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Biomedical subjects

C H Dicken

Publications and source records attributed to C H Dicken.

At least 55 records · Page 3Linked to original sources
PubMed1981

Actinic prurigo.

Actinic prurigo is a chronic photodermatitis found predominantly in North American Indians. Other terms have been used to describe similar cases in Central and South America and in Europe. Relatively little has been written about this condition in the English literature, and confusion exists over whether this is a form of polymorphic light eruption. Actinic prurigo can be considered a unique variant of polymorphic light eruption; however, we believe that certain differences help to distinguish actinic prurigo as a separate disease entity. Herein we report three cases of this disease and review the related literature. Characteristic clinical features include prurigolike papules and cheilitis. Pruritus is the predominant symptom, and a familial tendency and an early age at onset are usually noted. Results of karyotyping and analysis of sister chromatid exchanges were normal in two of our patients so tested. Skin testing for photosensitivity has yielded inconsistent results, and use of light testing for diagnosing actinic prurigo does not seem to be a predictable procedure. Actinic prurigo is a chronic disease that often is refractory to therapy.

Adult↗
PubMed1981

Factitious lip crusting.

Four cases of factitious crusting of the lips in women are reported. Two of the women had hemorrhagic crusts, and two had keratotic yellow crusts. All four patients had personality disturbances. Biting, picking, or unconscious licking of the lips may be the underlying mechanism for trauma and crust formation. This entity should be distinguished from contact cheilitis, actinic cheilitis, infectious cheilitis glandularis, and cheilitis granulomatosa. Some cases of exfoliative cheilitis may also be factitious. The presence of bizarre hemorrhagic or keratotic crusts on the lips should alert the clinician to a possible factitious origin, and a psychiatric evaluation should be done.

Adolescent↗
PubMed1981

Blue fingertips associated with myxedema.

A 42-year-old woman had blue telangiectases of the fingertips associated with myxedema. In addition to this clinical finding, the patient had abnormal Doppler ultrasound study findings analogous to those seen in peripheral vascular occlusion. With thyroid replacement therapy, the telangiectases disappeared, and a dramatic improvement was noted in the results of the Doppler studies. We believe that the clinical picture seen in our patient was caused by the deposition of mucin around small blood vessels.

Adult↗
PubMed1980

The therapeutic response of urticarial vasculitis to indomethacin.

Ten patients with urticarial vasculitis, characterized clinically by persistent painful urticarial lesions, angioedema, recurrent arthralgia, abdominal pain, and low-grade fever, were selected for study. All patients had histologic evidence of leukocytoclastic vasculitis in the urticarial lesions. Results of direct immunofluorescence microscopy of urticarial lesions were positive in all nine of the patients tested. Treatment with indomethacin in dosages from 25 mg three times daily to 50 mg four times daily resulted in complete clearing of all disease manifestations in six of ten patients within 17 days and partial improvement in three. In eight of the ten patients, disease activity recurred within 48 hours after discontinuation of the use of indomethacin. Gastrointestinal irritation was the only side effect noted. Indomethacin is proposed as an effective mode of therapy in a disorder unresponsive to treatment with conventional medications for urticaria, including high-dose corticosteroids.

Adolescent↗
PubMed1980

Cutaneous manifestations of angioimmunoblastic lymphadenopathy.

Six of 22 patients with angioimmunoblastic lymphadenopathy seen at the Mayo Clinic from 1962 to 1978 had associated cutaneous lesions exhibiting characteristic histologic features at biopsy. Clinically, three patients had generalized maculopapular eruptions, two had generalized petechiae, and one had generalized erythroderma and petechiae located on the extremities. In each patient, the eruption occurred concurrent with or prior to the onset of generalized lymphadenopathy. Pathologically, all skin biopsy specimens showed lymphohistiocytic vasculitis, vascular proliferation, extravasated RBCs, and occasional scattered mature plasma cells. These histologic findings were similar to but less intensive than those noted on biopsy specimens of involved lymph nodes. Although suggestive of angioimmunoblastic lymphadenopathy, the histologic findings of skin lesions do not appear to be diagnostic, thus stressing the difficulty of defining the syndrome in the absence of lymph node biopsy.

Aged↗
PubMed1980

Povidone panniculitis. Polyvinylpyrrolidone panniculitis.

Multiple subcutaneous nodules and recurrent flu-like episodes developed in a 60-year-old woman after she had received local intramuscular injections of procaine povidone for a seven-year period. A skin biopsy specimen showed distinctive gray-blue material in the histiocytes in sections stained with hematoxylin-eosin. Povidone is an inert substance that may accumulate in multiple organs, including the skin. Its presence can be verified by its affinity for special stains or by spectrophotometric analysis. In our patient, ultrastructural study showed amorphous inrahistiocytic deposits in the tissues. -revious reports have indicated that this substance may eventually accumulate in noninjected skin sites and may lead to pulmonary and arthritic symptoms in some patients, but no other patients, to our knowledge, have had complications associated with fever.

Female↗
PubMed1979

Hereditary acrolabial telangiectasia. A report of familial blue lips, nails, and nipples.

We describe a mother and two daughters who had the following clinical manifestations: bluish discoloration of the vermillion ridge of the lips, nipple areolae, and nail beds; discrete telangiectasia of the chest, elbows, and dorsa of the hands; varicosities of the lower part of the legs; and (in the two daughters) migraine headaches. Routine histologic examination of tissue from the lips and elbows disclosed extensive, dilated, horizontal subpapillary telangiectases. Enzyme histochemical stains demonstrated activity of adenosine triphosphatase and leucine aminopeptidase around these dilated vessels. Alkaline phosphatase activity was strikingly absent from the dilated subpapillary vessels. By electron microscopy, these vessels were demonstrated to be postcapillary venules. We propose an autosomal dominant mode of inheritance.

Adult↗
PubMed1979

Inflammatory macular atrophy: immunofluorescent and ultrastructural findings.

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.

Adult↗
PubMed1979

Bowel bypass syndrome.

We report two cases of a syndrome related to the bowel bypass surgical procedure. This syndrome consists of a flu-like illness, with temperatures from 38.3 to 39.4 degrees C (101 to 103 degrees F), chills, malaise, and inflammatory papules and pustules, 2 to 4 mm in diameter, on the extremities and upper part of the trunk. The illness lasts two to six days, and then recurs in one to six weeks. During some episodes, myalgia and polyarthralgia occur; between episodes, joints are normal. In both patients, extensive evaluations had been made to determine the cause of the persistent illness before this distinctive syndrome, related to the bowel bypass surgical procedure, was recognized. These two cases are also illustrative of the two therapeutic approaches that may be of value: administration of antibiotics, esecially metronidazole, or reconstitution of the normal bowel anatomy. The relationship of this syndrome to the arthritis associated with bowel bypass and to bypass enteropathy is discussed.

Female↗
PubMed1979

Bilateral verrucous carcinoma of the feet.

A 51-year-old woman had had bilateral verrucous carcinoma of the feet for ten years. The tumors had been treated many times as extensive verruca vulgaris before a biopsy was performed and the true neoplastic nature of the lesion recognized. This case illustrates the necessity of performing biopsies on atypical or frequently unresponsive verrucous tumors.

Biopsy↗
PubMed1978

Sister chromatid exchanges in Bloom's syndrome.

The importance of chromosome instability in Bloom's syndrome is reviewed, and the recently developed technique for demonstrating sister chromatid exchanges (SCE) is described. In Bloom's syndrome, but not in other heritable syndromes associated with chromosome instability, there is a nine- to ten-fold increase in the frequency of spontaneous SCE. We present a case of Bloom's syndrome in which this test facilitated the diagnosis. In four obligate heterozygotes (the parents of children with Bloom's syndrome), however, an increase in the frequency of spontaneous SCE was not observed.

Abnormalities, Multiple↗
PubMed1978

The Churg-Strauss granuloma: cutaneous, necrotizing, palisading granuloma in vasculitis syndromes.

The cutaneous, necrotizing, palisading granuloma (Churg-Strauss granuloma) was observed on histopathologic study of skin specimens from seven patients. Two patients had Wegener's granulomatosis and one patient each had allergic granulomatosis, limited Wegener's granulomatosis, bacterial endocarditis, systemic lupus erythematosus, and rheumatoid arthritis. The microscopic picture consists of extravascular, palisading, dermal granuloma. The center of the granuloma consists of basophilic fibrillar necrosis in which linear bands of destroyed tissue are interspersed with masses of polymorphonuclear leukocytes and leukocytoclastic debris. This necrotic leukocytic mass is surrounded by histiocytes and some lymphocytes. The clinical lesions are symmetric, erythematous papules or nodules on the extremities. The histopathologic picture of the Churg-Strauss granuloma is unique and, as demonstrated in these cases, indicates the presence of systemic vasculitis.

Granulomatosis with Polyangiitis↗