Large Number Of Lesions Research Articles

Treatment modalities for molluscum contagiosum

: Molluscum contagiosum (MC) is caused by a poxvirus which produces cutaneous lesions which appear as small, firm, umbilicated papules. In general, there are three clinical presentations of MC: the childhood variety due to casual contact; the sexually transmitted variety in adults; and the aggressive form seen in patients infected with the human immunodeficiency virus (HIV). Removal of MC lesions is usually straightforward in the first two presentations and can include mechanical removal with a blade or curette, cryosurgery, podophyllin or podophyllotoxin, cantharidin, various acids or retinoids. In the HIV seropositive patient such treatments are usually inadequate due to the very large number of lesions and the rapid recurrence after mechanical removal. Combination therapy has been more successful in such cases especially if treatment includes such experimental antiviral/immunomodulatory agents as imiquimod or cidofovir.

Frequent homologous recombination events between molecules of one RNA component in a multipartite RNA virus.

Brome mosaic bromovirus (BMV), a tripartite plus-sense RNA virus, has been used as a model system to study homologous RNA recombination among molecules of the same RNA component. Pairs of BMV RNA3 variants carrying marker mutations at different locations were coinoculated on a local lesion host, and the progeny RNA3 in a large number of lesions was analyzed. The majority of doubly infected lesions accumulated the RNA3 recombinants. The distribution of the recombinant types was relatively even, indicating that both RNA3 counterparts could serve as donor or as acceptor molecules. The frequency of crossovers between one pair of RNA3 variants, which possessed closely located markers, was similar to that of another pair of RNA3 variants with more distant markers, suggesting the existence of an internal recombination hot spot. The majority of crossovers were precise, but some recombinants had minor sequence modifications, possibly marking the sites of imprecise homologous crossovers. Our results suggest discontinuous RNA replication, with the replicase changing among the homologous RNA templates and generating RNA diversity. This approach can be easily extended to other RNA viruses for identification of homologous recombination hot spots.

Endoscopic Nd-YAG laser therapy of gastric polyposis

Thirteen patients with gastric polyposis (113 polyps) were treated by endoscopic Nd-YAG laser irradiation. Among them there were five cases with adenomas, six with hyperplastic polyps and two with inflammatory polyps. Ninety-six polyps were <1 cm, 13 polyps were ⩾ 1 cm, and four polyps were ⩾ 2 cm. In the patient who had the largest number of lesions, 22 polyps were found at endoscopic examination. All but two patients were regularly followed up endoscopically for 2–5 years after treatment and showed no sign of recurrence. Mild bleeding occurred in three cases. No perforation or any other serious complications occurred. The results were encouraging. It is concluded that endoscopic Nd-YAG laser ablation of gastric polyposis is effective, simple to perform, safe and deserves recommendation.

CLINICAL STUDY ON 103 OPERATED CASES OF INGRWON NAIL

Ingrown nail is not uncommon, but the disease has been rarely subjected to some studies up to now. In this paper 103 lesions of 80 patients with ingrown nail of the first toe operated on at our hospital from April 1989 to October 1991 are presented in terms of operative procedures, with some discussion. Patients with ingrown nail were predominant in their teens or twenties, representing about two-third of all patients. The male-to-female ratio was 1:1.2, showing a predominance in women. Somewhat larger number of lesions were located in the right side. Many lesions in both right and left sides were commonly found in the outside region. Postoperative recurrence was noted in 11 cases (10.7%), of which lesions were mostly found in the right inside or left outside areas. These recurrence patterns were: appearenece of spire of the nail in 6 cases; recurrence of ingrown nail in 4; and epidermoid cyst formation in one. In the treatment of ingrown nail, surgical treatment is recommended at present, though, the importance of more careful and certain operation would be emphasized.

Molluscum Contagiosum

• Background and Design.— Molluscum contagiosum in acquired immunodeficiency disease, although not life threatening, is often a marker of late-stage disease and may lead to disfiguring cutaneous lesions. Although most current therapy results in at least temporary clearing of individual lesions, lesions frequently recur and new lesions arise. Examination of hematoxylin-eosin-stained histologic sections in two patients showed changes suggestive of viral infection in the epidermis 0.5 cm and 1 cm lateral to obvious clinical lesions. These areas were clinically free of any lesions. Both routine histopathologic examination and ultrastructural examination were performed in two patients infected with human immunodeficiency virus type 1 (HIV-1) and three non-HIV-1-infected patients. Results.— All patients showed histologic changes diagnostic of molluscum contagiosum. In addition, the sections from HIV-1-infected patients showed areas of acanthosis, hyperkeratosis, and nuclear atypia. Electron microscopy of these areas revealed rare viral organisms in these areas. Similar acanthotic, hyperkeratotic areas were not seen in the biopsy specimens from the non-HIV-1-infected patients and no viral particles were found in the epidermis around the lesions. Conclusion.— Viral structures consistent with molluscum contagiosum are present within the clinically normal epidermis around lesions of molluscum contagiosum in some HIV-1-infected patients. This may explain the large number of lesions seen in these patients and the difficulty in controlling the spread and recurrence of molluscum contagiosum in HIV-1-infected patients. (Arch Dermatol.1992;128:223-227)

Papular Eruption of Human Immunodeficiency Virus Disease

The papular eruption (PE) associated with human immunodeficiency virus infection, although described as a distinctive clinicopathologic entity, has shown a wide range of histologic findings ranging from eosinophilic folliculitis to granuloma annulare. We examined 48 cases of the PE in order to define the histologic spectrum of these lesions, and to correlate these findings with clinical presentations. The most distinctive clinical features are the frequency of these lesions in this population, the large number of lesions, pruritus, and the chronic nature of the lesions. Histologically, the distinctive features are the prominent perivascular factor XIIIa-positive dermal dendritic cells, atypical vascular proliferation, and dermal fibrosis sometimes associated with diffuse necrobiotic changes.

DNA damage metabolism and aging

As a result of permanent exposure to low levels of various endogenous and exogenous genotoxic agents, large numbers of lesions are continuously induced in the DNA of cells of living organisms. Such lesions could lead to dysfunction of cells and tissues, and they might well be the underlying cause of the age-related reduction of homeostatic capacity and the increased incidence of cancer and other diseases of old age. The rate of damage induction as well as the persistence of the lesions depends on the activity, efficiency and reliability of a wide variety of molecular defense systems. However, a certain degree of imperfection seems to be a general characteristic of most of these defense systems and this could lead to a gradual accumulation of DNA alterations during aging. Even when the original lesions are quickly removed, they can still lead to secondary changes in the DNA, such as DNA-sequence changes and changes in gene expression. This process would be accelerated in case of the occurrence of an age-related decline in the efficiency of these molecular defense systems. This review deals with the present knowledge on the occurrence of 'spontaneous' DNA damage in aging organisms, its potential sources, the influence of preventive and processive cellular defense mechanisms and its consequences in terms of DNA-sequence changes, DNA conformational and configurational changes and changes in gene expression. In general, it can be concluded from the data discussed here that, in spite of a number of discrepancies and conflicting results, an age-related accumulation of DNA alterations occurs at all levels, e.g., chemical structure, DNA-sequence organization and gene expression.

Spatial and Temporal Analysis of Spread of Late Leaf Spot of Peanut

As secondary cycles developed, disease gradients became more shallow. Isopathic rates decreased with increasing isopath level. Defoliation was first observed about 2 wk after the appearance of lesions and progressed from the lowermost to the uppermost leaves, despite large numbers of lesions throughout the canopy. Disease incidence data were useful in defining a measure of the extent of disease spread within the plot. Severity data provided information on the intensity of disease across the incidence gradient

Cycles of repeated augmentation pressure in rapid production of pancreatic and cholangiocellular carcinomas in hamsters initiated with N-nitrosobis(2-oxopropyl)amine

We previously reported a rapid production model for pancreatic carcinoma development in Syrian hamsters incorporating the principle of selection by resistance to cytotoxicity. In the present experiment, the efficacy of repeated augmentation pressure with regard to generation of pancreatic lesions in hamsters initiated with N-nitrosobis(2-oxopropyl)amine (BOP) was investigated. Forty-eight female Syrian golden hamsters were divided into four groups according to the frequency of augmentation pressure. Group 1 received 70 mg/kg body weight of BOP and three injections of 20 mg/kg BOP. Groups 2-4 received 70 mg/kg BOP followed by one, two or three cycles of augmentation pressure consisting of dl-ethionine on sugar and salt diet, l-methionine and 20 mg/kg BOP. Hamsters were killed 10 weeks after the beginning of the experiment and the resultant incidences of pancreatic carcinomas from groups 1-4 were 0, 30, 50 and 46.2% respectively, the numbers of pancreatic carcinomas increasing with the frequency of augmentation pressure. A 46.2% yield of cholangiocarcinomas was also observed in group 4. The model should be useful for investigation of potential modulating factors since large numbers of lesions can be induced within a total experimental period of only 10 weeks.

Ia-like antigens on freshly explanted human melanoma

Human Ia-like antigens have unexpectedly been found on human melanoma cells maintained in long-term culture. Since these antigens may play a role in the biology of melanoma and in the interaction of the tumor with the host's immune system, tissues surgically removed from 16 patients in different stages of the disease were tested in indirect immunofluorescence with monoclonal antibodies and operationally specific xenoantisera to framework determinants of Ia-like antigens. All of the samples which included primary, metastatic, and recurrent lesions specifically reacted with anti Ia-like antigen antibodies. Melanoma cells can synthesize Ia-like antigens since they reappeared on cells cultured in vitro following treatment with pronase. The number of Ia-like antigen-positive cells in the melanoma lesions ranged from 15 to 90% and was unrelated to the presence of melanine and to the clinical stage of the disease; however, a low number of Ia-like antigen-bearing cells was found in primary tumors with high levels of invasivity (Clark's staging) and in lesions from patients with massive metastatic spreading. Intradermic nevi surgically removed from 14 patients did not react with anti Ia-like antigen xenoantibodies. If these results are confirmed with a large number of lesions then testing of tumor biopsies for Ia-like antigens may aid to solve controversial diagnosis of melanoma.

Two outbreaks of Microsporum canis ringworm in Israel.

An imported Persian cat and a young pooddle were the source of transmission for two outbreaks of ringworms. In the first outbreak 12 subjects were infected, in the second one six individuals became infected. The largest number of lesions, exceeding 150, were found in two girls, involved in the first outbreak. Scalp involvement was detected in 3 out of the 6 children in the first outbreak and in one out of the 5 children from the second one. The fungal nature of the infections was demonstrated by the presence of hyphae in KOH treated scrapings and by the fluorescing hairs found, both in the children as well as in the respective animals. M. canis was cultured from the human and animal lesions. Positive results were obtained with the isolated strains in white mouse and guinea pig inoculation. Microsporum canis is not a common dermatophyte in Israel. Human infections by this fungus have been sporadically reported and only in the last years (Alteras & Lehrer (1), Dvoretzky et al. (6). According to Kuttin & Beemer (10), animal infections by this organism in Israel have been found in cats and dogs.

O-diphenol O-methyltransferases of healthy and tobacco-mosaic-virus-infected hypersensitive tobacco

Three distinct o-diphenol O-methyltransferases (OMTs) were found in leaves of Nicotiana tabacum, variety Samsun NN. They could be clearly distinguished by differences in elution pattern upon chromatography on DEAE-cellulose and in specificity towards 16 diphenolic substrates. The phenylpropanoids caffeic acid and 5-hydroxyferulic acid, whose importance as lignin precursors is well known, were the best substrates of OMT I, but they were also efficiently methylated by the two other OMTs that showed a broader substrate specificity. The highest rates of methylation were observed by assaying these latter enzymes with catechol, homocatechol and protocatechuic aldehyde. The flavonoid quercetin, the major o-diphenol of tobacco leaves, was a good substrate for OMTs II and III, but was also methylated significantly by OMT I. The tobacco OMTs showed both para-and meta-directing activities with protocatechuic acid, protocatechuic aldehyde and esculetin as substrates. Para-O-methylation of the former substrate arose almost exclusively from OMT I whereas that of the two latter substrates from all three enzymes. In healthy leaves the total O-methylating activity varied very much with the batch of plants whereas the relative contributions of the three enzymes were rather constant. On an average, OMTs I, II and III acounted towards caffeic acid, respectively. In tobacco mosaic virus-infected leaves carrying local necrotic lesions we found the same three OMTs with the same substrate specificities, but with increased activities. The degree of stimulation of both OMTs II and III was 2-3 times greater than that of OMT I when the leaves had a moderate number of lesions, and 3-5 times greater with large number of lesions. It is very likely that the changes in both the pattern of the O-methylating enzymes and the concentrations of the naturally occuring o-diphenolic substrates are related to an increased biosynthesis of lignins and of lignin-like compounds. These aromatic polymers could be involved in the cell wall thickening associated with the hypersensitive reaction and with the resistance to virus spread that occur in the cells surrounding the local lesions.

CONDYLOMATOUS LESIONS OF THE CERVIX AND VAGINA. I. CYTOLOGIC PATTERNS

Condylomatous lesions, although readily diagnosed on the vulva, are often missed in the vagina and on the cervix by clinical examination alone. The lesions are, however, quite common and may be misdiagnosed as mild dysplasia by cytology, colposcopy and even tissue examination. Condylomatous lesions are presently diagnosed on cytologic evidence in nearly two per cent of asymptomatic patients screened in our program and followed-up by colposcopy and tissue examination, when indicated. The cytologic presentation of these lesions is quite characteristic. The main features are seen in squamous cells: enlargement, bi- or multinucleation, hyperchromasia, peri-nuclear clearing, amphophilia and dyskeratotic changes. Our present experience indicates that a large number of lesions previously classed as mild dysplasias actually represent various stages of condylomatous lesions. When these stages of viral changes are removed from the group of dysplasias, the remaining cases become of much greater significance as the early stages of evolution of carcinomata of the cervix.

Generalized Granuloma Annulare

A clinical and histologic study of 26 patients with generalized granuloma annulare was made at the Mayo Clinic. The histologic features and sex ratio were found to be similar to the localized form of granuloma annulare. The generalized form, in addition to having a large number of lesions, differs from the localized form in that most patients involved were in the fourth to the seventh decade. Follow-up indicates that, although the eruption is chronic, spontaneous clearing may occur. Neither the extent nor the duration of the eruption affected the general health of the patient. No significant association with other disease was noted. No laboratory abnormalities were found that could be associated with the skin eruptions. A similarity both clinically and histologically to sarcoidosis and a form of tuberculosis was noted.

Disseminated Superficial Actinic Porokeratosis

Lesions of disseminated superficial actinic porokeratosis (DSAP) were experimentally produced following prolonged artificial ultraviolet light radiation. DSAP, a genodermatosis with an autosomal dominant mode of inheritance, is disseminated primarily on sun exposed areas of the skin of adults, the largest number of lesions being on the extremities. Lesions often increase in number and become more prominent during summer months when sun exposure is great. It is important that DSAP be distinguished from porokeratosis of Mibelli because some lesions of DSAP mimic precancerous actinic keratoses and other conditions. DSAP is also more common in occurrence in some geographic areas with increased levels of sunlight.

Disseminated superficial actinic porokeratosis. Clinical studies and experimental production of lesions.

Lesions of disseminated superficial actinic porokeratosis (DSAP) were experimentally produced following prolonged artificial ultraviolet light radiation. DSAP, a genodermatosis with an autosomal dominant mode of inheritance, is disseminated primarily on sun exposed areas of the skin of adults, the largest number of lesions being on the extremities. Lesions often increase in number and become more prominent during summer months when sun exposure is great. It is important that DSAP be distinguished from porokeratosis of Mibelli because some lesions of DSAP mimic precancerous actinic keratoses and other conditions. DSAP is also more common in occurrence in some geographic areas with increased levels of sunlight.

Time-dose studies in irradiation of mycosis fungoides; iso-effect curve and tumor lethal dose.

Construction of iso-effect recovery curves for each type of tumor is a necessary step toward improving knowledge of irradiation dosage. It is suspected, though not demonstrated, that different types of tissue have specific recovery rates. The recovery rate is also influenced by the size of the daily fraction (1). The difficulty in constructing iso–effect curves was considered in a previous paper based on the treatment of multiple chest wall nodules of recurrent breast cancer (2). The same paper discussed Strandqvist's iso–effect curve for skin cancer and indicated potential errors when data are based on patients with a single lesion. Mycosis fungoides is a useful test object for study of the recovery rate because the multiplicity of lesions permits confirmation of each given dose by means of the corroborated dose technic (2) described below. Two cases, each with a large number of lesions (28 and 35, respectively), are reported below. This permitted the construction of a useful iso-effect curve for each patient. Furthermore, it became possible to compare the iso–effect curve of a markedly radiosensitive tumor with that of one which was only moderately radiosensitive. Case Reports CASE I: E. K., a white male aged 50 years, exhibited the first lesions of mycosis fungoides in 1945 at the age of forty-two. Severe generalized pruritus was present for a period of one and one-half years, at the end of which time numerous cutaneous lesions became apparent. Repeated biopsies of skin nodules led to a diagnosis of mycosis fungoides. Between the onset of disease and the first admission to the Radiation Therapy Department of University Hospital in August 1952, the patient had been treated with Fouadin, nitrogen mustard, ACTH, roentgen irradiation, and thorium–X. These agents had produced temporary remissions. Hospitaliza–tion became necessary because of anemia, loss of weight, and severe exacerbation of the cutaneous lesions. The patient was thin, undernourished, and showed signs of pruritus. The mycosis fungoides lesions were generalized and of three types: crusted papules, scaly plaques, and nodular tumors (Fig. 1). Twenty-eight cutaneous and subcutaneous nodular tumors were individually irradiated. The nodules ranged in diameter from 1 to 8 em., most of the irradiated nodules being from 2 to 4 em. in diameter. The factors were 200 kv; 0.75 mm. Cu and 1 mm. Al :filter; h.v.l, 1.0 mm. Cu; 25 em. target–skin distance. The portal size ranged from 9 to 50 sq. em. All doses are expressed as tumor doses measured with back–scatter. The corroborated dose technic, previously employed by the authors in the study of recurrent skin nodules of breast cancer, was used in this case to obtain iso-effect curves based on the “minimum tumorlethal dose.”

About skin changes when working with lime

In the study of occupational morbidity in new construction, a significant loss of working days of medium-sized industrial construction workers (plasterers, painters, bricklayers, laborers) attracts attention. It should be noted that a large number of lesions are also noted among cleaners when cleaning floors after whitewashing. Burnt lime-calcium oxide, is the most widely used in buildings, by adding water to it is obtained slaked lime, which is mixed with sand and clay for plastering. Lime is an important part of cement, which is used in building work. Regarding the action of lime on the skin, it should be noted that it is similar to the action of alkalis, consisting in saponification of fats, absorption of moisture from the skin, dissolution of proteins, irritation and cauterization of tissues.

About syphilitic diseases of internal organs

The very fact that I have the high honor to speak here, in the oldest center of medical science, in Utrecht, in your highly respected Society for Syphilitic Diseases of Internal Organs, testifies to the great interest and significant urgency of the problem of visceral syphilis. Three chronic infections are the cause of a large number of lesions of internal organs - tuberculosis, malaria and syphilis - and of them syphilis really deserves special attention, since it is about it that the doctor most often forgets, and meanwhile, at the time of recognizing a syphilitic disease of internal organs, it often means not only save the patient, but also experience the greatest pleasure of medical creativity and the joy of fulfilling the high duty of a doctor.