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Biomedical subjects

D J Margolis

Publications and source records attributed to D J Margolis.

At least 37 records · Page 2Linked to original sources
PubMed1999

Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis.

OBJECTIVE: The aim of the study was to determine the percentage of individuals with neuropathic diabetic foot ulcers receiving good wound care who heal within a defined period of time. RESEARCH DESIGN AND METHODS: We conducted a systematic review of the control groups of clinical trials that evaluated a treatment for diabetic neuropathic foot ulcers. The meta-analytic techniques used include an estimation of the weighted mean percentage healed by end point, an evaluation of the homogeneity of trials, and an estimate of the 95% CI of the grouped data. Grouped-data univariate and multivariate logistic regression was conducted to assess the impact of mean age, ulcer size, and duration on the percentage of ulcers healed at end point. RESULTS: We found a total of 10 control groups meeting our criteria. Six control groups used 20 weeks as the end point for healing or nonhealing. For the six control arms with a 20-week end point, we found a weighted mean healing rate of 30.9% (95% CI 26.6-35.1). A similar analysis for the four 12-week arms found a mean healing rate of 24.2% (19.5-28.8). We failed to detect any statistically significant heterogeneity for either the 20-week or the 12-week trials. CONCLUSIONS: After 20 weeks of good wound care, approximately 31% of diabetic neuropathic ulcers heal. Similarly, after 12 weeks of good care, approximately 24% of neuropathic ulcers attain complete healing. Further patient-level analyses are necessary to definitively determine the associations of age, wound size, and wound duration with likelihood of healing.

Diabetic Foot↗
PubMed1998

Efficacy and prognostic value of simple wound measurements.

OBJECTIVES: To assess the association between planimetric wound area and simple wound measurements. To ascertain the applicability of planimetry-based research to clinical practice. DESIGN: A retrospective cohort study of 260 consecutive patients followed up for at least 24 weeks. SETTING: Outpatient dermatology department of a major medical center. INTERVENTION: Wounds were measured using computer-based planimetry and were treated according to a standard protocol for venous leg ulcers. PATIENTS: Two hundred sixty patients with venous leg ulcers. MAIN OUTCOME MEASURES: Complete ulcer healing at 24 weeks. RESULTS: Using the Pearson, Spearman, and Kendall correlation coefficients, we found a tight correlation between planimetric wound area and wound width, length, width x length, perimeter, and area based on the formula for an ellipse. The values for all correlation coefficients were greater than 0.80 (P < .001 for all associations). Width, length, length x width, and elliptical area measurements all correlated closely with failure to heal (P < .001). The correlation between simple values and planimetric area dropped considerably for wounds more than 40 cm2, which represented 6% of the wounds in this study. CONCLUSIONS: The equivalence between simple and planimetric wound measurements allows for the extrapolation of wound measurements from clinical trials to clinical practice, and suggests that simple wound measurements may confidently be used as predictors of healing in the clinical setting.

Dermatology↗
PubMed1998

Validation of a melanoma prognostic model.

BACKGROUND: A "clinically accessible," 4-variable (patient age, patient sex, tumor location, and tumour thickness) prognostic model has been published previously. This model evaluated variables that were commonly available to the clinician. Because models are heuristic, validity of a prognostic model should be evaluated in a population different from the original population. OBJECTIVE: To evaluate the external validity of this 4-variable melanoma prognostic model. DESIGN: To estimate the external validity of this model, we used a population-based cohort of individuals with melanoma. We also evaluated a 1-variable model (tumor thickness). Estimates of the external validity of these logistic regression models were made using the c statistic and the Brier score. SETTINGS AND PATIENTS: A total of 1261 patients with melanoma evaluated in a multispecialty, university-based practice and 650 patients with melanoma from throughout Connecticut. MAIN OUTCOME MEASURE: Death from melanoma within 5 years of diagnosis. RESULTS: The c statistics for the 4-variable model were 0.86 (95% confidence interval [CI], 0.83-0.89) for the university-based practice data set and 0.81 (95% CI, 0.75-0.86) for the Connecticut data set. For thickness alone, the c statistics were 0.83 (95% CI, 0.80-0.86) and 0.79 (95% CI, 0.74-0.85), respectively. Brier scores for the 4-variable model were 0.09 (95% CI, 0.08-0.10) and 0.08 (95% CI, 0.06-0.09) and for the 1-variable model were 0.09 (95% CI, 0.08-0.10) and 0.08 (95% CI, 0.07-0.10), respectively. No significant differences exist between the data sets for the 4- and 1-variable models. CONCLUSIONS: The 4- and 1-variable models are generalizable. The simpler 1-variable model--tumor thickness--can be used with a relatively small loss in accuracy.

Female↗
PubMed1998

Trichophytic granuloma of the vulva.

Fungal infections causing deep tissue involvement are known as trichophytic granulomas. We describe an unusual case of trichophytic granuloma presenting in the vulva of a 39-year-old woman.

Adult↗
PubMed1998

Hormonal influences on women with psoriasis.

Various endogenous factors such as stress and infection are known to influence psoriasis. Previous data suggest that pregnancy has a significant influence on the course of psoriasis. This study explores the effect of pregnancy as well as other hormonal events on psoriasis in women.

Adolescent↗
PubMed1996

Effects of isotretinoin on bone mineralization during routine therapy with isotretinoin for acne vulgaris.

OBJECTIVE: To examine the effects of isotretinoin on bone mineralization and other markers of calcium homeostasis in individuals receiving isotretinoin for routine therapy for severe acne vulgaris. DESIGN: Cohort study. SETTING: An academic medical center. PATIENTS: Twenty individuals receiving isotretinoin for severe acne vulgaris. INTERVENTION: None. MAIN OUTCOME MEASURE: The primary outcome was the change in bone mineralization as measured by dual-energy x-ray absorptiometry of the lumbar spine and hip before and after isotretinoin therapy. Additional measurements included serum osteocalcin, calcium, 25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D, and intact parathyroid hormone and urine hydroxyproline or calcium. RESULTS: No changes were noted in bone mineralization of the lumbar spine or hip. Furthermore, no alterations were noted in serum measurements of osteocalcin, calcium, 25-dihydroxyvitamin D, intact parathyroid hormone, or urine measurements of hydroxyproline or calcium. A statistically significant change was noted in 1,25-dihydroxyvitamin D when serum from before and after isotretinoin therapy was compared. CONCLUSION: The use of isotretinoin for 20 weeks for the treatment of severe acne vulgaris does not appear to have any substantial adverse effect on bone mineralization.

Acne Vulgaris↗
PubMed1996

Fibrinolytic abnormalities in two different cutaneous manifestations of venous disease.

BACKGROUND: Chronic venous insufficiency may be associated with lipodermatosclerosis or atrophie blanche. Coagulation abnormalities may be related to these cutaneous disorders. OBJECTIVE: Our purpose was to determine whether fibrinolytic abnormalities exist in patients with lipodermatosclerosis or atrophie blanche. METHODS: A case control study of patients with venous disease and atrophie blanche or lipodermatosclerosis was performed. Plasma levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in a resting and venous occluded state were measured. RESULTS: Plasma levels of PAI-1 were different between the two groups of patients. The lipodermatosclerosis group had significantly higher levels of PAI-1 in both the resting and venous occluded states (p < 0.001). Patients with atrophie blanche had milder elevations of PAI-1 in the resting and venous occluded state (p = 0.06). CONCLUSION: Fibrinolytic abnormalities are present in patients with venous disease. These abnormalities are different between patients with lipodermatosclerosis and patients with atrophie blanche.

Aged↗
PubMed1995

Management of unusual causes of ulcers of lower extremities.

Treatment of any wound begins with the correct diagnosis. The vast majority of chronic wounds can be classified as pressure ulcers, venous ulcers, insensate ulcers, or arterial insufficiency ulcers. This article focuses on wounds of unusual origin that must be considered in evaluation. All of these wounds are difficult to treat, are more likely to occur in specialized clinical settings, may provide clues to underlying systemic illnesses, and can be life-threatening. Unusual wounds discussed include atrophe blanche, calciphylaxis, leukocytoclastic vasculitis, necrobosis lipoidica, necrotizing fasciitis, and pyoderma gangrenosum.

Humans↗
PubMed1995

A literature assessment of the use of miscellaneous topical agents, growth factors, and skin equivalents for the treatment of pressure ulcers.

BACKGROUND: Agents reviewed for this manuscript were both rare and popular topical treatments for pressure ulcers. OBJECTIVE: To review topical treatments for pressure ulcers and evaluate them based on available literature of controlled, blinded, and randomized trials. METHODS: A MEDLARS database (1966-1993) search and a thorough review of reference article lists of key articles produced over 100 manuscripts. Studies were considered for review if they were conducted on humans with chronic stage II to IV pressure ulcers, in a properly controlled and randomized fashion. RESULTS: The use of zinc acetate and aluminum hydroxide ointment, phenytoin, recombinant platelet-derived growth factor-BB (rPDGF-BB), and basic fibroblast growth factor (bFGF) have been evaluated in a controlled and blinded fashion. Many of the newer agents, cytokine growth factor (eg, rPDGF-BB and bFGF) and skin equivalents, are currently being scrutinized in clinical trials. CONCLUSION: A paucity of data exist that adequately address the efficacy of any topical agent for the treatment of pressure ulcers.

Administration, Topical↗
PubMed1994

Ulcerated necrobiosis lipoidica diabeticorum in a patient with a history of generalized granuloma annulare.

Granuloma annulare and necrobiosis lipoidica diabeticorum have rarely been reported in the same patient. We describe the unusual case of a woman with diabetes and a history of generalized granuloma annulare who noted leg ulcers that clinically represented ulcerated necrobiosis lipoidica diabeticorum and had histologic features of necrobiosis lipoidica diabeticorum and granuloma annulare. Her condition responded to treatment with antiplatelet agents.

Aged↗
PubMed1994

Definitions and guidelines for assessment of wounds and evaluation of healing.

BACKGROUND: Chronic wounds represent a worldwide problem. For laboratory and clinical research to adequately address this problem, a common language needs to exist. OBSERVATION: This language should include a system of wound classification, a lexicon of wound descriptors, and a description of the processes that are likely to affect wound healing and wound healing end points. CONCLUSIONS: The report that follows defines wound, acute wound, chronic wound, healing and forms of healing, wound assessment, wound extent, wound burden, and wound severity. The utility of these definitions is demonstrated as they relate to the healing of a skin wound, but these definitions are broadly applicable to all wounds.

Acute Disease↗