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Biomedical subjects

M Sigal-Grinberg

Publications and source records attributed to M Sigal-Grinberg.

7 recordsLinked to original sources
PubMed2006

[Steal syndrome].

BACKGROUND: Ischemic steal syndrome is a complication of arteriovenous access creation for hemodialysis, and is little known among dermatologists despite the fact is fairly common and has a cutaneous presentation. Herein we report the case of a man presenting with serious ischemic injuries to the fingers associated with steal syndrome. OBSERVATION: A 49-year-old diabetic man presented with painful acrosyndrome of the left hand, with a necrotic ulcer on the third finger appearing 5 months after the creation of an arteriovenous access. Clinical examination showed marked pain relief after manual compression of the fistula. Arteriography showed an overfunctional fistula, causing decreased distal perfusion pressure, and this was consistent with the diagnosis of steal syndrome. Banding of the anastomosis was performed but was insufficient to spare the finger from amputation. DISCUSSION: The aim of our case-report is to increase awareness among dermatologists of this fairly frequent complication of arteriovenous accesses. We discuss the physiopathology, risk factors, clinical features and therapeutic management of this condition. Since diagnosis of steal syndrome is fairly straightforward, early detection is essential. Only adequate surgical management can avoid gangrenous manifestations leading to more or less widespread amputation.

Amputation, Surgical↗
PubMedDate not supplied

[Extensive cutaneous candidiasis revealing cutaneous T-cell lymphoma: 2 cases].

BACKGROUND: During the course of immunodeficiency diseases, severe candidiasis can occur with extensive cutaneous and mucous membrane lesions. However, blood dyscrasias are very rarely revealed by diffuse candidiasis. We report two case of cutaneous T-cell lymphoma revealed by extensive and atypical cutaneous candidiasis. PATIENTS AND METHODS: Case No. 1:A 72-year-old woman presented a pruritic rash of circinate, serpiginous patches on glabrous skin and skinfolds with multiple intertrigo and rapidly worsening palmoplantar keratoderma. All mycological skin specimens tested positive for Candida albicans. Histological examination of a biopsy sample from a serpiginous patch revealed the presence of fungal elements while palmoplantar keratoderma biopsy showed an epidermotropic lymphocytic infiltrate in the superficial dermis evocative of mycosis fungoides. Blood tests showed a white cell count of 28 600/mm3 with 14% circulating Sezary cells and a T-cell clone. The T-cell lymphoma was treated with methotrexate, but the disease worsened a few months later, progressing to CD30- large T-cell pleomorphic lymphoma. The patient died of severe sepsis. Case No 2:A 60-year-old man presented a macular rash over the face, trunk and skinfolds as well as erythematous scaly annular plaques of the glabrous skin with lymphadenopathy. Cultures of skin scrapings were all positive for Candida albicans. Blood tests showed a white cell count of 15 000/mm3 with 30% circulating Sezary cells. A trunk patch biopsy revealed the histological appearance of mycosis fungoides. There was a T-cell clone in the peripheral blood and skin. DISCUSSION: In both cases, the patients presented with widespread annular and erythematous scaly lesions of the glabrous skin and skinfolds with evidence of Candida albicans on fungal tests of all skin scrapings. The discovery of circulating Sezary cells on a systematic smear for hyperleukocytosis led us to suspect underlying cutaneous T-cell lymphoma, which was confirmed by biopsy of the skin lesions accompanying the mycoses. Widespread cutaneous candidiasis can occur in patients with cell-mediated immunodepression. Cutaneous T-cell lymphoma can enhance such candidiasis through interference with skin integrity and impairment of cell-mediated immunity, with large amounts of IL10 and TGF-B, increased secretion of soluble interleukin-2 receptors (CD25) and impaired CD8 suppressor cell function.

Aged↗
PubMedDate not supplied

Leg ulcers and the Urgocell Non-Adhesive wound dressing.

The objectives of this clinical trial were to evaluate the efficacy and tolerance of the Urgocell Non-Adhesive (NA) dressing in the local management of venous or mixed leg ulcers. The study was a non-comparative, prospective, multicentre (15 centres) phase III, clinical trial. The studied population was composed of non-immunodepressed adults presenting a venous or mixed leg ulcer, uninfected, non-cancerous, present for less than 18 months. Patients were followed up for 6 weeks with a weekly visit, including a clinical examination, area tracings and photographs. Evaluation by nursing staff and patients was performed at each dressing changed. Forty-three patients were included, presenting a leg ulcer with a mean surface area of 10.7 cm2. The surface area was reduced by a mean of 38% after 6 weeks of treatment. Four local adverse events were deemed to be related to the tested treatment and acceptability was noted very good for patients and nursing staff. The Urgocell NA dressing, combined with compression therapy, promoted the healing of the chronic wounds under study. The good tolerance and acceptability of the tested dressing were greatly appreciated.

Aged↗
PubMedDate not supplied

Regression of cutis calcinosis with diltiazem in adult dermatomyositis.

Calcinosis cutis is common in several connective tissue diseases such as dermatomyositis, scleroderma or lupus erythematous. In dermatomyositis, it is more likely to concern children than adults but it is not exceptional in adults. Several treatments have been used empirically with inconsistent success. We report a case of adult cutis calcinosis associated with dermatomyositis which responded dramatically to treatment with diltiazem.

Calcinosis↗