Leon Gilead

Maggot therapy for the treatment of intractable wounds

Background Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid‐1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re‐introduced in the USA, UK, and Israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long‐term hospitalized patients in Israel.

A nonsense mutation in the desmoglein 1 gene underlies striate keratoderma

Abstract:  Striate keratodermas (PPKS) (OMIM 148700) are a rare group of autosomal dominant genodermatoses characterized by palmoplantar keratoderma typified by streaking hyperkeratosis along each finger and extending onto the palm of the hand. We report a four‐generation kindred originating from Iran‐Syria in which three members were affected with PPKS. Clinically, these patients present with hyperkeratotic palms and plantar plaques. Direct DNA sequencing analysis revealed a heterozygous C‐to‐A transversion at nt 395 of the DSG1 gene. This mutation converted a serine residue (TCA) in exon 5 to a nonsense mutation (TAA) designated S132X. The mutation identified in this study is a novel mutation in the DSG1 gene and extends the body of evidence implicating the desmoglein gene family in the pathogenesis of human skin disorders.

Efficacious topical treatment for human cutaneous leishmaniasis with ethanolic lipid amphotericin B

Old World cutaneous leishmaniasis (CL) is a widespread and potentially disfiguring protozoa1 infection, caused by the infection of dermal macrophages with Leishmania parasites. Despite the various implemented measures to prevent the disease, there is a steady number of infected individuals who seek treatment. Systemic treatments available are very often unjustified owing to their toxicity (e.g., pentavalent antimonials) or to their variable efficacy (e.g., ketoconazole). Topical treatment, the obvious way to treat a localized skin disease, still poses a challenge. Paromomycin-containing preparations have proven effective in some cases (El-On et al., 1985), but not in others (KLAUS et al., 1994; BEN SALAH et al., 1995), and often cause substantial skin irritation. Amphotericin B (AmB), a potent antileishmanial antibiotic, has not been previously delivered topically to dermal lesions. We have recently reported preliminary results showing that a colloidal dispersion of AmB and cholesteryl sulphate, in the presence of 5% ethanol and in the absence of glucose, has significant therapeutic effect in the treatment of CL lesions. The presence of glucose, on the other hand, inhibited the therapeutic effect (VARDY et al., 1999). Here we present results obtained in 1999-2000 on the treatment of 17 patients with AmB, in a prospective placebo-controlled study. Each patient had at least 1 placebo-treated and 1 AmB-treated lesion.

Bullous erysipelas: A retrospective study of 26 patients

BACKGROUND Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. OBJECTIVE We studied bullous erysipelas by conducting a retrospective analysis of 26 patients with bullous erysipelas of the legs treated by the authors during a 5-year period. METHODS We conducted a retrospective review of the records of all patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, Hadassah Medical Center, Jerusalem, between the years 1992 and 1996. Data regarding patients with nonbullous erysipelas were obtained from the medical centers computerized data pool. RESULTS A total of 26 cases of bullous erysipelas were found, comprising 22 women and 4 men whose ages ranged from 28 to 87 (mean, 58.8) years. The average hospital stay was 20.57 days (range, 12 to 46 days). The average hospital stay for patients with nonbullous erysipelas and cellulitis treated in the same department by the authors during the study period was 10.6 days (range, 2 to 54 days). CONCLUSION Bulla formation is a complication of erysipelas, seen in our series in 5.2% of the patients (26 of 498 admissions for erysipelas and cellulitis). The course of the disease is protracted, requiring longer medical attention.

Diagnostic performance and retention of acquired skills after dermatology elective.

Background   The dermatology elective often constitutes the future physicians only exposure to dermatologic practice. Cost–benefit considerations dictate that the elective enables the students to acquire useful diagnostic expertise in the short time period available, and that this expertise is not rapidly forgotten after completion of the elective.

South American cutaneous leishmaniasis: report of ten cases in Israeli travelers

Background Cutaneous South American leishmaniasis is caused by several species of leishmaniasis. Lack of appropriate treatment may lead to mucocutaneous leishmaniasis, mainly with L. b. braziliensis and L. b. panamensis.

Insulin-like growth factor-binding protein-7 (IGFBP7) transcript: A-to-I editing events in normal and cancerous human keratinocytes

Non-melanoma skin cancers (NMSC) are the most common malignancies in caucasians worldwide. Insulin-like growth factor-binding protein-7 (IGFBP7) was suggested to function as a tumor suppressor gene in several cancers, and to play a role in the proliferation of keratinocytes. A-to-I RNA editing is a post-transcriptional mechanism frequently used to expand and diversify transcriptome and proteome repertoire in eukaryotic cells. A-to-I RNA editing can alter codons, substitute amino acids and affect protein sequence, structure, and function. Two editing sites were identified within the IGFBP7 transcript. To evaluate the expression and editing of IGFBP7 mRNA in NMSC compared to normal epidermis. We examined the expression and mRNA editing level of IGFBP7 in 22 basal cell carcinoma (BCC), 15 squamous cell carcinoma (SCC), and 18 normal epidermis samples that were surgically removed from patients by the Mohs Micrographic Surgery procedure. We studied the effect of IGFBP7 editing on an immortalized HaCaT keratinocyte cell model. IGFBP7 mRNA is over expressed in BCC and SCC compared to normal epidermis. Moreover, the IGFBP7 transcript is highly edited in normal epidermis, but its editing is significantly reduced in BCC and SCC. The edited form of IGFBP7 can inhibit proliferation and induce senescence in cultured keratinocytes. This study describes for the first time A-to-I editing in the coding sequence of a tumor suppressor gene in humans, and suggests that IGFBP7 editing serves as a fine-tuning mechanism to maintain the equilibrium between proliferation and senescence in normal skin.

Fatal hemophagocytic syndrome in a patient with panniculitis-like T-cell lymphoma and no clinical evidence of disease.

Panniculitis-like T-cell lymphoma is an uncommon type of extranodal T-cell lymphoma which presents clinically with subcutaneous nodules. The clinical course can either be indolent or rapidly progressive, often complicated by hemophagocytic syndrome. We report a patient with primary subcutaneous disease and initial complete response to combination chemotherapy. The patient experienced an early relapse which responded to salvage chemotherapy. However, she died shortly thereafter with hemophagocytic syndrome, polymicrobial sepsis and systemic fungal infection. At autopsy there was no evidence of lymphoma in the bone marrow or other organs. We emphasize that a fatal hemophagocytic syndrome can occur despite minimal or even without evidence of clinically active lymphoma as demonstrated by autopsy in this case.

Salicylate intoxication from topically applied salicylic acid

A 42‐year‐old patient with psoriasis developed salicylism while being treated with topical salicylic acid. The clinical and biochemical abnormalities in salicylism are reviewed.