Biomedical subjects

S A Buechner

Publications and source records attributed to S A Buechner.

34 records · Page 2Linked to original sources

PubMed1994

Allergic contact dermatitis from ethyl chloride and sensitization to dichlorodifluoromethane (CFC 12).

Despite the widespread use of ethyl chloride as a local anesthetic and chlorofluorocarbons as propellants in medical and cosmetic aerosols, contact allergy to these 2 gases is rare. In a 30-year-old woman, an unusual itchy dermatitis appeared at all skin sites where a medical aerosol containing ethyl chloride had been briefly applied. Subsequent re-exposure to the spray and patch tests revealed contact sensitization to ethyl chloride and dichlorodifluoromethane (CFC 12). Histologic and immunohistochemical examinations of the test reaction were consistent with a T-cell-mediated allergic reaction. The low incidence of contact allergy to ethyl chloride and chlorofluorocarbons may be due to the rapid evaporation of these volatile gases, thus preventing intense and prolonged contact with the skin and consequently contact sensitization. A modified patch test procedure using perforated plastic chambers to allow gas evaporation is necessary to test volatile agents.

Adult↗

PubMed1993

Acrodermatitis chronic atrophicans: a chronic T-cell-mediated immune reaction against Borrelia burgdorferi? Clinical, histologic, and immunohistochemical study of five cases.

BACKGROUND: Acrodermatitis chronica atrophicans (ACA) is a late manifestation of infection caused by Borrelia burgdorferi. OBJECTIVE: Our purpose was to study the clinical, histopathologic, and immunohistochemical findings in patients with ACA to understand better the pathogenesis of the disease. METHODS: Five patients were studied. Skin biopsy specimens were obtained from active lesions for histologic and immunohistochemical studies. RESULTS: Clinical lesions included an initial erythematous discoloration in one patient and violaceous infiltrated plaques and nodules in four patients, three of whom also had late atrophic lesions. Biopsy specimens showed a dermal perivascular and interstitial lymphocytic infiltrate with plasma cells. There was a predominance of CD3+, CD4+ T cells in the dermal infiltrate. B cells were present in three patients. The dermal infiltrate showed an intense expression of lymphocyte function-associated antigen. The intercellular adhesion molecule type 1 was expressed on endothelial cells, perivascular mononuclear cells, and focally on basal keratinocytes. CONCLUSION: Our findings suggest that a chronic, T-cell-mediated immune reaction against B. burgdorferi is involved in the pathogenesis of ACA.

Acrodermatitis↗

PubMed1993

Localized scleroderma associated with Borrelia burgdorferi infection. Clinical, histologic, and immunohistochemical observations.

BACKGROUND: Recent reports have implicated Borrelia burgdorferi infection as a possible cause of localized scleroderma (LS). OBJECTIVE: Our purpose was to describe the clinical, histologic, and immunopathologic features of patients with LS who had serum antibodies to B. burgdorferi. METHODS: Ten patients were examined clinically and by routine microscopy. Biopsy specimens from seven patients were studied immunohistochemically with monoclonal antibodies. The proliferative response of peripheral blood mononuclear cells to B. burgdorferi was investigated in seven patients by lymphocyte proliferation assay. RESULTS: Seven patients had plaque-type morphea, and three patients had linear scleroderma. Two patients had a history of previous erythema migrans. One patient had coexistent acrodermatitis chronica atrophicans, and in two patients lichen sclerosus et atrophicus was observed. Histologically, a prominent inflammatory phase with sclerosis of the connective tissue was shown in all patients. Immunohistochemical studies revealed that the inflammatory infiltrates consisted of both B and T lymphocytes, predominantly of the CD4+ subset. All 10 patients had strongly elevated serum antibodies to B. burgdorferi. Patients with LS showed significantly elevated lymphoproliferative responses to B. burgdorferi when compared with healthy control subjects. CONCLUSION: Our findings suggest that some cases of LS are linked to Borrelia infection.

Adolescent↗

PubMed1991

Intralesional interferon alfa-2b in the treatment of basal cell carcinoma. Immunohistochemical study on cellular immune reaction leading to tumor regression.

Four patients with basal cell carcinomas were treated with intralesional injections of interferon alfa-2b (1.5 million IU per injection) three times a week for 2 weeks. Histopathologic examination of biopsy specimens of the lesions confirmed the absence of basal cell carcinoma in all cases 4 weeks after completion of therapy. A dense mononuclear cell infiltrate and numerous ectatic blood vessels were present in the dermis at the sites of previous basal cell carcinoma. Immunohistologic analysis of the dermal infiltrate revealed a marked increase of Leu-4+ T cells with a slight predominance of Leu-3+ helper/inducer T cells over Leu-2+ suppressor/cytotoxic T cells. Most of the dermal infiltrate expressed HLA-DR antigen. In addition, Leu-11+ natural killer cells were observed in the dermal infiltrate. Immunohistologic changes in the skin lesions at the sites of previous basal cell carcinoma suggest that intralesional interferon alfa-2b acts on tumor cells by enhancement of local T-cell-mediated immune responses.

Aged↗

PubMed1985

Leukemia cutis. A histopathologic study of 42 cases.

Biopsy specimens of skin from 42 patients with leukemia cutis were studied. Typing of leukemia was based on histopathologic and histochemical findings in peripheral blood and bone marrow. There were three patients with acute lymphocytic leukemia, 16 with chronic lymphocytic leukemia, 12 with acute granulocytic leukemia, three with chronic granulocytic leukemia, five with acute monocytic leukemia, and three with acute myelomonocytic leukemia. In general, leukemia cutis shows a diffuse infiltration of leukemic cells in the dermis and subcutaneous tissue, often infiltrating between collagen bundles. Extensive involvement and disruption of blood vessels and skin adnexa are characteristic findings in granulocytic, monocytic, and myelomonocytic leukemia cutis, but biopsy specimens of skin in patients with different types of leukemia show a wide range of histopathologic changes that are variable among the various types of leukemia and sometimes even among different patients with the same type of leukemia. A final typing of leukemia should not rely only on regular histopathologic findings of a skin biopsy, but should depend more on morphologic and histochemical studies of smears of peripheral blood or of bone marrow or both.

Humans↗

PubMed1984

Clinicopathologic correlations in leukemia cutis.

This clinicopathologic study involved 42 cases of leukemia cutis: 3 of acute lymphocytic leukemia (ALL), 16 of chronic lymphocytic leukemia (CLL), 12 of acute granulocytic leukemia (AGL), 3 of chronic granulocytic leukemia (CGL), 5 of acute monocytic leukemia (AML), and 3 of acute myelomonocytic leukemia (AMML). The clinical appearance of leukemia cutis included papules, macules, plaques, nodules, ecchymoses, palpable purpura, and ulcerative lesions, and these were seen in all types of leukemias. Gingival hypertrophy was seen only in AML or AMML, and erythroderma and bullous lesions of leukemic infiltration were observed only in CLL. Cutaneous leukemic lesions may be concomitant with or preceding the diagnosis of systemic leukemia. Therefore, skin biopsy may be helpful in detecting the leukemia and may facilitate the work-up. Leukemia cutis probably is a dissemination of systemic leukemia to the skin, and the demonstration of leukemia in skin is associated with a very poor prognosis.

Adolescent↗

PubMed1984

Pre-Sézary syndrome.

Eighteen patients with erythroderma, recurrent cycles of circulating Sézary cells of less than 1,000 cells/mm3, and a chronic course were followed for a mean time of nearly 5 years and were diagnosed as having pre-Sézary syndrome. Only one patient died, and none developed lymphoproliferative disease. All ten patients who underwent patch testing showed positive results. The elevation of IgE was striking when this group was compared with a group with Sézary syndrome. Most patients achieved partial or complete remission on low-dose chlorambucil and prednisone therapy. Some patients had lymphocytic or lymphomatoid bands on skin biopsy specimens and were like previously reported patients with pre-Sézary syndrome whose condition progressed to Sézary syndrome. A nontoxic chemotherapy or an anti-T cell treatment program can control this chronic erythroderma state.

Adult↗

PubMed1984

The treatment of Sézary syndrome.

The results of treatment programs were studied in forty patients with Sézary syndrome. Thirty-three patients died. The principal treatment was a low-dose chlorambucil and prednisone regimen. Patients so treated lived longer from diagnosis of erythroderma (median survival, 6.2 yr) than did patients on other regimens (median survival, 3.05 yr). The addition of x-ray or chemotherapeutic programs did not increase significant long-term benefit. Seven patients receiving chlorambucil and prednisone had remission (1 yr or more); most patients had partial remission, but two patients did not have a response to this program. The complications of sepsis, progressive disease, and lymphoma occurred both in patients who were and in those who were not treated with chlorambucil and prednisone. We believe that a regimen of low-dose chlorambucil and prednisone is satisfactory treatment that can be the basis for comparison of new therapeutic approaches to Sézary syndrome.

Adult↗

PubMed1984

T cells and T-cell subsets in mycosis fungoides and parapsoriasis. A study of 18 cases with anti-human T-cell monoclonal antibodies and histochemical techniques.

Skin lesions from 15 patients with mycosis fungoides (MF) and from three with parapsoriasis were studied immunohistochemically with monoclonal antibodies against T cells (Leu 1) and against T-cell subsets (Leu 2a, Leu 3a). Lymphoid cell reactivity was diverse among these sampled cases. In two cases of parapsoriasis and nine of MF, there was a predominance of helper/inducer (Leu-3a-reactive) cells over suppressor/cytotoxic (Leu-2a-reactive) cells. In one case of parapsoriasis and one (advanced tumor stage) of MF, there was suppressor/cytotoxic cell predominance. One case of MF showed strong reactivity for both T-cell subset markers. Four cases of MF (two plaque-stage and two tumor-stage) featured a predominant cell type in the dermis which was nonreactive for all three antibodies. The intraepidermal lymphoid cellularity was Leu-1-reactive in ten cases of MF and two of parapsoriasis. Among these 12 cases, the intraepidermal cellularity was Leu-2a-reactive in four and Leu-3a-reactive in three. The use of such studies of T-cell subsets on in situ cutaneous lymphoid infiltrates may demonstrate a correlation with cytomorphology, clinical stage, and disease prognosis.

Adult↗

PubMed1984

T cell subsets and macrophages in lichen planus. In situ identification using monoclonal antibodies and histochemical techniques.

Skin lesions from 6 patients with lichen planus were studied for the presence of T cells and T cell subsets using monoclonal antibodies and indirect immunoperoxidase technique. Small numbers of Leu-2a-reactive suppressor-cytotoxic cells were present early in the basal cell layer in 2 patients with recent lesions. The analysis of T cell subsets revealed the predominance of anti-pan-T-cell (Leu-1)- and Leu-3a-reactive helper-inducer cells in 4 patients with older active lichen planus lesions. Significant numbers of suppressor-cytotoxic cells were observed in the papillary dermis and within the epidermis associated with hydropic degeneration of the basal cell layer. Activated T lymphocytes with focal acid phosphatase activity, together with activated histiocytes-macrophages with strong diffuse activity of acid phosphatase and non-specific esterase, were identified in the dermis and within the epidermis. These findings suggest that a cytotoxic immune process directed against the basal cell layer of the epidermis is the dominant pathogenic event in lichen planus.

Antibodies, Monoclonal↗

PubMed1983

Sézary syndrome. A clinicopathologic study of 39 cases.

The histopathologic and clinicopathologic characteristics of 121 skin biopsy specimens from 39 patients with Sézary syndrome were reviewed. The most frequently noted histologic type was a lymphomatoid subepidermal band infiltrate, composed predominantly of atypical lymphoid cells with cerebriform nuclei, found in 53 (44%) of the skin biopsy specimens. A lymphocytic band infiltrate, characterized by a predominance of small lymphocytes and a variable admixture of atypical lymphoid cells, was found in 47 (39%) of the specimens. Only 18 (15%) of the lymphomatoid band specimens from ten patients demonstrated epidermal involvement suggesting mycosis fungoides. Twenty-one (17%) of the biopsy specimens were interpreted as showing changes consistent with those of chronic dermatitis. Despite multiple skin biopsy specimens, there was a weak association noted between the histologic patterns and the clinical stage of disease or the prognosis.

Adult↗

PubMed1983

The T-lymphocyte and cutaneous Churg-Strauss granuloma.

Studies of biopsy specimens from 4 patients with Churg-Strauss granulomas of the skin were performed with monoclonal antibodies to T-lymphocyte subset antigens. The finding of a predominance of a LEU3 antibody-reactive helper T-cell population in the perivascular areas and in the palisading and central granuloma areas was noteworthy. Pronounced reduction of suppressor T-cells in the lesions was observed in 2 patients; the lesions were associated with vasculitis and rheumatoid arthritis in one patient and with vasculitis and lupus erythematosus in the other. The Churg-Strauss granuloma demonstrated features of a cutaneous helper T-cell granuloma.

Antibodies, Monoclonal↗

PubMed1983

Identification of T-cell subpopulations in granuloma annulare.

Granuloma annulare is a lymphohistiocytic process of unknown cause characterized by necrobiotic dermal papules. Acetone-fixed frozen sections of eight granuloma annulare lesions were studied for the presence of T-cell subsets, using monoclonal antibodies to T-cell surface antigens. The palisading and perivascular lymphocytic infiltrate shows that most of the mononuclear cells are reactive with LEU-1 antibody, which characterizes peripheral T cells and activated T cells. Numerous cells were reactive with LEU-3a antibody, which identifies the helper-inducer T-cell subset. Some cells were positive with LEU-2a antibody, which detects suppressor-cytotoxic cell populations. Masses of histiocytes were identified infiltrating between the collagen fibers and surrounding the central necrobiosis area; the histiocytes showed a very strong diffuse acid phosphatase and nonspecific esterase activity. These findings suggest that a cell-mediated immune response may be the dominant pathogenic event in granuloma annulare.

Antibodies, Monoclonal↗

PubMed1983

Pre-Sézary erythroderma evolving to Sézary syndrome. A report of seven cases.

Seven patients with pre-Sézary erythroderma were followed up for three to 16 years as Sézary erythroderma syndrome developed. With the transition, the clinical and skin manifestations of the disease became chronic, more florid, and more resistant to therapy. Four patients had multiple contact allergies or drug reactions, and one patient had severe atopic dermatitis. Lymphoma developed in one patient, and multiple myeloma developed in a second patient. An increased absolute number of Sézary cells to more than 1,000/cu mm occurred in all patients with Sézary syndrome. Histologic study showed chronic dermatitis in most patients with the pre-Sézary condition and subepidermal lymphocytic band inflammation in most patients with the Sézary syndrome.

Aged↗

PubMed1983

T-cell subsets in cutaneous sarcoidosis.

Skin lesions from four patients with systemic and cutaneous sarcoidosis were studied, by the use of monoclonal antibodies, for the presence of T cells and T-cell subsets. Large numbers of lymphoid cells reacting with anti-pan T-cell (LEU-1) and anti-helper and inducer subset (LEU-3) monoclonal antibodies were observed around and within the sarcoid granulomas in three of the four patients. Only rare LEU-2-reactive suppressor cells were observed in all four patients. Activated T lymphocytes with focal acid phosphatase activity, together with epithelioid cells and multinucleated giant cells with strong diffuse activity of acid phosphatase and nonspecific esterase, were identified within the granulomas. The two patients with active disease demonstrated substantially more T cells in the sarcoid granulomas than did the two patients with chronic disease. Our study results suggest the importance of helper T cells in the formation of the sarcoid granuloma by mononuclear phagocytes and imply that the activity and duration of disease may be related to the T-cell populations.

Acid Phosphatase↗

PubMed1983

T cells in cutaneous lesions of Sézary syndrome and T-cell leukemia. Characterization by monoclonal antibodies.

Anti-T-cell monoclonal antibodies (LEU series) immunoperoxidase technique study for the presence of T cells in cutaneous lesions from four patients with Sézary syndrome and one patient with chronic T-cell leukemia showed that most dermal-lymphoid cells from three patients with Sézary syndrome were reactive with monoclonal antibodies to anti-pan T-cell (LEU-1) and helper T-cell (LEU-3a) subsets but not with those to suppressor-cytotoxic T-cell (LEU-2a) subsets. One patient with progressive disease had atypical dermal-lymphoid cells positive for pan T-cell (LEU-1). Epidermotropic cells were reactive to LEU-1 in all four patients, LEU-2a in one patient, and LEU-3a in one patient. Neoplastic cells in skin lesions of chronic T-cell leukemia showed strong positive staining with LEU-1, but were reactive with both anti-T-cell subset, monoclonal antibodies. The atypical, dermal-lymphoid cells in Sézary syndrome represent mature, helper T cells in most cases. The absence of T-cell subset antigens in one patient with fulminant Sézary syndrome and the finding of both T-cell subset antigens on T-cell leukemia cells suggest the presence of actively proliferating, immature T cells in those cases.

Adult↗