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Biomedical subjects

S D Resnick

Publications and source records attributed to S D Resnick.

33 records · Page 2Linked to original sources

Dermatophytosis mimicking Kaposi's sarcoma in human immunodeficiency virus disease.

Kaposi's sarcoma (KS) is an important finding in patients infected with human immunodeficiency virus (HIV), with a distinctive spectrum of clinical presentations. Three cases of dermatophytosis in HIV-infected patients are presented which clinically mimic the appearance of KS. This new observation underscores the importance of histopathologic examination in the evaluation of skin lesions suspicious for the diagnosis of KS. The other clinical mimickers of KS are reviewed.

Acquired Immunodeficiency Syndrome↗

Giant juvenile xanthogranuloma: exophytic and endophytic variants.

Xanthogranulomas larger than 2 cm are rarely reported variants of this otherwise common, benign lesion usually measuring 1 mm to 1 cm in diameter. The natural history of such macronodular xanthogranulomas is uncertain, but appears to parallel the generally predictable course toward involution seen in micronodular lesions. Two patients with macronodular xanthogranuloma illustrate exophytic and endophytic variants, as well as the problems of managing this unusual tumor. Nonoperative observation is advisable if possible, but complicating factors may necessitate surgical excision in some cases.

Child, Preschool↗

Livedo reticularis.

A wide variety of internal diseases may be associated with livedo reticularis. In adults, the most frequently encountered associated diseases are characterized by vessel wall disease or intravascular obstruction. In the former group, lupus erythematosus is particularly important, since LR along with anticardiolipin antibodies appears to be a marker of serious cerebrovascular and renal disease. Appropriate evaluation of patients presenting with LR includes a careful history and physical examination. Laboratory studies, including a complete blood count, platelets, coagulation profile, cryoproteins, antinuclear antibodies, and anticardiolipin antibodies, are useful screening tools for the important associated diseases. Table 1 summarizes the spectrum of entities associated with LR and points up the challenge of evaluating this distinctive cutaneous finding.

Drug-Related Side Effects and Adverse Reactions↗

Extracellular proteases of Onchocerca.

Two important events in infection by Onchocerca parasites involve cutaneous tissue migration by larval stages. L3 larvae migrate from the blackfly bite site to subcutaneous locations for adult development, and microfilariae from subcutaneous nodules to distant regions of the skin and sometimes the eye. By analogy to other tissue-invasive helminth larvae, it has been proposed that migration of Onchocerca larvae through cutaneous tissue is facilitated by secretion of proteolytic enzymes. To test this hypothesis, neutral protease activity capable of degrading a model of cutaneous extracellular matrix was assayed using live L3 larvae of O. lienalis and microfilariae of O. cervicalis and O. cervipedis. Five hundred L3 larvae degraded most of the matrix within 24 hr of incubation. Substrate gel electrophoresis and other protease assays showed a 43-kDa serine elastase was secreted by O. lienalis L3 larvae. Larvae and adults of the free-living nematode, Caenorhobditis elegans, by contrast, did not secrete neutral proteases and large numbers of motile C. elegans juveniles and adults produced no degradation of the extracellular matrix. Expression of Onchocerca neutral protease activity was stage specific. No protease activity corresponding to that seen in L3 larvae was found in adult worms. Microfilariae of O. cervicalis and O. cervipedis produced both a serine and a metalloprotease, but the level of protease activity of these microfilariae was substantially lower than that of L3 larvae, and no significant protease activity was detected in extracts of O. lienalis microfilariae. Uterine microfilariae of O. cervicalis had different protease species than skin microfilariae, suggesting that changes in protease expression parallel other morphologic and biochemical changes in the development of skin microfilariae. The serine protease of L3 larvae probably plays an important parasitic function, facilitating L3 migration from the blackfly bite site to distant regions of the body where adults will develop and form nodules. The protease activity of microfilariae, while individually considerably less than that of L3 larvae, may still contribute to the tissue destruction seen with heavy skin densities of microfilariae.

Animals↗

Autoinoculated palmar pustules in neonatal candidiasis.

A 2-week-old infant had grouped pustules on the right hand, wrist, and antecubital flexure that appeared after the first week of life. The infant was seen repeatedly to suck the involved areas of the hand and wrist. Clinically typical candidiasis was noted in the oral cavity and the diaper area. Wright's-stained smears of pustular contents, potassium hydroxide preparations of pustular material, and scale from the diaper dermatitis confirmed the presence of pseudohyphae and budding yeasts in all the involved sites. This case demonstrates fairly typical manifestations of neonatal-onset candidiasis, with the unusual feature of unilateral upper extremity pustules that appeared to represent an autoinoculated cutaneous infection.

Candidiasis, Cutaneous↗

Use of the stapler in anterior resection for cancer of the rectosigmoid.

The circular stapling device was used for anterior resection in 61 of 88 patients who underwent curative surgery for rectosigmoid cancer. Use of the autosuture increased the success rate to 68.5% for this radical sphincter-saving procedure. In three-quarters of the patients the stapling end-to-end inverting colorectal anastomosis was created within 3 to 8 cm from the dentate line, where it is difficult or even impossible to perform anastamoses by the conventional manual technique. Anastomotic leakage (3.3%) and hemorrhage (4.9%), mild anastomotic stenosis (1.6%) and transitory anal incontinence (4.9%) were the main complications. There were no deaths in our series. The great safety of the stapling anastomosis and the low rate of anal incontinence may be explained by the preservation of an adequate blood supply and innervation of the rectal stump and its sphincter apparatus, as the stapling device needs only minimal mobilization of the bowel involved in the anastomosis. Restoring colorectal continuity after Hartmann's resection is a speedy, safe and simple procedure with the EEA (enteroenterostomy) stapler. Hartmann's operation may thus be considered the procedure of choice in emergency surgery for obstructed rectosigmoid cancer.

Adult↗

Congenital erosive and vesicular dermatosis healing with reticulated supple scarring: report of three new cases and review of the literature.

Congenital erosive and vesicular dermatosis healing with reticulated, supple scarring is a rare disease with seven reported cases in the literature. This congenital cutaneous defect of unknown etiology presents with patchy or generalized erosions and vesicles at birth that heal with striking reticulated scarring. We report three new cases of this rare disease and review the literature.

Biopsy, Needle↗