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Biomedical subjects

W D James

Publications and source records attributed to W D James.

At least 19 recordsLinked to original sources
PubMed2003

Topical nitrogen mustard ointment with occlusion for Langerhans' cell histiocytosis of the scalp.

BACKGROUND: Topical nitrogen mustard solution has been used as an effective alternative to corticosteroids for the treatment of cutaneous eruptions of Langerhans' cell histiocytosis (LCH). When used as an ointment under occlusion, nitrogen mustard may still be effective and possess less risk of unwanted side effects. METHODS: A patient with scalp LCH was treated topically with nitrogen mustard ointment 0.01% under occlusion. RESULTS: The lesions cleared in 3 weeks without irritation. CONCLUSION: Topical nitrogen mustard ointment 0.01% under occlusion is a well-tolerated, non-irritating treatment for scalp LCH.

Administration, Cutaneous↗
PubMed2001

Contact dermatitis due to printer's ink in a milk industry employee: case report and review of the allergen paraphenylenediamine.

Paraphenylenediamine is a common cause of occupational dermatoses in hairdressers, metallurgy workers, and others. Hand dermatitis developed in an employee of a milk packaging facility. The employee's hands were exposed to milk cartons embossed with wet printer's ink on a daily basis for 2 years. The worker was evaluated through a history, physical examination, and patch testing with 50 standard allergens. Patch testing revealed a positive reaction to paraphenylenediamine. The hand dermatitis resolved once the patient instituted protective measures. The worker's reaction might represent a delayed-type hypersensitivity reaction to printer's ink that contained this agent. More likely, the inciting agent was some other ingredient of the printer's ink that cross-reacts with paraphenylenediamine.

Adult↗
PubMed2001

Aquagenic palmoplantar keratoderma.

Aquagenic palmoplantar keratoderma is an acquired condition characterized by burning and edema limited to the hands after brief immersion in water. The 3 patients described possess a striking similarity to those with transient reactive papulotranslucent acrokeratoderma. All 3 patients manifested the "hand-in-the-bucket" sign, having presented to a physician with a hand immersed in a bucket of water to more promptly demonstrate the physical findings. Aluminum chloride hexahydrate represents a potentially valuable therapeutic option for this unusual condition.

Adolescent↗
PubMed2001

Great cases from the University of Pennsylvania.

New skin diseases are reported yearly. Some well-known conditions may develop unusual manifestations. Other cutaneous findings are simply rare. While patients with such diseases represent only a small fraction of our practice they are an important subset of our experience. Many of these diseases are treatable, pinpoint the discovery of internal disease, or simply allow for a diagnosis and prognosis to be given to a concerned patient who had previously escaped classification. Such cases expand our knowledge and provide excitement to our day. Several patients from whom I have learned the most in the last few years are detailed for your enjoyment.

Alopecia↗
PubMed2001

Imported skin diseases in dermatology.

Millions of afflicted people suffer from conditions which Japanese dermatologists may rarely encounter. Many of our patients travel extensively either as part of work-related business trips or during vacationing. From three to ten percent of travelers experience skin, hair or nail disorders. With worldwide travel heightening exposure to the causative agents, there is an increasing likelihood that a patient with leishmaniasis, Boutonneuse fever, onchocerciasis, loaiasis, dengue fever, cutaneous larva migrans or other recently acquired skin conditions from a far away land will visit your office for diagnosis and treatment. The clinical characteristics, diagnostic tests and therapeutic options for such imported tropical diseases will be discussed.

Boutonneuse Fever↗
PubMed2001

Newer skin signs of systemic disease.

The skin is a well-known reflection of internal disease states. It provides the astute clinician with clues that lead to the diagnosis of systemic illness. While skin disease is rarely life-threatening, serious morbidity and mortality may be avoided by early recognition of subtle cutaneous signs signaling internal problems. The recent literature was reviewed to glean new findings that either added new associations to older syndromes or described completely new diseases. While entire books are written regarding the "Skin Signs of Internal Disease", this article focuses only on the newest of such findings.

Connective Tissue Diseases↗
PubMed2000

The flow of forage particles and solutes through segments of the digestive tracts of cattle.

An experiment was conducted to investigate the compartmental mean residence time, (CMRT) of feed residues in segments of gastrointestinal digesta of mature Holstein steers. The objective was to evaluate assumptions that feed residues flow through ruminal digesta as sequential mixing pools having age-dependent (GN) and age-independent (G1) distributed residence times respectively (GN-->G1 flow). The basal diet was a semi-tropical hay containing 98 g crude protein and 503 g apparently digestible DM per kg DM. The hay was consumed and feed residues of different size and/or previous digestion from the hay were inserted into the reticulo-rumen (rumen) and abomasum. Marker profiles appearing at the duodenum and faeces were fitted to various compartment models to estimate CMRT. Post-abomasal CMRT did not differ among solutes or feed residues of different size and previous digestion and constituted only 5.8% of the CMRT for the entire gastrointestinal tract. Markers initially applied to orally or ruminally dosed feed residues exhibited profiles in duodenal digesta and faeces conforming to GN-->G1 flow. Previously undigested, masticated feed residues inserted into the dorsal rumen digesta had longer ruminal CMRT in the GN pool but not the G1 pool than did similarly inserted faecal small particles or normally ingested hay. These results support model assumptions of GN-->G1 flow within rumen digesta. The results support mechanisms proposed for the GN pool as the 'lag-rumination pool' and the G1 pool as the 'mass action turnover pool'. If further validated, rumen CMRT in cattle could be estimated from marker profiles in more easily obtained faeces to estimate ruminal CMRT required for feed evaluation systems.

Abomasum↗
PubMed2000

Neutrophilic dermatosis of the dorsal hands: pustular vasculitis revisited.

An entity termed "pustular vasculitis of the hands" was recently described. Patients with this condition presented with low-grade fevers and erythematous plaques, pustules, and bullae limited to the dorsal hands and fingers, which were characterized histologically by a dense neutrophilic infiltrate and leukocytoclastic vasculitis. We describe patients with a similar clinical presentation, but who lacked vasculitis on biopsy findings. We describe 3 otherwise asymptomatic patients with hemorrhagic bullae, plaques, and pustules solely on the dorsal hands. Biopsy specimens showed a neutrophilic infiltrate and leukocytoclasis, but no necrotizing vasculitis, and were reminiscent of Sweet's neutrophilic dermatoses. In our patients, corticosteroids or dapsone led to clearing of the lesions, and small maintenance doses of dapsone prevented their recurrence. Our 3 patients had clinical lesions similar to those termed pustular vasculitis of the hands, but which lacked leukocytoclastic vasculitis on biopsy findings. Because of histologic findings and a therapeutic response more characteristic of Sweet's syndrome, we propose the term neutrophilic dermatosis of the dorsal hands. In addition, low-dose dapsone is proposed as a possible first-line therapy in this condition, especially in those with recurrent disease.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Cutaneous microenvironment of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative individuals, with special reference to Staphylococcus aureus colonization.

A cross-sectional quantitative study of cutaneous bacterial and yeast flora at seven body sites in 99 human immunodeficiency virus-seropositive and 50 seronegative military personnel was performed. Statistically significant differences in carriage rates were only observed for Staphylococcus aureus on the foreheads of seropositive individuals. Seronegative individuals demonstrated staphylococcal carriage rates 1.3 to 2 times as great as those of historical controls (defined as healthy individuals not receiving any medications) at five of six body sites. We conclude that seropositive military personnel do not exhibit statistically significant elevations in densities and carriage rates of the microorganisms examined (except Staphylococcus aureus), relative to seronegative individuals. Seropositive individuals may be predisposed to staphylococcal carriage. The elevated staphylococcal carriage rates of military personnel undergoing basic training warrants a formal evaluation of the impact of training exercises on cutaneous flora. The information gained may serve to limit the spread of infection during training exercises and battlefield conditions.

Adolescent↗
PubMed1999

Erysipeloid sporotrichosis in a woman with Cushing's disease.

A woman presented with a swollen red leg of 2 weeks' duration. Culture of the skin biopsy specimen confirmed this to be an infection caused by Sporothrix schenckii. Systemic evaluation led to the diagnosis of Cushing's disease and explained the unusual morphology. Treatment-related complications are also discussed.

Adult↗
PubMed1999

Painful red nodules of the legs: a manifestation of chronic infection with gram-negative organisms.

Skin infection secondary to gram-negative organisms is uncommon and is typically limited to persons who are immunocompromised. When these do occur, they are acute, progressive, and severe. Here we report 2 cases of painful red nodules that presented with a waxing and waning course over a long period. One case is that of a 45-year-old healthy white man who developed Serratia marcescens infection in 1 leg. The other case is that of a 78-year-old man with chronic lymphocytic leukemia treated with prednisone who developed infection of the leg secondary to Pseudomonas aeruginosa. In the first case, symptoms were present for 2 years before definitive diagnosis and treatment. In the second case, 4 months elapsed. Ultimately, both patients responded to antibiotic therapy and recovered. These cases illustrate an unusual presentation of chronic red painful nodules of the leg secondary to infection with gram-negative organisms and underscore the importance of culture even when infection seems unlikely.

Adult↗
PubMed1999

Accentuated viral exanthems in areas of inflammation.

Types of lesions and patterns of distribution aid in the recognition of viral exanthems. Varicella and hand-foot-and-mouth disease can appear atypically in areas of inflammation. We describe 5 cases of morphologically altered exanthems that localized early and preferentially to areas of inflammation.

Chickenpox↗
PubMed1999

Viral folliculitis.

Viral folliculitis is an infrequently reported entity. We describe two patients with viral folliculitides, including a case of herpetic sycosis caused by herpes simplex (HSV) and a case of herpes zoster (HZ) without blisters. Clinicians should consider viral etiologies in the differential diagnosis of superficial infectious folliculitis, especially those cases refractory to antibacterial or antifungal therapy.

AIDS-Related Opportunistic Infections↗
PubMed1999

Cutaneous manifestations of cancer.

The appearance of skin lesions in patients with occult or obvious malignancy may be of extreme value in the detection and management of cancer because the skin is readily accessible to examination and biopsy. Examination of the skin of our patients can provide important insights into underlying malignant processes or possible complications from cancer treatment. The range of cutaneous abnormalities is wide, and include cutaneous paraneoplastic syndromes such as xanthomas, acanthosis nigricans, carcinoid syndrome, unusual erythematous eruptions such as erythema gyratum repens, and a number of genetic syndromes associated with malignancies and inherited dermatoses.

Humans↗
PubMed1998

On the importance of the clinician-educator. Dermatology fellowship for academic clinician teachers.

Within each academic dermatology department there usually exists one clinician who is viewed as the "gold standard" against which diagnostic and therapeutic acumen are measured. As a patient with a puzzling disorder is discussed at rounds, it is to this master that the final word falls, whose recommendation for treatment gets the nod; it is to his or her words that people remain quiet and listen intently. They are commonly also the leading teachers in the medical centers, passing on to succeeding generations the factual knowledge, spiced with bits of philosophy, ethics, and anecdote, that helps to ensure the development of dermatology residents into superb practitioners. They are often the ones most responsible for generating medical student interest in our specialty. Such individuals in our current lingo are "clinician-educators," the rock residents depend on to provide role models to emulate in the diagnosis, care, and treatment of our patients and to whom the community looks to for help in caring for their patients with the most difficult diagnoses.

Academic Medical Centers↗
PubMed1998

Patterns of X chromosome inactivation in sporadic basal cell carcinomas: evidence for clonality.

BACKGROUND: Some basal cell carcinomas (BCCs) contain genetic mutations, suggesting that the lesion is composed of a monoclonal population of cells. Clonality, a distinguishing feature of neoplasia, can be inferred by referencing clonal markers such as the pattern of X chromosome inactivation. The X-linked human androgen receptor gene (HUMARA; GenBank) contains a polymorphic DNA marker that reliably illustrates the pattern of X chromosome inactivation in a tissue. OBJECTIVE: Our purpose was to determine the clonality of sporadic BCCs by examining patterns of X chromosome inactivation. METHODS: The patterns of X chromosome inactivation in paired samples of normal skin and sporadic BCCs from 24 women were compared by means of the HUMARA gene assay. RESULTS: All samples from normal skin displayed random X chromosome inactivation, consistent with lyonization. In 15 of 25 tumor samples (60%), nonrandom X chromosome inactivation was detected, consistent with monoclonality. CONCLUSION: At least some sporadic BCCs are composed of a monoclonal population of cells, strengthening the contention that a collection of mutations confers a growth advantage to this epithelial lesion.

Adult↗