Search PubMed⌕ Search

Biomedical subjects

N H Cox

Publications and source records attributed to N H Cox.

At least 55 records · Page 3Linked to original sources
PubMed1999

Oxypentifylline in the management of recurrent aphthous oral ulcers: an open clinical trial.

OBJECTIVE: The purpose of this study was to determine the efficacy of oxypentifylline in the treatment of recurrent oral aphthous ulcers and to compare the results with those of previous studies. STUDY DESIGN: A 6-week open trial and a patient survey regarding pain were conducted at the Oral and Maxillofacial Surgery Unit, City General Hospital, Carlisle. Twenty-four patients (11 male and 13 female) were selected from sequential referrals involving complaints of recurrent oral ulcers. A 2-week pretrial period was used to record data pertaining to the occurrence, duration, and pain associated with ulcers. A 4-week period of treatment with oxypentifylline (400 mg administered orally 3 times daily) was followed by an assessment of improvement at the end of 6 weeks. RESULTS: The results were comparable to those of previous studies, with positive responses seen in 63.6% of male patients and 61.5% of female patients. However, recurrence of ulcers was noted in all patients once the drug was discontinued. This was attributed to the small size of the patient sample studied and to the relatively short duration of treatment. No significant side effects were noted. CONCLUSIONS: Double-blind, controlled studies are indicated for a definitive assessment of the efficacy of oxypentifylline in the management of recurrent oral aphthous ulcers. The encouraging results of this study support the suggestion that the use of oxypentifylline be considered in refractory cases of recurrent oral aphthous ulcers.

Adjuvants, Immunologic↗
PubMed1999

The expanding role of nurses in surgery and prescribing in British departments of dermatology. Therapy Guidelines and Audit Subcommittee of the British Association of Dermatologists.

A questionnaire to all 463 consultant members of the British Association of Dermatologists regarding nursing developments received 183 responses (40%) from over 127 departments. Sixty-nine per cent of respondents have nurse-run clinics, anticipated to increase to 91% at base hospitals and 79% in community settings. Fifty-seven per cent have protocols for nurses to alter treatments; 20% have nurses who initiate treatments. Twenty-six per cent have nurses who prescribe with medical countersignature, and 5% have nurses who can prescribe without medical countersignature (likely to increase fourfold). Seventy-two per cent anticipate nurses administering cryotherapy within the next few years. Few respondents supported nurses treating malignancies or lesions not seen by a dermatologist, but supervised procedures such as curettage, shave biopsy and punch biopsy were all likely to increase from about 15% to 30-40%. These interventional procedures, and particularly prescribing without medical countersignature, were currently most frequent in units without specialist registrar support. Obstacles to extending nursing roles included opposition from administration or nursing hierarchies (about 40%), funding problems (about 25%) and uncertainties from departmental nurses themselves (17%). There is clearly support from dermatologists for these developments, but the importance of adequate training, protocols and support from all relevant staff is paramount.

Ambulatory Care↗
PubMed1999

Guidelines for management of Bowen's disease. British Association of Dermatologists.

These guidelines for management of Bowen's disease have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

Antimetabolites↗
PubMed1999

The long-term results of cartilage removal alone for the treatment of chondrodermatitis nodularis.

Cartilage excision alone has been demonstrated to be an effective technique in the treatment of chondrodermatitis nodularis (CDN), and in the short term is associated with an 80% cure rate. The objective of this study was to demonstrate that long-term disease control could be achieved using this surgical technique. Set in three hospital dermatology departments, 94 patients with CDN affecting the helix and antihelix were contacted by postal questionnaire at least 6 months after surgery. Replies were received from 77; 11 patients had died and six could not be traced. The main outcome measure was the identification of those patients in remission and those with disease recurrence. Sixty-two helix lesions were followed up for a mean of 52 months (range 8-99). There was recurrence in 10 patients (all men; 16%). Twenty antihelix lesions were followed up for a mean of 55 months (range 8-93). There was recurrence in five patients (all women; 25%). In conclusion, this study confirms that only cartilage needs to be excised for the long-term effective treatment of CDN. The only relevant aetiological factor identified was that all except one patient slept on the same side as the CDN. We believe that pressure on the ear during sleep causes CDN. This is most evident on the most protuberant part of the ear.

Adult↗
PubMed1998

Prescribing for out-patients by nursing staff in a dermatology department.

Nurse prescribing for a small range of products has been introduced in primary care, but not in hospitals, in the U.K. We have evaluated the benefits, costs, practicality and patient satisfaction with the formal introduction of dermatology nurse prescribing in the out-patient treatment facility of a district general hospital dermatology department with a wide geographical catchment area. Over a 6-month period, 91 items were prescribed to 47 patients on 72 occasions (items/patient: range 1-8, mean 2, median 1). The cost to the department was 249.04 Pounds (cost per patient: range 0.39 Pound-24.61 Pounds, mean 5.30 Pounds). A small number of patients appeared to use nurse prescribing as a substitute for medical consultations. A total of 33 of 45 adult patients replied to a questionnaire. In 15 respondents, the prescription was necessitated by a change in the skin condition and in 10 by the exhaustion of supplies of the current medication, and both of these factors applied in six patients. All had understood the instructions for the use of the treatment prescribed, and only three felt that it had failed to work as anticipated. Only one patient had (unspecified) side-effects, caused by a prescription for a topical antipruritic. Eight patients were able to defer appointments with their general practitioner as a result of the nurse-prescribed item being supplied. Prescribing by appropriately trained nurses therefore appears to be a safe and effective development in dermatology.

Adult↗
PubMed1998

Extrafacial lentigo maligna melanoma: analysis of 71 cases and comparison with lentigo maligna melanoma of the head and neck.

We report a retrospective analysis of extrafacial lentigo maligna melanoma (LMM), and a comparison with patients with LMM of the head and neck. Seventy-one patients (22 men, 49 women) with extrafacial LMM were identified from the Scottish Melanoma Group database for January 1979-March 1996. Their mean age (63 years) was significantly less than that of 335 patients with head and neck LMM (mean 72 years, P < 0.001), with a significantly greater difference among women than men. Extrafacial sites comprised 17.5% of LMMs. There was a marked body site distribution difference between the sexes (P = 0. 001): 68% of extrafacial LMMs in men were on the trunk while 80% in women were on the limbs, particularly the lower leg. Extrafacial LMMs were thinner at presentation than head and neck LMMs (P < 0.05) in both sexes, but this was not simply explained by the younger age of these patients as there was no significant correlation between age and tumour thickness at either extrafacial or at head and neck sites. Although the female lower leg is a site of chronic solar exposure in older women, the other extrafacial sites are habitually covered in the temperate Scottish climate. The significantly younger age group of patients with LMM at extrafacial compared with head and neck sites therefore suggests that the relationship between LMM and sunlight is not simply related to cumulative solar exposure. The demonstration that head and neck LMMs were thicker at presentation compared with extrafacial sites, despite being at a more routinely visible part of the body, suggests that there are still opportunities for targeted pigmented lesion public education.

Age Factors↗
PubMed1998

Management and morbidity of cellulitis of the leg.

Ascending cellulitis of the leg is a common emergency. An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy. Case notes were reviewed for 92 patients admitted to hospital under adult specialties. Mean duration of inpatient therapy was 10 days. A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis. Pathogens were rarely identified, group G streptococci being the single most frequent organism. Benzylpenicillin was administered in only 43 cases. Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently. Ascending cellulitis of the leg has substantial short-term and long-term morbidity. Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect. The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful.

Adult↗
PubMed1997

Superficial spreading melanoma and blue naevus within naevus spilus--ultrastructural assessment of giant pigment granules.

BACKGROUND: Abnormal melanosomes occur in naevus spilus (NS). OBJECTIVE: To determine whether melanoma arising in NS contains abnormal melanosomes. METHODS: Light and electron microscopy of melanoma within NS and congenital naevus (Case 1), and of blue naevus within NS (Case 2). Light microscopy of additional naevi and melanomas. RESULTS: The melanoma and NS (Case 1) both had large numbers of giant pigment granules (GPGs), demonstrated ultrastructurally to be melanosome macrocomplexes. These were not observed in a congenital naevus (Case 1), or in the blue naevus within NS (Case 2). Small numbers of GPGs were observed in 0/2 NS, 8/16 benign naevi and 11/16 malignant melanomas (MMs). CONCLUSION: NS may be associated with other melanocytic tumours including MM and blue naevi; abnormal melanosomes in NS may also be present in the associated tumour. The prognostic importance of these is unknown, but occasional GPGs in melanocytic lesions are a frequent finding.

Adult↗
PubMed1996

Comparison between lentigo maligna melanoma and other histogenetic types of malignant melanoma of the head and neck. Scottish Melanoma Group.

A study of 953 invasive cutaneous malignant melanomas of the head and neck was performed to determine differences between lentigo maligna melanoma and other histogenetic types with regard to patients and sites affected; prognosis was analysed in 595 of these cases. The cases studied comprised all head and neck melanomas registered with the Scottish Melanoma Group between 1979 and 1992, apart from the 3% of cases that were unclassifiable or rare histogenetic types. The histogenetic types of melanoma were 498 (52%) lentigo maligna melanoma (LMM), 237 (25%) superficial spreading melanoma (SSM) and 218 (23%) nodular melanoma (NM). All types increased in incidence throughout the study period. Patients with LMM (mean age 73 years) and NM (mean 68 years) were significantly older than those with SSM (mean 57 years). There were significant anatomical subsite differences related to sex of patients and histogenetic type of melanoma; melanomas on the face were more frequent in females and 90% of LMM occurred at this site, whereas melanomas on the scalp, neck and ears were more frequent in men. Kaplan-Meier estimates of the probability of survival were produced for the 595 of these 953 patients with 5 year follow-up details. In this group of patients the prognostic significance of tumour thickness, Clark level of invasion, ulceration, histogenetic type of melanoma and number of mitoses were studied using stepwise variable selection of procedures. Each of these possible prognostic factors attained individual significance but the tumour thickness was the dominant risk factor in the proportional hazards analysis. When patients were divided into four sex/ulceration subgroups (male/ulcerated, female/ulcerated, male/non-ulcerated, female/non-ulcerated) and analysed by proportional hazards analysis, no variable other than the tumour thickness had any further prognostic effect. Histogenetic type did not remain an independent prognostic variable at this stage. Despite sex and subsite differences, the prognosis for invasive lentigo maligna melanoma does not differ from that for other histogenetic types after controlling for tumour thickness.

Adolescent↗
PubMed1996

Woody hands in a patient with pancreatic carcinoma: a variant of cancer-associated fasciitis--panniculitis syndrome.

We report an elderly woman with rapidly progressive painless, woody induration of the hands. Mild diabetes mellitus was demonstrated. Skin biopsy features included broad fibrous bands extending deeply into subcutaneous fat, a mild mononuclear cell infiltrate, and post-thrombotic recanalization of a deep vessel in one specimen. The patient developed uncontrolled haematemesis and was demonstrated at laparotomy to have disseminated pancreatic carcinoma. The unusual clinical features and temporal relationship between the skin changes and the tumour suggest a paraneoplastic eruption. Which appears best classified as an example of cancer-associated fasciitis-panniculitis syndrome.

Aged↗
PubMed1996

Milia en plaque--a new site and novel treatment.

Milia en plaque is an unusual eruption typically occurring in the retroauricular area. Two cases of this disorder occurring in a novel position and treated with oral minocycline are now reported.

Anti-Bacterial Agents↗
PubMed1996

Persistent erythema and pruritus, with a confluent histiocytic skin infiltrate, following the use of a hydroxyethylstarch plasma expander.

A 40-year-old woman developed a persistent pruritus with erythema of the head and upper trunk, which started within 2 weeks of a hydroxyethylstarch (HES) infusion and was still present 2 years later. Histological examination demonstrated a striking dermal infiltrate of KP1-positive foamy macrophages which had electron-lucent vacuoles. The timing of the onset, the body site distribution, the exclusion of other possibilities and an appropriate history of high dosage HES infusion, suggested that this was the cause of the eruption. Staining with periodic acid-Schiff (PAS) surprisingly was negative but we could not stain HES in vitro with this histochemical stain, and we postulate that the unique extent of the infiltrate and the negative PAS stain in our patient may indicate an impaired ability to degrade this chemical. This may be an important factor in the poorly understood pathogenesis of persistent pruritus induced by HES.

Adult↗
PubMed1996

A case of Sjögren's syndrome, sarcoidosis, previous ulcerative colitis and gastric autoantibodies.

We describe a patient with sicca syndrome, Raynaud's phenomenon and fixed waxy skin lesions. Investigations confirmed both Sjögren's syndrome and sarcoidosis. The patient had previously had ulcerative colitis and other antibody evidence of autoimmunity. The spectrum of disorders reported in association with Sjögren's syndrome and sarcoidosis is wider than suggested in the acronym TASS syndrome (thyroiditis, Addison's disease, Sjögren's syndrome and sarcoidosis), and we suggest that the acronym TOASSUC (thyroiditis, other autoimmunity, Sjögren's syndrome, sarcoidosis, ulcerative colitis) includes a wider range of disorders and may be more memorable.

Autoantibodies↗