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Biomedical subjects

N H Cox

Publications and source records attributed to N H Cox.

At least 73 records · Page 4Linked to original sources
PubMed1996

A reticulate vascular abnormality in patients with lymphoedema: observations in eight patients.

We describe eight patients with lymphoedema who had prominent compressible ridges of tissue in a reticulate pattern, situated predominantly on the upper part of the lower leg. In five patients the lymphoedema was primary, two patients had circumferential venous ulceration, and one had marked venous disease with a small ulcer. One patient had a squamous cell carcinoma of the medial thigh and dysplastic keratoses in the distribution of the reticulate ridges. In three of the four cases in whom histological examination of the ridges was performed, the skin at these areas was demonstrated to contain grossly dilated angular vessels in the mid-dermis, many with valves visible. The vessel walls had a single layer of endothelial cells (anti-factor VIII-related antigen positive) and a basement membrane containing type IV collagen. Abnormal elastic tissue in these biopsies was similar to that in erythema ab igne. Indirect lymphography in one case did not demonstrate dilated lymphatic vessels. The body site distribution and clinical pattern of the abnormality appeared to be similar to erythema ab igne but associated with an underlying abnormality of lymphatic rather than blood vasculature. We propose that our cases may represent 'lymphoedema ag igne'.

Aged↗
PubMed1995

Wound healing on the lower leg after radiotherapy or cryotherapy of Bowen's disease and other malignant skin lesions.

To investigate lower leg wound healing after treatment of skin tumours, the results of external beam radiotherapy were assessed for 141 lesions in 91 patients. Poor healing or failure to heal occurred in 33%, and was related to the age of the patients, the diameter of the radiotherapy field, and the dose and energy of radiotherapy used. No effect of fractionation on healing was apparent, but only 14% of patients were exposed to regimens with a nominal standard dose of over 1800 rets. Age > 90 years, field diameter > 4 cm and dose > 3000 cGy were all associated with a risk of impaired healing of over 50%. The most frequent single diagnosis (59 lesions) in the radiotherapy patients was Bowen's disease. The results of wound healing in these patients were compared with the results of cryotherapy to 82 lower leg Bowen's disease lesions in 49 dermatology patients. Only 2% of the cryotherapy lesions failed to heal compared with 20% of the radiotherapy wounds, although 6% of cryotherapy cases had local recurrence compared with none in the radiotherapy group. Serial overlapping cryotherapy fields of up to 2 cm diameter were shown to be a valid treatment option for Bowen's disease, as no patients had therapy-related failure to heal. To avoid the requirement for potentially more difficult post-radiotherapy salvage surgery, intra-epidermal non-invasive skin tumours > 4 cm in diameter on the lower leg are probably initially best treated by a primary surgical procedure or by staged cryotherapy. Invasive carcinoma of > 4 cm diameter is best treated by surgical excision.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

The effect of ketanserin on healing of fresh surgical wounds.

This study was designed to investigate the effect of topical ketanserin, a selective S2-serotonin antagonist, on wound healing and contraction in surgical wounds allowed to heal by second intention. Thirty-five patients applied placebo or 2% ketanserin gel, double-blind, to head and neck wounds resulting from skin tumour excision, and allowed to heal by second intention. Healing rate was assessed from the change in the square root of wound area, and in 11 patients wound contraction was assessed by the change in the area delineated by wound margin tattoo marks. There were no significant differences in any of the measurements made between the ketanserin- and placebo gel-treated patients. Wound healing was significantly faster in large wounds. Wound contraction was greatest in the early stages of healing, and accounted for 53% of healing. We conclude that, on normally vascularized skin, ketanserin gel has no significant effect on wound healing rate.

Adult↗
PubMed1994

Body site distribution of Bowen's disease.

Several studies of Bowen's disease suggest that most lesions occur on the head and neck, a finding which does not concur with observations in clinical practice in the U.K. In order to test the hypothesis that this reported distribution is due to an increased tendency of physicians to submit lesions of Bowen's disease occurring at these sites for histopathological examination, in comparison with lesions at other body sites, 52 cases of Bowen's disease identified from out-patient clinic diagnostic records were compared with 56 cases derived from pathology records. In both groups, the majority of lesions were on the lower leg; a greater number in the clinical cases group (45/52; 87%) than in the pathology cases (26/56;46%). The lower leg lesions were almost exclusively in women (96% of lower leg lesions occurred in women in each group). The pathology group contained more men (29%) than the clinical group (12%), and also more upper limb lesions (23% compared with 8% in the clinical group). There was no evidence that these differences were due to incorrect clinical diagnosis, and the likely explanation is that lesions diagnosed as Bowen's disease in men, or at sites other than the lower leg, are more likely to be biopsied than clinically typical lesions on the female lower leg. This type of bias is likely to affect larger series in which only biopsied cases are included, and may explain the discrepancy between observations reported in previous publications and the situation in routine clinical practice.

Aged↗
PubMed1994

Ocular toxicity of antimalarials in dermatology: a survey of current practice.

A questionnaire sent to 325 U.K. dermatologists regarding toxicity of antimalarials had a 70% response rate. Hydroxychloroquine (HCQ) was used by 168 respondents, chloroquine (CQ) by 66, and mepacrine by 89 (only 111 always chose one of these). HCQ was considered to be the most effective by 59%, and to have the least cutaneous side-effects by 66%; mepacrine was considered to have the lowest frequency of ocular side-effects by 50%. Thirty respondents had encountered ocular side-effects, but in most cases these were mild. Maculopathy after short-term therapy was identified as a side-effect which is rarely considered. Ocular side-effects were believed to be due to cumulative dose alone by 31%, to dose/body weight alone by 8%, to duration of treatment alone by 3%, and to combinations of these by 58%. Overall, cumulative dose was considered relevant by 85%, duration of treatment by 52%, and dose/body weight by 41%. Referral for ophthalmology screening was always performed at baseline or after an initial trial of therapy by 56%; 17% never referred patients for baseline screening; 60% routinely requested ophthalmological follow-up. In comparison, 14% of respondents routinely referred patients for baseline ophthalmological screening before PUVA therapy (only 52% of whom routinely referred patients before antimalarial therapy). The most important factor contributing to an individual's current practice was experience in training posts (52%), followed by advice of local ophthalmologists (45%), personal experience (19%), specific publications (16%), and manufacturers' recommendations (14%).(ABSTRACT TRUNCATED AT 250 WORDS)

Antimalarials↗
PubMed1994

Sweet's syndrome associated with trans-retinoic acid treatment in acute promyelocytic leukaemia.

A case of acute promyelocytic leukaemia is reported in which Sweet's syndrome developed at the time of an improvement in white blood cell count due to transretinoic acid. Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a disorder characterized by acute onset of inflammatory skin nodules associated with systemic features which include malaise, fever and neutrophilia. Many triggers and associated disorders have been identified since the syndrome was described, the most important being the association with haematological diseases including leukaemias and other myeloproliferative disorders. We describe a case apparently provoked by drug therapy.

Female↗
PubMed1994

Pre-septal cellulitis and facial erysipelas due to Moraxella species.

We describe a patient with an acute ulcerated pre-septal cellulitis with subsequent spread across the face, in whom conjunctival swabs demonstrated the presence of Moraxella species. Unusually, this organism was resistant to penicillin. Clinical improvement was only achieved when treatment with co-amoxiclav was commenced on the basis of the antibiotic sensitivities demonstrated by culture of this organism. Moraxella species are rare skin pathogens but may be underestimated as they usually respond to a wide range of antibiotics; they should be considered as a cause of facial cellulitis or erysipelas which responds poorly to conventional therapy.

Adult↗
PubMed1993

Cutaneous 'ringworm' lesions of Scopulariopsis brevicaulis.

Scopulariopsis brevicaulis is a saprophytic fungus which is occasionally isolated as an apparent cause of toenail fungal infection, and which rarely has been reported as a cause of deep fungal granuloma. We report a case of skin infection with this organism, which was proved by culture of a pure isolate. The skin lesions had an annular ringworm appearance with pustules, they occurred initially at a site of minor injury, and they responded to treatment with terbinafine and itraconazole.

Adolescent↗