271/307. Video-assisted thoracic surgery for thorascopic resection of giant bulla. This report outlines our experience of 6 patients who underwent video-assisted thoracic surgery (VATS) using a linear endoscopic stapler to remove a giant bulla from the lung. Successful treatment with VATS was carried out in 4 patients, but the procedure needed to be changed to a thoracotomy in 2 patients - in one because of difficulty in single-lung ventilation, and in the other, due to a persistent air leak. Thus, we conclude that giant bulla without any associated severe respiratory failure can be an indication for VATS. ( info) |
272/307. Angina bullosa hemorrhagica. Angina bullosa hemorrhagica is characterized by acute blood blisters, mainly on the soft palate. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long term use of steroid inhalers has also been implicated in the disease. No underlying hematologic or immunopathogenic disorder has been found. Treatment is symptomatic. We present a 67-year-old patient with recurrent oral blood blisters which were diagnosed as angina bullosa hemorrhagica. Trauma by dental injections and use of steroid inhalers were identified as etiologic factors in this case. Erosions healed with a week. Although this is a benign condition, it may result in acute airway obstruction. Recognition is, therefore, of great importance for dermatologists. ( info) |
273/307. Angina bullosa haemorrhagica: an unusual complication following crown preparation. A case of angina bullosa haemorrhagica is reported in which blood blisters appeared during crown preparation. The aetiology, differential diagnosis and management are discussed. Practitioners should be aware of this disorder and take precautions to minimise trauma during operative procedures. ( info) |
274/307. Staphylococcal blistering dactylitis: report of two patients. Two children with staphylococcal blistering distal dactylitis (BDD), a condition usually caused by streptococci, are reported. Etiologic distinction in BDD can be made only bacteriologically. Staphylococci are increasingly the cause of bacterial cutaneous infections. ( info) |
275/307. epidermolysis bullosa simplex herpetiformis of Dowling-Meara with mottled pigmentation: the relationship between EBS herpetiformis and EBS with mottled pigmentation. A 6-year-old girl with epidermolysis bullosa simplex (EBS) is described. Clinical features include generalized herpetiform blistering of the skin, healing without scars, intraoral blistering, nail dystrophy, palmoplantar keratoderma, and improvement with age. An unusual feature was the presence of a striking mottled pigmentation involving the arms, trunk, and legs. histology, immunofluorescence, and electron microscopy of a fresh lesion showed an intraepidermal split within the basal keratinocytes, focal hyperpigmentation of the basal cells without an inflammatory infiltrate, and tonofilament clumping. Our patient illustrates the clinical features of Dowling-Meara EBS with the pigmentary changes of EBS with mottled pigmentation. The relationship between EBS of Dowling-Meara and EBS with mottled pigmentation is discussed. ( info) |
276/307. Acute poisoning with Diffenbachia picta. plants from the araceae family contain unidentified volatile compounds that are highly irritative or corrosive. Patient aged 38 was admitted with acute poisoning with Diffenbachia picta exhibited as severe salivation, burning and pain of the oral cavity, mucosal edema and blistering. Treatment was conservative similar to that in corrosive poisonings. Patient was discharged after 14 d hospitalization without postburning complications. ( info) |
277/307. Kindler syndrome: report of a case with ultrastructural study and review of the literature. Kindler syndrome is characterized by a generalized, progressive poikiloderma with cutaneous atrophy, congenital acral skin blistering, and photosensitivity. Since the first description, approximately 70 cases have been reported worldwide, but ultrastructural studies were performed in only five patients. In none of these patients were biopsies done at birth. In our patient ultrastructural studies were performed both of the blister at birth and of the poikilodermatous and atrophic skin at 6 years of age. Some ultrastructural features in the context of a bullous disease of the newborn that resembles epidermolysis bullosa, should alert investigators to the possibility of Kindler syndrome even in absence of the typical clinical signs. ( info) |
278/307. nursing care of the thoracoscopic lung volume reduction patient. BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. methods: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients. ( info) |
| urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis. Three-quarters of all cases occur during infancy or early childhood. Occasionally, vesicles or bullae may appear in persons with urticaria pigmentosa. We describe an unusual case of bullous urticaria pigmentosa with prominent scalp involvement. prognosis and therapy are reviewed. ( info) |
280/307. Kindler syndrome. Clinical and ultrastructural findings. BACKGROUND: Kindler syndrome is a genodermatosis that combines clinical features of hereditary epidermolysis bullosa and poikiloderma congenitale. The ultrastructural level of blister formation has not been well characterized. OBSERVATIONS: Two brothers with Kindler syndrome had a history of primarily acral blistering since infancy as well as photosensitivity. blister formation was found through the basal layer. Marked tonofilament clumping was found in intact keratinocytes adjacent to the blisters. The younger brother (aged 21 years) had actinic keratoses, which have not been previously described in Kindler syndrome. CONCLUSIONS: The findings of basal layer separation in both spontaneous and induced blisters in Kindler syndrome suggest this is the true level of blister formation. The finding of actinic keratoses in a young patient with Kindler syndrome suggests that some patients may be at increased risk for early solar-induced skin disease. The presence of clumped tonofilaments in keratinocytes adjacent to blistered areas suggests an abnormality of keratin 5 or 14 could be present and may play a role in blister formation in patients with Kindler syndrome. ( info) |