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Biomedical subjects

T G Berger

Publications and source records attributed to T G Berger.

At least 55 records · Page 3Linked to original sources
PubMed1994

Angiodysplastic syndrome with capillary and venous malformation associated with soft tissue hypotrophy.

Angiodysplastic syndromes include a vascular malformation which may often be associated with secondary changes such as further vascular abnormalities, soft tissue and bone hypertrophy. One of the best known is the syndrome triad originally described by Klippel and Trenaunay, which includes a unilateral capillary malformation, ectatic veins and osseous and soft tissue hypertrophy. A female patient is reported who had an extensive capillary malformation, discrete ectatic veins overlying an extensive venous malformation and soft tissue hypotrophy without bone involvement. Our patient and cases from the literature illustrate the occurrence of 'atypical', hypotrophic variants of angiodysplastic syndromes. Discrete superficial angiodysplasias may overlie deep, extensive malformations, and identification of such cases is important with regard to management and prognosis. The current classification of angiodysplasias is based on the primary vascular malformation. The use of eponyms should be avoided, because they do not contribute to the diagnosis and management of such cases.

Adolescent↗
PubMed1994

Lichenoid photoeruptions in human immunodeficiency virus infection.

BACKGROUND: The clinical features of lichenoid eruptions in the setting of human immunodeficiency virus (HIV) infection are poorly described. Idiopathic lichen planus is rarely reported. All patients (n = 32) with a histologic diagnosis of a lichenoid eruption or photodermatitis at the University of California, San Francisco, over a 15-month period were reviewed and studied. OBSERVATIONS: Twelve of the 32 patients were HIV infected, and all 12 had photodistributed eruptions. Ten of 12 patients had received photosensitizing medication (usually nonsteroidal anti-inflammatory drugs or sulfamethoxazole/trimethoprim) at the onset of eruption. Most patients were black (10 of 12), and all had acquired immunodeficiency syndrome and a helper T-cell count of less than 50 cells per cubic milliliter. Nine patients had lichenoid eruptions, two showed histopathologic features of lichen niditus, and one had a photodistributed subacute dermatitis. Two patients with lichenoid eruptions developed marked depigmentation. No cases of lichen planus were found in HIV-infected persons. CONCLUSION: Lichenoid photoeruptions are seen in advanced HIV disease (CD4, < 0.05 x 10(9)L), and black patients are disproportionately affected. Idiopathic lichen planus in HIV-infected patients seems to be less common than lichenoid photoeruptions. Previously reported cases of idiopathic lichen planus in HIV-infected patients may represent lichenoid photodermatitis.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The epidemiology of bacillary angiomatosis and bacillary peliosis.

OBJECTIVE: To determine environmental risk factors for bacillary angiomatosis-bacillary peliosis (BAP), and to confirm infection with Rochalimaea species. DESIGN: Case-control study. SETTING: Community and university hospitals and clinics. PATIENTS: Case patients (N = 48) had biopsy-confirmed BAP. Controls (N = 94) were matched to patients by institution and by human immunodeficiency virus (HIV) serological status. MAIN OUTCOME MEASURES: Clinical information was obtained from medical records. Subjects were queried about environmental exposures. Univariate odds ratios (ORs) with 95% confidence intervals (CIs) were determined. Bivariate analyses were performed on variables associated with disease by univariate analysis. DNA from 22 available case-patient tissues and from 22 control tissues was amplified with the polymerase chain reaction (PCR) using primers designed to detect Rochalimaea species. RESULTS: We identified five HIV-negative, immunocompetent case patients; one HIV-negative, immunodeficient case patient; and 42 HIV-positive case patients. There were no significant differences between case patients and controls by race, sex, age, or risk factors for HIV infection. Owning a cat (OR, 2.8; CI, 1.4 to 5.8) and history of a recent cat lick (OR, 1.95; CI, 1.0 to 3.8), cat scratch (OR, 3.7; CI, 1.7 to 8.0), or cat bite (OR, 3.9; CI, 1.8 to 8.9) were associated with disease in the univariate analysis. In bivariate analyses, only the variables representing traumatic contact with a cat (bite or scratch) remained associated with disease. No other environmental exposure was associated with disease. The PCR amplified a DNA fragment of the size expected for Rochalimaea species in all 22 case-patient tissue specimens. CONCLUSIONS: These data suggest that BAP is a new zoonosis associated with both traumatic exposure to cats and infection with Rochalimaea species or a closely related organism.

Adult↗
PubMed1993

Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection.

Dendritic cells, the primary antigen presenting cells of the human immune system, are heavily infected with human immunodeficiency virus (HIV) in patients with the acquired immunodeficiency syndrome (AIDS). Dinitrochlorobenzene (DNCB) is a contact sensitizing agent that acts as a potent immune modulator of dendritic cells. In this pilot study, we examined the safety and efficacy of topical DNCB application in patients with early HIV disease. Topical DNCB was well tolerated by these patients, with an adverse reaction rate of 10%. CD4+ T-cell counts remained stable with repeated DNCB use. In contrast, CD8+ T-cell counts and natural killer cells increased significantly following DNCB sensitization. This increase in CD8+ T-cell and natural killer cell subsets was accompanied by a decrease in HIV replication, as measured by serum HIV RNA levels. Based on this pilot study, we conclude that topical DNCB is safe in early HIV disease and may decrease viral load via a systemic effect on dendritic cells, CD8+ T-cells and natural killer cells. These results require confirmation in larger controlled trials.

Administration, Cutaneous↗
PubMed1993

Intralesional vinblastine for cutaneous Kaposi's sarcoma associated with acquired immunodeficiency syndrome. A clinical trial to evaluate efficacy and discomfort associated with infection.

BACKGROUND: Intralesional vinblastine has been used to treat Kaposi's sarcoma associated with acquired immunodeficiency syndrome (AIDS-KS). Injections are painful and anticipated response rates are not well documented. OBJECTIVE: Eleven homosexual men were studied to evaluate the efficacy and pain associated with intralesional vinblastine with or without 1% bicarbonate buffered lidocaine (BBL). METHODS: Six lesions on each patient were selected and treated with either vinblastine, vinblastine mixed with BBL, or vinblastine 5 minutes after BBL injection. Control lesions received BBL, saline, or no treatment. Patients recorded injection pain on a visual analog scale. RESULTS: There was a complete or partial clinical response in 88% of vinblastine-treated lesions. Pain scores for BBL, vinblastine, and the mixture of BBL and vinblastine were not statistically different. CONCLUSION: Intralesional vinblastine is effective therapy for AIDS-KS. Local anesthesia does not reduce efficacy of treatment, or reduce the pain experienced by the patient.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Kaposi's sarcoma. Epidemiology, pathogenesis, histology, clinical spectrum, staging criteria and therapy.

The acquired immunodeficiency syndrome (AIDS) epidemic has had a profound impact on our understanding of Kaposi's sarcoma (KS). Epidemiologic features suggest a sexually transmitted cofactor in the pathogenesis of AIDS-associated KS (AIDS-KS), and several putative agents have received intense scrutiny. Cell culture studies suggest that the angiogenesis of AIDS-KS is stimulated by both human immunodeficiency virus proteins and growth factors that may be involved in the development and progression of AIDS-KS, thereby providing a rationale for new therapeutic interventions. The dermatologist is uniquely qualified to provide care for the majority of patients with KS, as many patients have cutaneous lesions amendable to local therapy (cryotherapy, intralesional therapy, simple excision). Patients requiring more aggressive local therapy (radiation therapy) or systemic therapies (interferon, chemotherapy) can be easily recognized. Standardized staging criteria provide assistance for determining appropriate local or systemic therapy and for evaluating and comparing responses to new therapies. This article reviews the epidemiology, pathogenesis, histologic features, clinical spectrum, staging criteria, and treatment of KS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Treatment of bacterial, fungal, and parasitic infections in the HIV-infected host.

In the human immunodeficiency virus (HIV) infected patient, skin infections caused by S aureus are extremely common. Impetigo, ecthyma, and folliculitis are all seen. Recurrences are common due to a nasal carriage rate of 50%. Dermatophytosis usually manifests as tinea pedis or unguium and is caused by Trichophyton rubrum. Oral candidiasis may be the initial evidence of HIV infection, and is predictive of more rapid progression to acquired immune deficiency syndrome (AIDS). Topical agents are usually effective for oral lesions, but involvement of the esophagus requires oral imidazole therapy. Systemic fungal infections are most commonly caused by cryptococcosis or histoplasmosis. The finding of either of these infectious agents in the skin is pathognomonic of disseminated infection. Cryptococcus presents as umbilicated papules resembling molluscum or as large ulcerations. Histoplasmosis has no specific cutaneous morphology. Scabies is very common in HIV-infected persons, and once the helper T-cell count is less than 200, it may present atypically. Permethrin is the recommended treatment in this setting.

Anti-Infective Agents↗
PubMed1992

Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis.

BACKGROUND: Bacillary angiomatosis is characterized by vascular lesions, which occur usually in patients infected with the human immunodeficiency virus (HIV). A newly described gram-negative organism, Rochalimaea henselae, has been associated with cutaneous bacillary angiomatosis, but no organism has been isolated and cultivated directly from cutaneous tissue. METHODS: We used two methods to isolate the infecting bacterium from four HIV-infected patients with cutaneous lesions suggestive of bacillary angiomatosis: cultivation with eukaryotic tissue-culture monolayers and direct plating of homogenized tissue onto agar. The patients' blood was cultured with the lysis-centrifugation method. Isolates recovered from skin and blood were identified by sequencing all or part of the 16S ribosomal RNA gene amplified with the polymerase chain reaction. RESULTS: R. quintana, historically known as the agent of trench fever, was isolated from cutaneous lesions in three patients, after tissue homogenates were cultivated with endothelial-cell monolayers; R. henselae was isolated from a cutaneous lesion in one patient. In two patients, R. quintana was isolated from both cutaneous tissue and blood; in one patient it was also isolated from bone. CONCLUSIONS: In bacillary angiomatosis, either of two species of rochalimaea--R. quintana or R. henselae--can be isolated from cutaneous lesions or blood, providing an additional method of diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1992

Management of urinary tract in children with epidermolysis bullosa.

Epidermolysis bullosa is a group of rare genetic disorders characterized by noninflammatory blistering lesions of the skin occurring after minor mechanical trauma. In association with junctional epidermolysis bullosa, a syndrome of pyloric atresia has occasionally been noted in the literature. Several infants who had this combined disorder have been reported to have severe genitourinary tract involvement. Most of these patients have died at an early age because of severe urinary tract involvement. We describe a rare survivor who was initially treated with urinary diversion. Subsequent attempts at undiversion of this patient were unsuccessful. He is presently stable following rediversion. The entities of e. bullosa and e. bullosa/pyloric atresia are reviewed with emphasis on urologic associations.

Child↗
PubMed1992

Genital benign chronic pemphigus (Hailey-Hailey disease) presenting as condylomas.

BACKGROUND: Genital lesion sof benign chronic pemphigus (FBCP)(Hailey-Hailey disease) may present as verrucous papules. Genital warts and papular acantholytic dyskeratosis of the genitalia may be considered in the differential diagnosis. OBJECTIVE: Our purpose was to describe the clinical characteristics and histologic features of verrucous anogenital FBCP. METHODS: Six patients, five women and one man, with verrucous anogenital lesions of FBCP, initially diagnosed as warts, were examined and biopsy specimens were evaluated histologically. RESULTS: The lesions were located exclusively in the perineal and perianal regions with axillary involvement in one case. Family history was negative in three of the six cases. Histologic examination confirmed the diagnosis of FBCP but was significant for the absence of crusts and the presence of only minimal inflammation. CONCLUSION: Our cases and the literature are reviewed with the conclusion that all verrucoid genital lesions with the histologic characteristics of Hailey-Hailey disease may represent FBCP.

Adult↗
PubMed1992

Pulsed-dye laser therapy for cutaneous Kaposi's sarcoma associated with acquired immunodeficiency syndrome.

BACKGROUND: Cutaneous lesions of Kaposi's sarcoma associated with acquired immunodeficiency syndrome (AIDS-KS) are disfiguring. OBJECTIVE: This study assesses the response of AIDS-KS to pulsed-dye laser (PDL) therapy. METHODS: The PDL was used to treat 15 AIDS-KS patients. Treatment was repeated at 4-week intervals. On average, patients received three treatments per treated lesion. RESULTS: At 6 weeks' follow-up, the patients' treated lesions were reduced in size when compared with their matched control lesions (p less than 0.002). A complete or partial clinical response occurred in 44% of treated lesions (17 of 39) compared with 18% of matched control lesions (7 of 39) [corrected]. Patients experienced limited pain, infrequent blistering, and no scarring. However, histopathologic findings of treated lesions throughout therapy correlated poorly with clinical response. At 12 weeks, all treated lesions had recurred. CONCLUSION: PDL therapy for AIDS-KS is not recommended. Although safe, the rapid recurrence of disease at initially responsive sites would require costly, long-term therapy to maintain cosmetic improvement.

AIDS-Related Opportunistic Infections↗
PubMed1992

Psoriasis and human immunodeficiency virus infection.

BACKGROUND: Psoriasis associated with human immunodeficiency virus (HIV) infection has been reported to be severe and perhaps associated with decreased survival. OBJECTIVE: Our purpose was to document the natural history, response to therapy, and effect of psoriasis and its treatment on survival in HIV-infected patients with psoriasis. METHODS: This was an observational cohort study of 50 persons with psoriasis and HIV infection followed up during a 2-year period. RESULTS: In one third of the patients the psoriasis appeared before 1978, the year when HIV seroconversion began in San Francisco (group I). In two thirds psoriasis developed after 1978 (group II). Group I had a lower mean age of onset (19 vs 36 years) and more commonly had a family history of psoriasis. Palmoplantar and inverse psoriasis were more common in group II. Severe psoriasis occurred in one fourth of this group (12 of 50 patients). The median survival in this group after diagnosis of acquired immunodeficiency syndrome (AIDS) was 19 months, which is comparable to the median survival for all AIDS patients diagnosed in San Francisco between 1984 and 1990. CONCLUSION: Psoriasis in the setting of HIV disease may be mild, moderate, or severe. Standard therapies and zidovudine are effective in management. Survival does not seem to be adversely affected by the presence of psoriasis or its therapy.

Adolescent↗