may induce various respiratory complications which diagnosis can be of varying shades of difficulty. The classical post radiation pneumonitis occurring exclusively in the field of radiation hardly poses any problem unless it could be masking a recurrence. Certain clinical manifestations address very difficult problems of differential diagnosis by their lack of specificity and by their often unforeseeable character (except for bleomycin fibrosis which is perfectly dose dependent). Moreover patients often have multiple treatments and the identification of the single responsible agent becomes very difficult. We will not discuss here the infectious or secondary haemorrhagic complications of radiotherapy or chemotherapy but rather the anaphylactic manifestations, diffuse interstitial pneumonia with lymphocytic alveolitis or fibrosis, eosinophilic pneumonia, non-cardiogenic pulmonary oedema, bronchiolitis obliterans with organising pneumonia and the rare pulmonary vascular disorders such as pulmonary veno-occlusive disease.     

Cutaneous manifestations of type 1 neurofibromatosis and their treatment

After recalling the frequency and pathophysiology of type 1 neurofibromatosis, or Von Recklinghausen disease, the authors report the various cutaneous manifestations: café-au-lait spots, lentigines, cutaneous neurofibromas, plexiform neurofibromas. Treatment must be multidisciplinary, as surgery is difficult and often gives disappointing results. The various surgical treatments are considered according to the type and site of the lesions to be treated, with particular emphasis on the treatment plan, which must be discussed with the patient.     

Hyperimmunoglobulinemia D or periodic fever syndrome. Cutaneous manifestations in 3 cases

INTRODUCTION: We describe 3 cases of hyperimmunoglobulinemia D syndrome (hyper-IgD syndrome). CASES REPORT: As the 2 first cases are conventional with an onset in childhood, the third one appeared later suggesting possibility of acquired syndrome. The 3 cases presented with one or several skin eruptions during febrile attacks. COMMENTS: Up to now, 64 cases of this syndrome have been described. Skin lesions are observed in 80 p. 100 of patients. In this particular clinical context, they must lead to the diagnosis. This 3 cases and the review of literature show that skin manifestations are polymorphic, transient, not very symptomatic and not correlated to IgD rates. Histological examination may reveal urticarial reaction with leucocytoclasic vasculitis, where IgD could directly or not interact.     

HIV-1 and bleach

The high proportion of diabetic patients is partly responsible for the high frequency of chronic renal failure in Reunion. The confection and maintenance of an arterio-venous fistule is a major problem in those patients. We report herein our experience with temporary vascular access by internal jugular vein catherization with subcutaneous tunnelization using silastic catheters. The mean duration of utilisation of these accesses is 107 days for diabetic patients and 98 days for nondiabetic patients. The major complication observed is sepsis (18.36%). Diabetes mellitus which represent a traditional risk factor does not seem to be responsible here, the climatic and hygienic conditions prevailing in this part of the world could be a contributing factor. Nevertheless, we find the utilisation of these catheters a suitable solution during the waiting period because it is an easy operation, of the good quality of the material used and the comfort brought to the patient.     

Cutaneous immediate and late phase reactions to schistosomin in schistosomiasis patients

Cutaneous immediate and late phase reactions (LPR) to schistosomin were studied in 29 patients with schistosomiasis mansoni. In 12 of these patients, the determination of total and specific serum IgE by immunoenzymatic method against schistosome antigen was carried out using serum samples obtained on the same day as the cutaneous tests. Skin biopsies were taken from 4 typical LPRs. Immediate reactions occurred in all except one and LPRs in 12 (41.3%). Patients with positive cutaneous reactions had highe levels of specific serum IgE against schistosome antigen. Histopathological studies showed a moderate exudate consisting mainly of neutrophils (60%) and eosinophils (40%). LPRs in schistosomiasis have the same characteristics reported in the medical literature in relation to time of appearance, morphology and histopathology. The immunopathogenic role played by LPRs in the patients remains to be clarified.     

Study of the respiratory manifestations of systemic lupus erythematosus

Following a short discussion of the anatomopathological and clinical features of respiratory signs during systemic l.e., some clinical cases in which involvement of the respiratory system (pleural and/or parenchymal) was observed alone or was clearly predominant are reported. The cases also presented some unusual clinical characteristics. Clinical investigations must be extended to the systemic mesenchyma in the presence of pleuritis or pulmonary fibrosis of unclear aetiology, even where there are no extra-respiratory signs of S.L.E.     

Specific respiratory manifestations associated with hemorrhagic rectocolitis. Analysis of a case and review of the literature

In a 59-year-old woman suffering from the syndrome of inappropriate antidiuretic hormone secretion, a small cell carcinoma of the uterine cervix was detected. The tumor was immunoreactive for antidiuretic hormone as well as for neuron specific enolase, chromogranin A, and Leu-7, but not vimentin. Electron microscopic examination of the tumor revealed neurosecretory granules. To our knowledge, this is only the second report of the syndrome of inappropriate antidiuretic hormone secretion with small cell carcinoma of the uterine cervix and the first one confirmed immunohistopathologically.     

Drive strength and symptom manifestations.

Behavior ratings of patients in a psychiatric hospital were used to test the Hullian principle: reaction potential of a response is a function of habit strength and drive strength. Given equality of one factor, individual differences in reaction potential may be attributed to the other. Assuming equality of the habit strength of 3 classes of behavior, 9 submeasures of reaction potential were correlated with these behaviors in 4 diagnostically differentiated groups. Hypotheses were formulated, tested, and the results discussed in regard to an understanding of the patients as well as the research methodology employed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variability of respiratory system reactions to air pollutants. Epidemiologic study of children in Cracow

The main purpose of the study was to corroborate the hypothesis that the history of allergic skin reactions is the marker of individual susceptibility of respiratory tract to air pollutants in children. The study has been carried out in two contrast areas of the city regarding the air pollution level. In the dirty area the annual daily mean concentrations of particulate matter was 51.5-74.5 micrograms/m3 and sulfur dioxide 58.4-73.8 micrograms/m3; in the cleaner part of the city the corresponding concentrations were 31.7 and 36.1 micrograms/m3. The medical examination of 171 children covered standardized interviews with mothers and spirometric measurements. The results obtained showed that despite the marked decline in air pollution level, the current level of common air pollutants in the city is hazardous to the health of inhabitants. The children with history of allergic skin reactions have been affected much stronger by the higher level of air pollutants than other children. Beside the higher frequency of chronic cough or phlegm, wheezing or shortness of breath, they had significantly poorer lung function measured by FEVI/FVC index.     

Cutaneous mechanical staplers. Our experience

This paper reports the results of a trial, comparing the use of disposable skin staplers with conventional nylon or silk sutures in skin closure. This study began in 1986; 7274 patients undergoing elective and emergency operations were controlled during the postoperative period, 3 and 6 months after surgery. It was shown that skin clips instead of sutures decrease the operative time, produce wound healing with a good cosmetic results, and above all a significant lowering of the wound infection rate.     

Herpes. Atypical clinical manifestations

Herpes simplex viruses (HSV) 1 and 2 are responsible for genital herpes which is usually recognized as vesicles that ulcerate and eventually heal but recur periodically. Atypical genital herpes is often described in immunocompromised patients and can present as large, chronic, hyperkeratotic ulcers. Acyclovir-resistant HSV is occasionally isolated from such ulcers. Most cases of HSV infection reproduce subtle signs and symptoms, or more commonly, asymptomatic viral shedding. Such subclinical presentations may be responsible for most of the 30% increase in the prevalence of genital herpes in the United States during the past two decades.     

Cutaneous reactions following herpes zoster infections: report of three cases and a review of the literature

Three patients, one healthy and two immunocompromised, developed cutaneous reactions that histologically mimicked granuloma annulare at sites of resolved varicella-zoster virus (VZV) reactivation infections. Variable latency periods between the infection and the granulomatous reaction were noted. As in other case reports, the presence of VZV DNA in these lesions was inconsistently demonstrated by the polymerase chain reaction (PCR) and appears more common in early, as opposed to late, post-zoster granulomas. In addition to various granulomatous reactions, vasculitic and neoplastic eruptions following resolved VZV infections have been described and are reviewed here. Therapeutically, topical, intralesional and systemic corticosteroids, as well as acyclovir, have been tried with inconsistent results. Although the pathogenesis remains unclear, the presence of VZV DNA in early lesions that histologically do not display viral cytopathic changes, suggests the virus induces an atypical delayed hypersensitivity reaction not affected by antiviral therapy.