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Biomedical subjects

N S Sadick

Publications and source records attributed to N S Sadick.

At least 37 records · Page 2Linked to original sources
PubMed1997

Antimicrobial agents for the dermatologist. II. Macrolides, fluoroquinolones, rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

This article is the second of a two-part series reviewing antimicrobial agents that are used by the dermatologist. In part I we reviewed beta-lactam antibiotics and related compounds. In this section we again emphasize some newer agents (macrolides, fluoroquinolones) as well as some of the more commonly employed older agents (rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

Anti-Bacterial Agents↗
PubMed1997

Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds.

We review the newer antimicrobial agents that are being employed by dermatologists with increased frequency as well as some of the more commonly used older agents. Particular emphasis is based on selection factors such as causative pathogens and their resistance profiles, routes of administration, toxicity, drug interactions, and dosing requirements. Emphasis in this review is on the newer classes of antimicrobials such as third- and fourth-generation cephalosporins; beta-lactam, beta-lactamase inhibitor combination agents; monobactams; carbapenems; macrolides; and fluoroquinolones. Dermatologic indications and treatment alternatives are highlighted; this will expand the practicing clinician's therapeutic armamentarium and enable him/her to make rational decisions concerning treatment approaches to infectious disease problems encountered in daily practice.

Anti-Bacterial Agents↗
PubMed1997

Current aspects of bacterial infections of the skin.

The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.

Erysipelas↗
PubMed1996

The intrinsic antimicrobial activity of selected sclerosing agents in sclerotherapy.

BACKGROUND: Detergent sclerosing agents may have intrinsic antimicrobial properties. In addition, they may have synergistic effects with other antibiotics such as penicillin. They may induce suppression of intrinsic resistance to penicillin in Staphylococcus aureus. OBJECTIVE: It is in this setting that the present study was carried out in order to determine the degree of suppression of resistance to methicillin and oxacillin in S. aureus by two detergent sclerosing solutions. METHODS: Four strains of S. aureus including a quality control strain were isolated. The minimal inhibitory concentration (MIC) of Sotradecol 1.0% and Polidocanol 0.5% were determined in Mueller Hinton Broth. These dilutions were subsequently seeded with 10(5) organisms of the strain of S. aureus being tested. Serial dilutions of penicillin were made and then the sclerosing agents were added in the appropriate dilutions. RESULTS: Sotradecol 1.0% produced a MIC of 1/64 in two strains of S. aureus and 1/128 in two other variant strains. Polidocanol 0.5% produced a MIC of 1/64 against two strains of S. aureus and an MIC of 1/8 and 1/4 with two other variant strains. In addition, in three of the four S. aureus strains both sclerosing agents had synergistic activity with penicillin and augmented its activity approximately 16-fold. CONCLUSION: This study presents the first successful modification in which detergent sclerosing solutions influence methicillin resistance in a Staphylococcal species. This points out a new potential therapeutic indication for this class of agents.

Anti-Bacterial Agents↗
PubMed1995

Congenital erosive and vesicular dermatosis with reticulated, supple scarring: a neutrophilic dermatosis.

Congenital erosive and vesicular dermatosis with reticulated, supple scarring is a rare disease seen at birth with blisters that become eroded and crusted and then heal with characteristic scars. We report the seventh case in the American literature, and the first description of biopsy specimens of early lesions. The acute skin lesions were characterized by sterile, neutrophilic infiltrates in the dermis.

Humans↗
PubMed1995

Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment.

BACKGROUND: Telangiectatic matting and hyperpigmentation are some of the most commonly observed side effects of sclerotherapy. Cutaneous necrosis is relatively rare and often of limited sequelae but most commonly related to extravasation of sclerosant. Physicians treating varicosities and telangiectasia by sclerotherapy must be familiar with causes and means for minimization of all three side effects. OBJECTIVE: This review article discusses the proposed etiology, risk factors, approach for minimizing, and suggested treatment for the three side effects of cutaneous necrosis, telangiectatic matting, and hyperpigmentation. RESULTS: Cutaneous necrosis may occur with the injection of any sclerosing agent even under ideal circumstances and does not necessarily represent physician error. When sclerosant extravasation occurs, dilution must occur immediately. Telangiectatic matting is a recognized complication occurring in approximately 15-20% of patients treated by sclerotherapy. Although the exact mechanism of the phenomena remains unknown, reactive inflammatory and/or angiogenic mechanisms are felt to play a role. Patients are advised that telangiectatic matting is usually not permanent and usually resolves spontaneously in 3-12 months. Postsclerosis pigmentation is defined as the appearance of persistent, increased pigmentation running the course of an ectatic blood vessel treated by sclerotherapy. The general incidence of hyperpigmentation ranges from 10 to 30%. Although hyperpigmentation may persist for months, its presence rarely deters patients from continuing treatment. Spontaneous resolution occurs in 70% at 6 months with 99% resolution occurring within 1 year. CONCLUSIONS: With understanding the etiology, risk factors, and ways to minimize these side effects our goal is to reduce their incidence. Attempting prevention may ultimately be the most effective means of treatment. Dermatol Surg 1995;21:19-29. LEARNING OBJECTIVES: After studying the following article, participant should be able to: 1. Understand the definition and potential causes of cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. 2. Advise patients prior to treatment on the common risks involved in sclerotherapy and to advise them on the relative incidence. 3. Understand the concept of minimal sclerosant concentration and how it can help the physician to choose sclerosing solution concentrations to minimize risks.

Dermatology↗
PubMed1994

Use of nitrous oxide in hair transplantation surgery.

A study of 400 hair transplants carried out in 200 patients using nitrous oxide as an inducing agent before instillation of lidocaine 1%/epinephrine 100,000 parts anesthesia is presented. Clinical efficacy, side effect profile, and toxicity profile are presented. Nitrous oxide is an excellent agent used for the preanesthetic induction phase of hair transplantation surgery.

Administration, Inhalation↗
PubMed1994

Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration.

BACKGROUND: Sclerosing agents produce local endothelial destruction extending to the adventitia of the vessel wall while producing minimal thrombosis formation. They are rapidly inactivated in order to prevent damage far beyond the injection site. It has been stated that detergent sclerosants may have more distal sclerosing capabilities than hyperosmolar sclerosants. OBJECTIVE: The present study compares the in vivo relative potential of polidocanol (POL.), a detergent sclerosing agent, and hypertonic saline (H.S.), a hyperosmolar sclerosant in their effects on distal vessel obliteration. METHOD: Symmetrical Class III reticular vessels of 2-3-mm diameter were injected with equal amounts (0.5 cc) of sclerosing solutions: 0.5% POL. in the left leg and 23.4% H.S. in the right leg. Distance of vessel sclerosing effect was calibrated from the inferior patellar tendon employing a calibrated measuring window. Standard compression (20-30 mm Hg) was employed for 72 hours after each treatment session. Patients were examined at 2-, 4-, 6-, 8-, 10-, and 16-week intervals for vascular sclerosing resolution effect. RESULTS: The mean distance of vessel sclerosis utilizing 23.4% H.S. was 6.24 cm vs 6.34 cm utilizing 0.5% POL. The mean duration of time to clinical disappearance of treated vessels was 6.4 weeks for the H.S.-treated extremity vs 6.2 weeks of the POL.-treated extremity. The difference of both parameters in terms of distance of sclerosing effect and time interval to achieve this effect were not statistically significant for either variable utilizing POL. or H.S. CONCLUSIONS: Hyperosmolar and detergent sclerosants such as POL. and H.S. in comparable concentrations for given vessel diameter may provide equal degrees of vessel obliteration clinically over equivalent periods of time in vivo. Other factors such as minimal sclerosant concentration, hypersensitivity/complication profile, patient discomfort, sclerosant availability, and physician experience are other important factors in choosing a sclerosing agent for a given clinical setting.

Adult↗
PubMed1994

The modified buried vertical mattress suture. A new technique of buried absorbable wound closure associated with excellent cosmesis for wounds under tension.

BACKGROUND: Recent modifications of mattress suturing techniques have been reported producing rapid and effective skin eversion and excellent tensile strength while producing cosmetically elegant results. OBJECTIVE: Presented here is a new modification of the buried vertical mattress suture. Results employing this technique compared with conventional bi-layered wound closure are presented. METHODS: One hundred patients were analyzed in a double-blind randomized study where excision was carried out on benign pigmented lesions of the upper back. Fifty patients were treated by a conventional bi-layered closure technique while another 50 patients were treated by the newly described buried vertical mattress suture technique. Parameters of infection, hypertrophic scar/keloid formation, dehiscence, suture reaction, wound spread, and patient satisfaction were examined. RESULTS: The modified buried vertical mattress suture technique produced less hypertrophic scar/keloid formation (2% vs 16%) as well as less wound scar spread (6% vs 24%) compared with conventional bi-layered suturing techniques. In addition, it was associated with a high degree of patient satisfaction (96%). CONCLUSION: The modified buried dermal mattress suture technique produces excellent cosmetic results in closing elliptical excisions on thick dermal cutaneous anatomic areas under considerable wound tension. Its decreased requirement for postoperative wound care makes it an excellent alternative for patients living long distances from physician referral centers.

Cicatrix, Hypertrophic↗
PubMed1994

The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness.

The effects of the 5 alpha-reductase inhibitor, finasteride, on scalp skin testosterone (T) and dihydrotestosterone (DHT) levels were studied in patients with male pattern baldness. In a double blind study, male patients undergoing hair transplantation were treated with oral finasteride (5 mg/day) or placebo for 28 days. Scalp skin biopsies were obtained before and after treatment for measurement of T and DHT by high pressure liquid chromatography-RIA. In 10 male subjects studied at baseline, mean (+/- SEM) DHT levels were significantly higher in bald (7.37 +/- 1.24 pmol/g) compared to hair-containing (4.20 +/- 0.65 pmol/g) scalp, whereas there was no difference in mean T levels at baseline. In bald scalp from 8 patients treated with finasteride, the mean DHT concentration decreased from 6.40 +/- 1.07 pmol/g at baseline to 3.62 +/- 0.38 pmol/g on day 28. Scalp T levels increased in 6 of 8 subjects treated with finasteride. Finasteride decreased the mean serum DHT concentration from 1.36 +/- 0.18 nmol/L (n = 8) at baseline to 0.46 +/- 0.10 nmol/L on day 28 and had no effect on serum T. There were no significant changes in scalp or serum T or DHT in placebo-treated patients. In this study, male subjects treated with 5 mg/day finasteride for 4 weeks had significantly decreased concentrations of DHT in bald scalp, resulting in a mean level similar to the baseline levels found in hair-containing scalp.

5-alpha Reductase Inhibitors↗
PubMed1993

Acquired ichthyosis in concomitant HIV-1 and HTLV-II infection: a new association with intravenous drug abuse.

BACKGROUND: Papulosquamous eruptions are common in HIV-1-infected patients. Acquired ichthyosis may occur after profound T-cell depletion. Intravenous drug users infected with HIV-1 can be coinfected with human lymphotropic virus II (HTLV-II). OBJECTIVE: We examined the relation between acquired ichthyosis and concomitant infection with HIV-1 and HTLV-II in intravenous drug users. METHODS: We examined 184 male and female HIV-1-positive intravenous drug users for acquired ichthyosis. Enzyme-linked immunosorbent assay was used to screen these patients for antibody to HTLV-I/II. Western blot, viral isolation, and the polymerase chain reaction were used to confirm that serologic responses were from HTLV-II and not HTLV-I. RESULTS: Acquired ichthyosis occurred in 6.3% of white, 16.4% of Hispanic, and 21.7% of black patients. It occurred only after profound helper T-cell depletion, in association with increasing age, and with concomitant infection with HTLV-II (22.2% vs. 6.8% in HIV-1 singly infected patients [p < 0.038]). CONCLUSION: Acquired ichthyosis may be a marker of concomitant infection with HIV-1 and HTLV-II in intravenous drug users and occurs after profound helper T-cell depletion.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical and laboratory evaluation of AIDS trichopathy.

BACKGROUND: The present study reports the incidence of trichocutaneous disorders studied in 500 patients infected with HIV 1 in a large university-based setting. Correlation of these findings with immunologic function at the time of diagnosis is presented. Unusual presentations and therapeutic interventions are discussed. Prognosis as related to various trichocutaneous disorders is elaborated. METHODS: All patients in this study were HIV 1 positive by Western blot assay. T-cell subsets were evaluated by monoclonal antibodies against T-cell surface markers. Hair disorders were analyzed by means of light hair pull test, hair mount, polarizing microscopy, trichogram, scalp biopsy, and cultures for bacteria, fungi, and mycobacteria as indicated. Trichologic manifestations were classified based upon immunologic correlation of absolute level of helper T cells/mm3. RESULTS: The majority of hair disorders in the study population occurred with helper T cell numbers of less than 150/mm3. Papulosquamous problems including seborrheic dermatitis and psoriasis were most commonly noted followed by disorders of cell growth cycle regulation and trichokeratinization, i.e., telogen effluvium and loose anagen syndrome. CONCLUSIONS: Multiple trichocutaneous disorders occur in the setting of retroviral infection. Most of these disorders occur in the setting of progressive immunoincompetence. The awareness of the disorders described here will aid the clinician in both the recognition and management of pilar aberrations in the appropriate clinical setting.

Acquired Immunodeficiency Syndrome↗
PubMed1993

A microbiologic study of diluted sclerotherapy solutions.

BACKGROUND: As sclerotherapy has become more of an exact science it has become appropriate to dilute various sclerosing solutions to produce the least concentration of sclerosant producing effective endosclerosis of a given vessel diameter--the minimal sclerosant concentration. OBJECTIVE: In this setting it has become necessary to take into account various microbiologic considerations. Contamination of infusates is the most common cause of epidemic device-related bloodstream infections. With these considerations in mind, the following study was undertaken to determine the bacterial and fungal content of varied concentrations of four commonly employed sclerotherapy agents. METHODS: Dilutions were made of hypertonic saline 23.4% to 11.7% with both bacteriostatic water and 0.9% normal saline, Polidocanol 0.5% to 0.25% with bacteriostatic water, sodium tetradecyl sulfate 1.0% to 0.5% with bacteriostatic water, and polyiodide iodide 2% to 1% with bacteriostatic water under sterile conditions. Each sclerosant was analyzed for bacterial, fungal, and spore content at determined time intervals with standardized utilization indices for up to 3 months. RESULTS: At each sclerosant concentration for sodium chloride, polidocanol, sodium tetradechol sulfate, and polyiodide iodide at each study design time interval for sampling all bacterial and fungal cultures remained sterile. CONCLUSIONS: With appropriate aseptic techniques we may dilute sclerosing solutions to desired concentrations that will remain sterile for a period of at least 3 months under daily usage conditions.

Bacteria↗
PubMed1993

HIV and associated cutaneous diseases.

HIV infections manifest a wide spectrum of dermatologic diseases. These can be classified and described as primary bacterial infections, fungal infections, associated cutaneous disorders, and hypersensitivity reactions. The presentation of each disease can be clearly identified, and current preferred medical therapies recommended for each disorder.

Diagnosis, Differential↗
PubMed1992

The pulley suture. Utilization in scalp reduction surgery.

A suture variation not commonly utilized in dermatologic surgery is helpful in approximating wound edges without the complications of excessive undermining or the scarring of conventional retention sutures. It is especially useful in scalp reduction surgery.

Alopecia↗
PubMed1992

Predisposing factors of varicose and telangiectatic leg veins.

Presented is an epidemiologic study on predisposing factors in telangiectatic and varicose leg veins on 500 female patients. Genetic predisposition, hyperestrogenemic states, standing vocations, and obesity were found to be the major predisposing factors. Recognition of these factors may help to prevent further progression of proliferative venous disease after sclerotherapy in susceptible individuals.

Adolescent↗