Biomedical subjects
Publications and source records attributed to R R Walther.
Viral diseases of the skin have become a much more serious problem with the increasing number of patients immunosuppressed by either AIDS or cancer chemotherapy. The emphasis in research on the diagnosis and treatment of these diseases is similar to that on the bacterial diseases several decades ago.
Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster.
A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the placentas of the last three pregnancies revealed varying grades of villositis. Symptoms improved with oral corticosteroids.
Two patients with spontaneously resolving hyperpigmented patches of the oral mucosa are reported. Histologically, lesions in both cases showed large pigment-laden dendritic cells singly dispersed at all levels of the epidermis, which simulated in situ melanoma. The absence of such cells in the basal layer of the epidermis served to histologically distinguish these lesions from a biologically malignant melanocytic tumor. Spontaneous resolution in both patients suggests that the condition is reactive. We propose the term mucosal melanotic macule, reactive type, for this lesion, which has been described previously under the misnomer oral melanoacanthoma.
Increased exposure to systemic medications in older patients makes drug reactions a likely cause of skin eruptions. Efforts to increase return of venous blood to the heart is the primary therapeutic and preventive measure in stasis dermatitis. If there is a suggestion of infection, antibiotics are indicated. The dermatitis can be treated with standard therapies.
Hydroa vacciniforme is a rare photosensitivity disorder with onset in childhood. The distinctive lesion is a vesicle which heals with scarring. We report a case of hydroa vacciniforme in which an abnormal minimal erythema dose to wavelengths of 322 to 370 nm within the ultraviolet A (UVA) range was demonstrated. Vesicles could be induced only with multiple exposures to UVA. Increased tolerance to UVA erythema was induced by multiple UVB exposures, although tanning was poor. Of note were the presence of several halo nevi and a history of the loss of ability to tan. The clinical features and appropriate laboratory evaluation of hydroa vacciniforme are reviewed.
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The clinical features of the porphyrias are often characteristic; and all can be definitively diagnosed by appropriate biochemical tests. Many of the cutaneous lesions are thought to be the result of photochemical damage which occurs due to 400 nm radiation exciting abnormally high concentrations of porphyrins in the skin. Others are probably based on hormonal or unidentified systemic factors. The effects of exogenous environmental porphyrinogenic agents have become increasingly well understood in recent years and at present treatment for many of the porphyrias is available. Early diagnosis, aided by recognition of the initial cutaneous signs and symptoms, is crucial for rapid implementation of appropriate therapy.
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The development of skin cancers in areas treated with X rays for benign dermatoses has not been common. Moreover, basal-cell carcinomas in blacks are exceedingly rare. We report successive development of two basal-cell carcinomas in the hair-covered scalp of a black man three decades after he had undergone epilation of the scalp by X rays of tinea capitis while a youth.
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Infestation by the flea Tunga penetrans, although quite prevalent in Central America, South America, and Africa, is rarely recognized or reported in North America. This report describes a case of tungiasis occurring in a New York resident who acquired the disease in Africa. The patient manifested characteristic lesions of white papules with central black pits on the dorsa of her toes. Treatment consisted of removal of the offending parasites.
Measurements of the ethanol flow from the blood into the gastrointestinal tract revealed an exponential characteristic. The rates of transport were proportional to the differences in concentration. The constants of the exsorption were equal to those of the insorption. The constants of the exsorption were 0.033 min-1 for the stomach, 0.071 min-1 for the small, and 0.019 min-1 for the large intestine.
Recognition of the characteristic cutaneous lesions of disseminated candidiasis may allow earlier diagnosis and treatment of this often fatal fungal infection. The skin lesion developed in patients with hematologic malignancies and compromised host defenses, at a time when they were febrile, clinically deteriorating, and failing to respond to multiple antibiotics. This report discusses two patients with acute myelogenous leukemia with cutaneous manifestations of disseminated candidiasis due to Candida tropicalis. Single or multiple erythematous or purpuric 0.5- to 1-cm papulonodules with pale centers were seen on the trunk and proximal extremities. In most reported cases of disseminated candidiasis with skin lesions, the diagnosis can be confirmed by histologic evaluation of a skin biopsy before appropriate cultures identify the organism.
Exophytic neoplasms arise rarely in neurotrophic ulcers of leprosy. When such a lesion does develop, it has clinical resemblance to an indolent and locally invasive epithelioma cuniculatum, may invade deeply, and may metastasize. The case described showed deep invasion and extensive involvement of bone. Exophytic neoplasms in neurotrophic ulcers of leprosy should be considered to be squamous-cell carcinomas, not epitheliomata cuniculata, because of their potential for rapid, deep invasion and metastases.
A 17-year-old boy with chronic papules of the scrotum showed no improvement after topical therapy. A skin biopsy specimen showed Schistosoma mansoni eggs. No evidence of bladder or bowel involvement was found. No treatment is necessary for schistosomal infections without severe symptoms or excessive egg production.
A 67-year-old white man presented with bilateral blancing erythema and scale of the second through fifth toes extending on to the dorsa and moccasin areas of the feet for two years. The right great toe had subungual debris. No cultures or KOH studies were recorded. A course of tolnaftate cream therapy was initiated. Two years later, the patient returned and complained of no change in his condition. Previously recorded descriptions and diagrams in the medical record confirmed his report. At this time, KOH preparations from the skin and nail were positive for hyphae. He refused to accept medical recommendations for a fungal culture and griseofulvin therapy. He, therefore, was instructed to use miconazole cream twice daily as alternative treatment. One year later, physical examination was unchanged. KOH preparations and fungal cultures of the skin were twice negative. A 4-mm punch skin biopsy specimen of the erythematous patch on the dorsum of the foot was performed. Hematoxylin and eosin-stained sections revealed a proliferating vascular process in the cutis. Many spindle-shaped cells formed vascular slits and endothelial-lined spaces in which there were erythrocytes. No hyphae were seen. One year after the biopsy specimen was taken, the erythema of his feet persists, and a few nonblanching nodules are visible. He declined further studies.
Pyoderma gangrenosum (PG) has been increasingly reported in association with myeloproliferative disorders. Monoclonal gammaopathy, myeloma, myeloid metaplasia, and polycythemia have all been found in association with PG. Recently, seven cases of PG in association with leukemia have been described: three cases with acute myeloblastic leukemia, two cases with chronic myelogenous leukemia, one case with acute lymphoblastic leukemia, and one case with acute leukemia of either plasma cell or myeloblast origin. To these we add two cases of PG with acute myeloblastic leukemia. These patients often have an atypical clinical presentation for PG, with bullae and relatively superficial involvement obscuring the correct diagnosis.