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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of reticular erythematous mucinosis associated with chronic idiopathic thrombocytopenic purpura and circulating immune complexes is described. We compare reticular erythematous mucinosis with the similar plaquelike cutaneous mucinosis. We discuss the apparent photosensitivity of reticular erythematous mucinosis and its possible relationship with altered states of immune function such as diabetes, thyroid disease, and neoplasia. The somewhat varied but characteristic histopathologic findings and staining are reviewed, including the characteristic perivascular and occasional perifollicular lymphocytic infiltrate and Alcian blue-positive dermal mucin. Treatment with antimalarial drugs still appears to be the most uniformly successful therapeutic approach to the management of this chronic dermatosis. Further research efforts should be directed at understanding its link with altered states of immune function.
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PMID:Reticular erythematous mucinosis and thrombocytopenic purpura. Report of a case and review of the world literature, including plaquelike cutaneous mucinosis. 305 96

Reactive perforating collagenosis is an uncommon skin disorder characterized by extrusion of collagen fibers through the epidermis. The lesions may appear in infancy, from genetic inheritance, or in adulthood in association with diabetes mellitus and/or chronic renal insufficiency. One case of reactive perforating collagenosis is reported, in a 42 year old man, with chronic renal failure diabetes mellitus and undergoing hemodialysis. The literature was reviewed on perforating dermatoses in adults associated with diabetes and chronic renal insufficiency.
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PMID:[Reactive perforating collagenosis associated with chronic renal insufficiency and diabetes mellitus]. 307 Jan 98

Acanthosis nigricans is a skin disorder associated with endocrine abnormalities, autoimmune disease, and systemic malignancies. Insulin resistance is a common accompaniment of the nonmalignant varieties of acanthosis nigricans. A 44-year-old man is described with a functioning metastatic pheochromocytoma, acanthosis nigricans, and insulin-resistant diabetes mellitus. Studies of insulin action showed a low titer of anti-insulin antibodies and a very high titer of antibodies against the insulin receptor. This case documents for the first time insulin resistance due to anti-insulin receptor antibodies in a paraneoplastic variety of acanthosis nigricans.
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PMID:Antibodies against the insulin receptor in paraneoplastic acanthosis nigricans. 360 42

Standard vasectomy techniques used in India are reviewed, including indications, history, male reproductive anatomy, preoperative assessment, exam and preparation, anesthesia, surgical procedure, closure of suture, postoperative treatment and advice, and resumption of coitus. Vasectomy is the safest and most popular method of fertility control, used since the 1930s. Male genital anatomy is presented in detail with diagrams, emphasizing innervation of the vas. Vasectomy clients should be assessed to rule out diabetes, bleeding, skin disease, infection, drug sensitivity, genital tuberculosis, hernia, and anatomical defects. The author recommends local anesthesia with lidocaine or xylocaine, without the use of adrenaline. Variations in techniques of immobilizing the vas, making scrotal incisions, treating the cut ends of the vas and removing the cut segment are presented. The author recommends immobilizing the vas with Allis forceps, making a single incision and removing a 1 cm section of vas. To prevent spontaneous recanalization, it is best to fold the distal end back, and suture, clamp or cauterize the proximal end, burying it in fascia to make a barrier. Although interposing fascia between the cut ends is best, for any operator, experience improves results significantly, no matter what method is used. Of the available methods of closing the suture, nonabsorbable sutures are best if the man can return for their removal, or even better, a small incision closed only with tincture of benzoin is most practical. Generally the man is given penicillin or tetracycline. Some type of vas irrigation, such as 0.125% nitrofurazone preferred by the author, will shorten the time to azoospermic semen. 12 to 24 ejaculations are required otherwise. There is no evidence that coitus as soon as the man feels well will encourage sperm granuloma formation. Recanalization is rare. The most common reasons for failure of vasectomy are section of some other structure, or less often, recanalization. Rarely, there is an accessory vas or a viable inguinal testis. An appendix lists equipment used in the procedure.
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PMID:Vasectomy. 654 28

Macroscopically papillomatosis confluens et reticularis (PCR) is a typical dermatosis with three different clinical forms. Histologically the characteristics are orthokeratosis, papillomatosis and hyperpigmentation. A case report of PCR and diabetes mellitus reveals further histological factors, these being interstitial and intracellular edema in the epidermis and a homogenization of collagen and rarefication of elastic fibres. Ultrastructurally intracytoplasmic lipid vacuoles in the basal and suprabasal squamous cell layer were a prominent feature. These findings could be demonstrated in normal and PCR skin, which until now has not been described in the skin of diabetes mellitus patients. The question arises if PCR can be interpreted as a symptom of a fat metabolism disease in which unknown additional factors may play a role.
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PMID:[Morphological studies of papillomatosis confluens et reticularis in diabetes mellitus]. 662 9

Granuloma annular (GA) is a benign inflammatory skin disease usually localized to the distal extremities, although generalized, perforating, and subcutaneous variants have also been identified. A regular histopathologic feature is the presence of mononuclear cells, often in palisading array, around foci of altered collagen. The clinical and histologic features of each subtype of GA are discussed along with a differential diagnosis. A variety of remedies have been used to treat GA, but efficacy is hard to define in a disease in which spontaneous resolution is usual outcome. GA has not been conclusively linked either to diabetes or solar radiation. Recent data suggest a role for vascular injury or delayed-type hypersensitivity in the pathogenesis, but the cause of GA remains obscure.
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PMID:Granuloma annulare. 700 73

Three patients developed perforating skin lesions on the legs shortly after beginning hemodialysis for chronic renal failure. All had long-standing insulin-dependent diabetes mellitus and all three were white. The skin disease was refractory to all attempts at management. In one patient, however, the eruption cleared completely when hemodialysis was stopped in favor of a renal allograft transplanted from a cadaver. Clinically and histologically, some of the lesions showed evidence of prurigo nodularis, a consequence of vigorous rubbing of a discrete focus.
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PMID:Perforating folliculitis of hemodialysis. 710 12

Dermatitis herpetiformis (DH) is a relatively rare skin disorder with an estimated incidence of 1:10,000 in the UK. It is characterized by urticarial plaques and blisters on the elbows, buttocks, and knees, although other sites may also be involved. The eruption tends to be persistent: only 10-15% of patients have spontaneous remission over a 25-year study period. The disease is characterized by the presence of IgA deposits in the upper dermis of uninvolved skin and the diagnosis should not be made in the absence of these deposits. Two-thirds of patients have a small intestinal enteropathy with villous atrophy as seen in coeliac disease (CD). However, the remaining third also show evidence of a gluten sensitivity in the intestine, as judged by increased lymphocytic infiltration of the epithelium. Villous atrophy also ensues after gluten challenge in those patients with previous normal villous architecture. The initial treatment of the rash is with one of the following three drugs, dapsone, sulphapyridine or sulphamethoxypyridazine. However, the rash also clears with gluten withdrawal. It must be stressed, however, that the average time to achieve significant reduction in drug requirements is 6 months and it can be over 2 years before drugs are no longer required. On re-introduction of gluten the eruption recurs. Patients with DH have a high incidence of auto-immune disorders, thyroid disease, pernicious anaemia, and insulin-dependent diabetes, and should be screened for those diseases on a yearly basis. As with coeliac disease there is also an increased incidence of lymphoma and a gluten-free diet appears to protect patients from this complication. The mechanism by which gluten causes the skin lesions has still to be elucidated, but current investigations implicate lymphocytes and cytokines in the pathogenesis. The original hypothesis of an antigen-antibody reaction in the skin with complement activation causing the skin lesions, may not be correct.
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PMID:Dermatitis herpetiformis. 754 32

Necrobiosis lipoidica (NL), a skin disease, is associated with insulin-dependent diabetes mellitus (IDDM). Natural autoantibody (NAb) activity in sera from 16 patients suffering from NL, with or without IDDM, was compared to that in sera from 41 patients with IDDM and 43 healthy controls. Isotype-specific enzyme-linked immunosorbent assays (ELISAs) were used to detect NAbs against actin, myosin, keratin, desmin, troponin, tropomyosin, thyroglobulin, insulin, single-stranded DNA and the hapten trinitrophenyl. NAb activity was significantly higher in sera from patients with NL (either with or without IDDM), compared with that detected in sera from patients with IDDM which was similar to that of healthy individuals. High proportion of NL sera exhibited increased IgG anti-tropomyosin (69%), anti-troponin, anti-desmin and anti-keratin (50% each), anti-insulin (44%) and anti-trinitrophenyl (31%) activities, as well as increased IgA and IgM anti-keratin activities (26% and 31%, respectively). The great majority (88%) of positive sera were polyreactive and contained NAbs, polyspecific and monospecific (as demonstrated by immunoadsorption studies), belonging to more than one isotype; there was no predominant serological reactivity pattern. In conclusion, increased NAb activity to cytoskeleton proteins is associated with the dermatological disease NL and not to the overlapping autoimmune disease (IDDM). The origin and significance of these NAbs is discussed.
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PMID:Increased natural autoantibody activity to cytoskeleton proteins in sera from patients with necrobiosis lipoidica, with or without insulin-dependent diabetes mellitus. 757 89

It is now recognized that it is casual exposure to sunlight that provides most humans with their vitamin D requirement. During exposure to sunlight, the high energy ultraviolet B photons (290-315 mm) photolyzes cutaneous stores of 7-dehydrocholesterol to previtamin D3. Once formed, previtamin D3 undergoes a thermal isomerization that results in the formation of vitamin D3. Vitamin D3 is biologically inert and requires successive hydroxylations in the liver and kidney to form its biologically active hormone 1,25-dihydroxyvitamin D3. The major physiologic function of 1,25-dihydroxy-vitamin D3 is to maintain blood calcium in the normal range. It accomplishes this by increasing the efficiency of intestinal calcium absorption and mobilizing stem cells to become osteoclasts which, in turn, remove calcium from the bone. It is now recognized that there are a variety of calcium metabolic disorders that are related to defects in the synthesis and metabolism of vitamin D. Chronic granulomatous disorders are often associated with hypercalciuria and hypercalcemia. The mechanism by which this occurs is that activated macrophages within granulomatous tissue, in an unregulated manner, convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. Besides its calcemic activity 1,25-dihydroxyvitamin D3 is a potent antiproliferative factor for cells and tissues that possess its vitamin D receptor. This has clinical utility in that 1,25-dihydroxyvitamin D3 and its analogs have been successfully used for the treatment of the hyperproliferative skin disease psoriasis.
Exp Clin Endocrinol Diabetes 1995
PMID:Defects in the synthesis and metabolism of vitamin D. 758 27


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