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J L Millns

Publications and source records attributed to J L Millns.

At least 19 recordsLinked to original sources
PubMed2000

The sign of Leser-Trélat in a case of adenocarcinoma of the lung.

This is what we believe to be the first report of the sign of Leser-Trélat in association with occult adenocarcinoma of the lung. The sign of Leser-Trélat is proposed as a sign of possible occult malignancy, despite various suggestions to the contrary. Also, it is suggested that a tumor-produced humoral factor (eg, transforming growth factor-alpha [TGF-alpha]) could be responsible for both the acute eruption of the monomorphous seborrheic keratoses and the nearly concomitant development of acanthosis nigricans, which occurred in our case. The possible distinction between a hyperplastic and a neoplastic origin of various types of seborrheic keratosis is discussed in relation to this hypothetical humoral factor. In addition, we suggest a refinement of the definition of the sign of Leser-Trélat and discuss the use of "sign of Leser-Trélat" and "syndrome of Leser-Trélat" in relation to physical findings. All patients with the sign of Leser-Trélat should undergo a thorough evaluation for occult malignancy.

Acanthosis Nigricans↗
PubMed1985

Secondary neuroendocrine carcinomas of the skin. An immunohistochemical comparison with primary neuroendocrine carcinoma of the skin ("Merkel cell" carcinoma).

Since the initial clinical presentation of visceral neuroendocrine carcinoma is occasionally a cutaneous metastasis, diagnostic confusion with primary neuroendocrine carcinoma of the skin (Merkel cell carcinoma) may ensue. In this study, seven cases of secondary cutaneous neuroendocrine carcinoma were immunohistochemically compared with twenty-one Merkel cell carcinomas for ten antigenic moieties that have been associated with endocrine tumors. Six of seven secondary tumors stained for bombesin, leucine enkephalin, methionine enkephalin, or beta-endorphin, none of which was detected in the primary cutaneous neuroendocrine carcinomas. These data suggest that immunohistochemical study may be useful in separating primary from secondary neuroendocrine tumors of the skin and may assist in directing clinical attention to the most probable site of visceral neoplasia.

Adult↗
PubMed1984

Factitial cutaneous ulcers and nodules: the use of electron-probe microanalysis in diagnosis.

Two cases are reported in which persistent nodular or ulcerative skin lesions with granulomatous histology suggested possible injection of foreign material. Electron-probe microanalysis was used to determine the presence and nature of foreign materials present in the skin. This technic identified specific agents used as fillers in tablets, indicating the injection of pulverized tablet material. The patients were counseled regarding this evidence, and psychotherapy and drug rehabilitation were recommended in each instance. This technic provides a valuable tool for accurate identification of foreign substances in the skin.

Adult↗
PubMed1982

Mechanisms of sebum production and delivery in man.

Utilizing a solvent extraction system and colorimetric analysis, surface lipid levels were determined on the forehead. To understand the mechanisms involved in the sebaceous gland apparatus, repeated sampling at varying timed intervals were made. The data suggest that frequent surface samplings produce higher rates of lipid replacement. The increasing lipid replacement rates seen with sampling intervals of greater frequency do not follow a linear pattern. Also, lipid replacement rates show a gradual decline with time. This data suggest the existence of a multifunctional sebaceous apparatus involved in sebum production (a rate function), sebum storage (a volume function) and surface delivery (a rate function).

Female↗
PubMed1981

Cutaneous immunofluorescence in primary biliary cirrhosis.

Biopsy specimens of normal skin of 11 patients with primary biliary cirrhosis were studied by immunofluorescence for immunoglobulin and complement deposition. Of the 11 patients, seven had positive immunofluorescent staining, primarily in a granular pattern either at the basement membrane zone or around the blood vessels or in both locations. The principal immunoglobulin noted was IgM, which, in six of the seven patients, was seen at the basement membrane zone or around the vessels (or both). Deposition with C3, fibrin, IgA, and IgG was seen less frequently. In this series of patients, cutaneous lesions included discoid lupus erythematosus, lichen planus, vitiligo, chronic bullous lesions of the legs, and scleroderma. Non-organ-specific immunologic markers in this group included elevated levels of IgG, IgM, and IgA, antinuclear antibodies, anti-nDNA, rheumatoid factor, antimitochondrial antibodies, smooth-muscle antibodies, and circulating immune complexes. We wish to add cutaneous immunofluorescence as an additional immunologic marker for primary biliary cirrhosis.

Adult↗
PubMed1981

Resistant cutaneous infection caused by Mycobacterium chelonei.

Induration of the lower parts of the legs with abscess and ulcer formation occurred in a 60-year-old woman. Mycobacterium chelonei, a ubiquitous, saprophytic pathogen that uncommonly causes human disease, was cultured from biopsy material. Although spontaneous healing usually occurs in a few months with such infections, our patient's disease persisted for more than two years until control was achieved with minocycline hydrochloride.

Abscess↗
PubMed1980

Minocycline-induced pigmentation at sites of cutaneous inflammation.

In four cases of minocycline hydrochloride-induced cutaneous pigmentation, blue-gray discoloration in sites of cutaneous inflammation was seen in all cases. An additional finding of generalized, brown hyperpigmentation with accentuation in sun-exposed areas was noted in one. Although all of the patients had used relatively high doses of medication, the variable duration of therapy before pigmentary changes and dearth of similar reports suggest an idiosyncratic response to this commonly used medication. Histochemical stains and electron microscopic studies suggest hemosiderin or a pigment with similar staining properties; a minocycline degradation product, however, cannot be discounted.

Acne Vulgaris↗
PubMed1980

Skin manifestations of pentazocine abuse.

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.

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

Neurological complications of cryosurgery.

Among the few serious complications of cryosurgery are neuropathies. Three cases are reported. Prevention of neuropathy from cryosurgery depends upon awareness of the superficiality of the course of certain peripheral nerves in certain anatomic sites and cautious practice or avoidance of cryosurgery in those sites.

Adolescent↗
PubMed1980

The coexistence of psoriasis and lupus erythematosus. An analysis of 27 cases.

From 1950 through 1975, 27 patients at the Mayo Clinic, Rochester, Minn, had coexistent psoriasis and lupus erythematosus (LE). Of the 27 patients, ten had systemic LE (SLE), 13 had discoid LE, and four had drug-induced LE or an SLE-like syndrome. The onset of psoriasis preceded LE in ten patients and was concomitant with it in six. Photosensitivity was noted in 23 patients. In 20 patients, the lesions of psoriasis and LE remained clinically distinct. Morphologic overlap and clinical interaction occurred in seven patients in whom the disorders were severe and complicated by a third disease. Generally, this latter group had extensive psoriasis, prominent photosensitivity, and a poor response to therapy.

Adolescent↗
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↗