Perioral dermatitis and inadvertent topical corticosteroid exposure.
Explore the source record for details and available documents.
Administration, Topical↗
Biomedical subjects
A Yung
Publications and source records attributed to A Yung.
Ethics and early intervention in psychosis: keeping up the pace and staying in step.
The intense clinical and research interest in early psychosis in recent years has highlighted a range of ethical issues which need to be considered carefully. Our perspective is based on 16 years of clinical and research experience with young people at this phase of illness as well as the research contributions of many others. We discuss the ethical dilemmas in relation to the three key foci, which make up the early psychosis paradigm. These are the pre-psychotic or prodromal phase, the period of untreated psychosis and the first psychotic episode and the critical period of recovery, which follows this. Most attention is devoted to the pre-psychotic period, however ethical considerations related to research in the other two clinical foci are briefly covered as well. Our contention is that the ethical issues are essentially identical to those arising in early intervention research in mainstream medicine. This has been concealed by inconsistency and emotion, which has great potential to confuse, politicize and derail rational debate. The legacy of the isolation of psychiatry from medicine and consequent prejudice and stigma in the professional as well as the public mind seems to be fueling a tendency in some societies to view psychiatric research as qualitatively different from other medical research. Sound clinical research data should be allowed to illuminate the options for potential consumers across all phases of illness. The alternative is research paralysis, which would force clinical practice to expand blindly without an evidence base.
Clinical Trials as Topic↗
Subcutaneous panniculitic T-cell lymphoma and cytophagic histiocytic panniculitis.
A 43-year-old Maori man presented with a 1 month history of malaise, weight loss, anorexia, arthralgia, recurrent fever and tender erythematous subcutaneous skin lesions. Histological examination of an incisional biopsy of a lesion revealed a lobular panniculitis with an inflammatory infiltrate of atypical lymphocytes and evidence of cytophagocytosis consistent with a diagnosis of subcutaneous T-cell lymphoma. The systemic symptoms and skin lesions resolved spontaneously within 3 weeks, only to recur 2 months later, requiring treatment with oral prednisolone. T-cell gene rearrangement studies demonstrated a monoclonal T-cell receptor (gamma-chain) gene rearrangement, further supporting the diagnosis of subcutaneous panniculitic T-cell lymphoma. Treatment with chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone) led to remission of symptoms. Four months after completing chemotherapy, the patient remained asymptomatic with a few indurated subcutaneous plaques on the chest. Biopsy of these areas revealed lobular panniculitis, lymphocytic infiltrate without cytological atypia, abundant lipophages and fibrosis and sclerosis consistent with a healing response. He remains well 24 months following chemotherapy.
Antineoplastic Combined Chemotherapy Protocols↗
Evaluating complex, collaborative programmes: the Partnership Project as a case study.
OBJECTIVE: In Australia, mental health services are delivered by a complex web of public- and private-sector providers. There is a growing recognition that linkages between these groups are not optimal, and a concern that this may lead to poor outcomes. This paper illustrates a conceptual framework for developing, implementing and evaluating programmes concerned with linkages. METHOD: Drawing on theoretical and practical literature, this paper identifies different levels of integration, issues in evaluating programmes to address poor linkages, and features of useful evaluations. Within this context, it describes the method by which the Public and Private Partnerships in Mental Health Project (Partnership Project) is being evaluated. Conducted by St Vincent's Mental Health Service and The Melbourne Clinic, this is one of several Demonstration Projects in Integrated Mental Health Care funded under the National Mental Health Strategy. RESULTS: Collaboration is hard to conceptualize and collaborative programmes usually have many players and components, and tend to operate within already-complex systems. This creates difficulties for evaluation, in terms of what to measure, how to measure it, and how to interpret findings. In spite of these difficulties, the illustrative example demonstrates a model for evaluating collaborative programmes that is currently working well because it is strongly conceptualized, descriptive, comparative, constructively sceptical, positioned from the bottom up, and collaborative. CONCLUSIONS: This model, or aspects of it, could be extended to the evaluation of other mental health programmes and services that have collaborative elements.
Delivery of Health Care, Integrated↗
Neurobiological findings in early phase schizophrenia.
This paper summarises the available information on MRI-determined hippocampal morphometry in first-episode patients as an illustration of the value and interpretation of findings in the neurobiology of early phase schizophrenia. We report a thin slice (1.5 mm) study of 32 first episode and 39 high risk patients which demonstrated significantly smaller hippocampi (right -9%, left -11%) in first episode patients that were of a similar magnitude to those found in chronic patients (right -10%, left -11%) but non-significant volume reductions in high risk individuals, including the 15 subjects who subsequently developed psychoses. Consideration is given to the implications of these findings, including the possible role of early and later neurodevelopmental influences. We present animal data showing that chronic placental insufficiency, as elicited by uterine artery ligation can give rise to substantial reduction (31%) in hippocampal volumes and reflect on other potentially relevant pathophysiological mechanisms, including those that may occur during the early phases of psychotic illnesses, including their prodromes. Greater attention needs to be paid to the study of early phase psychosis in order to obtain a clearer understanding of the nature and time course of neurobiological changes associated with it. Although there is a growing literature on first episode psychosis, there is a striking dearth of information on the neurobiology of the prodrome.
Animals↗
Bullous systemic lupus erythematosus.
A 19-year-old woman with a 6 month history of systemic lupus erythematosus (SLE) developed a widespread urticated, erythematous eruption associated with tense, fluid-filled blisters, erosions and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence showed markedly positive granular IgG deposition with weak IgM, IgA and C3 at the dermoepidermal junction. No circulating antibodies were detected on indirect immunofluorescence. A diagnosis of bullous systemic erythematosus was made. Treatment with prednisone was ineffective. Subsequent treatment with dapsone led to rapid sustained remission of skin symptoms. Bullous SLE is a rare manifestation of SLE. We review the recent literature and discuss the distinctive features of this condition and contrast them with cutaneous SLE with blisters and the subepidermal blistering disorders.
Adult↗
Contact dermatitis to Asparagus officinalis.
A 53-year-old farm worker presented with a 3-year history of an occupational allergic contact dermatitis to asparagus. The dermatitis cleared quickly with courses of systemic corticosteroids but relapsed within days of further exposure to asparagus. The genera Asparagus is made up of some 300 species. It belongs to the family Liliaceae which includes tulips, onions and garlic. Asparagus contains asparagin, coniferin and the glucoside vanillin. The allergen may be a plant growth inhibitor, 1,2,3-Trithiane-5-carboxylic acid, which is present in young shoots.
Agricultural Workers' Diseases↗
A case of relapsing polychondritis with coronary ostial stenosis and severe aortic incompetence.
Explore the source record for details and available documents.
Aortic Valve Insufficiency↗
Comparison of the long-term efficacy of implantable defibrillators and sotalol for documented spontaneous sustained ventricular tachyarrhythmias secondary to coronary artery disease.
BACKGROUND: The relative efficacy of antitachycardia pacing implantable cardioverter defibrillators (ATPICD) and sotalol in the treatment of ventricular tachyarrhythmias is controversial. AIM: To compare the mortality in patients treated with ATPICD and sotalol for documented spontaneous sustained ventricular tachyarrhythmias occurring late after previous myocardial infarction. METHODS: In this non-randomised retrospective study of 139 consecutive patients all patients had inducible ventricular tachycardia at baseline electrophysiological studies. Before the availability of ATPICD, 22 patients were treated with sotalol as part of a randomised study comparing the efficacy of sotalol to amiodarone. After ATPICD became available sotalol was used in 49 patients in whom intravenous testing predicted sotalol to be effective and ATPICD were implanted in 68 patients in whom sotalol was predicted to be ineffective at electrophysiological testing. Thus, 68 patients were treated with an ATPICD and 71 with sotalol. RESULTS: The two groups were well-matched for age, type of presenting arrhythmia, severity of coronary artery disease and ventricular function. At 36 months Kaplan-Meier estimates of mortality from ventricular tachyarrhythmia were 0% with ATPICD and 15% with sotalol (p=0.03). Kaplan-Meier estimates of total mortality at 36 months were 12% with ATPICD and 25% with sotalol (p=0.09). Multivariate analysis showed hazard ratio of 7.9 (p=0.06) for death from ventricular tachyarrhythmia in patients treated with sotalol compared to ATPICD. CONCLUSIONS: While no difference in total mortality was demonstrated, treatment with ATPICD is probably superior to sotalol for preventing deaths due to ventricular tachyarrhythmia.
Aged↗
People at risk of schizophrenia and other psychoses: comments on the Edinburgh High-Risk Study.
Explore the source record for details and available documents.
Humans↗
Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome.
PURPOSE: To investigate the variability of tumor volume in nasopharyngeal carcinoma using quantitative measurements of tumor bulk derived from computed tomography, and to study the prognostic value of tumor volume in comparison with other variables. METHODS AND MATERIALS: Two hundred ninety patients with newly diagnosed nasopharyngeal carcinoma were included in the study. The primary tumor volume (PTV) and nodal tumor volume (NTV) were obtained by outlining the tumor contour followed by summation of areas in sequential pretreatment computed tomography axial scans. Total tumor volume (TTV) was obtained by adding the PTV and NTV. All patients had radiotherapy as the primary treatment, 67 patients also received cisplatin-based neoadjuvant chemotheraphy. RESULTS: A large variation in tumor volume was observed, especially in advanced stage disease. The median PTV (cc) in Ho's T1, T2, and T3 disease were: 6.9 (range: 0.9-42.7), 18.8 (1.6-127.9), and 52.4 (3.3-166.8). The median TTV (cc) in Ho's stage I to IV disease were: 7.6 (range: 1.3-42.7), 19.8 (3.2-55.7), 40.7 (4.1-222.7), and 51.1 (3.1-274.7). Patients with a large PTV (>60 cc) were associated with significantly poorer local control (5-year local control rate: 56%) and disease-specific survival (5-year survival rate: 53%). In patients with a small PTV (< or =20 cc), there were no significant differences in local control among different T stages. Large NTV (>30 cc) was associated with significantly higher distant failure rate (5-year distant relapse-free survival rate: 54%) and lower disease-specific survival (5-year survival rate: 40%). In multivariate analysis, only PTV was found to be an independent factor in predicting local control. CONCLUSION: A large variation of tumor volume was present in different T stage disease of nasopharyngeal carcinoma, and PTV represents an independent prognostic factor of local control that appears to be more predictive than Ho's T stage classification.
Adult↗
Tumor control probability of nasopharyngeal carcinoma: a comparison of different mathematical models.
PURPOSE: Radiation dose and tumor volume are factors known to affect the local control of a given type of tumor. Local tumor control is a major factor to consider when a treatment plan is evaluated. This article reports the correlation between tumor control probability, dose, and volume in a retrospective study of 142 patients with nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: The tumor volume was outlined and calculated from a computed tomographic scan. Patients were categorized according to tumor volume and radiation dose received in treatment. Local control rate was calculated for each category by the Kaplan-Meier method. Mathematical models were fitted to correlate the local control rate, dose, and volume. Both empirical and mechanistic approaches were attempted; the former included logistic models with two and three parameters, and the latter, the formulation from Brenner and Bentzen with a radiobiological basis. RESULTS: Brenner's model estimated alpha at 0.041 Gy(-1) with 95% confidence limits (-0.032, 0.113) Gy(-1). The volume dependent constant h was estimated at 0.160 cm(-3) with 95% confidence limits (-0.729, 1.048) cm(-3). The Pearson correlation coefficient was 0.64. The magnitude and sign of the fitted parameters were reasonable and consistent with reported clinical experience. The other models were fitted with slightly better goodness of fit (r = 0.65 - 0.68), but with less interpretable parameters. CONCLUSION: Brenner's model is considered appropriate for a description of the dose and volume effect on the local control of the NPC. It could be used in combination with normal tissue complication probability for treatment plan evaluation to optimize treatment results.
Adult↗
Usefulness of Semen Microscopy in the Diagnosis of a Difficult Case of Schistosoma haematobium Infection in a Returned Traveler.
Schistosoma haematobium is endemic in many countries of Southeast Asia, eastern and western Africa, and South America. It affects mainly the urinary system, although infection of the genital organs is not infrequent.1,2 Infection of male genital organs, especially of the seminal vesicles and prostate1,3 may result in hematospermia and infertility.2,4,5,6,7,8,9 The diagnosis of Schistosoma haematobium traditionally relies on demonstrating the presence of characteristic ova in urine and, less often, in feces. Serology is nonspecific and lacks sensitivity because the antigens utilized in the indirect hemagglutination assay are derived from Schistosoma mansoni. In addition, serology cannot differentiate past from recently acquired infection. We report a case of Schistosoma haematobium infection in a returned traveler in whom numerous ova were detected in semen despite repeated negative urinary and fecal examinations and negative serology.
Journal Article↗
Missed opportunities for prevention of tuberculosis in Victoria, Australia.
SETTING: Victoria, Australia. OBJECTIVE: To ascertain missed opportunities for prevention in all persons notified in 1991 to the state registry with active tuberculosis (TB), and to examine aspects of case management relevant to prevention. DESIGN: A descriptive study. Records were reviewed for 231/236 cases of TB notified in the state of Victoria in 1991. Documentation of past screening for TB, preventive therapy, treatment of active disease and follow up was sought for all cases. Past screening was defined as past contact screening, migrant screening, refugee screening and health undertakings for TB. RESULTS: Of the 231 cases, 13 were not confirmed to have TB. Of the remaining 218 cases, 78% were foreign born, and of these, nearly half were diagnosed within 3 years of arriving in Australia. Nearly half of all cases (97/218) had some form of past screening for TB. The most common type of screening was refugee and migrant screening (45/218, 21%) followed by tuberculosis health undertakings (25/218, 12%) and contact screening (15/218, 7%). Of those with past screening, 70% (68/97) had a positive screening result at the time. Among these, the first screening episode resulted in the diagnosis of active TB in 5/68, and TB infection in 63/68. In the latter group only 5% (3/63) received preventive therapy. CONCLUSION: There are significant missed opportunities for prevention in Victoria, particularly in the foreign born cases who receive screening on entry into the country. For screening to be a meaningful exercise, preventive therapy should be used where medically indicated.
Adolescent↗
Emergence of multidrug resistance in Campylobacter jejuni isolates from three patients infected with human immunodeficiency virus.
Single-drug resistance to tetracycline, doxycycline, erythromycin, or fluoroquinolones in Campylobacter isolates recovered from humans has been documented worldwide. Multidrug resistance to these antibiotics is rare in Campylobacter jejuni. We report the sequential development of multidrug resistance in C. jejuni isolates from three patients who were infected with human immunodeficiency virus. Multiple isolates recovered from stool specimens from these patients were ribotyped, and antibiotic susceptibility profiles were determined. The results indicated that each patient was infected with a single strain of C. jejuni that had progressively acquired resistance to the antibiotics used during treatment. The emergence of resistant isolates appeared to correlate with clinical relapse. In these patients, campylobacter enteritis was prolonged, severe, and relapsing, and antimicrobial therapy was required. Once these first-line antibiotics become ineffective, few other antibiotics are available for treating patients with campylobacter enteritis. Acquisition of antibiotic resistance in C. jejuni is therefore of concern in these cases.
AIDS-Related Opportunistic Infections↗
In-111 DTPA Ommayagrams in leptomeningeal carcinomatosis.
Radionuclide Ommayagrams in 25 patients with leptomeningeal carcinomatosis were performed after injection of 0.5 mCl of In-111 DTPA into Ommaya shunt reservoirs to evaluate cerebrospinal fluid-shunt communication, detect the blockage of the cerebrospinal fluid pathway, evaluate the cerebrospinal fluid flow pattern, and predict the distribution of the chemotherapeutics. All results were correlated with MRI evaluations of the brain and spine, as well as clinical findings. Radionuclide Ommayagrams were found to be 73% sensitive and 100% specific in the evaluation of cerebrospinal fluid space disease. MRI of the spine and head was found to be 100% sensitive, but 86% specific for obstructive cerebrospinal fluid space disease.
Adolescent↗
Status epilepticus in 37 Chinese children: aetiology and outcome.
OBJECTIVE: The aetiology and clinical features of status epilepticus (SE) are described, with the aim of defining any relationship between risk factors and clinical outcome. METHODOLOGY: A retrospective review was performed of 37 Chinese children admitted to Queen Mary Hospital, Hong Kong, from 1989 to 1993 with the diagnosis of SE. RESULTS: Eighty-six per cent had onset before 5 years of age; 60% were due to an acute central nervous system (CNS) insult, 11% were idiopathic, 13% had a pre-existing CNS insult, 5% were febrile and 11% were due to progressive encephalopathy. An abnormal neurological status was present in 24% before the episode of SE, and a history of seizures before the onset of SE was present in 35% of patients. Fifty-four per cent of the episodes of SE were generalized. The mortality rate was 11% during the period of follow up but no deaths were attributed to SE. Neurological sequelae were observed in 27% of patients and recurrent SE occurred in 12%. CONCLUSIONS: In those patients with normal neurological status before an episode of SE and without acute CNS insult or progressive encephalopathy, the outcome was favourable.
Age of Onset↗
Tuberculous meningitis: a 30-year review.
Tuberculous meningitis remains an important illness that can be difficult to diagnose in a timely fashion and carries significant morbidity. We present a retrospective review of the cases of tuberculous meningitis diagnosed and treated at a single institution. Fifty-eight cases were identified and stratified according to stage of disease at presentation. Four patients (7%) died; three (5%) developed severe neurological sequelae. Poor outcomes were largely confined to cases presenting in an advanced stage and at the extremes of age. Corticosteroids were administered to 56 patients and may have contributed to the comparatively good outcome in these cases.
Adrenal Cortex Hormones↗