1/15. pyoderma gangrenosum involving the foot. A case report.pyoderma gangrenosum is a rare and destructive inflammatory skin disease. The authors present a report of a patient with a classic case of pyoderma gangrenosum involving the foot. The diagnosis was made on the basis of clinical presentation and progression of the disease after differential diagnoses of common conditions were excluded. A brief overview of the disease process, its treatment, and its correlation with ulcerative colitis is provided.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
2/15. nocardia brasiliensis infection seen on grafted skin of the dorsum of a foot.For the past 4 years a 23 y-old female has noticed erythema on the dorsum of the right foot, where skin was grafted due to a traffic accident 20 years ago. She visited the Department of dermatology of Gifu Prefectural Hospital on Oct. 19, 1998; her general health was good. physical examination disclosed a swelling with erythema, papules and pustules on the dorsum of the right foot. The results of routine laboratory investigations were within normal limits except for the white blood cell count (11,300/mm(3)), blood sediment rate (25 mm/hrs), C reactive protein (1.21) and rheumatoid factor (x 16.6). Several yellowish and verrucous or wrinkled colonies were grown on Sabourauds agar culture from the biopsied specimen of the foot. Histopathological features showed epidermal hyperplasia with elongation of rete ridges and granulomatous changes in the dermis; many mononuclear and giant cells were present, and several positive fine filamentous and irregularly branching structures with PAS and Grocott stains were seen in the granulomatous nests. Both clinical and histopathological features led to speculation of nocardia infection, and nocardia brasiliensis was determined. The patient was treated by surgical total resection including the grafted skin. Although a soybean-sized nodule was seen on the border of the skin-graft of the foot three months later, there was no recurrence after the local resection.- - - - - - - - - - ranking = 165.63248448957keywords = ridge (Clic here for more details about this article) |
3/15. Generalized eruptive porokeratosis of Mibelli with associated psoriasis.A case of eruptive porokeratosis of Mibelli with diverse morphologic features, including circinate macular, circinate plaque and verrucous varieties is presented. No matter how variable the clinical presentation may be, the histologic hallmark of porokeratosis, the cornoid lamellae, is always present. The cornoid lamellae vary in height in relation to how prominent the thready ridge of the clinical lesion appears. Our patient also had psoriasis which initially masked the porokeratotic lesions both clinically and histologically. awareness of the various clinical expressions of porokeratosis of Mibelli would 1) make unnecessary the segregation of certain forms of porokeratosis into separate entities, and 2) help in the recognition of less classical forms of porokeratosis.- - - - - - - - - - ranking = 165.63248448957keywords = ridge (Clic here for more details about this article) |
4/15. hand-foot syndrome in a patient with multiple fire ant stings.The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. HFS was initially reported in association with acute crisis in sickle cell anemia and thalassemia and more recently as a common toxicity of chemotherapy administration. This is the first report of its occurrence in the setting of fire ant envenomization. Although recent literature may indicate a potential therapeutic benefit from COX-2 antagonists, the process appears to be self-limited, and requires only conservative treatment.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
5/15. Human papillomavirus-associated plantar epidermoid cyst related to epidermoid metaplasia of the eccrine duct epithelium: a combined histological, immunohistochemical, dna-dna in situ hybridization and three-dimensional reconstruction analysis.BACKGROUND: We recently proposed that certain palmoplantar epidermoid cysts may be related to eccrine ducts and that human papillomavirus (HPV) 60 may play a role in their pathomechanism. However, the origin of palmoplantar epidermoid cysts is still controversial. OBJECTIVES: To examine the contribution of eccrine ducts and HPV 60 in the development of epidermoid cysts. methods: Five epidermoid cysts and four ridged warts that had developed on the soles of a patient were studied histologically, immunohistochemically and by dna-dna in situ hybridization. Using serial sections obtained from its entire body, a three-dimensional reconstruction (3DR) analysis was performed on the smallest cyst to analyse the relationship between the epidermoid cyst, eccrine duct and the overlying epidermis. RESULTS: Histological and dna-dna in situ hybridization analyses demonstrated both homogeneous intracytoplasmic inclusion bodies pathognomonic for HPV 60 infection and HPV 60 dna sequences not only in all of the epidermoid cysts and ridged warts but also in the acrosyringeal portion of an eccrine duct, with the dermal portion of which the smallest cyst had been revealed to connect by 3DR analysis. However, immunohistochemical analyses using antibodies against human carcinoembryonic antigen (CEA), involucrin and several cytokeratins (CKs) revealed that the immunoreactivity of the cyst was not identical to that of the eccrine dermal duct but was identical to that of suprabasal layers of the epidermis. CONCLUSIONS: It was clearly demonstrated that an HPV 60-associated epidermoid cyst with immunoreactivities for CEA, involucrin and CKs which were identical to those of the epidermis connected with the eccrine dermal duct, supporting the idea that certain palmoplantar epidermoid cysts may develop following the epidermoid metaplasia of eccrine ducts with HPV 60 infection.- - - - - - - - - - ranking = 331.26496897914keywords = ridge (Clic here for more details about this article) |
6/15. Complication of a Portuguese man-of-war envenomation to the foot: a case report.Jellyfish stings have become more prevalent on account of larger commercial presence along coastal waterways. Stings are referred to as envenomations, due to the process of a neurotoxic venom being injected into the victim at the site of the sting. These events are usually mild, and for the most part, confined to local hypersensitivity reactions at the site of the injury. Certain species of jellyfish, however, have been associated with more severe, systemic insults including muscle cramping, respiratory distress, hypotension, circulatory collapse and death. One such example of a more potent venom is the Portuguese man-of-war. Most case reports of Portuguese man-of-war envenomations do not involve local soft tissue necrosis. The purpose of this case report is to present such a consequence after a jellyfish sting to the dorsum of the foot. A large area of skin necrosis developed after an envenomation that required extensive debridement and skin grafting.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
7/15. Acral melanoma simulating warts: dermoscopic clues to prevent missing a melanoma.BACKGROUND: Acral melanoma may adopt a variety of clinical characteristics simulating other tumors, ulcers, hemorrhage, or infections. In the Caucasian population health care providers often misdiagnose acral melanoma, and this is the cause of inadequate treatments. Clinical and dermoscopic clues can be easily recognized, which help to prevent missing a melanoma. OBJECTIVES: To study the clinical and dermoscopic findings in three cases of acral melanoma simulating warts that had been treated by dermatologists with curettage and cryotherapy. MATERIAL AND methods: Clinical and dermoscopic study of the tumors and review of the most frequent simulators of acral melanoma reported in the literature. RESULTS: In all three tumors, hyperkeratosis and the lack of specific pigmentation were observed. The parallel ridge pattern, revealed by dermoscopic examination, precipitated the recognition of acral melanoma. CONCLUSION: In these cases that presented atypical characteristics of acral lesions, therefore challenging the diagnostic process, dermoscopic examination helped to confirm an accurate diagnosis of acral melanoma.- - - - - - - - - - ranking = 166.63248448957keywords = ridge, process (Clic here for more details about this article) |
8/15. The diagnosis and treatment of infections of the pedal integument.Dr. Miller's discussion of the diagnosis and management of soft tissue infections is probably one of the most important topics in this issue. We are all faced with the potential for relatively minor infections becoming serious problems. Having a sound understanding of the infectious process and treatment regimens is extremely important in our general practices. Few things can make a patient as unhappy or destroy good surgical results as quickly and easily as an infection. I recommend reading the articles suggested by Dr. Miller and add that I believe that if the infection has not responded as quickly to therapy as is expected, an infectious disease consultation should be requested.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
9/15. phialophora richardsiae infection in humans.phialophora richardsiae infection in humans is rare. The first human isolate was recovered from a patient with a phaeomycotic cyst in 1968. Since 1975 seven other cases have appeared in the world literature, and an additional case is reported here. The mean age of these nine patients was 61.4 years. Two patients had diabetes mellitus, one had diabetes mellitus and disseminated adrenocortical carcinoma, and one had a myeloproliferative disorder. The mode of acquisition was presumed to be inoculation with contaminated plant material, but a history consistent with an inoculation injury was obtained in only four patients and a retained splinter was found in the lesion of only one patient. Infection with P. richardsiae was not associated with systemic symptoms or signs. Six patients presented with a single subcutaneous cystic granulomatous lesion. One patient had chronic dacryocystitis. More extensive or invasive disease occurred in two patients, both with an ultimately fatal underlying neoplastic process. A specific etiologic diagnosis was made by culture of purulent material obtained by excisional biopsy in six patients, incision and drainage in one patient, aspiration in one, and spontaneous drainage in one. Subcutaneous nodules were cured with surgical excision. There is insufficient information concerning antifungal therapy to recommend its use.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
10/15. First report of subcutaneous phaeohyphomycosis of the foot caused by Phoma minutella.Phoma minutella, a dematiaceous hyphomycete, was isolated to the exclusion of all other fungi from a subcutaneous inflammatory process on the foot of a farmer undergoing corticosteroid therapy for myasthenia gravis. Isolation was achieved on several nutrient media. Examination of stained smears and sections revealed dematiaceous fungal elements consistent with the mold. This is the first reported association of P. minutella with a human infection and only the second reported case involving a Phoma sp. as the etiologic agent of a subcutaneous infection.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
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