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D Lipsker

Publications and source records attributed to D Lipsker.

69 records · Page 4Linked to original sources
PubMed1996

Examination of cutaneous macroglobulinosis by immunoelectron microscopy.

Cutaneous macroglobulinosis is a rare cutaneous manifestation of Waldenström's disease. Lesions are though to result from accumulation of macroglobulin in the dermis and are therefore called IgM storage papules. Ultrastructural findings in the previously reported cases were contradictory and the nature of the deposits was not established by electron microscopy. The purpose of this study was to analyse such deposits by the use of immunoelectron microscopy. A 60-year-old woman had multiple erythematous papules for 1 year. The histopathological changes consisted of plasmocytic infiltration of the dermis and eosinophilic deposits. The skin changes and other investigations led to a diagnosis of Waldenström's disease. Samples from normal and diseased skin were analysed by electron microscopy and by immunogold labelling with anti-IgM antibodies, after Lowicryl K4M embedding. An extracellular electron dense granular and filamentous material was observed in the mid- and upper dermis, between and within the collagen bundles. No periodicity was noted and no deposits were seen at the dermoepidermal junction. Immunoelectron microscopy showed a positive labelling located only on these deposits, in both normal-appearing skin and in lesions. In this patient, immunoelectron microscopy clearly demonstrated the presence of large amounts of IgM in the dermis, which were found in the lesions of cutaneous macroglobulinosis and in normal skin. These results suggest that the IgM storage papules result from a greater density of deposits rather than a site-specific accumulation.

Female↗
PubMed1993

[Squamous syringometaplasia: an original manifestation of pathomimesis].

INTRODUCTION: Epidermoid syringometaplasia consists in rare changes of the eccrine sweat glands, which show keratinization of their ductal part. Many conditions are associated with epidermoid syringometaplasia: chronic ulcers, scars, keratoacanthoma and various drugs or toxic agents, suggesting a toxic effect of drugs or an inflammatory mechanism. OBSERVATION: A 22-year-old woman presented with large painless ulcero-vegetating lesions of the forearm; the X-ray examination showed an major emphysema. She also had multiple scars on her trunk and limbs. The curious features of the lesions and the psychiatric troubles suggested the diagnosis of dermatitis artefacta. Histopathological examination showed a pseudocarcinomatous epidermal hyperplasia; in the deep dermis the eccrine ducts were connected to the epidermal cell masses or seemed to be included into the proliferation. Keratinization was noted within the keratinocytes surrounding the duct lumen. A dense inflammatory cell infiltrate was observed, containing many macrophages with a foamy cytoplasm, probably resulting from the injection of a foreign substance. All lesions healed within a few days using an occlusive dressing. COMMENTS: In this patient, the voluntary injection of an unknown substance probably induced these metaplastic changes of the sweat ducts, which are probably related to a toxic mechanism. Epidermoid syringometaplasia has never been described after cutaneous injections.

Adult↗
PubMed1993

[Cutis verticis gyrata: reduction surgical treatment].

Cutis verticis gyrata (CVG) is a rare cause of acquired scalp thickening; in its primary form, the disease does not show any bone involvement. A 19-year old man had noticed a moderate thickening of the scalp at the age of 15. He progressively developed ridges and furrows in the occipital and parietal areas: after a four-year period, there were ten sagittal and irregularly parallel folds. There was neither pain nor pruritus, and the hair had a normal appearance. Complete neurological examination was unremarkable and the patient was of normal intelligence. All biological investigations, including STH and TSH levels, were normal. X-ray examination and tomodensitometry did not show any bone involvement. Our patient was treated by surgical reduction of the scalp areas involved under general anesthesia, with a very good result. This is a typical case of primary CVG. Differential diagnosis of primary cutis verticis gyrata comprises pachydermoperiostosis, cerebriform intradermal nevus and many secondary conditions associated with hypertrophy and folding of the scalp. A relatively simple surgical treatment results in a major reduction of the scalp thickening, and avoids maceration.

Adult↗
PubMedDate not supplied

[Knowledge and prevention of tick-bite borreliosis: survey of the population in Alsace, an endemic area].

INTRODUCTION: European borreliosis, known to the general public as 'Lyme disease' in analogy with the American form, which it differs from in many points, is endemic in the area of Alsace and is a public health problem. The level of knowledge and prevention of the population with regard to the disease has never been assessed in France. MATERIAL AND METHODS: A survey was conducted in all the national health examination centers in Alsace using a self-applied questionnaire. The data collected concerned the socio-demographical characteristics, knowledge on the disease, history of tick bites, fear the disease creates, frequency of visits to the forest, prevention habits when visiting the forest and the attitude adopted in the case of a tick bite. RESULTS: Out of the 600 persons included, 99 (16.5 p.cent) had been bitten by ticks once or more over the past year. The existence of Lyme's disease was known to 74 p.cent of the consultants, 63 p.cent claimed they were worried by the disease and 43 p.cent knew that the first manifestation is redness spreading over the skin. Twenty-seven percent wore trousers and long sleeves when visiting the forest and 19 p.cent inspected their body carefully on their return. The persons least well informed were also those who did little to protect themselves against tick bites. They often were under 30 years old, lived in urban settings and had few diplomas. Those who had frequent spare time in forest and those who had a history of tick bites were the best informed and protected themselves better. The fear of the disease was associated with better knowledge and more appropriate behaviour. DISCUSSION: This study shows that a large percent of the population in Alsace is exposed to tick bites. Tick bite borreliosis is relatively well known, but protection remains insufficient. Better knowledge of the disease is related to better prevention. Information and teaching campaigns for the general public could specifically target the young people, urban dwellers and those with few diplomas. Specific messages of prevention could be delivered to the most exposed at-risk subjects (i.e. those bitten by ticks or having leisure in forest) at the places of their leisure or medical consultations.

Adult↗
PubMedDate not supplied

[Oral ulcers induced by nicorandil: prevalence and clinicopathological aspects].

INTRODUCTION: The first observations of "giant buccal aphthosis" induced by nicorandil were published in 1996. Nicorandil is a potassium channel activator used in the treatment of angina pectoris, which seems to induce specific buccal ulcerations. The purpose of this study was to analyze the clinicopathologic data of patients with aphthosis induced by nicorandil and to study the prevalence of this side effect. PATIENTS AND METHODS: We have seen 3 patients who spontaneously consulted, and 5 patients who were addressed to us after a telephone survey. We have then examined 100 consecutive patients treated by nicorandil for at least 1 month, who were hospitalized in 3 departments of cardiology in Strasbourg, and 100 age- and sex-matched controls who were treated by other antianginal drugs. RESULTS: Our 8 patients suffered from large, chronic and painful ulcerations of a 4-week duration, located on the tongue, the gingiva and the cheeks despite various symptomatic treatments. In one case, histopathologic data were consistent with an eosinophilic ulcer. Prospective study: among 100 patients treated by nicorandil, 5 had unusual chronic buccal ulcerations, whereas none of the 100 controls had aphthosis (p = 0.03). The confidence interval (99 p. 100) of this side effect prevalence was therefore 1 p. 100 to 14 p. 100. DISCUSSION: Nicorandil can induce large and painful buccal ulcerations with severe dysphagia, weight loss, and depression. Dermatologists should be aware of this particular side-effect, since our study showed a high prevalence, and because lesions heal rapidly after withdrawal of nicorandil. Why nicorandil may be associated with mouth ulcers remains unanswered. A past history of aphthae could be a cofactor of this side-effect.

Aged↗
PubMedDate not supplied

[Painful edema of the feet revealing ankylosing spondylitis].

INTRODUCTION: Painful peripheral oligoarthritis can reveal ankylosing spondylitis. In some instances, an acral pitting edema can be the sign of this affection. CASE REPORT: A 39-year-old man, with no significant previous medical history, consulted in a dermatology department for acral pain and edema of both feet, which were exacerbated during the second part of the night. On examination, he had a pitting edema and a livedo of the distal part of the feet. Biological investigations revealed an inflammatory syndrome and the presence of the histocompatibility HLA-B27 antigen. Bone scintigraphy revealed distal hyperfixation on both feet. Diagnosis of ankylosing spondylitis was established. DISCUSSION: Late-onset ankylosing spondylitis, which appears in subjects older than 35 years, can manifest as peripheral arthritis with systemic signs, often in the absence of involvement of the axial skeleton. Peripheral pitting edema of lower limbs can be the presenting sign. Since cutaneous involvement can be the presenting sign, dermatologists should be aware of this entity.

Adult↗