Garry R Cutting, M.D.
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0002718/garry-cutting
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Apocrine gland cyst with hemosiderotic dermatofibroma-like stroma: Report of two cases. Familial syringoma: Case history and application of monoclonal anti-eccrine gland antibodies. Clear cells of eccrine glands in a patient with clear cell syringoma associated with diabetes mellitus. Autoimmune acrosyringitis with ductal cysts: Reclassification of case of eruptive syringoma. Vulvar syringoma: A clinicopathologic and immunohistologic examine of 18 patients and results of therapy. Immunohistochemical analysis of keratin expression in clear cell syringoma: A comparative examine with standard syringoma. Multiple Syringome mit Vermehrung von Mastzellen unter dem klinischen Bild einer Urticaria pigmentosa. Solitary syringoma: Report of five instances and clinicopathologic comparison with microcystic adnexal carcinoma of the pores and skin. Malignant dermal cylindroma in a affected person with a number of dermal cylindromas, trichoepitheliomas, and bilateral dermal analogue tumors of the parotid gland. The pathogenesis of familial a quantity of cylindromas, trichoepitheliomas, milia, and spiradenomas. Dermal eccrine cylindroma, epithelioma adenoides cysticum of Brooke, and eccrine spiradenoma. Dermal cylindromas (turban tumor) and eccrine spiradenomas in a patient with membranous basal cell adenoma of the parotid gland. Metamorphosis of dermal cylindroma: Possible relation to malignant transformation. Brooke�Spiegler syndrome: Report of a case, with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation. Cylindroma (dermal analog tumor) of the breast: A comparability with cylindroma of the pores and skin and adenoid cystic carcinoma of the breast. Ultrastructure and histochemical traits of dermal eccrine cylindroma (turban tumor).
The papillae had cellular cores containing pericytes and stromal cells, arranged round regular small capillaries. These vessels are lined by endothelium and have a fibromuscular wall that incorporates elastic fibers but no definite elastic laminae. Old lesions are composed of collapsed thin-walled anastomosing vascular channels with hemosiderin. Staining with D2-40, the new lymphatic endothelial marker, exhibits microshunts between neoplastic lymphatic channels and small blood vessels, explaining the aneurysmal microstructures and the erythrocytes and hemosiderin. In the deep dermis and subcutis, the channels dissect collagen bundles and encompass sweat glands. Lesions could also be single or a quantity of; multiple lesions are likely to occur in a single area. The arms and toes are the most common sites, however lesions additionally happen on the trunk. Such recurrences could come up from contiguous spread along or multifocal involvement of a vessel. The first is a vascular element of thin-walled cavernous channels that will include thrombi or phleboliths. The third element is plump endothelial cells, either in teams or lining vascular channels. Although all six circumstances within the unique report by Requena and colleagues had been women, two of the 5 instances seen by the creator have been in males. Extensive cutaneous involvement and linear lesions alongside the lines of Blaschko have been reported. Electron microscopy Ultrastructural studies have proven a heterogeneous cell population in stable areas; nevertheless, occasional cells contain Weibel�Palade our bodies, confirming that some cells are displaying endothelial differentiation. The eruptive instances (discussed previously) cleared with corticosteroids, only to recur later. It is a circumscribed, mainly strong proliferation of large polygonal epithelioid cells with eosinophilic cytoplasm, with enlarged nuclei and outstanding nucleoli. Thick-walled capillaries and downgrowth of the rete ridges between groups of vessels have also been described. Although beforehand considered a telangiectatic process, a component of vascular proliferation appears to be current.
Acral pseudolymphomatous angiokeratoma of kids: Immunohistochemical and clonal analyses of the infiltrating cells. Cutaneous collagenous vasculopathy associated with intravascular occlusive fibrin thrombi. Cutaneous collagenous vasculopathy: Description of two new instances in aged girls and evaluation of the literature. Telangiectasia and gingival hyperplasia as side-effects of amlodipine (Norvasc) in a 3-year-old lady. Photodistributed eruptive telangiectasia: An unusual opposed drug reaction to venlafaxine. Reticular telangiectatic erythema associated with an implantable cardioverter defibrillator: An underpublished entity Is postsurgical sternal erythema synonymous with reticular telangiectatic erythema Ultrastructure and organization of the cutaneous microvasculature in normal and pathologic states. Acquired scrotal lymphangiomas: Successful treatment with slicing diathermy and carbon dioxide laser. Cutaneous lymphangiectases after remedy for, carcinoma of the cervix � A case with uncommon medical and histological features. Vulvar lymphangioma circumscriptum: A uncommon complication of therapy for squamous cell carcinoma of the cervix. Treatment of acquired cutaneous lymphangiectasis of the, thigh and vulva with a carbon dioxide laser. Acquired cutaneous lymphangiectasia with mesothelial cells reflux in a affected person with cirrhotic ascites. Cutaneous lymphangiectases related to extreme photoaging and topical corticosteroid utility. Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis. Proceedings of a Research Workshop on Infantile Hemangiomas, April 7�9, 2005, Bethesda, Maryland. Comparison of infantile hemangiomas in preterm and time period infants: A potential research.
Antibody to S100a6 protein is a delicate immunohistochemical marker for neurothekeoma. Neurothekeoma: An evaluation of 178 tumors with detailed immunohistochemical knowledge and long-term affected person follow-up data. Multiple mobile neurothekeomas � A case report and evaluation of the position of immunohistochemistry as a histologic adjunct. Cellular neurothekeoma with a plexiform morphology: A case report with a dialogue of the plexiform lesions of the skin. Cellular neurothekeoma: Analysis of 37 circumstances emphasizing atypical histologic options. Neurothekeoma of Gallager and Helwig (dermal nerve sheath myxoma variant): Report of a case with electron microscopic and immunohistochemical research. Cellular neurothekeoma: A distinctive variant of neurothekeoma mimicking nevomelanocytic tumors. Ossifying plexiform tumor: Report of a cutaneous ossifying lesion with histologic options of neurothekeoma. Cellular neurothekeoma in a lady: Could oestrogens favour the event and growth of this uncommon tumour Arborizing vessels under dermoscopy: A case of mobile neurothekeoma as a substitute of basal cell carcinoma. The histogenesis of nerve sheath myxoma: Report of a case with electron microscopy. Multiple granular cell tumors in a baby with development retardation: Report of a case and evaluation of the literature. Multiple granular cell tumors related to big speckled lentiginous nevus and nevus flammeus in a child. Multiple visceral and cutaneous granular cell tumors: Ultrastructural and immunocytochemical proof of Schwann cell origin. Multiple cutaneous granular cell tumors in a baby with possible neurofibromatosis.
Diseases
All antiarrhythmic medicine have the potential for proarrhythmia, the unintended precipitation of a new arrhythmic drawback brought on by the drug. Adverse rhythm results of drugs may include sinus node dysfunction, heart block, promotion of drug-slowed atrial flutter allowing speedy 1: 1 conduction, and promotion of doubtless deadly ventricular arrhythmias. Class I medicine such as flecainide, propafenone, and disopyramide might result in significant direct myocardial despair and consequent exacerbation of heart failure. The array of potential adverse results of antiarrhythmic drugs is past the scope of this chapter, however certain important concepts are necessary to acknowledge. Use of these medication is restricted to sufferers with preserved cardiac perform and no proof of obstructive coronary artery disease. However, on this chosen group of sufferers with regular hearts, these medicine are exceedingly secure, nicely tolerated, and infrequently efficient. However, sotalol and dofetilide may provoke TdP, even in sufferers with normal cardiac function, they usually have to be used with caution. Amiodarone has higher longterm efficacy than different drugs and a decrease threat of proarrhythmia, but long-term somatic toxicity consisting of thyroid dysfunction, pulmonary, and occasional hepatotoxicity limits the use of this drug in older patients or those with restricted anticipated longevity or an inability to safely tolerate alternative brokers because of superior cardiac disease or proarrhythmia. Dronedarone, which was accredited in 2009, was derived by modification of the amiodarone molecule. However, the techniques used differ extensively from one heart to one other and long-term reporting of outcomes is inconsistent. In a big sequence that included 282 sufferers present process an open bi-atrial ablation procedure, 78% have been in sinus rhythm without antiarrhythmic therapy on the 1 12 months follow-up analysis. This could be completed by full amputation of the appendage with oversewing of the appendage or clamping off the opening to the appendage with particular units designed for this function. This could also be especially necessary in patients with absolute or relative contraindications to anticoagulation. Antiarrhythmic medication other than sotalol, dronedarone, or amiodarone ought to therefore be mixed with a fee management agent similar to a -blocker or nondihydropyridine calcium-channel blocker throughout long-term therapy. The preliminary process was thought to be highly profitable however was related to important surgical risks and issues with sinus node dysfunction.
The ensuing large stroke quantity, together with the regurgitation, is liable for lots of the findings on bodily examination. The elevated diastolic filling leads to a soft S1 heart sound, and an S3 gallop may be present even within the absence of clinical heart failure. Auscultation of the everyday diastolic decrescendo murmur, heard at either the left or the right sternal border, may be improved by inspecting the affected person as she or he is leaning forward at end-expiration. A diastolic flow rumble on the left sternal border may be confused with mitral stenosis; this is known as an Austin-Flint murmur. A soft systolic murmur could additionally be present because of the big stroke volume ejected in systole (see Table 7-2). Left heart filling pressures rise rapidly, and respiratory failure from pulmonary edema develops. If mitral leaflet motion becomes restricted in opening, resistance to circulate develops. The resulting severity of stenosis could be described by the pressure gradient that develops between the left atrium and left ventricle throughout diastole or by the size of the mitral valve opening. Treatment Acute Severe Regurgitation the mainstay of management within the affected person with cardiogenic shock consists of attempts at medical stabilization through afterload reduction while preparing for urgent surgery. Death because of pulmonary edema, ventricular arrhythmias, or hemodynamic collapse is well described, and surgical procedure is the established commonplace of look after these severely ill sufferers. Drugs similar to intravenous nitroprusside may be helpful to rapidly obtain afterload discount and improve cardiac output whereas the patient is prepared for urgent surgery. Chronic Severe Regurgitation Patients might tolerate this lesion properly because of compensatory mechanisms, remaining asymptomatic for many years. Although restricted mitral leaflet motion due to rheumatic coronary heart disease is by far the most common trigger, immune disease affecting the valve and congenital abnormalities can also lead to stenosis. Mitral influx stenosis also can sometimes happen from extreme calcification around the mitral annulus. A left atrial myxoma might lodge persistently or intermittently in the mitral annulus, leading to obstruction to ventricular inflow.
In cases of pseudolymphoma as a outcome of phenytoin therapy, discontinuation of the drug is associated with sustained remission of signs and signs. It has also been reported sporadically in areas of Europe and the southeastern United States. An aggressive acute form seen in roughly 65% of sufferers and related to a very high white cell rely, hepatosplenomegaly, hypercalcemia, and lytic bone lesions 2. Lymphadenopathy and hepatosplenomegaly could additionally be current in addition to pores and skin manifestations three. Erythroderma and vesiculobullous and purpuric eruptions are less common cutaneous manifestations. In lymphomatoid granulomatosis, the perivascular T cells are morphologically bland, and the atypical lymphocytes mark as B cells. In the nodule and tumor stage, the dermal infiltrate is extra in depth, confluent, and atypical and might lengthen into the subcutis. A small cell variant with intermediate-sized atypical cells has additionally been described. Potential morphologic clues to the prognosis include scattered cells with options of mononucleated Reed� Sternberg cells and, in one recent report, the discovering of epidermotropic foci. Lesions spontaneously regress after a number of weeks or months, generally resulting in atrophic scars. Initially, the lesions are smooth, but later they turn into necrotic, crusted, and ulcerated. There is an elevated frequency of prior, coexisting, or subsequent lymphoproliferative issues related to LyP: that is most com- Histopathology645 the appearance of the lesions varies to a certain extent according to their age. There are presently 5 overlapping histopathological subtypes of LyP: sorts A, B, C,3D,646�648 and E. There is a background inhabitants of small lymphocytes, eosinophils, neutrophils, and histiocytes. The predominant cell varieties are small to mediumsized lymphocytes with cerebriform nuclei.
Treatment of capillary hemangiomas of early childhood with a new technique of cryosurgery. Periocular capillary hemangioma: A evaluate for pediatricians and family physicians. Orbit and eyelid hemangiomas: Is there a relationship between location and ocular problems Oral corticosteroid use is effective for cutaneous hemangiomas: An evidence-based evaluation. Evidence for loss of heterozygosity of 5q in sporadic haemangiomas: Are somatic mutations concerned in haemangioma formation Familial segregation of hemangiomas and vascular malformations as an autosomal dominant trait. Multiple hemangiomas in a patient with a t(3q;4p) translocation: An rare affiliation with Wolf-Hirschhorn syndrome. A unique microvascular phenotype shared by juvenile hemangiomas and human placenta. Endothelial cells in childish haemangiomas originate from the kid and not from the mom (a fluorescence in situ hybridizationbased study). Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Reticular infantile hemangioma of the limb may be related to ventral�caudal anomalies, refractory ulceration, and cardiac overload. Hemangiomas of infancy: Clinical traits, morphologic subtypes, and their relationship to race, ethnicity, and intercourse. Adverse effects of systemic glucocorticosteroid remedy in infants with hemangiomas. Simultaneous occurrence of childish hemangioma and congenital melanocytic nevus: Coincidence or actual affiliation
Bengerd, 39 years: Pleomorphic rhabdomyosarcoma in adults: Immunohistochemistry as a software for its analysis. Multiple dermatofibromas in patients with autoimmune disorders receiving immunosuppressive therapy. Basal cell carcinoma with distinguished central, palisading of epithelial cells mimicking schwannoma.
Hurit, 52 years: Cutaneous leiomyosarcoma originating in a symplastic pilar leiomyoma: A rare occurrence and potential diagnostic pitfall. Chronic energetic Epstein�Barr virus infection: A novel explanation for lymphocytic variant of hypereosinophilic syndrome. Histopathologic study of Koenen tumors: Are they totally different from acquired digital fibrokeratoma
Ketil, 33 years: Epidermal adjustments such as acanthosis and hyperkeratosis can also be present in addition to a lichenoid response with vacuolar change and apoptotic bodies on the dermoepidermal junction. Superficial angiomyxoma (cutaneous myxoma): A clinicopathologic examine of 17 instances arising in the genital area. ClinicalPresentation Hypercapnic encephalopathy is a clinical syndrome that often starts with irritability, headache, mental cloudiness, apathy, confusion, nervousness, and restlessness.
Sanuyem, 29 years: Superficial angiomyxoma: Clinicopathologic analysis of a sequence of distinctive but poorly acknowledged cutaneous tumors with tendency for recurrence. Chapter 27 FluidandElectrolyteDisorders 303 K+ rapidly enough in this setting to stop life-threatening hyperkalemia. Surgical therapy options for renal involvement due to aortic dissection depend on particular person circumstances, and cautious evaluation by an skilled vascular surgeon is really helpful.
References
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