Biomedical subjects
T A Chapel
Publications and source records attributed to T A Chapel.
Syphilis: review and update.
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Extragenital syphilitic chancres.
Two patients with extragenital chancres are presented to emphasize unusual expressions of primary syphilis. The clinical presentations and differential diagnosis of extragenital chancres are discussed.
Disuse contractures in a patient with tinea manuum and irritant contact dermatitis.
Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.
Primary and secondary syphilis.
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Congenital cutaneous candidiasis.
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Scabies presenting as urticaria.
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Physician recognition of the signs and symptoms of secondary syphilis.
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Histologic findings in mummified skin.
Skin specimens from five mummies were examined histologically. The specimens ranged in age from 2,000 to 3,200 years. Material from two mummies had carbonized and showed only amorphous debris. The histology of the three remaining skin fragments retained surprising histologic architectural detail. One specimen obtained from the sole of the foot was compatible with a callus.
Becker's melanosis: an organoid hamartoma.
Herein we have reported the histologic findings in two cases of Becker's melanosis. In one patient the lesion showed hyperplasia or hair muscles and in the other patient the lesion was associated with an underlying neurofibroma. The proliferative changes seen in the epidermis and dermis in Becker's melanosis can best be explained by the concept of an organoid hamartoma with involvement of the epidermis, pilar structures, and some other dermal components. The localization of the plexiform neurofibroma within the Becker's nervus is a unique observation. It may fall within the spectrum of an organoid hamartoma or it may only represent a chance occurrence.
Pseudomonas chromonychia.
The patient reported on herein presented with a greenish black great toenail. The discoloration was due to Pseudomonas aeruginosa. This report should alert the practitioner to the fact that Pseudomonas chromonychia may occasionally be mistaken for color changes produced by subungual hematomas, nevi, or malignant melanomas.
Enzymatic detection of Neisseria gonorrhoeae.
In a study using a non-serological enzymatic approach for the detection of Neisseria gonorrhoeae in cervical and urethral swabs, the technique was shown to be technically feasible. The enzyme, 1, 2-propanediol oxidoreductase, was used as a presumptive diagnostic marker for N gonorrhoeae. Enzymatic activity was measured with a fluorometer. Two assay procedures were performed: (a) enzyme detection (two-tube and three-tube assays) requiring 60 minutes; and (b) enzyme inhibition (EI) (90-minute and modified 20-minute assays). Sensitivities of the two-tube, three-tube, and the 90-minute EI assays with male urethral specimens from a high-prevalence population were 80%, 84%, and 91% respectively. The specificities of these assays in a low-prevalence male population were not determined. Sensitivity of the 90-minute EI assay in a high-prevalence female group was 77% and specificity in a low-prevalence female group was 75%. The modified EI assay was tested only in a low-prevalence female group and had 87% specificity. Although the specificity of the assays needs improvement, several advantages--including early case detection, rapid availability of results, detection of current active infections, and the possibility of automation--are intrinsic in this enzymatic approach.
Psoriasis with tinea corporis.
The case report presented herein documents the unusual simulaneous occurrence of psoriasis and tinea corporis in a patient and reviews the diagnostic and therapeutic problems that arose during the treatment of these two morphologically similar papulosquamous diseases. The report emphasizes the need for careful re-evaluation of patients who have atypical response to therapy.
Volar melanotic macules.
Asymptomatic light brown or tannish-gray macules are seen on palms and/or soles of black patients, and occasionally on the volar surfaces of whites. They may be mistaken for lesions of secondary syphilis or other postinflammatory hyperpigmented dermatoses. Histologic examination of 14 specimens obtained at necropsy showed purely epidermal hyperpigmentation of all epidermal layers; or (3) melanin restricted to large dendritic melanocytes without appreciable transfer to keratinocytes. The number of melanocytes was not significantly increased, and with one exception, there were no nevus cells. These volar melanotic macules have close clinical and histologic resemblance to melanotic macules observed occasionally on the vermillion area of the lips.
Simultaneous infection with Treponema pallidum and herpes simplex virus.
Two cases are presented of simultaneous infection with Treponema pallidum and herpes simplex virus. The occasional concurrence of these diseases suggests that all cases of herpes genitalis, including those with negative darkfield examinations and initial nonreactive serologic tests for syphilis, should be followed in two to four weeks by a repeat serologic test for syphilis.
Bullous pemphigoid:therapy in patients with and without diabetes mellitus.
Retrospective analysis of 34 patients with bullous pemphigoid (BP) showed 24 (70.6%) with widespread disease and 10 (29.4%) with localized disease. Initial prednisone therapy was significantly lower for patients with localized BP, mean dose of 38 mg vs 58 mg, compared with widespread disease. Fifteen of 24 (62%) patients responded; however, 9 (38%) failed to respond to moderate-dose prednisone therapy and ultimately required daily doses of 100 mg or more and/or an immunosuppressive agent. Adult-onset diabetes mellitus was present in 14 of 34 (41%) patients. Initial prednisone dose for diabetic patients with widespread BP was significantly greater, 70 mg vs 54 mg, compared with nondiabetic patients. Addition of methotrexate, 2.5 to 15 mg, every other day or twice-weekly oral administration, was effective when moderate-dose prednisone therapy failed. It is possible that insulin-dependent diabetic patients with BP should be preferentially started on immunosuppressive drugs.
Coexistent bullous pemphigoid and systemic lupus erythematosus.
A case of coexistent bullous pemphigoid and systemic lupus erythematosus is reported. Evidence for an immunologic pathogenesis is reviewed for both disorders. It is suggested that the coexistence of bullous pemphigoid and systemic lupus erythematosus may represent a similar pathomechanism.