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Biomedical subjects

E F Bernstein

Publications and source records attributed to E F Bernstein.

At least 19 recordsLinked to original sources
PubMed1999

Treatment of spider veins using a 10 millisecond pulse-duration frequency-doubled neodymium YAG laser.

BACKGROUND: The pulsed dye laser has been the standard for treating vascular lesions. Although quite effective for treating facial vessels and port-wine stains, spider veins of the lower extremities are more difficult to treat. Recent studies have shown that lasers with longer pulse durations are more effective at treating spider veins. A new long-pulse frequency-doubled Neodymium:YAG laser has been developed with a 10-ms pulse duration and sufficient energy to enable treatment with a 3- or 4-mm diameter treatment beam. OBJECTIVE: To determine the effectiveness of the long pulse Neodymium:YAG laser for treating spider veins of the lower extremities. METHODS: Spider veins less than 0.75 mm in diameter on the legs of 15 female volunteers were treated in 1 or 2 areas. Treatments were administered through a water-cooled chill tip using the frequency-doubled Neodymium:YAG laser with a 10-ms pulse duration. A dose of 16 J/cm2 was administered, completing 3 passes over each visible vein during each session, for a total of 2 sessions administered 6 weeks apart. Photographs of treatment areas were digitally analyzed for degree of vessel clearance. RESULTS: Computer-based image analysis revealed clearing of over 75% of veins following 2 treatments with 16 J/cm2. Side effects were minimal, and the treatments were well tolerated. CONCLUSIONS: The 532 nm, 10 ms pulse duration, frequency-doubled Neodymium:YAG laser is safe and effective for treating spider veins of the lower extremities less than 0.75 mm in diameter, in patients with Fitzpatrick skin Types I-III.

Adult↗
PubMed1998

Treatment of spider veins with the 595 nm pulsed-dye laser.

BACKGROUND: Previous attempts to treat spider veins with the conventional 585 nm pulsed-dye laser with a 0.5-ms pulse duration have been relatively ineffective. Recently, a new pulsed-dye laser that is tunable from 585 to 600 nm with a pulse duration 3 times longer than previously available lasers has preliminarily been shown to be effective for treatment of spider veins. OBJECTIVE: Our purpose was to evaluate the effectiveness of multiple treatments with the tunable long-pulse dye laser in treatment of spider veins of the lower extremity. METHODS: Ten female volunteers were treated in two separate areas containing blue or red linear spider veins less than 1.5 mm in diameter. Treatments were administered with the pulsed-dye laser with a 1.5-ms pulse duration and 595-nm light at fluences of 15 and 20 J/cm2, and each subject received a total of 3 treatments at each site, administered at 6-week intervals. Photographs were taken before and 6 weeks after the last treatment. RESULTS: Computer-based image analysis showed clearing of more than three fourths of veins after 3 treatments with 15 or 20 J/cm2. Side effects were minimal and the treatments were well tolerated. CONCLUSION: The 595 nm, 1.5 ms pulse duration, pulsed-dye laser is safe and effective for treating blue or red spider veins of the lower extremities less than 1.5 mm in diameter in nontanned patients with Fitzpatrick skin types I and II. Multiple treatments improve on the results obtained after a single treatment.

Adult↗
PubMed1998

A novel in vivo model for evaluating agents that protect against ultraviolet A-induced photoaging.

Increasing evidence demonstrates that ultraviolet A radiation (UVA) contributes to photoaging, which results in the accumulation of massive amounts of abnormal elastic material in the dermis of photoaged skin. To study UVA-induced photoaging in an in vivo system, we utilized a line of transgenic mice containing the human elastin promoter linked to a chloramphenicol acetyl transferase reporter gene. Our prior work demonstrates promoter activation in response to ultraviolet B radiation (UVB), UVA, and psoralen plus ultraviolet A radiation in the skin of these mice. The addition of psoralen (8-MOP) prior to administration of UVA results in substantial increases in promoter activation, as compared with UVA alone. To demonstrate the utility of these mice as a model of UVA-induced photodamage, we administered four lotions to the skin of our transgenic mice that included: a sunscreen containing octyl methoxycinnamate and benzophenone-3 with a sun protection factor (SPF) of 15, the UVA filter butyl methoxydibenzoylmethane, the SPF 15 sunscreen and the UVA filter together, and the lotion vehicle alone. Following sunscreen administration, mice received a single psoralen plus ultraviolet A radiation treatment. All sunscreens decreased chloramphenicol acetyl transferase activity with the SPF 15 sunscreen, the UVA filter, and the combination SPF 15 sunscreen and UVA filter, resulting in increasing degrees of protection against psoralen plus ultraviolet A radiation. These results demonstrate that this model functions as a rapid and sensitive model of UVA photodamage for the identification and comparison of compounds that protect against UVA-induced photoaging.

Animals↗
PubMed1998

Molecular mechanisms of cutaneous aging: connective tissue alterations in the dermis.

Cutaneous aging is a complex biological phenomenon consisting of two distinct components, (a) the intrinsic, genetically determined degenerative aging processes and (b) extrinsic aging due to exposure to the environment, also known as "photoaging". These two processes are superimposed in the sun-exposed areas of skin, with profound effects on the biology of cellular and structural elements of the skin. This overview summarizes our current understanding of the mechanisms of innate versus extrinsic aging with emphasis on connective tissue alterations, primarily collagen and the elastic fiber network. We also introduce a novel transgenic mouse model, expressing a human elastin promoter-reporter gene construct, suitable for studies on biology and preventive pharmacology of the cutaneous aging.

Animals↗
PubMed1997

Evaluation of sunscreens with various sun protection factors in a new transgenic mouse model of cutaneous photoaging that measures elastin promoter activation.

BACKGROUND: Long-term sun exposure can cause major alterations in the papillary dermis, resulting in the deposition of massive amounts of abnormal elastic material, termed solar elastosis. Previous work has demonstrated that this type of photodamage is accompanied by an increase in elastin and fibrillin messenger RNAs and elastin promoter activity. OBJECTIVE: Our purpose was to develop a rapid and sensitive in vivo method for evaluating compounds offering protection against cutaneous photodamage. METHODS: Using a line of transgenic mice that expresses the human elastin promoter linked to a chloramphenicol acetyltransferase reporter gene, we applied sunscreens with various sun protection factors to 5-day-old mice followed by 30 minimal erythema doses of solar simulating radiation for three consecutive days. RESULTS: Solar simulating radiation alone resulted in a fivefold increase in elastin promoter activity. Sun protection factors of 2, 4, 8, and 15 yielded a reduction in promoter activity by 2.8%, 42.5%, 58.1%, and 70.3%, respectively. CONCLUSION: These results confirm the use of this system as a rapid and sensitive in vivo model for evaluating compounds that protect against photodamage.

Animals↗
PubMed1997

Citric acid increases viable epidermal thickness and glycosaminoglycan content of sun-damaged skin.

BACKGROUND: Recently, there has been an exponential increase in the use of alpha-hydroxy acids in dermatologic practice. Their inclusion in a myriad of cosmetic preparations underscores their popularity. Among the clinical effects of alpha-hydroxy acids are their ability to prevent the atropy resulting from potent topical corticosteroids, improve the appearance of photoaged skin, and correct disorders of keratinization. Despite this range of desirable effects, very little is known about the specific changes produced by various alpha-hydroxy acid preparations in the epidermis and dermal extracellular matrix. Previous work by others has demonstrated the ability of another alpha-hydroxy acid to increase viable epidermal thickness, and dermal glycosaminoglycans. OBJECTIVE: In this study, we examined the effect of 20% citric acid lotion, as compared with vehicle alone, on skin thickness, viable epidermal thickness, and dermal glycosaminoglycan content. Biopsy samples were harvested after 3 months of treatment. RESULTS: Image analysis of biopsy sections revealed increases in viable epidermal thickness and dermal glycosaminoglycans in treated skin. CONCLUSIONS: Topical citric acid produces changes similar to those observed in response to glycolic acid, ammonium lactate, and retinoic acid including increases in epidermal and dermal glycosaminoglycans and viable epidermal thickness. Further studies of citric acid and other alpha-hydroxy acids are warranted to clarify their clinical effects and mechanisms of action.

Administration, Cutaneous↗
PubMed1996

Long-term sun exposure alters the collagen of the papillary dermis. Comparison of sun-protected and photoaged skin by northern analysis, immunohistochemical staining, and confocal laser scanning microscopy.

BACKGROUND: Long-term solar irradiation produces both morphologic and functional changes in affected skin. Because collagen is the major structural component of skin, any alteration in its production or degradation could have profound effects on cutaneous functional integrity. OBJECTIVE: Our purpose was to investigate alterations in the production and morphology of collagen fibers brought about by long-term sun exposure. METHODS: We compared collagen and collagenase gene expression and collagen immunohistochemical staining and used confocal laser scanning microscopy for morphologic examination of dermal collagen fibers in photodamaged compared with sun-protected skin from the same persons. RESULTS: Despite a large increase in elastin messenger RNA in sun-damaged skin, collagen and collagenase gene expression remained essentially unchanged. However, striking alterations in the papillary dermis of photoaged skin were found, which revealed large, abnormally clumped elastic fibers and deformed collagen fibers of various diameters, replacing the normal architecture of the papillary dermis. CONCLUSION: Our data provide evidence for normal collagen gene expression in sun-damaged skin and suggest that degradation and remodeling of collagen take place in the papillary dermis accompanied by deposition of other matrix components, predominantly abnormal elastic fibers.

Blotting, Northern↗
PubMed1996

Chronic sun exposure alters both the content and distribution of dermal glycosaminoglycans.

Chronic sun exposure leads to structural and functional alterations in exposed skin. Photoageing is a process distinct from the changes taking place due to chronological ageing. Unique alterations in the dermal extracellular matrix occur as a result of photoageing and are responsible for many of these physiological changes taking place in sun-damaged skin. Accompanying the deposition of abnormal elastic tissue, or solar elastosis, are significant alterations in dermal glycosaminoglycans (GAGs). Accumulation of GAGs as a result of photoageing, as demonstrated in both humans and animal models of photoageing, seems almost paradoxical in view of the large amounts of GAGs present in the skin of newborns, making their skin well hydrated and supple, in sharp contrast to the weathered appearance of photoaged skin. We investigate the relative GAG content of photoaged skin using immunoperoxidase stains specific for hyaluronic acid and chondroitin sulphate, and determine the location of these GAGs using confocal laser scanning microscopy. Our results demonstrate significant increases in GAG staining in sun-damaged vs. sun-protected skin from the same individuals, as measured by computer-based image analysis. Furthermore, confocal laser scanning microscopy reveals that the increased dermal GAGs in sun-damaged skin are deposited on the elastotic material of the superficial dermis of photodamaged skin, and not between collagen and elastic fibres as in normal skin. The abnormal location of GAGs on these fibres may explain the apparent paradoxical weathered appearance of photodamaged skin despite increased GAGs.

Chondroitin Sulfates↗
PubMed1996

8-methoxypsoralen and ultraviolet a radiation activate the human elastin promoter in transgenic mice: in vivo and in vitro evidence for gene induction.

Treatment of skin diseases with the combination of 8-methoxypsoralen and ultraviolet A radiation (PUVA) results in clinical alterations in treated skin that resemble those observed in chronically photodamaged skin. The PUVA-treated patients develop nonmelanoma skin cancers, pigmentary alterations and wrinkling characteristic of sun-induced changes. The major alteration in the dermis of sun-damaged skin is the deposition of abnormal elastic fibers, termed solar elastosis. Up-regulation of elastin promoter activity in dermal fibroblasts explains the excess elastic tissue but not the reason for the aberrant morphology of the elastotic material. In order to study photoaging in an experimental system, we utilized a transgenic mouse line that expresses the human elastin promoter/chloramphenicol acetyltransferase construct in a tissue-specific and developmentally regulated manner. Although UVB radiation has been demonstrated to increase promoter activity in vitro, UVA fails to demonstrate a similar effect at the doses utilized. In this study, we demonstrate the ability of PUVA treatment to up-regulate elastin promoter activity both in vitro and in vivo. These data help to explain the development of photoaging in sun-protected PUVA-treated skin. We attribute the up-regulation of elastin promoter activity in response to PUVA to the formation of DNA photoadducts, which do not occur in response to UVA radiation alone.

Animals↗
PubMed1995

Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.

BACKGROUND AND PURPOSE: Indications for carotid endarterectomy have engendered considerable debate among experts and have resulted in publication of retrospective reviews, natural history studies, audits of community practice, position papers, expert opinion statements, and finally prospective randomized trials. The American Heart Association assembled a group of experts in a multidisciplinary consensus conference to develop this statement. METHODS: A conference was held July 16-18, 1993, in Park City, Utah, that included recognized experts in neurology, neurosurgery, vascular surgery, and healthcare planning. A program of critical topics was developed, and each expert presented a talk and provided the chairman with a summary statement. From these summary statements a document was developed and edited onsite to achieve consensus before final revision. RESULTS: The first section of this document reviews the natural history, methods of patient evaluation, options for medical management, results of surgical management, data from position statements, and results to date of prospective randomized trials for symptomatic and asymptomatic patients with carotid artery disease. The second section divides 96 potential indications for carotid endarterectomy, based on surgical risk, into four categories: (1) Proven: This is the strongest indication for carotid endarterectomy; data are supported by results of prospective contemporary randomized trials. (2) Acceptable but not proven: a good indication for operation; supported by promising but not scientifically certain data. (3) Uncertain: Data are insufficient to define the risk/benefit ratio. (4) Proven inappropriate: Current data are adequate to show that the risk of surgery outweighs any benefit. CONCLUSIONS: Indications for carotid endarterectomy in symptomatic good-risk patients with a surgeon whose surgical morbidity and mortality rate is less than 6% are as follows. (1) Proven: one or more TIAs in the past 6 months and carotid stenosis > or = 70% or mild stroke within 6 months and a carotid stenosis > or = 70%; (2) acceptable but not proven: TIAs within the past 6 months and a stenosis 50% to 69%, progressive stroke and a stenosis > or = 70%, mild or moderate stroke in the past 6 months and a stenosis 50% to 69%, or carotid endarterectomy ipsilateral to TIAs and a stenosis > or = 70% combined with required coronary artery bypass grafting; (3) uncertain: TIAs with a stenosis < 50%, mild stroke and stenosis < 50%, TIAs with a stenosis < 70% combined with coronary artery bypass grafting, or symptomatic, acute carotid thrombosis; (4) proven inappropriate: moderate stroke with stenosis < 50%, not on aspirin; single TIA, < 50% stenosis, not on aspirin; high-risk patient with multiple TIAs, not on aspirin, stenosis < 50%; high-risk patient, mild or moderate stroke, stenosis < 50%, not on aspirin; global ischemic symptoms with stenosis < 50%; acute dissection, asymptomatic on heparin. Indications for carotid endarterectomy in asymptomatic good-risk patients performed by a surgeon whose surgical morbidity and mortality rate is less than 3% are as follows. (1) Proven: none. As this statement went to press, the National Institute of Neurological Disorders and Stroke issued a clinical advisory stating that the Institute has halted the Asymptomatic Carotid Atherosclerosis Study (ACAS) because of a clear benefit in favor of surgery for patients with carotid stenosis > or = 60% as measured by diameter reduction. When the ACAS report is published, this indication will be recategorized as proven. (2) acceptable but not proven: stenosis > 75% by linear diameter; (3) uncertain: stenosis > 75% in a high-risk patient/surgeon (surgical morbidity and mortality rate > 3%), combined carotid/coronary operations, or ulcerative lesions without hemodynamically significant stenosis; (4) proven inappropriate: operations with a combined stroke morbidity and mortality > 5%.

Arterial Occlusive Diseases↗
PubMed1995

A diffusing sphere which delivers homogeneous laser light for use in photodynamic therapy.

Photodynamic therapy (PDT) exploits the selective uptake of a photosensitizer in tumors and other hyperproliferative target tissues, as well as the ability to direct the treatment light beam to a specific region. Since the photodynamic effect depends on light dose, tissue optical properties and photosensitizer concentration, uniform delivery of light is crucial to attain optimal photodynamic effect. Many commonly used methods for delivering laser light during photodynamic therapy, such as a free fiber or microlens, require fiber and laser adjustments to obtain a highly uniform beam. In this study, we test the ability of a diffusing sphere to improve the uniformity of a light field coming from an argon laser coupled to a free fiber, in which no attempt has been made to optimize beam characteristics. Light fields from the free fiber, a microlens and the diffusing sphere are compared for uniformity via light intensity readings. An in vivo comparison between the sphere and the free fiber is also made in guinea pigs given Photofrin-II. The diffusing sphere decreases problems with shielding, allows quick and easy application of light by simply applying the device over the desired treatment area, and optimizes the desired photodynamic effect by producing ad highly uniform beam of light with no necessity to optimize light delivery by vibrating, looping or re-cleaving fibers.

Animals↗
PubMed1995

Screening for abdominal aortic aneurysms during lower extremity arterial evaluation in the vascular laboratory.

PURPOSE: The purpose of this study was to evaluate the cost-effectiveness of screening for abdominal aortic aneurysms (AAA) during noninvasive lower extremity arterial examination in the vascular laboratory. METHODS: Over 30 months we screened 531 patients who underwent lower extremity arterial evaluations in the vascular laboratory. The patients had fasted overnight, and, after the regular noninvasive lower extremity arterial examination, the abdominal aorta was screened with B-mode ultrasonography. RESULTS: The aorta was adequately visualized in 475 patients (89%). Mean aortic diameter was 19.6 +/- 4.1 mm at the juxtarenal level and 18.8 +/- 7.2 mm in the lower infrarenal aorta. The aortic diameter was larger in men (p < 0.001) and in smokers (p < 0.001). AAA (diameter greater than 3.0 cm) were identified in 32 patients (6.0% of the 531 patients screened), and 15 of the aneurysms were equal to or larger than 4.0 cm. The best predictors for AAA by logistic regression analysis were male sex (p < 0.005), advanced age (greater than 65 years, p < 0.01), and a history of smoking (p < 0.01). The prevalence of AAA was 6.7% (32/475) in the population in whom the aorta was visualized and 15.2% (19/125) in male smokers over 65 years of age. Aneurysms of 4.0 cm or greater were identified in 3.2% of the entire population screened and 8.8% of male smokers over age 65. Limited aortic scanning prolonged the vascular laboratory examination by an average of 5 minutes. Thus detection of one aneurysm required 83 minutes of scanning time for the whole population studied and 36 minutes of scanning of male smokers over age 65, at a cost of $240 to $553 per aneurysm identified. CONCLUSION: Screening for AAA during lower extremity arterial evaluation in the vascular laboratory addresses a high-risk population, is cost-effective, and should be considered an appropriate and valuable addition to the examination protocol.

Aged↗
PubMed1995

Ultraviolet radiation activates the human elastin promoter in transgenic mice: a novel in vivo and in vitro model of cutaneous photoaging.

The major alteration in photoaged skin is the deposition of massive amounts of abnormal elastic material, termed solar elastosis. In previous work, it has been shown that solar elastosis is accompanied by increased abundance of elastin and fibrillin mRNAs and upregulation of elastin promoter activity. Using a transgenic mouse line, which expresses the human elastin promoter, linked to a chloramphenicol acetyltransferase reporter gene, in a tissue-specific and developmentally regulated manner, we investigated the effects of ultraviolet A radiation and ultraviolet B radiation on human elastin promoter activity in vivo and in vitro. Irradiation of mice with a single dose of ultraviolet B radiation (491.4 mJ/cm2) resulted in an increase up to 8.5-fold in promoter activity, whereas a more modest increase of 1.8-fold was measured with ultraviolet A radiation (38.2 J/cm2). In addition, in vitro studies revealed over a thirtyfold increase in elastin promoter activity in response to ultraviolet B radiation (5.5 mJ/cm2), whereas no change was measured in response to ultraviolet A radiation (2.2 J/cm2). These results confirm the role of ultraviolet B radiation in elastin promoter activation in photoaging, and identify ultraviolet A radiation as a contributing factor. This system should serve as a useful in vivo and in vitro model to study cutaneous photoaging, and for testing compounds that may protect against cutaneous photodamage.

Animals↗
PubMed1995

Disseminated cutaneous Pseudallescheria boydii.

As increasingly aggressive chemotherapeutic regimens are used to treat malignancy, more patients will become susceptible to various opportunistic pathogens. Specifically, several fungal organisms previously viewed as relatively non-pathogenic are more frequently causing serious disease in these patients. Identification of these organisms is of paramount importance, as some are relatively resistant to standard antifungal therapies. We report a patient with disseminated cutaneous Pseudallescheria boydii, diagnosed from histopathological examination and culture of a skin biopsy specimen. Identification of the organism was achieved shortly before the patient died. Clinicians must be aware of the numerous emerging opportunistic pathogens, which may require special culture techniques for diagnosis and varied or combined modes of therapy.

Adult↗
PubMed1995

Systemic lupus erythematosus in patients diagnosed with treatment-resistant acne.

BACKGROUND: Systemic lupus erythematosus (SLE) may involve any number of organ systems and varies greatly in the severity and type of involvement. Cutaneous manifestations of SLE are equally numerous and varied throughout the course of the disease within an individual, as well as varying between patients. Cutaneous manifestations of SLE are frequently the presenting symptoms, typically noted in the classic malar "butterfly" rash; however, other cutaneous patterns are frequently observed. METHODS: We present here two patients who presented with what was thought to be acne refractory to treatment. RESULTS: These patients actually were found to have a facial eruption associated with SLE as confirmed by skin biopsy. CONCLUSIONS: The importance of investigating atypical or treatment-resistant eruptions, especially in patients experiencing other symptoms, is emphasized.

Acne Vulgaris↗