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P K Ramdial

Publications and source records attributed to P K Ramdial.

At least 19 recordsLinked to original sources
PubMed2001

Pemphigus in South Africa.

BACKGROUND: Pemphigus is an autoimmune disease characterized by intraepidermal blistering. We describe the demography, prevalence, clinical features, response to treatment, and human leukocyte antigen (HLA) characteristics of pemphigus in Kwa-Zulu Natal, South Africa. METHODS: All patients with pemphigus were prospectively recruited over 12 years from January 1987 to December 1999. The demography, clinical features, histology, and immunofluorescence (IF) were recorded. In a subset of patients, HLA tests were performed. RESULTS: One hundred and twelve patients had pemphigus. Pemphigus foliaceus (PF) was the commonest variant seen (62 patients) and 80% of these patients were black. The mean age was 43 years (12-93 years) and the male to female ratio was 1 : 1.4. Fifty patients had pemphigus vulgaris (PV), of whom 82% were Indian. The mean age of presentation of PV was 48 years (21-82 years). The male to female ratio was 1 : 1.7. There was no mucosal involvement in PF. PV patients had painful oral lesions. The mortality rate was 14% in the total sample (six in PV and two in PF). HLA-B8 was positive in 41% of patients with PF (P < 0.001). CONCLUSIONS: PF occurs more commonly in black people, while most cases in Indians present with the PV subtype. Pemphigus patients present with severe and extensive disease, and PV patients share features in common with patients from their land of origin (India), suggesting a genetic link.

Adult↗
PubMed2001

Transepithelial elimination of late cutaneous vulvar schistosomiasis.

Late cutaneous vulvar schistosomiasis (LCVS), which represents the cutaneous response to the deposition of schistosomal ova, is characterized by a range of clinical manifestations. Histopathological descriptions of LCVS have highlighted the hyperplastic epithelial reaction, and a few reports have alluded to the presence of intraepidermal bilharzial ova. Although transepithelial elimination (TEE), a well-known phenomenon whereby the skin rids itself of foreign, potentially dangerous substances, has been documented in a range of infectious processes, it has not been recognized as a distinct process in LCVS. This study not only documents TEE in 23 biopsies of LCVS but also correlates the role of the histopathological inflammatory reaction pattern, density of ova, and pseudoepitheliomatous hyperplasia in the pathogenesis of TEE. The importance of TEE as an additional, hitherto unrecognized mechanism of release and spread of schistosomal ova to the exterior is also highlighted.

Adolescent↗
PubMed2000

bcl-2 protein expression in aggressive and non-aggressive basal cell carcinomas.

bcl-2, the well known anti-apoptotic gene, cloned more than a decade ago, promotes cell viability without promoting cell proliferation. With few exceptions, high bcl-2 protein expression is associated with a favourable outcome in epithelial tumours. bcl-2 immunoreactivity in basal cell carcinomas (BCCs) is contradictory, with 67-100% immunopositivity being reported. Although BCCs are traditionally regarded as low-grade, indolent tumours, aggressive BCCs (A-BCCs) are mutilative, locally destructive tumours that often recur. bcl-2 protein expression as a predictor of BCC aggressiveness is poorly documented in the English-language literature. The bcl-2 protein immunoprofile of 50 clinically non-aggressive (NA-BCCs) and 25 clinically A-BCCs was investigated. Of the latter, 17 manifested with one, two or three recurrences. bcl-2 protein expression in each of the recurrences was also evaluated. bcl-2 expression was scored as follows: 0-5% positive cells=negative, 6-25%=1+, 26-50%=2+, 51-75%=3+, >75%=4+. "High" labeling encompassed 3+ or 4+ labeling while "low" labeling referred to 1 + or 2 + labeling. Although bcl-2 positivity was noted in all BCCs, low bcl-2 labeling was a statistically significant feature of A-BCCs (p < 0.01). High bcl-2 labeling of NA-BCCs was a reflection of the bcl-2 labeling of the dominant constituent nodular or superficial subtypes. Micronodular BCCs revealed 2+ or 3+ labeling. Initial and recurrent A-BCCs with a pure or predominantly infiltrative component, demonstrated 1+ or 2+ bcl-2 labeling. The differential bcl-2 expression in the various clinicopathological subtypes of BCCs suggests that, despite the common derivation of these tumours from a primitive basaloid stem cell and a limited potential for metastasis, they form a heterogeneous group of tumours that differ markedly in histologic and biological behaviour. While the superficial and nodular BCCs are indolent slow-growing tumours with high bcl-2 labeling, the aggressive BCCs are infiltrative, desmoplastic tumours with low bcl-2 labeling. In mixed tumours, heterogeneity of labeling is a distinctive feature and is contributed to in part by the labeling trends of the different histological subtypes. The micronodular BCC shows varied bcl-2 labeling but in combined tumours occupies a niche intermediate between the non-aggressive nodular and superficial and the aggressive infiltrative subtypes. The initial and subsequent biopsies of recurrent, adequately excised BCCs share a pure or mixed, predominantly infiltrative, stroma-rich histomorphology with low bcl-2 labeling, reflecting the immunoprofile of a more aggressive growth pattern.

Adult↗
PubMed2000

Transepithelial elimination of cutaneous vulval granuloma inguinale.

BACKGROUND: Transepithelial elimination (TEE), a distinct and well-known entity, is a process during which the skin eradicates undesirable or irritative dermal substances through intact epidermis or follicular epithelium by passive or active means. Although TEE is being described in an increasing number and range of pathological processes, to date, TEE of granuloma inguinale (GI) remains unrecorded in the English-language literature. The aims of this study were: 1) To appraise the light microscopic and ultrastructural morphological epidermal changes that are associated with TEE of cutaneous vulval GI; and 2) To determine the role of intra-epidermal leucocytes and histiocytes in the pathogenesis of TEE of vulval GI. METHODS: This is a retrospective 9-year histopathological review of all cases diagnosed and coded as vulval granuloma inguinale in the Department of Anatomical Pathology, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. Ultrastructural evaluation was performed on selected cases using a Jeol transmission electron microscope. RESULTS: Of 53 skin biopsies from 47 patients with vulval GI, 43 were suitable for the study. The age range of patients was 15-40 years (mean age=22 years). There were eleven papular, twelve nodular, seven verrucous and thirteen ulcerative lesions. Donovan bodies within macrophages, free-lying Donovan bodies and dense aggregates of neutrophils and plasma cells were seen in the dermis of all biopsies. There was consistent overlying pseudoepitheliomatous hyperplasia. The dermal inflammatory infiltrate hugged the dermo-epidermal junction and appeared entrapped between elongated and acanthotic epidermal rete ridges and pegs. Transepidermal neutrophil microabscesses, histiocytes containing Donovan bodies and neutrophilic and histiocytic fragmentation were present. A variable number of free-lying and intra-histiocytic Donovan bodies and neutrophils were present on the surface of the epidermis. On ultrastructural investigation epidermal spongiosis, intracellular oedema, free-lying, intra-neutrophilic and intra-histiocytic Donovan bodies, and intact and degenerating neutrophils and histiocytes were evident between keratinocytes. The degenerative histiocytes demonstrated marked vacuolation, mitochondrial swelling and bacilli within phagolysosomal vacuoles, bound by intact or disrupted limiting membranes. CONCLUSION: The inflammatory infiltrate at the epitheliomesenchymal interface, pseudoepitheliomatous hyperplasia, intra-epidermal accumulation and disintegration of neutrophils and histiocytes, and the associated release of lytic enzymes, play important contributory roles in TEE of GI. TEE of infectious agents is a poorly recognised mechanism of spread of infectious diseases and represents a public health hazard. In cutaneous vulval GI, TEE is highlighted as a hitherto unrecognised, potential method of spread of Calymmatobacterium granulomatis.

Adolescent↗
PubMed2000

Subpectoral post-traumatic lipoma.

Although post-traumatic lipomas have been reported in various sites, a subpectoral location has, to the best of our knowledge, not previously been described. We report on the clinicopathological, radiological, intraoperative and postoperative details of a post-traumatic subpectoral lipoma in a 35-year-old black African female.

Accidents, Traffic↗
PubMed2000

Solid and cystic papillary epithelial neoplasm of the pancreas. A report of 3 cases.

This is a report of 3 female patients presenting with solid and cystic papillary epithelial neoplasms of the pancreas (SCPEN). All 3 lesions were incidental findings. SCPEN is an uncommon low-grade malignant tumour that is histologically distinct from ductal adenocarcinoma and islet cell tumour, occurs chiefly in young women, and is amenable to surgery. The cell of origin is the subject of some debate.

Adult↗
PubMed1999

Erythroderma: a comparison between HIV positive and negative patients.

UNLABELLED: Background Erythroderma has protean underlying causes. There have been isolated case reports suggesting an association between erythroderma and the human immunodeficiency virus (HIV). OBJECTIVE: To describe and characterize further the prevalence, etiology, and metabolic sequelae of erythroderma in HIV positive and negative patients. In a subset of patients, clinicopathologic correlation was performed. METHOD: One hundred and thirty-eight consecutive patients were prospectively recruited over a one and a half year period at the skin clinic of King Edward VIII Hospital. Demographic, clinical, biochemical, and histologic data were recorded. RESULTS: Seventy-five per cent of the patients were black, 22.5% Indian, and 2.5% white. The men to women ratio was 1.9 : 1. The mean age was 34. 7 years (range, 1 month to 85 years). Forty-three per cent of patients were HIV positive, of whom 90% were black. The commonest causes of erythroderma in the total sample were atopic dermatitis (23.9%), psoriasis (23.9%), and drug reactions (22.5%). The commonest cause in the HIV positive group was drug reactions (40.6%), the commonest being ethambutol (30.8%). HIV positive patients had a significantly lower (P < 0.05) white cell count (7.6 vs. 10.5 x 109 /L), hemoglobin (11.1 vs. 12.6 g/dL), platelets (278.3 vs. 378.0 x 109 /L), and albumin (25.4 vs. 28.7 g/L) and significantly higher serum urates (0.6 vs. 0.4 mM/L) than HIV negative patients. HIV positive patients did not have a significant increase in the number of episodes of erythroderma. Clinicopathologic correlation was greatest with psoriasis in the HIV negative group and with psoriasis and drug reactions in the HIV positive group. CONCLUSIONS: A large proportion of erythrodermic patients in this study were HIV positive. Inflammatory dermatoses were the commonest cause of erythroderma in all the patients studied. Drug reactions were the commonest cause in HIV positive patients. In the young black patient, erythroderma may be a marker for HIV infection.

Adolescent↗
PubMed1999

HIV-associated eosinophilic folliculitis in an infant.

HIV-associated eosinophilic folliculitis (HIV-EF), which is a well-known entity in adults, has not been described in children. Although Ofuji's disease (OD) or eosinophilic pustular folliculitis (EPF) has been described in children and shares histopathologic features with HIV-EF, it is a distinct entity with characteristic clinical features. We report the occurrence of eosinophilic folliculitis in an 8-month-old HIV-positive patient and discuss the clinical, pathologic and possible pathogenetic aspects thereof. In addition, differences in the clinical manifestations of the present case and that of I-EPF are addressed. Because of clinicopathologic similarities between the present case and HIV-associated eosinophilic folliculitis (HIV-EF) in adults, we believe that eosinophilic folliculitis in this patient represents a cutaneous manifestation of HIV infection, rather than co-incidental occurrence of the infantile form of Ofuji's disease in an HIV-positive patient.

Adult↗
PubMed1999

Membranous fat necrosis due to subcutaneous elemental mercury injections.

Membranous fat necrosis (MFN) is a distinct abnormality in systemic and subcutaneous fatty tissue. Although ischemia and trauma have been implicated in its causation, the exact pathogenesis of MFN remains unknown. The deposition of metallic mercury in subcutaneous tissue due to accidental penetration or deliberate injection of mercury is unusual. Depending on the duration of the deposition, localized necrosis, suppuration, and granuloma formation have been described at mercury injection sites. We report subcutaneous MFN, a hitherto unrecognized histopathologic phenomenon at sites of mercury deposition, in a 21-year-old soccer player who had deliberate subcutaneous and intramuscular elemental mercury injections to improve his sporting performance.

Adult↗
PubMed1999

Vasculitis-induced membranous fat necrosis.

Membranous fat necrosis (MFN) a distinct degenerative process of adipose tissue, is characterised by the presence of membranocystic lesions (MCLs) superimposed on a background of typical traumatic-type fat necrosis. MCLs are cysts, of varying size and shape, that are lined by an eosinophilic, crenulated membrane, having the staining properties of ceroid. Although MFN has been documented in varying systemic adipose tissue sites and in tumours, the pathogenesis of this pathological curiosity is unknown. To date, an ischemic basis for MFN has been the most proximate, and atherosclerosis and venous insufficiency, due to large and medium vessel disease, have been the most popular underlying clinical disorders. Although systemic vasculitis has been quoted as the underlying ischemic disorder in some patients, vasculitis has not been commented on nor demonstrated in tissue sections in association with MFN. In,reporting vasculitis-induced MFN, we document the occurrence of MFN in association with uncommon causes of vasculitis, namely: 1) Granulomatous vasculitis in a post-herpetic zosteriform scar; 2) Cytomegalovirus-induced vasculitis in the clinical setting of systemic lupus erythematosus; and 3) Lymphocytic vasculitis in a tetanus toxoid immunization site reaction.

Adolescent↗
PubMed1999

Lues maligna.

Explore the source record for details and available documents.

Adult↗
PubMed1999

Histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans.

OBJECTIVE: To document histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans. DESIGN: Retrospective case series study of the histology of sigmoid volvulus over seven years with cadaveric controls. SETTING: King Edward VIII Teaching Hospital, University of Natal, Durban, South Africa. SUBJECTS: Fifty African patients with sigmoid volvulus and nine cadavers with normal sigmoid colon. RESULTS: There was hypertrophy of the submucosa, muscularis propria and nerve plexuses with features of ischaemia in the patients' specimens. Their veins were thrombosed and recanalized while mesentery and submucosa had fibrosis and vascular hyalinization. There was also hypertrophy and hyperplasia of Meissner's nerve plexus. In the autopsy study, normal African sigmoid specimen showed similar ischaemic features but specimens from the four Indian patients in the study did not have such abnormalities. CONCLUSION: We postulate that chronic ischaemia may account for postoperative anastomosis dehiscence in some cases where the resection margins involved the hypertrophic segment. The benefit of an extended resection with anastomosis being effected on the bowel with apparent normal thickness to avoid this possibility should be investigated.

Adolescent↗
PubMed1998

Membranous fat necrosis in appendices epiploicae. A clinicopathological study.

Membranous fat necrosis (MFN) is a degenerative process involving mature systemic adipose tissue. It is characterised by the presence of membranocystic foci surrounded by a lipophagic fibro-inflammatory reaction typical of fat necrosis. Membranocystic foci are cysts lined by an eosinophilic membrane with pseudopapillary infoldings having the histochemical staining profile of ceroid. Although MFN is described in an increasing number of adipose tissue sites, it has not been described as a distinct entity in appendices epiploicae (AE). Macroscopically, MFN in AE mimics nodal tuberculosis or metastatic tumour with necrosis and cystic change. Ischaemia, which can be secondary to physiological or pathologic processes, is crucial in the pathogenesis of MFN in AE. Heightened awareness of MFN as a distinct entity in AE is essential for accurate diagnosis and establishment of the pathogenesis of this enigmatic pathological process.

Adult↗
PubMed1998

Folliculosebaceous cystic hamartoma.

Although folliculosebaceous cystic hamartoma (FCH) is an uncommon cutaneous entity with distinct classical and variant histopathologic features, it lacks distinctive typifying clinical features. Since the original description of five cases of FCH by Kimura et al. in 1991, 12 cases have been documented. We report a further case of FCH presenting as facial lesion in a 35 year old African male. FCH comprises prominent epithelial and mesenchymal components. The epithelial component is characterised by folliculosebaceous proliferation with cyst-like infundibular dilatation, and the mesenchymal component exhibits variable fibroplasia, vascular and neural proliferation and adipocyte metaplasia. Awareness of the lesion is important to avoid confusion with other cystic or cyst-like cutaneous lesions that contain prominent epithelial folliculosebaceous and variable mesenchymal components.

Adipocytes↗
PubMed1998

Membranous fat necrosis in mature cystic teratomas of the ovary.

We identified and documented the occurrence of membranous fat necrosis (MFN) in 217 mature cystic teratomas (MCTs) of the ovary. Cysts lined by an eosinophilic and scalloped membrane with pseudopapillary infoldings, the characteristic histologic features of MFN, were identified in 9 tumors. The membranes had the histochemical staining properties of ceroid, as evidenced by periodic acid-Schiff, sudan black, and long Ziehl Neelsen (ZN) positivity, diastase resistance, and autofluorescence. The causes and pathogenesis of MFN are enigmatic, but trauma, torsion, and ischemia are probable factors. MFN is a distinct entity in ovarian MCTs and heightened awareness will increase its histopathologic recognition.

Adult↗
PubMed1998

Intracranial tuberculous subdural empyema: case report.

OBJECTIVE AND IMPORTANCE: Many types of neurotuberculosis have been described; the most common intracranial forms are tuberculous meningitis and tuberculomas. We report a unique and as yet unreported form of neurotuberculosis, which is an intracranial tuberculous subdural empyema. CLINICAL PRESENTATION: A 59-year-old man who had been previously treated for pulmonary tuberculosis (TB) presented at our institution with a long-standing history of headaches. General and neurological examinations revealed no abnormalities. Radiography of the chest confirmed fibrotic lung changes caused by healed pulmonary TB. A cranial computed tomographic scan revealed a hypodense extra-axial collection with mass effect as well as adjacent osteitis and scalp swelling. INTERVENTION: The patient underwent craniectomy of the osteitic bone and drainage of 50 ml of fluid pus located subdurally. Microscopic examination of the bone and pus revealed tuberculous granulation tissue with numerous acid-fast bacilli identified using Ziehl-Neelsen stain. Mycobacterium TB bacillus was cultured from the pus at 42 days. The patient required two further operative procedures as well as a protracted course of anti-TB therapy. CONCLUSION: The patient eventually achieved a good recovery. We recommend surgical drainage of tuberculous subdural empyema to relieve mass effect and to obtain microbiological confirmation. Furthermore, surgical treatment should be combined with an 18-month course of anti-TB chemotherapy, during which period patient compliance should be closely monitored.

Craniotomy↗