Clinical Features Suggestive (clinical + feature_suggestive)

Distribution by Scientific Domains

Selected Abstracts

Oral lichen planus: a condition with more persistence and extra-oral involvement than suspected?

Marta Bidarra
Background:, Lichen planus is a relatively common and often studied chronic mucocutaneous condition. Reports detailing certain aspects relevant to patients affected have been lacking or inconsistent. Methods:, A questionnaire-based survey was employed to assess the duration of oral lesions and the prevalence of self-reported potential extra-oral manifestations associated with oral lichen planus in 87 patients. All patients had recognized clinical features of oral lichen planus, and most had had histopathological confirmation following oral biopsy. Results:, We report the findings of a preliminary survey which assessed the duration of oral lesions and the prevalence of extra-oral lesions consistent with lichen planus in patients presenting with oral lesions. The study confirmed the chronic nature of oral lichen planus and the rarity of spontaneous resolution. Most subjects had experienced symptoms for one to ten years (66 patients; 75.8%). Approximately 40% (36 patients) of the sample reported clinical features suggestive of extra-oral manifestations of lichen planus by the time that their oral lesions were apparent. The most commonly reported extra-oral manifestations involved the nails (27.6%, 24 patients). 25.3% (22 patients) reported a persistently sore throat suggestive of oesophageal or pharyngeal involvement. Skin (17.2%, 11 patients), and genital (10.3%, 9 patients) involvement was relatively infrequently reported. Most patients reported extra-oral lesions at only one site. Conclusions:, The survey results suggest that in patients with oral lichen planus oral lesions persist for a prolonged period, and that extra-oral lesions may be more common than suspected. However, further studies involving specialists to examine extra-oral sites are required. [source]

Possible role of dermoscopy in the detection of a primary cutaneous melanoma of unknown origin

M Stante
Abstract For 2,8% of patients with metastatic melanoma, cutaneous and mucosal clinical examination does not lead to diagnosis of the primary tumour, which remains unknown. We report the case of a 41-year-old male patient who had received a diagnosis of metastatic melanoma after histological examination of an enlarged axillary lymph node, without previous detection of the primary lesion at his first dermatological examination. No pigmented skin lesions located in the anatomical area potentially drained by the affected axillary basin showed clinical features suggestive of a melanoma. Neither did the so-called ,ugly duckling' sign help us to identify the melanoma, because of the presence of a large number of clinically similar, common or slightly atypical melanocytic lesions located in that area. After dermoscopic examination we were able to narrow the field of possible candidates for excision to four lesions, selected on the basis of their dermoscopic features. Histological examination revealed the primary melanoma (superficial spreading melanoma (SSM), level III, thickness 0.5 mm) , located on the back , and three naevi with atypia. Preoperative distinction of the melanoma from the other three lesions was not possible because of the lack of well-established features of malignancy, even at dermoscopic analysis (,featureless' melanoma). Dermoscopy may thus play a role in the detection of a clinically unknown primary melanoma by narrowing the field of lesions to be removed for histological examination, saving many unnecessary excisions that would otherwise be inevitable. [source]

Pemphigus Herpetiformis in Childhood

Isabela B. Duarte M.D.
The clinical features of this form of pemphigus resembles dermatitis herpetiformis, however, histological examination and immunofluorescence yield findings diagnostic for pemphigus. A 5-year-old female patient with clinical features suggestive of dermatitis herpetiformis is reported. Histopathological exam showed skin with subcorneous blisters, epidermal spongiosis containing predominantly neutrophils, few eosinophils and rare acantholytic cells. Direct immunofluorescence showed intercellular deposits of IgG and C3. The skin lesions responded poorly to dapsone associated with systemic corticosteroid therapy. A complete remission of bullous lesions was obtained with azathioprine and immunosuppressive doses of systemic corticosteroids (prednisone). A case of PH in childhood is reported here, emphasizing the rarity and young age of onset. [source]

Solar urticaria treated successfully with intravenous high-dose immunoglobulin: a case report

Isabel Correia
Solar urticaria is an idiopathic, chronic and rare photodermatosis, characterized by the sudden onset of pruritic urticarial hives and plaques on the exposed areas of the skin, after a brief period of exposure to the natural sunlight or to an artificial light source. A Caucasian 27-year-old man presented with clinical features suggestive of solar urticaria was referred to our photodermatology unit, where phototesting confirmed the diagnosis of solar urticaria induced by visible light. As he was refractory to oral antihistamines and had slight improvement under UVA plus visible phototherapy, human high-dose intravenous immunoglobulin was administered, with an excellent clinical-sustained response. [source]

Sexual Function and Tunica Albuginea Wound Healing Following Penile Fracture: An 18-year Follow-Up Study of 352 Patients from Kermanshah, Iran

Javaad Zargooshi MD
ABSTRACT Introduction., We present a study on the experiences of penile fracture in an Iranian population. Aim., To determine the long-term outcome of penile fracture. Methods., Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients' permission, their full name and hospital chart number was sent to the journal. Main Outcome Measures., Clinical findings and IIEF and EHGS scores. Results., Mean patients' age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie's disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 ± 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Conclusion., Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med **;**:**,**. [source]

Systemic anti-inflammatory fibrosis suppression in threatened trabeculectomy failure

Brendan Vote FRANZCO
Abstract Purpose:,To provide a rationale for the use of systemic anti-inflammatory fibrosis suppression in the postoperative management of threatened early trabeculectomy bleb failure. Methods:,A review of the literature and of the authors' own experiences was conducted. Results:,The most important cause of persistent elevation of intraocular pressure after trabeculectomy is unduly marked or persistent inflammation with deposition of fibrous tissue, which prevents the formation of an adequately draining bleb. It was found that a clinically useful degree of suppression of bleb inflammation and fibrosis can be obtained with a 4,6 week course of the combined systemic administration of prednisone (10 mg t.i.d.), a non-steroidal anti-inflammatory agent (e.g. diclofenac 100 mg SR daily) and colchicine (0.25 mg or 0.3 mg t.i.d.), which was termed anti-inflammatory fibrosis suppression. Topical atropine 1% t.i.d. and adrenaline 1% t.i.d. eye drops can also be considered in addition to routine postoperative topical steroids. Conclusions:,Despite advances in surgical techniques and methods to control fibrosis, anti-inflammatory fibrosis suppression is a valuable tool to have available in the post­operative period for management of trabeculectomies that threaten failure. This regime produces a diffuse bleb, which has a very low risk of late infection or bleb perforation. It is recommend that this regime be added to the list of therapies that are considered when clinical features suggestive of a failing bleb are confronted early in the post­operative course. [source]