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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We review the medical issues and emergencies potentially encountered in the practice of general or surgical dermatology. Traditional guidelines have largely consisted of dated extrapolations from the nondermatologic literature concerning procedures that are primarily irrelevant to dermatology. This article outlines a rational approach to organizing an office emergency plan for anaphylaxis, stroke, status epilepticus, myocardial infarction, and hypertensive crisis. We discuss the literature that has influenced current office behavior regarding endocarditis prophylaxis, the use of electrosurgery with pacemakers, arrhythmogenic drug interactions, vasovagal syncope, lidocaine "allergy," and bleeding complications from oral anticoagulants. Recommendations for managing these issues in a dermatologic context are provided.
J Am Acad Dermatol 1997 Jan
PMID:Medical issues and emergencies in the dermatology office. 948 99

Livedo reticularis is a vascular abnormality of the skin resulting in an erythematous reticular rash. The combination of livedo reticularis and stroke-like episodes in adults is known as Sneddon syndrome [Sneddon, IB (1965). Br J Dermatol 77:180-188]. A similar combination of stroke-like episodes and livedo reticularis has been reported to occur in children [Baxter P et al. (1993). Dev Med Child Neuro 35:917-926]. We present here a 7-year-old male with congenital livedo reticularis, obesity, developmental delay, stroke-like episode, hypertension and cystic kidneys. We summarize our patient's findings and family history, and compare his disorder to other possibly related conditions.
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PMID:Livedo reticularis, developmental delay and stroke-like episode in a 7-year-old male. 954 37

The MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) belongs to the category of mitochondrial disorders. The most common molecular aetiology of the syndrome is a mutation at base pair (bp) 3243 in the mitochondrial genome (mtDNA). The phenotype is varied and, apart from central nervous system involvement, the patients with this mutation may present with neurosensory hearing loss, diabetes mellitus and cardiomyopathy. These phenotypes suggest that organs dependent on aerobic metabolism suffer most. We investigated the possible clinical and physiological manifestations of impaired energy metabolism in the skin of 28 patients with the bp 3243 mutation in mtDNA. Non-invasive sonography and laser Doppler flowmetry were used to measure skin thickness and the blood flow of the skin. Skin collagen synthesis was assayed from suction blister fluid. Evaporimetry was used to assess the re-epithelialization rate of suction blister wounds. Histochemistry and immunohistochemistry were used to evaluate the melanocytes and pigment in the skin. Vitiligo was found in three of the 28 patients (11%), which was markedly more than in the general population. Histological findings showed an absence of pigment, but an apparently normal distribution of melanocytes in the dermoepidermal junction. Seborrhoeic eczema and atopy were also somewhat more frequent. No features of premature ageing, such as a marked decrease in skin thickness, blood flow, collagen synthesis or re-epithelialization rate, were demonstrated.
Br J Dermatol 1999 Apr
PMID:Increased prevalence of vitiligo, but no evidence of premature ageing, in the skin of patients with bp 3243 mutation in mitochondrial DNA in the mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS). 1023 12

Linear scleroderma involving the frontal or frontoparietal region of the scalp (with or without associated facial hemiatrophy) is called "en coup de sabre" (like the stroke of a sabre). We report a case which to the best of our knowledge is only the fifth instance of this subset of localized morphea occurring in a bilateral distribution. We believe that the rarity of this presentation warrants a report.
Pediatr Dermatol
PMID:Bilateral en coup de sabre-a rare entity. 1088 57

We report a typical case of bullous pemphigoid (BP) associated with a neurological disorder and study a possible link between neurological disorders and BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemiparetic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were retrospectively analyzed (average age: 79; median age: 85). Thirty of the 46 patients with BP had neurological disorders. These disorders included dementia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, gonadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis. In a control group of the 46 consecutive oldest patients (older than 71; average age: 82,5; median age: 80) with another skin disease referred during the previous two-year-period to our one-day-unit only, 13 patients had a neurological disorder. This study demonstrates that there is a high prevalence of neurological disorders in patients with BP (p = 0.0004). A prospective case control study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associated with the aging process or neurological disorders may be involved in pemphigoid development via an autoimmune response against dystonin which shares homology with bullous pemphigoid antigen 1. Bullous pemphigoid could be considered to be a marker of neurological disorder.
Eur J Dermatol
PMID:Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid? 1250 86

Two dermatologic patients displaying peripheral and central nerve damage, respectively, are described. Cutaneous nerve fibers in both patients were studied in skin biopsy specimens taken from neuropathic areas and from the contralateral side, immunocytochemistry being applied to a pan-neuronal marker, a protein gene-product (PGP 9.5). One of the patients, suffering from compression of the ulnar nerve, had dyshidrotic eczema of the hands that was absent on areas of skin that were neuropathic. The cutaneous innervation (most of which was sensory) was reduced by 50% in the neuropathic area as compared with the contralateral side. The other patient had unilateral pruritus on the parethic side after a stroke. The cutaneous innervation of that side was reduced by 80% as compared with the other side. It seems that peripheral sensory innervation is a prerequisite for inflammation, whereas spontaneous itching may emanate from a central nervous system disorder such as a stroke and continue on in partly denervated skin.
J Am Acad Dermatol 2002 Feb
PMID:Cutaneous sensory nerve fibers are decreased in number after peripheral and central nerve damage. 1180 32

Most of the biologic filler materials that increase the thickness of the corium in a wrinkle line are phagocytosed within a certain time. Therefore, a lasting effect can only be achieved with nonresorbable synthetic substances. Artefill consists of 20 volume percent microspheres of polymethyl-methacrylate and 80 volume percent of bovine collagen. Beneath the crease, the microspheres with their exceptional surface smoothness stimulate fibroblasts to encapsulate each individual one of the 6-million microspheres contained in 1 mL of Artefill. Collagen is merely a carrier substance that prevents the microspheres from agglomerating during tissue ingrowth. The 20 volume percent of microspheres in Artefill provides the scaffold for the 80% volume of connective tissue deposition, a complete replacement of the injected collagen. The filler material beneath a crease acts like a splint and prevents the possibility of its further folding, thereby allowing the diminished thickness of the corium in a crease to recover. This recovery process is well known even in older patients with facial paralysis or after a stroke, whose facial wrinkles and furrows on the paralyzed side disappear over time.
Dermatol Surg 2003 Jun
PMID:Soft tissue augmentation with artecoll: 10-year history, indications, techniques, and complications. 1278 99

A syndrome associating Livedo Reticularis (LR) with Cerebrovascular disease (CVD) was described, in 1965, by Sneddon. It occurs sporadically, but a few familial cases of Sneddon's Syndrome (SS) have been reported, like these 3 cases that represent one of the largest number among siblings. We studied three male brothers, aged 28, 37 and 42 years, with CVD (ischaemic stroke in 2 patients and cerebral haemorrhages in the third) and their sister with no CVD. All patients presented with long lasting Livedo Reticularis, extending beyond the lower limbs. Skin biopsy on the centre of the reticular pattern showed, only in the second patient, partial endothelium detachment in dermo-hypodermic blood vessels. The males also had accesses of Livedoid Vasculitis (LV), in which a skin biopsy showed obliteration of several upper dermal vessels with hialin thrombi and a very scarce inflammatory infiltrate. Complementary studies, with an extensive investigation on pro-coagulation/pro-thrombotic features including antiphospholipid antibodies, were repeatedly negative. Their non-consanguineous parents were not affected, but among these kindred of 9 individuals, apart from the 4 patients reported above, LR and LV were present in two other brothers and also in an aunt and uncle, suggesting autosomal dominant pattern of inheritance, with incomplete penetrance. The relationship between Sneddon's Syndrome and Antiphospholipid Antibody Syndrome is controversial. The present cases, having repeatedly negative antiphospholipid antibodies, support the classification of Sneddon's Syndrome as an independent nosological entity.
Eur J Dermatol
PMID:Familial Sneddon's syndrome. 1280 91

A 72-year-old man with diabetes-associated scleredema is presented. The patient had a long history of diabetes mellitus that had been difficult to control with complications of retinopathy, nephropathy, and arteriosclerosis leading to myocardial infarcts and stroke. The scleredema has remained stable with 4 months of topical clobetasol ointment twice daily and biweekly physical therapy. Diseases associated with scleredema and therapeutic options are summarized.
Dermatol Online J 2003 Oct
PMID:Scleroderma. 1459 84

Pterygium inversum unguis (PIU) is an uncommon nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate with obliteration of the distal nail groove. This rare condition, whether congenital, acquired, or idiopathic, has been reported in a few patients. Because of the rarity of this condition, the exact origin remains speculative. In addition, there have been no histopathologic features described in PIU. We describe an unusual case of acquired PIU of the right fingernails alone associated with a cerebral vascular accident resulting in right-sided paralysis and sensory deficit. We also present the first histologic features of PIU.
J Am Acad Dermatol 2005 Sep
PMID:Pterygium inversum unguis associated with stroke. 1611 62


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