Biomedical subjects
Publications and source records attributed to M J Goodfield.
Lichen aureus is one of the subtypes of a rare group of diseases, pigmented purpuric dermatoses. The natural course of the disease is slow evolution and slow resolution. Treatment is generally limited. We report a case of lichen aureus that responded dramatically to photochemotherapy (PUVA).
Explore the source record for details and available documents.
We undertook a prospective, randomised, double-blind, double-dummy, multicentre, parallel-group study to compare the efficacy and tolerability of continuous terbinafine (Lamisil) with intermittent itraconazole (Sporanox) in the treatment of toenail onychomycosis. A total of 496 patients (age range 18-75 years) with a clinical diagnosis of dermatophyte toenail onychomycosis, confirmed by positive mycological culture and microscopy (KOH), were recruited from 35 centres in six European countries. They were randomly divided into four parallel groups to receive either terbinafine 250 mg/day for 12 or 16 weeks (groups T12 and T16), or itraconazole 400 mg/day for 1 week in every 4 weeks for 12 or 16 weeks (groups I3 and I4). The primary efficacy measurement at week 72 was mycological cure, defined as negative microscopy and negative culture of samples from the target toenail. At week 72, the mycological cure rates were 75.5% (81/107) in the T12 group and 80.8% (80/99) in the T16 group, compared with 38.3% (41/107) in the I3 group and 49.1% (53/108) in the I4 group. All comparisons (T12 vs. I3, T12 vs. I4, T16 vs. I3, T16 vs. I4) showed significantly higher cure rates in the terbinafine groups (all P<0.0001). In addition, all secondary clinical outcome measures were significantly in favour of terbinafine at week 72. Both treatments were well tolerated, with no significant differences in the number or type of adverse events reported. We conclude that continuous terbinafine is significantly more effective than intermittent itraconazole in the treatment of toenail dermatophyte onychomycosis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Systemic sclerosis is a multi system disorder, for which there is no satisfactory treatment. Theoretically, dietary supplementation with essential fatty acids may lead to an increase in their derivatives, the vasoactive prostaglandins, which benefit the acute and chronic ischaemic lesions of this disease. We assessed the value of concentrated essential fatty acids in patients with systemic sclerosis, concentrating particularly on vascular symptoms and objective tests of vascular reactivity. Twenty-five patients with systemic sclerosis were randomised to receive concentrated essential fatty acids or placebo, for 6 months in a double-blind parallel group study. There was no significant difference between the active and placebo groups in terms of maximum blood flow after warming, minimum blood flow after cooling or the recovery time after cooling. There were no significant differences between the groups in the other parameters measured. Dietary essential fatty acids have no role in the treatment of vascular symptoms in established systemic sclerosis.
Tissue calcification of the fingers associated with limited systemic sclerosis is a common problem and is the source of considerable morbidity as it may be extremely tender and cause considerable functional disability. The current treatment of digital calcification is unsatisfactory. We evaluated the use of the carbon dioxide (CO2) laser in the management of this condition in six patients with the limited form of systemic sclerosis. A total of 21 areas of symptomatic digital calcification of the fingers were treated. Complete resolution of symptoms occurred in 12, moderate response with partial improvement was seen in five, little improvement was observed in two, and recurrence of calcinosis was found in two. The patient's average healing time was 6 weeks (range 4-10). The median duration of follow-up was 20 months (range 12-40). Postoperative infection was seen in two patients, and resolved completely in both with the use of topical and oral antibiotics. We found the CO2 laser a simple and effective treatment for most of the symptomatic lesions of digital calcification, and it may obviate the need for deforming surgery in many cases.
We report a 7-year-old girl with extensive toxic epidermal necrolysis (TEN) and neutropenia who was successfully treated using recombinant granulocyte colony-stimulating factor. Our patient had extensive epidermal loss and neutropenia, both indicators of a poor prognosis, but none the less made a rapid and complete recovery.
Explore the source record for details and available documents.
An increased rate of venous ulcer healing with the use of oral enteric-coated aspirin (300 mg) daily has been reported. Whether the effect of aspirin in this condition is related to its action on the haemostatic mechanism is unclear, and therefore this study aimed to assess the effect of aspirin on some haemostatic parameters in patients with chronic venous leg ulcers. A double-blind, randomized, placebo-controlled, parallel-group study of haemostatic activity and the effect of aspirin was implemented over a 4-month period. Twenty patients with venous leg ulcers, and 20 age- and sex-matched controls were studied. Patients received enteric-coated aspirin (300 mg) or placebo (one tablet) daily for 4 months, in addition to standardized local compressive bandaging (Setopress). Assessments made at recruitment, and at 2 and 4 months, included measurement of total ulcer surface area, haematological and biochemical screening, measurement of coagulation times, coagulation factor VIII:C (FVIII:C) and von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) levels. Procoagulant activity was assessed by a computer-assisted technique, to determine the rate of thrombin production in vitro. Patients with venous ulcers had increased levels of fibrinogen (P < 0.01), FVIII:C (P < 0.05), vWF (P < 0.05) and PAI-1 antigen (P < 0.01) compared with controls. Shortening of the coagulation rate, shown by a reduction of the time to generate 50% maximal thrombin activity in seconds (T50), was seen in patients, in comparison with control subjects (P < 0.05). T50 was longer in patients receiving aspirin than those receiving placebo, reflecting prolongation of coagulation rate in the aspirin-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)
We report the case of a 74-year-old woman with long-standing systemic lupus erythematosus (SLE) who developed Salmonella septicaemia and an aortic mycotic aneurysm which proved fatal. She had received only low dose prednisolone (average 5-10 mg) as treatment for her disease, which appeared to be inactive at the time of her presentation with septicaemia. This is the first case report of this particular manifestation of salmonellosis in SLE and the patient died despite standard antibiotic treatment. This case emphasizes the need for continued vigilance for signs of Salmonella infection when managing patients with SLE.
Over the past four years terbinafine has become established as an effective systemic antimycotic agent with an excellent safety profile. However, experience with its use in children is very limited. We report the effective treatment of five children with oral terbinafine.
Explore the source record for details and available documents.
The effect of oral aspirin on the healing rate of chronic venous leg ulcers was compared with that of placebo in a double-blind randomised trial. 20 subjects with chronic venous leg ulcers were randomised to daily enteric-coated aspirin 300 mg or placebo, and standardised compression bandaging. 4 months of treatment achieved ulcer healing in 38% of the patients receiving aspirin compared with 0% of those receiving placebo (p < 0.007). 52% of the aspirin-treated group showed significant reduction in ulcer size compared with 26% of placebo recipients (p < 0.007). Reduction in ulcer surface area was significantly better in the aspirin-treated group at 2 (p < 0.01) and 4 months (p < 0.002) compared with that in the placebo group.
Explore the source record for details and available documents.
Dermatofibromata are common benign dermal tumours of unknown aetiology. They usually present as a single lesion on the limbs of young adults. Multiple dermatofibromata have been reported occurring in patients with autoimmune disease, who were receiving immunosuppressive treatment. A 25-year-old female is reported who developed multiple dermatofibromata during her first pregnancy, a state of altered immunity.