Biomedical subjects
Publications and source records attributed to A L Schroeter.
Direct immunofluorescence of scabies lesions revealed IgM, IgA, C3, and fibrin in the cornified layer of the epidermis, dermoepidermal junction, and papillary dermal vessels. The granular deposits of IgM and IgG in the dermoepidermal junction had a pattern similar to that found in lupus erythematosus. These findings support a humoral immune response secondary to scabetic infestation.
Seventeen patients who had cutaneous complications following pentazocine injections are presented. The mean age was 50 years; total daily pentazocine dose ranged from 60 to 2,400 mg; evidence of psychiatric illness was present in 94%, and previous drug or alcohol abuse was noted in 65%. Fifty-three percent of our series of patients had a medical or paramedical background. Eighteen percent had diabetes mellitus, and 65% had a personal or family history (or both) of diabetes. A hypothesis is presented for this association. Characteristic histologic findings included fibrosis of the dermis and panniculus, with vascular alterations, fat necrosis with granulomatous inflammation, and vascular thrombosis with occasional endarteritis. We emphasize that medical and paramedical personnel and patients with a personal or family history of diabetes should be added to the group of patients considered to be at special risk for cutaneous complications of pentazocine injections.
The study of ten cases of cutaneous periarteritis nodosa by direct immunofluorescence microscopy of excision biopsy specimens revealed positive findings in nine. Deposition of IgM was found in the vessel walls in six cases, and C3 was observed in four; however, only in two cases was C3 found with IgM in the vessel walls. Deposits of IgM in the superficial vessels were found in five cases, although only the deep muscular vessels showed evidence of the vasculitis in cutaneous periarteritis nodosa. Serum hepatitis B antigen was absent in the nine cases that were tested. Positive immunofluorescence findings in superficial as well as in deep vessels suggest that although periarteritis nodosa is characterized by an inflammatory panarteritis, occasional vasculitis of small vessels might be expected.
The presence of a receptor for C3b in normal human oral mucosa was studied using C3b produced by treating normal human serum with cobra venom factor. Cryostat sections of normal human oral mucosa were incubated with C3b, followed by a direct immunofluorescence technique using monospecific goat-antihuman C3. The histologic localization of C3b fluorescence was determined by fixing cryostat sections with glutaraldehyde and staining with hematoxylin and eosin. The endothelial cells of the capillaries and smaller venules in the oral mucosa showed staining by anti-C3. C3b did not bind to the intercellular substance nor to the basement membrane zone of normal human oral mucosa. Normal human serum treated with EDTA was negative, thus indicating that native C3 did not bind to the receptor. The endothelial C3b receptor of the oral mucosa may have an important function in the localization of immune complexes that occur in systemic diseases, as well as in diseases restricted to the oral mucosa.
In a patient with primary inflammatory macular atrophy, immunofluorescence studies disclosed both C'3 and IgM in a granular and fibrillar pattern in the dermis between the coagen fibers and at the basement membrane zone. Localization of C'3 to autofluorescent elastic fibers was demonstrated. Ultrastructural examination showed the presence of activated macrophages enveloping fragmented elastic fibers. Immunologic mechanisms may play a participatory role in some forms of macular atrophy.
Necrolytic migratory erythema is the distinctive cutaneous eruption seen with glucagon-producing tumours of the pancreas. Recognition of this eruption is important because it may lead to the early diagnosis of a glucagonoma. Recently, we saw a patient who had necrolytic migratory erythema, hyperglucagonaemia, and cirrhosis of the liver with no evidence of pancreatic tumour while alive or at autopsy. Serum glucagon levels during the period of observation and during an oral glucose tolerance test suggested that the hyperglucagonaemia was not due to an occult glucagon-producing tumour but may have been the result of advanced hepatic cirrhosis.
In a 1964 study of the pharmacokinetic determinants of penicillin cure of gonococcal urethritis, 45 male prisoner volunteers were experimentally infected with strains of Neisseria gonorrhoeae having known in vitro penicillin susceptibility. After developing urethritis, subjects received intramuscular penicillin G and had serum samples obtained serially to determine penicillin concentration. Using a multiple regression technique, we studied patient-associated parameters and parameters of the serum penicillin curves to determine the best predictors of treatment results. Cure was best predicted by the time the serum penicillin concentration remained above three to four times the penicillin minimum inhibitory concentration of the infecting strain (probability of correct classification, >0.80). Those cured had serum penicillin concentrations which remained in this range for means of 7 to 10 h. Our findings confirm principles of antimicrobial therapy derived from animal models and may have application in studying therapy of gonorrhea and other infectious diseases.
A beaded pattern of immunofluorescence (IF) occasionally occurs in routine FTA-ABS testing. This phenomenon strongly correlates with false-positive reactions in patients with SLE. We report on this IF finding in association with carcinoma of the colon.
Explore the source record for details and available documents.
We studied the potential usefulness of CSF treponemal tests in the diagnosis of neurosyphillis. The CSF was tested with the microhemagglutination test for Treponema pallidum (CSF-MHA-TP test) and with the CSF-FTA test by using undiluted CSF and CSF diluted in saline and in sorbent. In a prospective evaluation, of 177 nonsyphilitics, none had reactive CSF-MHA-TP tests and only one had a reactive CSF-FTA test. However, five of 15 syphilitics with no other evidence of neurosyphilis had reactive CSF-FTA tests. The CSF-FTA test reactivity appeared most likely when the titer of the serum FTA test was high. In a retrospective evaluation of syphilitics with reactive CSF-FTA tests, similar patterns of reactivity occurred in patients with and without other evidence of neurosyphilis. Without other supporting clinical or laboratory data, the diagnostic value of a reactive CSF-FTA test is unknown.
A patient with papulonecrotic tuberculid had a pruritic papular eruption associated with constitutional symptoms. The eruption flared whenever the patient received low doses of prednisone to control symptoms of temporal arteritis. A cervical lymph node biopsy specimen demonstrated acid-fast bacilli, and Mycobacterium bovis grew on the cultures. The eruption cleared completely with antituberculous therapy. This case demonstrated the clinicopathologic findings compatible with a diagnosis of papulonecrotic tuberculid. Skepticism regarding the existence of papulonecrotic tuberculid is probably a result of the current decreased prevalence of untreated tuberculosis, and the subsequently increased rarity of this entity.
Twelve of 54 patients with systemic lupus erythematosus (SLE) had nonpuric, chronic urticaria-like lessions. Skin biopsy of the lesions was performed in 11 cases, and nine showed necrotizing vasculitis. The 54 patients, in general, had severe disease, and laboratory and clinical data suggested a postivite relationship between the urticaria-like lesions and disease severity. There was no consistent relationship between the course of the urticaria-like lesions and the serologic findings and clinical activity of the SLE. The frequency and importance of urticaria-like lesions in SLE deserve further study.
Explore the source record for details and available documents.
A 42-year-old woman had an acquired zinc deficiency. The patient was malnourished, secondary to chronic alcohol (ethanol) abuse and cirrhosis, with associated low serum and urinary levels of zinc. Her acrodermatitis was unresponsive to topically applied triamcinolone acetonide but cleared after oral zinc sulfate therapy.
Explore the source record for details and available documents.
Over 700 patients were screened by patch testing for sensitivity to the components of a vehicle tray from July 1974 through June 1976 at the Mayo Clinic. A modified version of the vehicle tray originally suggested by Fisher et al. (1971) was used, containing 14 substances commonly found in vehicles. Patches were applied for 24 rather than the usual 48 hours. Our percentage of reactivity compares favorably with the 48-h application method, thus demonstrating the efficacy of this time-saving technique. The method and usefulness of determining a percentage of irritancy are discussed. This was found to be a valuable tool in assessing false-positive reactions among our percentage of reactivity. Four irritants were demonstrated: phenylmercuric acetate (0.05% pet.), sodium lauryl sulfate (1% aq), thimerosal (0.1% aq) and hexachlorophene (1% pet.).
IgE antibodies can produce a late inflammatory response 6--12 h after allergen challenge which is characterized by diffuse edema, erythema, pruritus, tenderness and heat. That IgE is involved in inducing the late reaction was shown by the abolition of both immediate and late responses by passive transfer tests: (1) by heating atopic serum at 56 degrees C for 4 h; (2) by removing IgE from the atopic serum by a solid phase anti-IgE immunoabsorbent, and (3) by competitively inhibiting the binding of IgE antibodies to cells by an IgE myeloma protein. Also, both responses were induced by affinity chromatography-purified IgE antibody followed by antigenic challenge. Very similar lesions could be induced by intradermal injection of Compound 48/80. The late phase is characterized by edema and a mixed cellular infiltration, predominantly lymphocytic but also containing eosinophils, neutrophils and basophils. Direct immunofluorescent staining did not show deposition of immunoglobulins or complement components, except IgM in two of 15 and C3 in one of 15 patients, respectively.
A patient given long-term total parenteral nutrition acquired a zinc deficiency severe enough to cause typical cutaneous manifestations of acrodermatitis enteropathica. This report, the first detailed one, to our knowledge, of such an association, adds to the accumulating evidence that supplementation of trace elements is needed in long-term parenteral nutrition.