The importance of proper insertion of Norplant contraceptive implants.
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Biomedical subjects
Publications and source records attributed to R Ghadially.
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Many of the ichthyotic disorders have characteristic ocular findings. These disorders include X-linked ichthyosis, lamellar ichthyosis, Sjögren-Larsson syndrome, KID syndrome, Refsum's disease, neutral lipid storage disease, chondrodysplasia punctata, and Richner-Hanhart syndrome. A knowledge of the ocular manifestations may provide a valuable aid to diagnosis in difficult cases. In some cases, knowledge of the ocular complications results in early referral for optimal ophthalmologic care.
Despite the importance of intercellular lamellar bilayers for stratum corneum (SC) barrier function, knowledge about the structure of these bilayers is limited due to their poor visualization and/or retention. Whereas substitution of ruthenium tetroxide (RuO4) for osmium tetroxide fixation provides clear images of these bilayers, the usefulness of RuO4 has been limited by its slow penetration and cytotoxicity. Utilizing a new fixation protocol for RuO4, we obtained clear images of lamellar domains at all levels of murine SC. Computer-aided image reconstructions demonstrated a lamellar spacing of 129 +/- 2 A, which agreed with x-ray diffraction data from parallel, unfixed samples (131 +/- 2 A), a spacing not affected by hydration. Furthermore, novel structures were seen in the intercellular spaces of normal SC. Finally, in murine essential fatty acid deficiency (EFAD), the overall lamellar spacing is comparable to normal [127 +/- 7 A by computer transform vs. 131.9 +/- 2 A (hydrated) and 129.6 +/- 2.2 A (dry) by x-ray diffraction]. Yet, these domains are structurally abnormal, displaying regions with either an excess or absence of lamellae. The new RuO4 protocol provides quantitative information about SC lamellar dimensions and morphologic abnormalities in bilayer distribution and substructure in EFAD stratum corneum that are not detected by either x-ray diffraction or computer-aided image reconstruction. Thus, the barrier abnormality in EFAD stratum corneum can be ascribed either to focal depletion of lamellae or abnormalities in lamellar substructure.
A recent report documents three homosexual men with porphyria cutanea tarda associated with acquired immune deficiency syndrome (AIDS). We report two brothers with hemophilia and human immunodeficiency virus (HIV) exposure who developed porphyria cutanea tarda. These brothers are heterosexual, have familial porphyria cutanea tarda, and developed overt familial porphyria cutanea tarda in their early twenties. One brother's symptoms were provoked by attending an ultraviolet A suntanning parlor. Our two patients, unlike the previously reported three patients, have not developed AIDS, though one patient has evidence of defective cell-mediated immunity. Three of the five cases of porphyria cutanea tarda associated with HIV infection involved familial porphyria cutanea tarda. It now may be advisable to order HIV serology tests in patients who have porphyria cutanea tarda. We recommend that HIV-positive individuals avoid ultraviolet A radiation because of its immunosuppressive effects in persons already at risk of immunosuppression. Such exposure is further contraindicated in those individuals with porphyria cutanea tarda.
We present four cases of granuloma annulare occurring in patients with human immunodeficiency virus (HIV) infection. These patients had either an extensive localized form or generalized granuloma annulare. The patient with generalized granuloma annulare was clinically reminiscent of the previously described papular eruption seen in HIV-positive patients. In several patients with the localized form, Kaposi's sarcoma was considered in the differential diagnosis. In all patients, however, the eruptions were surprisingly transient. The similarity of the localized form of granuloma annulare to Kaposi's sarcoma and the generalized micropapular form to the papular eruption of acquired immunodeficiency syndrome seen in HIV-positive patients illustrates the usefulness of skin biopsies in these patients.
To the best of our knowledge anchoring fibrils in tumours have been reported to occur only in cutaneous cylindromas and squamous cell carcinomas of oral mucosa and larynx. In this paper we describe a difficult-to-diagnose malignant spindle cell tumour where the striking feature was the presence of large numbers of anchoring plaques and anchoring fibrils in the tumour matrix. On the basis of light microscopic and immunohistochemical studies several diagnoses were preferred, such as malignant fibrous histiocytoma, neurofibrosarcoma, malignant schwannoma, desmoplastic melanoma and spindle cell squamous carcinoma (more fully referred to as 'spindle cell variant of squamous cell carcinoma'). The presence of anchoring fibrils in this tumour strongly supports the diagnosis of spindle cell squamous carcinoma. Our knowledge about the occurrence of anchoring fibrils in tumours is scant, perhaps because they are likely to be missed unless they are present in large numbers, or perhaps because they are mistaken for native collagen fibrils. It seems to us that a systematic search for anchoring fibrils in tumours is warranted, for knowledge about their occurrence or absence in various types of tumours may add yet another diagnostic marker in the armamentarium of the diagnostic electron microscopist and it may also assist in resolving the histogenesis of some controversial neoplasms.
A case is presented of an allergic dermatitis provoked by intravenous gentamicin in a patient previously sensitized by topical medications. Patch tests confirmed hypersensitivity to gentamicin and neomycin. The nature of reactions to contact allergens given systemically and the nature of cross-reactions between aminoglycoside antibiotics are reviewed.
A comparative study of 12 human blue naevi and 15 carcinogen-induced hamster blue naevi showed no significant ultrastructural difference between these two groups of tumours. Both groups of tumours showed melanotic and hypomelanotic variants, and both were composed almost entirely of cells acceptable as melanocytes and melanophages. However, a few cells in some human and hamster tumours were partially or completely surrounded by a slender or quite thick external lamina. This may indicate a tendency towards a schwannocytic type of differentiation, but no other feature of schwannocytic differentiation such as the formation of mesaxons or pseudomesaxons was detected. Several cutaneous nerves were embedded in some of these tumours but they were clearly uninvolved in the neoplastic process and there was no evidence whatsoever that the tumours had developed from neural elements. We conclude that both human and hamster blue naevi are essentially melanocytomas which develop from dermal melanocytes which failed to reach the epidermis during development. We regard the occasional occurrence of an external lamina as an aberration of the neoplastic state which reflects the close kinship of melanocytes and Schwann cells i.e. their common origin from the neural crest.
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Core defects produced in the medial femoral condyle of the rabbit were studied by scanning electron microscopy and light microscopy over a period of 2 years. In some cases the defect was filled by hyaline articular cartilage with a fairly smooth surface, but in others the tissue was markedly fibrillated and resembled fibrous tissue and fibrocartilage. Appearances suggesting disintegration of the newly formed cartilage were seen in some cases. It would appear that a continuation of this process can lead to the exposure of subchondral bone. In one instance no repair tissue or new cartilage could be identified but the surrounding old cartilage had formed a shelf over the defect. The cartilage surrounding the defect was either normal or showed superficial fibrillation, and/or flow formation, and/or fissures.