1/13. The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP).A 78-year-old South Korean man was referred to us from the Medical intensive care Unit (MICU) for an opinion. He was comatose and was on ventilatory care due to aspiration pneumonia. Multiple tiny papules had developed 10 years previously and since then the number and size had been increasing gradually. He had been diabetic for the past 4 years, and had Parkinson's disease diagnosed 1 year previously. Laboratory examinations revealed an elevated level of white blood cells (WBCs) (25,000/microL) and decreased hemoglobin (8.8 g/dL). Other laboratory results were negative or within normal limits. skin examination showed multiple, discrete, crust-like, brownish papules over the erythematous base on the face, upper extremities, and lower extremities. With the clinical impressions of irritated verruca vulgaris, seborrheic keratosis, or cutaneous fungal infection, a skin biopsy was taken from a papule on the left shin, and histopathologic examination revealed several pronounced hyperkeratotic and parakeratotic columns, and characteristic cornoid lamellae in the stratum corneum. Beneath the cornoid lamellae, the granular layer was decreased. A number of round or oval, dyskeratotic, homogenized eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the cornoid lamellae. A mild lymphohistiocytic infiltrate was observed in the papillary dermis and around the blood vessels in the upper dermis. Also, actinic degeneration was present in the upper dermis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/13. Pustular vasculitis of the hands.A case of pustular vasculitis of the hands with evidence of systemic involvement is described. A 64-year-old woman presented with a 2-day history of large, tense bullae arranged symmetrically over the dorsum of the three radial digits and extending on to the radial aspect of the dorsum of each hand. The bullae caused some discomfort and prevented normal use of her hands. There was no response to antibiotic therapy initiated prior to referral to hospital. Initial investigations revealed a raised white cell count with a neutrophilia, a raised erythrocyte sedimentation rate and a raised c-reactive protein. Abnormalities of liver function were detected. Aspirates from the bullae and blood cultures were sterile. The histology of debrided tissue demonstrated a florid neutrophilic dermal infiltrate with many blood vessels associated with prominent fibrin. A diagnosis of pustular vasculitis of the hands was made. The bullae were surgically debrided and treatment with oral corticosteroids was started. Two days after commencement of oral prednisolone, a crusted pustule appeared on her upper cutaneous lip. There was rapid resolution of both the vasculitis of the hands and the pustule on her upper lip following an increase in the dose of oral prednisolone. The patient was discharged on the seventeenth day following admission.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/13. Case report. Lymphatic vessel-type sporotrichosis: immunohistochemical evaluation and cytokine expression pattern.A 57-year-old male carpenter living in Sagamihara, Kanagawa Prefecture, visited the Department of dermatology of Kitasato University Hospital because an ulcer which appeared in his left forearm around May 1992 had spread gradually. An oval, shallow ulcer measuring 39 mm x 18 mm was found on the flexor aspect of the left forearm. Histopathological examination showed partial ulceration on the epidermis and marked cell infiltration throughout the entire dermal layer with an abscess in the centre and granulomatous reactions around it. PAS-positive spores were present between infiltrating cells and in giant cells in abscess and in granulomatous reactions. The skin lesion rapidly disappeared after beginning treatment with 125 mg day(-1) terbinafine and only a slight redness remained 14 weeks after starting the treatment. At this time the culture was negative. We conducted immunohistochemical examinations of the affected skin before, during and after starting treatment with terbinafine and studied local expression of cytokines at the affected lesion.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
4/13. calciphylaxis involving both the upper and lower extremities.calciphylaxis is an uncommon complication of end stage renal disease (ESRD) and secondary hyperparathyroidism. It characterized by cutaneous necrosis with mural calcifications and thrombosis in the small vessels of dermis. It is important to diagnose and treat, because of mortality rate from calciphylaxis is very high. We present the case of a patient with ESRD and type II diabetes mellitus developing calciphylaxis of the both upper and lower extremities had normal corrected calcium-phosphate product level. After amputation, necrosis was showed rapid progression resulting in death in one month.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/13. Lipoid proteinosis: report of a possible localized form on both hands and wrists.A 28-year-old woman was seen for pruritic lesions on both hands and wrists which had been present since the age of 10 years. Both palms showed symmetric, diffuse hyperkeratosis extending over both wrists and the dorsal aspects of both hands with well-demarcated, erythematous, lichenified plaques (Figs 1 and 2). The borders of the plaques were pigmented and studded with papules (Fig. 2). The skin lesions were not related to sun exposure. No similar lesions were found elsewhere on the body. The hair, nails, and dental development were normal. A skin biopsy was taken for histopathologic and ultrastructural studies under the clinical impression of pityriasis rubra pilaris. Microscopically, homogeneous perivascular deposits of hyaline-like material were seen in the papillary and reticular dermis, accompanied by mononuclear cells (Figs 3 and 4). The overlying epidermis was acanthotic with hyperkeratosis (Fig. 3). The hyaline deposits were positive for periodic acid-Schiff (PAS) and oil-red O stains (Figs 5 and 6). congo red stain was negative. Electron microscopic examination showed abundant amorphous material intermingled with short collagen fibrils in the dermis and around the blood vessels (Figs 7 and 8). Further examination revealed that the patient could protrude her tongue freely. The oral mucosa and vocal cords were smooth. There was no sign of systemic amyloidosis. The patient's complete blood cell count, biochemical tests, and protein electrophoresis were all within normal limits. Antinuclear antibody was negative. Results of porphyrin screening tests were negative for uroporphyrins and coproporphyrins in the urine and feces. The possibility of porphyria was therefore excluded. Both neurologic and ophthalmic examinations were negative. No intracranial calcification was found on a skull X-ray examination. The patient was treated with topical steroid and urea. She was lost to follow-up.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/13. imipramine hyperpigmentation: a slate-gray discoloration caused by long-term imipramine administration.A 48-year-old white woman, skin type III, had a slate-gray discoloration of the face and dorsa of both hands after ingesting imipramine, 150 mg/day for 5 years. Her iris color was also darkened. One year after cessation of the therapy, the discoloration became lighter. Sun-protected skin showed no discoloration. light microscopy revealed an accumulation of doubly refractile golden yellow granules in the papillary dermis, mostly scattered, with some concentration around the blood vessels but not in the endothelial cells. Electron micrographs showed numerous amorphous electron-dense inclusion bodies in histiocytes, phagocytes, fibroblasts, and dermal dendrocytes. melanosomes were phagocytosed in the same cells but in separated locations. imipramine is structurally related to chlorpromazine and can cause slate-gray discoloration. However, the color of the granules deposited in the papillary dermis is golden-yellow and they are not deposited in endothelial cells.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/13. On the role of proteinases from candida albicans in the pathogenesis of acronecrosis.Evidence is presented for the involvement of proteinases from candida albicans in the pathogenesis of acronecrosis that occurred in a young woman and which coincided with Candida sepsis. Secretory acid Candida proteinase by immunofluorescence was traced in the obstructed blood vessels of necrotic skin that was infested with yeast. The specificity of immunofluorescence was proven by exclusion of cross reactivity with pepsin, cathepsin-D, acid erythrocyte proteinase and porcine renin. The possible molecular mechanisms of interference of fungal proteinases are discussed with respect to the renin-angiotensin system and blood coagulation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/13. Multinucleate cell angiohistiocytoma: treatment with argon laser.Multinucleate cell angiohistiocytoma mainly affects middle-aged women, and usually presents as grouped reddish-brown papules. Histopathological features include the presence of multinucleate cells in the reticular dermis, and numerous dilated dermal vessels. The lesions are benign, and may persist for years. Treatment is needed for cosmetic reasons. We report the successful use of the argon laser to treat two patients who had multinucleate cell angiohistiocytoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/13. Severe exfoliative dermatitis associated with hand ischemia during cisplatin therapy.BACKGROUND: platinum is one of the most widely used agents in clinical oncology today. Serious toxic effects are well recognized. FINDINGS: To our knowledge, the current report describes the first case of severe allergic exfoliative dermatitis associated with ischemia and necrosis of the hands in a patient who had received multiple doses of this agent. We postulate that the tissue damage was caused by vasospasm of small vessels from the initial injury triggered by platinum or its associated immune complexes. CONCLUSION: platinum has become an integral part of combination chemotherapy for various solid tumors. Clinicians must recognize its toxic side effects and control them within tolerable limits.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/13. Recurrent pyogenic granulomas: a form of lobular capillary hemangioma.Two cases of pyogenic granuloma recurred despite what was originally thought to be a sufficient surgical excision. The granulomas presented clinically as polypoid structures, one on the finger and one on the chin. On histologic examination, all showed polypoid configuration with lobules of small vessels and endothelial cell proliferation. The recurrent lesions also showed similar lobules, but interspersed between the collagen bundles in the deeper dermis. Vascular tumors such as the lobular pyogenic granulomas, intravenous capillary hemangiomas, and acquired tufted angiomas were compared to our tumors.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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