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Biomedical subjects

K V Ratnam

Publications and source records attributed to K V Ratnam.

At least 19 recordsLinked to original sources
PubMed1995

Idiopathic hypersensitivity vasculitis: clinicopathologic correlation of 61 cases.

BACKGROUND: Little is known of the course and prognosis of hypersensitivity vasculitis (HV). METHODS: Sixty-one cases of idiopathic HV were biopsied and followed-up for 5 years. RESULTS: There were two predominant patterns of presentation: palpable purpura (PP) and vasculitic ulcers (VU). The former was self-limiting, whereas the prognosis of the latter was poor. Findings on histopathology correlate well in PP patients having acute episodes, whereas in patients with VU there is correlation with duration and recurrence. CONCLUSION: A biopsy of a fresh lesion is recommended to help in determining the outcome.

Adolescent↗
PubMed1995

Chronic discoid lupus erythematosus: an immunopathological and electron microscopic study.

We studied 100 cases of chronic cutaneous discoid lupus erythematosus (DLE) to evaluate the diagnostic sensitivity of immunoreactant deposition and its possible role in basement membrane thickening. Histopathology was diagnostic in 71% of cases. Sixty-two percent (41/66) of lesions with thickened and 50% (17/34) with normal basement membrane had immunoreactant deposition. Ultrastructural study of 6 cases (3 with and 3 without immunoreactant deposition) with thickened basement membrane all showed reduplication of the lamina densa. Thickening of the basement membrane appears to be contributed mainly by reduplication of the lamina densa rather than by immunoreactant deposition. The direct immunofluorescence (DIF) test of lesional skin was positive in 58% of patients and was independent of duration of lesion, age and sex. Light microscopy has greater diagnostic sensitivity in confirming DLE lesions than DIF. Direct salt split skin technique did not increase DIF sensitivity. Scalp lesions showed the highest frequency (83%) of immunoreactant deposition. As C1q was the commonest immunoreactant found in our study, we suggest that it should be routinely used when DIF is employed in the evaluation of DLE. DIF is especially helpful in confirming cicatricial alopecia due to DLE.

Adolescent↗
PubMed1994

Pemphigus in remission: value of negative direct immunofluorescence in management.

BACKGROUND: Pemphigus vulgaris is characterized by relapses and remission, and there are currently no sensitive markers to predict remission. OBJECTIVE: Our purpose was to determine if direct immunofluorescence (DIF) performed during clinical remission of pemphigus is useful in management of the disease. METHODS: Twenty-eight patients with pemphigus that was in clinical remission (i.e., patients who were taking low-dose prednisolone [10 mg/day] and had been blister-free for at least 6 months) underwent DIF. Therapy was then discontinued and patients were prospectively followed up for 5 years. RESULTS: Twenty-two patients had negative results and six patients had positive results of DIF. The disease remained in remission in three quarters of the patients with negative results of DIF. Of those who had a relapse, intercellular C3 on DIF and oral lesions on initial presentation were important risk factors, and the relapses in patients with negative results of DIF were mild. The biopsy site was unimportant. All patients with positive results of DIF had major relapses within 3 months of cessation of therapy. CONCLUSION: DIF should be performed before therapy is discontinued. A negative DIF finding is a good indicator of remission in pemphigus.

Adolescent↗
PubMed1994

Current therapy of HIV associated infections and malignancies.

Drug therapy in AIDS is used to prolong life as there are many infections and malignancies which appear as a consequence of the immunosuppression and these can be fatal. Current anti-virals which specifically inhibit HIV replication are being used earlier to extend quality of life, maintain immune status and reduce the prevalence of opportunisitic infections and malignancies. Some infections cannot yet be treated and new therapies are awaited. It is too early in the epidemic for significant drug resistance to emerge. However, this is to be expected in the future. The prevalence of adverse drug reactions is significantly increased and therefore newer alternatives are keenly awaited. Drug treatment of HIV infected individuals is a formidable task requiring skilled multidisciplinary approach. This review summarises the most current treatment modalities for HIV associated infections and malignancies.

AIDS-Related Opportunistic Infections↗
PubMed1994

Leukemia cutis.

Leukemia cutis is an uncommon manifestation of leukemia that is strongly associated with the presence of extramedullary disease at other sites. Patients usually present with leukemia cutis concomitantly with systemic leukemia or after leukemia has been diagnosed. Acute monocytic, myelomonocytic, and the T-cell leukemias show the highest incidence of leukemia cutis. The lesions show varied morphology and can be difficult to distinguish both clinically and histopathologically from nonspecific cutaneous lesions, which occur much more frequently. Immunohistochemistry is useful in making the distinction between them. The prognosis in leukemia cutis is generally poor; the best results have been achieved with a combination of systemic and local therapy.

Antigens, CD↗
PubMed1994

Cutaneous angiofibromas: treatment with the carbon dioxide laser.

A keloid-prone young Chinese patient with multiple facial angiofibromas (incomplete form of tuberous sclerosis) who had been previously treated with liquid nitrogen and electrocautery is presented. He was treated with carbon dioxide laser using low irradiance to vapourize most of the lesions. Postoperative progress was uneventful and results after one-year follow-up showed very satisfactory cosmetic results. There was no recurrence or complication on prolonged follow-up. Carbon dioxide laser is advocated as the treatment of choice for angiofibromas.

Adult↗
PubMed1993

Drug-induced purpura simplex: clinical and histological characteristics.

Purpura simplex (PS) is a chronic condition manifesting as purpura, dermatitis and pigmentation. Histologically it is characterised by extravasation of erythrocytes and perivascular inflammation without fibrinoid necrosis. Most cases of PS are idiopathic. In order to determine if PS can be drug induced, a prospective study of 183 patients with PS was carried out. Of these, 27 patients were confirmed to be drug induced, as the purpura cleared on withdrawal of medications within four months. Lesions of drug-induced PS were significantly more generalised as compared to PS patients without a drug history. No epidermal involvement and an absence of lichenoid infiltrate characterised drug-induced as compared to idiopathic PS. NSAIDs, diuretics, meprobamate and ampicillin were the commonest offenders. We conclude that a drug-induced subgroup of PS exists and can be identified by clinical and histological features. Therefore, a careful drug history and skin biopsy are recommended in all cases of PS.

Drug Eruptions↗
PubMed1993

Floor-pattern salt-split skin cannot distinguish bullous pemphigoid from epidermolysis bullosa acquisita. Use of toad skin.

BACKGROUND AND DESIGN: Patients with epidermolysis bullosa acquisita (EBA) and bullous pemphigoid (BP) can present with similar clinical features. These antigens have different phylogenetic origins. It was thought that sodium chloride split-skin immunofluorescence could reliably distinguish between BP and EBA. However, it has now been recognized that both diseases can present with a floor pattern fluorescence on salt-split skin. A simple method is required to distinguish these diseases. RESULTS: Serum specimens from two patients presenting with pruritic blisters showing a floor pattern immunofluorescence on salt-split skin were found to have positive fluorescence on toad skin that has the BP and not the EBA antigen. The diagnosis of BP in these patients was confirmed by a prompt response to treatment with systemic steroids. Electron microscopy showed a split at the lamina lucida. CONCLUSIONS: Bullous pemphigoid can present with a floor pattern immunofluorescence on salt-split skin. The use of the skin from invertebrates like the toad may help in distinguishing BP from EBA.

Aged↗
PubMed1992

Value of immunohistochemistry in the diagnosis of leukemia cutis: study of 54 cases using paraffin-section markers.

A grave prognosis is usually associated with leukemic skin infiltrates (leukemia cutis). However, some leukemic skin infiltrates are clinically similar to reactive non-leukemic infiltrates in patients with leukemia; thus it is of great importance to distinguish them. Fifty-four cases which were thought clinically to be leukemia cutis underwent immunophenotyping with a panel of nine T, B, monocytic, and macrophage markers using paraffin sections. Immunohistochemistry helped identify 44 cases with leukemia cutis and 10 with reactive infiltrates. In all cases of leukemia cutis, the staining patterns of skin infiltrates were concordant with cell type in the bone marrow. Furthermore, the panel of markers was usually helpful in distinguishing reactive from leukemia infiltrates, especially in cases with chronic lymphatic leukemia. Immunohistochemistry is a valuable adjunct in histopathologic differentiation of skin infiltrates in most cases of leukemia. With formalin-fixed, paraffin-embedded biopsies, we recommend that CD45 (LCA), CD45RO (UCHL-1), CD3, CD20 (L-26), CD43 (Leu-22), CD68 (KP-1), lysozyme, and chloroacetate esterase be considered in cases of systemic leukemia with cutaneous papules and nodules that prove difficult to interpret with routine section.

Acute Disease↗
PubMed1991

Purpura simplex (inflammatory purpura without vasculitis): a clinicopathologic study of 174 cases.

Purpura simplex manifests clinically as macular purpuric and petechial pigmented, golden, annular, or lichenoid lesions. These subtypes have been termed Schamberg's purpura, lichen aureus, Majocchi's purpura, and Gougerot-Blum purpura. Histologically, there is inflammation and hemorrhage without fibrinoid necrosis of vessels. One hundred seventy-four cases were retrospectively reviewed. In some patients, the eruption was related to medications. Treatment was usually of limited benefit. Fifty-eight of 87 patients (67%) who had follow-up data did eventually have clearing of lesions. Because of the clinical and histologic similarities among the subtypes, the inclusive term purpura simplex is favored.

Eczema↗
PubMed1990

Pemphigus therapy with oral prednisolone regimens. A 5-year study.

Twenty-two newly diagnosed patients with pemphigus were randomly divided into two groups of 11 each. One group was placed on a high-dose prednisolone (120 mg/day) therapy and the other group on a low-dose (60 mg/day) therapy. The patients were followed for 5 years. Although a rapid initial control of the pemphigus appeared to be achieved with the high-dose regimen, this regimen did not have any long-term benefit over the low-dose regimen with respect to the frequency of relapse or in the incidence of complications.

Administration, Oral↗
PubMed1990

Cutaneous carcinogenesis: a review of recent advances in pathogenesis.

The clinical spectrum of cutaneous carcinogenesis has not changed substantially. New insights into the pathogenesis of ultraviolet induced lesions have resulted in better understanding of the basic biology of cutaneous tumours. This has evolved into the development of 4 stages in skin carcinogenesis. New problems like Human Immunodeficiency Virus (HIV), associated tumours and ozone depletion are emerging, which will require greater research efforts into preventing a further increase in incidence.

Humans↗
PubMed1990

Efficacy of health education programme on awareness of AIDS among transsexuals.

A study of the awareness of Acquired Immunodeficiency Syndrome (AIDS) among Transsexual prostitutes attending the Middle Road Hospital was made. The present study involved 71 subjects of a cohort of 100 who were interviewed a year earlier and had subsequently been given intensive health education. The results show that there was now an increased awareness of AIDS in virtually all the subjects studied. In contrast, there has been no significant change in the use of safe sex practices as a direct consequence of this knowledge. The reasons for this are discussed. There may be a need for more intensive behaviour modification programme in this group of individuals.

Acquired Immunodeficiency Syndrome↗