Biomedical subjects
Publications and source records attributed to L Millikan.
Rosacea is a common disorder of the facial skin that tends to become apparent after age 30. Symptoms are usually progressive, but early diagnosis and appropriate management can alleviate patient discomfort and psychological distress as well as prevent serious long-term complications.
BACKGROUND: Androgenetic alopecia is a common condition of adult men. Finasteride, a type 2 5alpha-reductase inhibitor, decreases the formation of dihydrotestosterone from testosterone. OBJECTIVE: Two separate clinical studies were conducted to establish the optimal dose of finasteride in men with this condition. METHODS: Men from 18 to 36 years of age with moderate vertex male pattern hair loss received finasteride 5, 1, 0.2, or 0.01 mg/day or placebo based on random assignment. Efficacy was determined by scalp hair counts, patient self-assessment, investigator assessment, and assessment of clinical photographs. Safety was assessed by clinical and laboratory measurements and by analysis of adverse experiences. RESULTS: Efficacy was demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with 1 and 5 mg demonstrating similar efficacy that was superior to lower doses. Efficacy of the 0.01 mg dose was similar to placebo. No significant safety issues were identified in the trials. CONCLUSION: Finasteride 1 mg/day is the optimal dose for the treatment of men with male pattern hair loss and was subsequently identified for further clinical development.
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In a multicenter clinical trial 300 patients were treated with Fibrel, 4 weeks following a negative skin test, for the correction of cutaneous scars. Fibrel treatment was restricted to one or two implants in a maximum of four scars. The scar corrections were evaluated by the physician, the patient, and also via an objective photogrammetric method. At the end of 1 year the percentage of scars with moderate, marked, or complete correction were 65, 63.3, and 85.8% according to physician, patient, and photogrammetric evaluations, respectively. A cohort of 111 patients were followed for up to 2 years and 87 patients were followed up to 5 years postimplantation. The physician and patient evaluations showed 55.1 and 50.6%, respectively, of the scars in the moderate, marked, or complete correction category at the end of 5 years with only one or two treatments. Safety evaluations included tests for antinuclear antibodies, rheumatoid factor, and presence of antibodies to Fibrel and their crossreactivity to human collagen I and III. These tests did not show any causal relationship to Fibrel treatments and the patients did not have any untoward immunologic symptoms. The data from these patients demonstrate that one or two Fibrel treatments are effective in maintaining greater than 50% correction of depressed cutaneous scars up to 5 years with negligible adverse sequelae and no untoward immunologic symptoms.
Patients with skin and soft tissue infections were enrolled in a study comparing 2 dosage regimens of orally administered cefpodoxime proxetil; 204 patients with mild to moderate infections received cefpodoxime proxetil 200mg twice daily and 47 patients with severe infections received 400mg twice daily. Both dosage regimens were given for 7 to 14 days. 132 of 142 (93.0%) evaluable patients in the 200mg group and 22 of 29 (75.9%) in the 400mg group were clinically cured post-therapy, the remainder in both groups being classified as improved. The pathogen eradication rate at the end of therapy in the 200mg group was 161 of 165 (97.6%), and 38 of 38 (100%) in the 400mg group. Adverse reactions (drug-related) were reported by 20 (8.0%) patients overall, and there was no apparent relationship between the dosage group and the incidence of adverse reactions. The most commonly reported reactions involved the gastrointestinal tract (diarrhoea) or female genital tract (vaginitis). Cefpodoxime proxetil appears to be a useful and safe agent in the therapy of skin and soft tissue infections.
Three hundred patients were treated with Fibrel (Serono Laboratories, Randolph, MA) for the correction of cutaneous scars. Fibrel treatment was restricted to four scars with one or two treatments following a negative skin test. The scar corrections were evaluated by the physician, the patient, and also via an objective photogrammetric method. At the end of 1 year, the percentages of scars with moderate, marked, or complete correction were 65.0%, 63.3%, and 85.8% according to physician, patient, and photogrammetric evaluations, respectively. A cohort of 111 patients from the 1-year study were followed for up to 2 years postimplantation to evaluate safety and efficacy. These patients had similar demographic and scar characteristics as the total patient population in the initial study. The efficacy evaluation at the end of 24 months indicated that successful correction was maintained in 64.4%, 58.9%, and 78.9% of scars for physician, patient, and photogrammetric evaluations, respectively. There were no severe hypersensitivity reactions following treatment with Fibrel. The data from these patients demonstrate that one or two Fibrel treatments are effective in maintaining the correction of depressed cutaneous scars for up to 2 years with negligible adverse sequelae.
A double-blind, parallel comparison was made of the short-term efficacy and safety of three times daily regimens of 0.05% clobetasol propionate cream and 0.05% fluocinonide cream in 114 adolescent and adult patients with psoriasis and 113 with eczema. After 2 weeks of topical applications, patients were assessed according to (1) investigators' overall judgment of clinical response, (2) degree of severity of specific signs and symptoms, and (3) patients' evaluation of improvement. In all three response categories in psoriasis, and in two of three in eczema, clobetasol was statistically significantly superior to fluocinonide (p less than 0.05-p less than 0.001). Healing commenced more rapidly with clobetasol and there was no indication of tachyphylaxis. In contrast, the healing rate with fluocinonide slowed noticeably after the first week, and there was a greater tendency to relapse following fluocinonide treatment. Both regimens were safe: drug-related side effects were generally mild and occurred most commonly with fluocinonide therapy in eczema patients. Overall, drug-related effects occurred in 4% of patients receiving clobetasol and 12% receiving fluocinonide (p less than 0.05). Transient morning plasma cortisol reductions below 5 micrograms/dl occurred in 6% of clobetasol-treated patients, reverting to normal within 1 week of the end of treatment.
A possible potentiating effect of cholecystokinin octapeptide (CCK-OP) on the action of secretin on exocrine pancreatic secretion was studied in five dogs with gastric fistulas and modified Herrera pancreatic fistulas. Secretin in a dose, 2.45 pmol (0.03 clinical units) X kg-1 X h-1, that mimics the plasma secretin level in the postprandial state increased pancreatic bicarbonate secretion, but the increase was not statistically significant. CCK-OP in graded doses, 26.2, 52.5, 109, and 219 pmol (0.03, 0.06, 0.125, and 0.25 microgram) X kg-1 X h-1, given intravenously produced a significant increase in both bicarbonate and protein secretion, and the increase was dose related. The plasma concentrations of immunoreactive CCK during intravenous infusion of CCK-OP in doses of 26.2 and 52.5 pmol X kg-1 X h-1 were found to mimic the postprandial plasma concentrations of immunoreactive CCK in eight dogs. When CCK-OP in four graded doses was added to intravenous infusion of secretin, 2.45 pmol X kg-1 X h-1, the actual bicarbonate output at each dose level of CCK-OP was greater than the sum of the bicarbonate outputs produced by secretin alone and CCK-OP alone in a corresponding dose. Thus, we conclude that the action of secretin in a physiological dose that mimics the plasma level of secretin after a meal is potentiated by CCK-OP in a dose range that produces a plasma CCK-OP level comparable with that in the postprandial state and vice versa. The study indicates that, like secretin, CCK-OP is another necessary agent for pancreatic secretion of bicarbonate during digestion.(ABSTRACT TRUNCATED AT 250 WORDS)
1-Phenyl-1-hydroxy-N-pentane is a synthetic derivative of an ingredient of Curcuma longa that is used as a condiment and dye. The effects of 1-phenyl-1- hydroxy-N-pentane on release of secretin, gastrin, and pancreatic secretion of bicarbonate and protein were studied in both dogs and humans. In fasting dogs with gastric fistulas and modified Herrera's pancreatic fistulas, intraduodenal administration of 1-phenyl-1-hydroxy-N-pentane (pH 6.7) in three different doses (25, 50, and 100 mg/kg) resulted in significant increases in both plasma secretin concentration and bicarbonate output. The increases in the two variables were dose related. The bicarbonate output and plasma secretin concentration produced by the doses of 1-phenyl-1-hydroxy-N-pentane correlated well. No significant change occurred in either protein output or plasma gastrin concentration. The effect of intragastric 1-phenyl-1-hydroxy-N-pentane on release of secretin and pancreatic secretion was also studied in the digestive state. While gastric pH was maintained at 5.5 by intragastric titration with 1 N NaOH after intragastric administration of 5% liver extract solution, intragastric administration of 1-phenyl-1-hydroxy-N-pentane (100 mg/kg) resulted in significant increases in both plasma secretin concentrations and pancreatic bicarbonate output. In the same experiment, the plasma gastrin concentration did not change significantly, whereas gastric acid secretion decreased significantly after the 1-phenyl-1-hydroxy-N-pentane administration. In 6 human volunteers, both plasma secretin concentration and pancreatic bicarbonate output significantly increased when 2% 1-phenyl-1-hydroxy-N-pentane solution, 30 ml/30 min, was infused in the upper jejunum. Again, no increase in the protein output was apparent. These studies indicate that endogenous secretin is released by an agent other than acid and suggest strongly that the increased pancreatic bicarbonate secretion is attributed to the increased plasma concentration of secretin. 1-Phenyl-1-hydroxy-N-pentane may be a useful agent for release of secretin in subjects with achlorhydria, severe hyposecretory state, or total gastrectomy.
Plasma secretin concentrations were determined and duodenal pH was recorded continuously for a period of 24 hours after ingestion of a meal in 3 dogs with gastric cannula and duodenal cannula and in 4 dogs with pancratic fistulae. The mean plasma secretin concentration increased significantly after a meal and it remained elevated for the first 12-hour period (peak at 30 min). Duodenal pH frequently decreased below 4.5 during the first 12-hour postprandial period, but it remained above 5.0 during the second 12 hours. Pancreatic secretion peaked during the first hour of meal ingestion and remained elevated until the end of 12 hours. The increased plasma secretin level in pancreatic fistula dog during the postprandial period was significantly greater than that of duodenal cannula dog, but the trends of increase in the secretin levels were quite identical. The present study indicates that: (1) plasma secretin concentration increases significantly within 30 min after a meal and remains increased during the first 12-hour period, (2) duodenal pH frequently decreaded below 4.5 during the same 12 hours but more frequently during the first 6 hours, and (3) a significant increase in pancreatic water, HC03- and protein occurred during the same time period.
Twenty-three male patients with herpes simplex virus type 2 blisters on the prepuce, glans penis, and penile shaft were divided into two groups. Ten patients served as controls, and thirteen patients were treated with ultrasound (1 watt/cm2 for 60 seconds) and Herpigon on three consecutive days. Results showed a negative virus culture after three days of treatment and significant reduction of recurrent infection in the treated group while the control group experienced recurrent infection within 62-80 days. This method offers a new therapeutic treatment for genital herpes simplex virus.