Natural Scleroderma Relief

Natural Scleroderma Relief

Here's a quick look at what this new report covers: Calcium deposits (Calcinosis) noticible on the top layre of skin. How to permanently kill all the pathogenic nano bacteria using an easy to find supermarket product. A simple procedure which will stop the pathogenic bugs from ever returning. The easiest way to rid your body of all its harmful toxins & pollutants. Treating bacterial and fungal problems associated with the gastro-Intestinal tract naturally. A simple detoxification and cleansing agent for the kidneys. Re-build and strengthen your Immune-system. Restore your digestive system to its normal healthy state. Expelling excess free radicals from your body. Removing heavy metals deposits trapped in your body. Dealing with your depression. Re-charging your energy levels. Ease joints. Break down & remove excess calcium from your body without any medical intervention. Stop Acid Reflux problems in days without drugs

Natural Scleroderma Relief Summary

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Scleroderma

Limited cutaneous scleroderma, previously known as CREST syndrome (Calcinosis, Raynaud's, (o)Esophageal problems, Sclerodactyly, and Telangiectasia), has a high prevalence of ACA. Diffuse cutaneous scleroderma has ATA present in about 30 ofpatients.This is a more diffuse form with early onset of pulmonary, renal, gastrointestinal or myocardial disease.A third form has a high frequency of neurological disease. Scleroderma occurs more commonly in women, often in the 30 50-year age group. Pregnancy may worsen the disease, and there is a high incidence of fetal loss. Pulmonary hypertension was found to be the most frequent cause of death, and renal, cardiac and pulmonary involvement were features associated with reduced survival (Lee et al 1992).

Esophagectomy and Reconstruction

Gastric Pull

Esophageal resection is most frequently performed for carcinoma of the esophagus. Although less common, several other benign conditions may necessitate esophagectomy. For example, severe caustic burns to the esophagus often require esophageal resection and reconstruction. Esophageal perforation, primary motility disorders such as achalasia and scleroderma, and unsuccessful antireflux operations are additional indications for esophagectomy. Usually, these diseases may be managed with esophageal-sparing surgery, such as fundoplication or myotomy. Esophagectomy often represents the final treatment of patients with a variety of benign conditions who have failed more conservative surgical management.

Common Causes Of Malignant Hypertension

Atheroembolic renal disease (cholesterol embolism) Scleroderma renal crisis Antiphospholipid antibody syndromes Chronic lead poisoning Endocrine hypertension Aldosterone-producing adenoma (Conn's syndrome) Cushing's syndrome Congenital adrenal hyperplasia Pheochromocytoma

Radiation Therapy Factors

Certain collagen vascular diseases, such as scleroderma and systemic lupus erythematosus, have been associated with an increase in acute skin and subcutaneous toxicity to standard doses of radiotherapy and may be related to inadequate repair of sublethal radiation injury. However, a retrospective review of patients with collagen vascular disease showed that only patients with scleroderma exhibited prohibitive toxicity. Patients with other collagen vascular diseases did not experience prohibitive toxicity and could be considered candidates for BCT.58 The potentially deleterious effects of radiotherapy on the developing fetus prohibit patients in the first two trimesters of pregnancy from being candidates for BCT. Estimated cumulative fetal doses of 3 to 4 Gy are delivered with tangential radiotherapy.59 Because there is no known threshold dose for mutagenesis, radiotherapy is an absolute contraindication during the first two trimesters. Long-term effects of radiation during the third...

Novel Conformation of Phenotypespecific Autoantigens

B23 has also been found to be a scleroderma autoantigen associated with the development of pulmonary hypertension 98 and, in an analogous fashion to HCC B23, is also uniquely cleaved by GrB in differentiated smooth muscle cells 99 . Whether this selective cleavage in vascular smooth muscle cells reflects expression of cleavable B23 in areas of hyperplasia that is characteristic of pulmonary hypertension is unknown, but the association is tantalizing nonetheless. The striking restriction of a novel B23 conformation to the likely sites of immunization may indicate that distinct autoantigen conformations responsible for specific cellular functions (e.g., cell growth) are present during disease initiation and or propagation. It is possible that such pathways of autoantigen expression and conformation may become therapeutically tractable in the autoimmune diseases.

The SPOTscan Technique

100 antigen recognized by antibodies from patients with polymyositis-scleroderma overlap syndrome 98 and early endosome antigen 1 (EEA1) 99 . We have shown in our laboratory that the results obtained with overlapping peptides covering U1C protein prepared using either the SPOTsynthesis method or conventional techniques leading to free peptides tested by indirect ELISA largely agreed 62 .

Many Autoantigens Are Specifically Cleaved by GrB Generating Fragments Not Observed During Other Forms of Cell Death

The effect of autoantigen cleavage on recognition by autoantibodies has been addressed in part using an immunoblotting approach however, there is as yet no common feature that unifies all the antigens in terms of antibody recognition. Indeed, it is striking that GrB cleavage can have various effects on recognition of different molecules by autoantibodies. Although infrequently observed, GrB-generated fragments of autoantigens may be recognized better by autoantibodies than the intact molecule (e.g., the scleroderma autoantigen CENP-C 44 , enriched in patients with scleroderma and ischemic digital loss). There are also clear examples where GrB cleavage of an autoantigen greatly inhibits recognition by autoantibodies. For example, Gershwin and colleagues 92 demonstrated

Autoantigen Proteolysis During Granzyme Bmediated Cytotoxicity

In a recent study, Rosen's group demonstrated that the nucleolar autoantigen B23 was efficiently cleaved by GrB in vitro but was highly resistant to cleavage by GrB during CTL-induced cell death of many different types, with the exception of differentiated vascular smooth muscle cells, suggesting that the cleavage of this autoantigen is dependent upon cell type 147 . Given that B23 is associated with pulmonary vascular phenotype in scleroderma, it was concluded that GrB-mediated proteolytic modification of autoantigens may occur selectively in the target tissue and may play a role in shaping the phenotype-specific autoimmune response. According to this hypothesis, the immunizing microenvironment might play a central role in determining autoantibody responses in human systemic autoimmunity. To further test this hypothesis, it would be important to determine whether other autoantigens targeted in vitro by GrB (e.g., topo I, fibrillarin, CENP-B, PARP, and NuMA) are susceptible to...

Immediate Twostage Breast Reconstruction

Fibrosis resists effective expansion, limits ultimate projection, and increases the risk of capsule contracture, skin flap necrosis, implant exposure, and infection. Patients with compromised wound healing ability, such as those with scleroderma and lupus, may also benefit from alternative methods.

Toxicity Reports from Selected Single and Multi Institutional Studies

Stimulated in part by these early results from the Ochsner Clinic, the RTOG launched in 1995 a phase II trial (protocol 95-17) to further investigate the potential role of interstitial brachytherapy APBI in a multi-institutional setting. Enrollment allowed for randomization to two different dose delivery schedules LDR (45 Gy in 3.5-5 days) or HDR (34 Gy twice daily in ten fractions). This afforded the first opportunity to directly compare the effect of dose-rate technique on outcome. A toxicity analysis was reported on 99 patients (33 LDR, 66 HDR) after a median follow-up of 27 months (Kuske et al. 2002). The mean DHI for the entire study cohort was 0.82. Major acute toxicity was more commonly seen with LDR than with HDR techniques with grade 3 4 toxicity found in 9 and 3 , respectively. Similarly, late toxicity was found to be more severe with LDR technique with a 9 incidence of grade 3 4 skin thickening and a 12 incidence of grade 3 4 subcutaneous fibrosis. This was in contrast to...

Cladosporium Herbarum Nasal Problems Mexico

Basidiospores of Agaricus campestris, Coprinus micaceus, Lycoper-don perlatum, Scleroderma lycoperdoides, and Ustilago maydis caused allergies ranging from rhinitis to asthma in the eastern United States (Santilli et al., 1985). Basidiospores are antigenic and can elicit immediate skin reactivity in sensitive patients. Mushrooms and basi-diospores are considered most likely to be of outdoor origin, although mycelia and conidia of wood decay fungi and, occasionally, mushrooms of the genus Coprinus and wood decay fungi have been identified in indoor environments with a chronic water-damage history.

Antibodies to Nucleosomes Chromatin

In some studies, a high percentage of patients with systemic sclerosis were positive for anti-nucleosome antibodies 32, 41 . This was surprising because scleroderma patients do not exhibit a typical ANA immunofluorescence pattern when tested using HEp-2 cells. Methodological reasons for anti-nucleosomes reacting with scleroderma sera include the use of DNA reconstituted with the denatured antigens H2A and H2B, use of whole chromatin containing residual to-poisomerase I protein as the antigen, and use of an inappropriate cutoff. When H1-stripped chromatin or nucleosome core particles are used as the antigen with a cutoff that properly distinguishes between positive and negative, virtually no patients with systemic sclerosis should test positive for anti-nucleosome antibodies 53-55 . In one study, 50 of 36 patients with autoimmune hepatitis type I were anti-chromatin positive, while 5-13 of patients with other liver diseases were positive 56 .

Antitopoisomerase I Antibodies

The so-called anti-topoisomerase I (anti-scl-70) antibodies target DNA topoisome-rase I, which is found in the nucleoplasm and nucleolus and catalyzes the cleavage and rebinding of single-stranded DNA during the relaxation phase of supercoiled DNA. Although the name Scl-70 antibody is still used, the scientifically more correct name is anti-topoisomerase I antibody (ATA). IIF using HEp-2 cells usually reveals fine granular to homogeneous staining of the nucleoplasm with or without (depending on the substance used for fixation) staining of the nucleoli and chromatin of mitotic cells. Immunodiffusion, enzyme immunoassay, and Western blot are used in routine diagnostic testing. ATAs are marker antibodies with a diagnostic specificity of > 99 . The sensitivity for diagnosis of SSc is 1543 (reviewed in 42 ). ATAs are associated with diffuse skin involvement and internal manifestations (lung, heart, kidney). ATA-positive scleroderma patients generally have a more severe clinical course...

Management of Hypomotility Disorders

Hypomotility often is discovered incidentally during the investigation of GERD, during preoperative evaluations preceding antireflux surgery, and when clarifying the nature of dysmotility found on barium radiographs. Sometimes hypomotility is sought to support a diagnosis of connective tissue disease (eg, scleroderma or related illnesses). With the exception of its participation in the production of GERD, hypomotility rarely is symptomatic. One might expect dysphagia from severe hypomotility of the esophageal body, but dysphagia should not be attributed to this finding until intrinsic and extrinsic structural lesions as well as nonobstructive GERD have been excluded.

Racial Ethnic Variations in Frequency Epitope Recognition and Clinical Relevance of Diseaserelated Autoantibodies

The N-terminal end, the proline-rich C region, and the epidermal growth factorlike calcium-binding repeats, significant differences in epitope recognition among Caucasian, African American, Choctaw Native American, and Japanese SSc patients were found 8 . Furthermore, ethnic variations in clinical presentations may occur even in immunologically similar groups. All anti-fibrillarin antibody-positive Afro-Caribbean patients had diffuse cutaneous SSc (dcSSc) compared to only 47 of the Caucasian patients. Therefore, the anti-fibrillarin antibody-positive limited cutaneous SSc (lcSSc) subset seems to be almost of Caucasian origin 12 . Anti-Ku antibodies in Japanese patients are strongly associated with scleroderma-polymyositis and SLE-scleroderma-polymyositis overlap syndromes, whereas in African American patients these AABs are associated with SLE 10 . Anti-PR3 antibody is a highly specific marker for Wegener's gran-ulomatosis in Caucasians, whereas a marked variability in the spectrum of...

Mammographic Appearance Of Breast Cancer

Secondary signs of malignancy, often associated with advanced stages of breast cancer, are detectable clinically and radiographically as areas of skin thickening or dimpling, nipple retraction, and axillary adenopathy. Diffuse skin thickening and breast edema manifested as increased mammographic density are associated with lymphangitic spread of cancer involving the dermal lymphatics with inflammatory cancer. The underlying primary tumor is often obscured by the diffuse breast edema. These findings must be differentiated from mastitis. Typically, the diagnosis of inflammatory cancer is made clinically and by biopsy. Isolated nipple and areolar thickening can occur in patients with Paget's disease of the nipple.

Evaluation Of The Conservatively Treated Breast

Subsequent annual or more frequent mammograms should be obtained as indicated by clinical or radiographic evaluation. Comparison of the post-treatment mammo-grams to preceding studies is necessary to accurately assess radiographic changes following completion of therapy. Among the most common post-therapy changes are breast edema, skin thickening, postoperative fluid collections, scarring, fat necrosis, and calcifications. The mammographic findings of skin thickening, irregular breast parenchyma, and breast edema following surgery and radiation are most prominent on the post-treatment baseline study and typically diminish over 2 to 3 years following conservative therapy.3032 Once mammo-graphic stability of the breast has been established, any increase in the architectural distortion or enlargement of the dense scar at the surgical site suggests the presence of recurrent tumor. Interrupted lymphatic drainage after extensive axillary node dissection may produce...

Characteristics Heterogeneity and Subsets of Systemic Sclerosis

Systemic sclerosis (SSc), also called scleroderma, is a generalized autoimmune disorder characterized by vascular damage and fibrosis within the skin and visceral organs, notably the gut, lung, heart, kidney, joints, and muscles. With regard to the extent of skin and internal organ involvement, the pace of disease progression and, consequently, the prognosis, patients with SSc present a high degree of variability. According to the preliminary ACR criteria for the classification of SSc, the presence of either the major criterion (symmetric skin sclerosis proximal to the MCP and or MTP joints) or two or more of the minor criteria (sclerodactyly, digital pitting scars, bibasilar lung fibrosis) classify a condition as SSc with 97 sensitivity and 98 specificity 33 . If used for the diagnosis in the single patient, these criteria may be quite misleading, because they do not allow the diagnosis of early SSc or sclerosis sine scleroderma, a disorder with primary organ involvement in the...

Anticalpastatin Antibodies

Previously reported and that the prevalence was not significantly different between RA and other rheumatic diseases 43-46 . However, on the other hand, a recent report shows that anti-calpastatin reveals the high prevalence (82 sensitivity) and is exclusively detected (95 specificity) in RA patients 47 . Such discrepancy in the results might reflect the different assay systems, since in the former reports the synthetic C-terminal peptide containing 27 amino acids or recombinant domain I peptide was used for ELISA, whereas human erythrocyte calpastatin was utilized in the latter study. Other reports suggest that anti-calpastatin antibodies are associated with inflammatory-active scleroderma 48 , lupus vasculitis 44 , and deep vein thrombosis 49 . However, the true disease specificity and clinical significance of anti-calpastatin antibodies remain to be determined.

Clinical Appearence Classification

Systemic Sclerosis Diffuse

The hallmark of SSc is fibrosis of the skin resulting early on in oedema, often the first indication of SSc skin involvement, which is followed by fibrotic induration and finally atrophy. Several skin scoring methodologies have been developed with the modified Rodnan skin score having the broadest distribution (Kahaleh et al, 1986 Furst et al. 1998). It is assessed by palpation of skin using a 0-3 scale (normal, mild, moderate or severe thickening) at seventeen areas. Following the skin score and the distribution of cutaneous induration is of major clinical importance, as patients with diffuse cutaneous scleroderma are much more likely to have significant heart and or renal disease than those with the limited form of SSc, furthermore early disability and premature mortality are observed in this group (Clements et al. 1990). The period when skin thickening is most rapidly is also a time in which decline in visceral function is most likely to occur (Seibold 1994) (Fig. 1). Fig. 1....

Causes Of Parenchymatous Acute Renal Failure

Thrombosis or embolism, bilateral renal vein thrombosis Small vessels atheroembolic disease, thrombotic microangiopathy, hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura, postpartum acute renal failure, antiphospholipid syndrome, disseminated intravascular coagulation, scleroderma, malignant arterial hypertension, radiation nephritis, vasculitis

Autoantigen Proteolysis During Apoptosis

In the early 1990s the Rosens and colleagues elegantly demonstrated that specific SLE-associated autoantigens relocalize to surface blebs in cultured cells induced to die by apoptosis upon exposure to UV irradiation 131 . Following this observation, these investigators reported that the nuclear autoantigens PARP and U1-70kDa (70-kDa protein of the U1 ribonucleoprotein particle) were proteolytically cleaved by caspases during apoptosis 132, 133 . These observations led to the hypothesis that apoptotic cells are reservoirs of structurally modified forms of autoantigens that could initiate autoantibody responses in patients with systemic autoimmune diseases such as SLE and scleroderma. The development of this hypothesis triggered a search for modified forms of autoantigen that are generated in different types of cell death. Autoantigen modifications found to be associated with cell death included, but were not limited to, proteolysis, changes in the phosphoryla-tion state, and...

Anticentromere Antibodies

ACAs that are relevant for scleroderma diagnosis are directed against the centromere-associated proteins (CENP) CENP-A (17 kDa), CENP-B (80 kDa), and CENP-C (140 kDa). CENP-B is the antigen most commonly targeted by ACAs. Autoantibodies directed against other centromeric proteins (e.g., proteins only transiently associated with the centromere) are not included in the diagnostic-category ACAs. The method of choice for detecting ACAs is indirect immunofluorescence (IIF) using monolayers of tumor cells (usually HEp-2). The number of spots corresponds to the number of chromosomes in interphase nuclei and in the equatorial plane of mitotic cells. If the typical ACA pattern is masked by other autoantibodies, an enzyme immunoassay using recombinant CENP-B protein should be used. ACAs are diagnostic markers for systemic sclerosis with a specificity of > 95 (SSc versus other CTD) to nearly 100 (SSc versus normal controls) and a sensitivity of 20-30 in general (reviewed in 42 ). The frequency...

Clinical Manifestations

This form of EBA presents as a mechanobullous noninflammatory disease with an acral distribution. The blisters and erosions heal with scarring and milia formation. This presentation in its mild form is reminiscent of porphyria cutanea tarda, and in its more severe forms is reminiscent of hereditary recessive DEB (Yaoita et al. 1981). Despite the similarities between EBA and porphyria cutanea tarda, patients with EBA do not present with hirsutism, photodistribution, scleroderma like changes and high levels of urinary por-phyrins (Woodley 1988 Woodley et al. 1998).

Autoantibodies in Experimental Models of Autoimmunity

Scleroderma a) a) Autoantibody specificity is specific for scleroderma, but a scleroderma-like disease has not been described in mice treated with mercuric chloride. The second type of model also involves the manipulation of normal, non-autoimmune animals to produce an autoimmune response. In these cases the triggering event is the introduction into the animal of exogenous material that, unlike the case of direct immunization, may appear to bear little relationship to the ensuing autoimmune response. These mediators - which may include drugs, biologicals, and environmental agents such as hormones and microbes -and their role in inducing autoimmunity are discussed by Per Hultman in Chapter 22. An excellent example of this type of model is the autoimmunity induced by heavy metals 10 . Administration of mercury by several different routes and in several different forms (most notably, subcutaneous injection of mercuric chloride) produces in mice an autoantibody response that targets the...

Causes of Acute Renal Failure

Nursing School Hsp Nephritis

Thrombosis or embolism, bilateral renal vein thrombosis Small vessels atheroembolic disease, thrombotic microangiopathy, hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura, postpartum acute renal failure, antiphospholipid syndrome, disseminated intravascular coagulation, scleroderma, malignant arterial hypertension, radiation nephritis, vasculitis Sclerodermal crisis 1 Tumoral obstruction 1 Secondary glomerulonephritis 1 Vasculitis 1

Antinucleolar and AntiRNA Polymerase Antibodies

Anti-fibrillarin antibodies (AFAs) are directed against fibrillarin, the main protein component of the nucleolar U3-RNP complex, which is involved in pre-rRNA processing. Fibrillarin is also a component of other small nucleolar ribo-nucleoprotein (snoRNP) complexes. By IIF on Hep-2 cells, AFAs reveal a granular (clumpy) nucleolar immunofluorescence pattern. Chromosomal staining in metaphase may also be observed. Specific, highly sensitive methods for detection of fibrillarin antibodies are not yet available for routine use. AFAs are detectable in fewer than 10 of patients with SSc (associated with dcSSc) but have also been described in patients with SLE and localized scleroderma (reviewed in 42 ). Fibrillarin antibody production was induced using mercury salts in a mouse model 43 . This suggests that exogenous factors may play a role in pathogenesis. Anti-RNA polymerase antibodies target RNA polymerases (RNAPs) of the RNAP multiprotein complexes consisting of 8-14 proteins weighing...

Figure 1151

In the acute phase, small- and medium-sized renal arteries show mucoid thickening of the intima with severe narrowing of the lumen. Sometimes these lesions are accompanied by thrombosis and fibrinoid necrosis of the arterioles and glomeruli. Morphologically, the vascular alterations resemble malignant nephrosclerosis (malignant hypertension) or hemolytic-uremic syndrome. In the chronic phase, the mucoid intimal material is replaced by fibrous tissue. C, Severe intimal fibrosis of a medium-sized artery of a more chronic phase of scleroderma. (Panel A, methenamine silver, original magnification X 100. Panel B, alcian blue stain, original magnification X100. Panel C, cellulose acetate butyrate stain, original magnification X150.)

Figure 1737

A number of other conditions have been reported to recur in allo-grafts. Very few patients with systemic sclerosis have received transplantation, and the incidence of acute renal failure caused by systemic sclerosis has declined with the widespread use of angiotensin-converting enzyme (ACE) inhibitors. About 20 of patients with a malignant course of scleroderma receiving a transplantation develop

Figure 1150

The main features of renal involvement in scleroderma are summarized. The major manifestation is the so-called renal crisis. Besides this often life-threatening manifestation, other patients may display milder forms of renal involvement, clinically characterized by mild proteinuria or slight deterioration of kidney function. Renal involvement is more common in patients with the diffuse form of scleroder-ma that is serologically characterized by antibodies against topoiso-merase I or RNA polymerase III. Patients with progressive skin disease should be monitored carefully for hypertension and signs of renal involvement. Early institution of angiotensin-converting enzyme (ACE) inhibition in patients with micro-albuminuria can prevent further deterioration of kidney function 96,97 . ACE inhibition is also the mainstay of treatment for patients with scleroderma renal crisis, because it will significantly reduce progression to renal failure, increase the chance of recovery if renal failure...

Figure

Become apparent when a renal biopsy is performed. Recently, immunoglobulin A (IgA) nephropathy has been reported as an increasingly frequent cause of malignant hypertension. In one series of 66 patients with IgA nephropathy, 10 developed malignant hypertension 3 . Chronic atrophic pyelonephritis in children, often a result of underlying vesicoureteral reflux, is the most common cause of malignant hypertension 4 . In Australia, malignant hypertension complicates up to 7 of cases of analgesic nephropathy 5 . Transient malignant hypertension responsive to volume expansion has been reported in analgesic nephropathy. It has been suggested that interstitial disease with salt-wasting is important in the patho-genesis by causing profound volume depletion with activation of the renin-angiotensin axis. Malignant hypertension is both an early and late complication of radiation nephritis that can occur up to 11 years after radiotherapy. Renovascular hypertension from either fibromuscular...

Imaging Studies

Computed tomography may identify bowel wall thickening, pneumoperitoneum, or pneumatosis intestinalis, which are all potential complications of intestinal pseudo-obstruction. Barium studies (enteroclysis or upper GI with small bowel follow-through) to examine the upper GI tract, followed by barium enema, is often required to rule out mechanical obstruction and provide evidence of intestinal dilatation secondary to pseudo-obstruction. Consideration must always be given to the risk of barium impaction should complete obstruction be present. Alternatives may include water-soluble contrast or small amounts of barium with air contrast. Barium studies may also demonstrate a lack of peristalsis (myopathic processes) or chaotic peristalsis (neuropathic processes). An upper GI series may demonstrate isolated megaduode-num or wide-mouthed intestinal diverticula, commonly seen with myopathic processes such as scleroderma. Loss of haus-tral markings, a dilated colon, or a markedly dilated and...

Hypertensive Crises

Malignant hypertension is a clinical syndrome characterized by marked elevation of blood pressure, with widespread acute arteriolar injury (hypertensive vasculopathy). Funduscopy reveals hypertensive neuroretinopathy with flame-shaped hemorrhages, cottonwool spots (soft exudates), and sometimes papilledema. Regardless of the severity of blood pressure elevation, malignant hypertension cannot be diagnosed in the absence of hypertensive neuroretinopa-thy. Thus, hypertensive neuroretinopathy is an extremely important clinical finding, indicating the presence of a hypertension-induced arteriolitis that may involve the kidneys, heart, and central nervous system. In malignant hypertension, rapid and relentless progression to end-stage renal disease occurs if effective blood pressure control is not implemented. Mortality can result from acute hypertensive heart failure, intracerebral hemorrhage, hypertensive encephalopa-thy, or complications of uremia. Malignant hypertension represents a...

Vascular Diseases

Microangiopathic changes in a small artery, with endothelial activation, evidenced by the large endothelial cells with hyperchro-matic nuclei and vacuolization. There is intimal edema with some cell proliferation, and a prominent band of fibrinoid necrosis is seen the latter appears dark red-pink on this hematoxylin-eosin stain, and represents insudation of fibrin and plasma proteins into the wall of the injured vessel (original magnification X 250). The differential diagnosis includes hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, malignant hypertension, scleroderma, and drug toxicity, the latter due most commonly to mitomycin C or cyclosporine FK506 5 .

Total Mastectomy

DCIS, where achieving a clear surgical margin becomes difficult with a segmental mastectomy. It is also indicated for individuals who are not radiation therapy candidates, including those with active scleroderma, history of prior radiotherapy, ataxia telangectasia, and early pregnancy and for those who opt for it. Excellent cosmetic results can be achieved with a variety of reconstructive options, which can occur either simultaneously or as a delayed procedure. If a patient is contemplating reconstruction, a skin-sparing mastectomy should be performed. This operation involves the removal of the nipple-areolar complex and breast tissue but differs from a standard incision in preserving as much of the skin over the breast as possible (Figure 9-9).

Figure 433

Scleroderma associated with Raynaud's phenomenon, disseminated lupus erythematosus, and causalgia of the median nerve. The condition may be idiopathic, congenital, and familial or acquired. A congenital, aberrant, painful hyponychium has been described associated with oblique, deep fractures of the nails. In one case an unusual acquired association of pterygium inversum unguis and lenticular atrophy of the palmar creases was recorded.

Mimotopes

Populations of antibodies directed against known or unknown antigens. These sequences of linear or conformational epitopes have been identified as sequences of so-called mimotopes. According to the definition introduced by Geysen's group, mimotopes are not peptide structures with one or two natural amino acid exchanges only (which are simple peptide analogues), but molecules able to bind to the antigen combining site of an antibody molecule, not necessarily identical with the epitope inducing the antibody, but an acceptable mimic of the essential features of the epitope 170 . Therefore, mimotopes can be peptides capable of mimicking epitopes of carbohydrates, lipids, lipopeptides, or nucleic acids. It is beyond the scope of this chapter to describe the technical aspects of the strategy used to identify such mimotopes. Numerous review articles are available that describe this approach in full methodological detail (see, e.g., 171-175 ) and discuss their potential 176-178 . We will...

Systemic sclerosis

Workers manufacturing polyvinyl chloride can develop skin changes similar to systemic sclerosis with erosions of the bones, hepatic and pulmonary lesions. Pesticides and epoxy resin can also produce scleroderma-like changes. A variant is the CREST syndrome. In this type of scleroderma there is Calcinosis with calcium deposits below the skin on the fingers and toes, Raynaud's phenomenon with poor peripheral circulation, immobility of the oEsophagus, dermal Sclerosis of the fingers and toes, and Telangiectasia of the face and lips and adjacent to the toe and finger nails. It has a better prognosis than systemic sclerosis. Antinuclear antibodies at the centromere are frequently present.