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Biomedical subjects

P Kind

Publications and source records attributed to P Kind.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Skin ulcers in rheumatoid arthritis].

The appearance of severe ulceration of the skin in patients with rheumatoid arthritis is often associated with a tendency to progression of the underlying disease, involvement of internal organs and increased mortality. In the pathogenesis of such ulceration there are multiple causes for their development, persistence and tendency to poor healing. They include localized or generalized immune complex vasculitis, treatment with anti-inflammatory drugs and their side effects following the treatment, arterial and venous insufficiency, and mechanical factors. The management of severe ulceration requires stabilization of the underlying autoimmune disease, e.g. with high doses of glucocorticosteroids or other immunosuppressive drugs or plasmapheresis. Adjuvant treatment of pain with analgesics, improvement of blood perfusion and anti-inflammatory drugs should accompany the topical therapy of ulcers. After suppression of the local inflammatory reaction surgical intervention becomes necessary in most of the patients, and vascularized muscle flaps should be used in preference to meshgrafts or split skin grafts for extensive ulceration in rheumatoid arthritis. A hopeful perspective in the treatment of severe rheumatoid arthritis might be opened up with immunotherapy using monoclonal antibodies.

Aged↗
PubMed1995

[Exacerbation of Hailey-Hailey disease by infection with herpes simplex virus. Detection with polymerase chain reaction].

A 49-year-old man suffered from Hailey-Hailey disease for several years. The patient presented with an acute exacerbation of the disease, which did not respond to oral treatment with high doses of glucocorticosteroids. A skin biopsy was taken and the histological examination indicated a viral infection. Herpes simplex virus was confirmed by electron microscopy (negative staining) and polymerase chain reaction (PCR). The PCR presents a sensitive and effective molecular-biological method for the diagnosis of viral infections.

Biopsy↗
PubMed1995

Modelling the cost-effectiveness of the prophylactic use of SSRIs in the treatment of depression.

Major depressive illness is associated with significant costs for both the patient and health care systems. Against a background of limited resources, clinical efficacy cannot be regarded as the sole requirement in justifying innovative therapy. New therapies must establish both clinical and economic effectiveness. Even supposing that clinical trials offer the best vehicle for demonstrating such characteristics, trial data are not always in a form which enables cost-effectiveness to be investigated. There appears to be widespread agreement that patients should continue to receive active medication for a period of time, following an initial episode of depression. For the purposes of this paper, it is taken as axiomatic that such treatment would be based on selective serotonin reuptake inhibitors (SSRIs). The costs and consequences of the prophylactic use of SSRIs is investigated by simple modelling methods which enable several key parameters to be concurrently varied. The model simulates two alternative treatment strategies -- a 'watchful waiting' approach in which patients are actively treated for depression once it reemerges; a prophylactic in which all patients received SSRIs following their initial episode of depression. The average cost per symptom-free patient is estimated to be 271 pounds, under the first strategy and between 474 pounds and 389 pounds, under the second strategy. The results of this modelling exercise indicate that a strategy of maintaining patients with a known history of depression for a 12 month period on SSRIs, results in an increased number of patients who are symptom-free. Assessing the cost-effectiveness of such a strategy rests ultimately with the comparison of marginal costs and benefits.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1995

A nevoid plaque with histological changes of trichoepithelioma and cylindroma in Brooke-Spiegler syndrome. An immunohistochemical study with cytokeratins.

Brooke-Spiegler syndrome is characterized by the development of multiple trichoepitheliomas and cylindromas. In addition, multiple spiradenomas have been observed in this autosomal-dominant inherited disease. We report a 53-year-old woman with multiple cylindromas on the head and neck and multiple trichoepitheliomas on the face. Additionally, she had had since birth a plaque on the right side of her neck containing two nodules with features of both cylindroma and trichoepithelioma. Immunohistochemical investigations revealed in the basaloid cells of trichoepithelioma an expression of CK 5/6, CK 14, CK 17, CK 19 and vimentin. The cells of the cylindroma lacked vimentin but expressed additionally CK 7, CK 8 and CK 18. The occurrence of cylindroma and trichoepithelioma in a single nevoid plaque from a patient with Brooke-Spiegler syndrome implies an alteration in the stem cells of the folliculosebaceous-apocrine unit and could be characteristic of the disorder.

Antibodies, Monoclonal↗
PubMed1995

Quality of life in liaison psychiatry. A comparison of patient and clinician assessment.

BACKGROUND: This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures. METHOD: A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress. RESULTS: HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress. CONCLUSION: The HMQ is a useful measure of generic health status in liaison psychiatry settings.

Adolescent↗
PubMed1995

The effect of past and present illness experience on the valuations of health states.

The effects of age, sex, income, and other socioeconomic factors on valuations for health states have been reported in the literature. However, little attention has been paid to the influence of illness experience, either current or past, on valuations for of states. This paper addresses that question using six separate data sets covering some 1,900 subjects. Each data set contains information on self-reported current health status and experience of serious illness in self, family, and others. Past experience of illness has not been found to affect valuations, but there is some evidence to suggest that, compared with those who claim to be in full health, those who describe their current health as dysfunctional give higher valuations (i.e., closer to good health) for all health states, and particularly so for the more severe states. The most striking result, however, concerns the relationship between respondents' valuations of their own health and their subsequent valuations of hypothetical health states. In all studies, it has been observed that a low self-rated health status is associated with significantly lower valuations of less severe states, including full health. The findings of this paper suggest a real dilemma for health services researchers and policy makers. The importance of the choice of valuations used in the evaluation of health care now must be recognized, because different results may be obtained according to the current health status of those respondents from whom valuations are.

Adult↗
PubMed1994

HLA-G: expression in human keratinocytes in vitro and in human skin in vivo.

Classical, polymorphic major histocompatibility complex class I molecules are expressed on most nucleated cells. They present peptides at the cell surface and, thus, enable the immune system to scan peptides for their antigenicity. The function of the other, nonclassical class I molecules in man is controversial. HLA-G which has been shown by transfection experiments to be expressed at the cell surface, is only transcribed in placental tissue and in the fetal eye. Therefore, a role of HLA-G in the control of rejection of the allogeneic fetus has been discussed. We found that HLA-G expression is induced in keratinocytes by culture in vitro. Three different alternative splicing products of HLA-G can be detected: a full length transcript, an mRNA lacking exon 3 and a transcript devoid of exon 3 and 4. Reverse transcription followed by polymerase chain reaction also revealed the presence of HLA-G mRNA in vivo in biopsies of either diseased or healthy skin.

Alternative Splicing↗
PubMed1994

[Angina specifica and mucous plaques of the mouth cavity in lues II].

We report on a case of secondary syphilis that became clinically manifest as partially erosive, almost asymptomatic lesions of the oral mucosa. Dark-field microscopy, typical serological parameters and the presence of spirochetes in the biopsy material promptly led to the diagnosis. Depending on the clinical picture, the possibility of syphilis should not be overlooked in the differential diagnosis of disease of the oral mucosa.

Adult↗
PubMed1994

[Papular mucinosis. A rare cutaneous manifestation of lupus erythematosus].

The case of a 48-year-old patient with systemic lupus erythematosus is discussed. Under immunosuppressive therapy, symptomless papules occurred on the shoulders, back, chest and face. Histologically, there were deposits of mucinous matter which produced an intensive blue colour in the HALE-PAS and alcian blue colour test. The epidermal and dermal inflammatory changes which typically occur with lupus erythematosus were absent. Whereas mucin is commonly diagnosed in lupus erythematosus, the clinical manifestation of papulous mucinosis is a rare but diagnostically significant phenomenon, since it can occur without further findings which are typical of lupus erythematosus.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Immune responses of young mice to pneumococcal type 9V polysaccharide-tetanus toxoid conjugate.

Pneumococcal type 9V polysaccharide (PS), contained in the current pneumococcal vaccine, induces only a weak antibody response in young children and therefore is not an effective vaccine for young children. To increase its immunogenicity, a conjugate of PS to a protein carrier, tetanus toxoid (TT), was prepared. To quantify the immune response, mouse anti-9V PS immunoglobulin G (IgG) and IgM reference standards were established. Young mice immunized at 2 weeks of age produced IgM antibody in response to 9V PS alone or 9V PS conjugated to TT. However, only the 9V PS-TT conjugate induced an IgG antibody response and an anamnestic effect. Thus, a covalent linkage between TT and 9V PS was required for isotype switching from IgM to IgG. 9V PS-TT adsorbed with aluminum hydroxide adjuvant resulted in a fivefold or greater increase in the IgG antibody level. We also studied the effect of maternal immunization on the immune response of young mice to 9V PS-TT. Maternal immunization before mating or before mating and during gestation primed 2-week-old progeny given two injections of 9V PS-TT to produce more IgM antibody than progeny from unimmunized mothers. The IgG antibody level of neonates at birth was similar to that observed in the mothers and was probably passive antibody. These results indicate that maternal immunization with an optimum dose of a PS-protein conjugate before and/or during pregnancy, followed by immunization of the offspring with the conjugate, could provide young children with an enhanced IgM antibody response to pneumococcal PSs.

Age Factors↗
PubMed1994

Measuring health status in the community: a comparison of methods.

STUDY OBJECTIVE--The measurement of health outcomes is central to the evaluation of medical treatment and intervention. It is generally acknowledged that such measurement ought to include an assessment of the impact of health care on the quality of life, as well as its quantity. The Health Measurement Questionnaire (HMQ) was developed as a means of identifying respondents in terms of Rosser's classification of illness states. This study examines the extent of convergent validity of the HMQ when used as a self report measure of health status, alongside the General Health Questionnaire (GHQ) and the Nottingham Health Profile (NHP). DESIGN--A randomised survey of residents of Wolverhampton was drawn from the electoral register. Interviews were conducted in the respondents' own homes. The three measurement instruments formed part of an extensive battery of questionnaires aimed at assessing a broad range of health issues. PARTICIPANTS--A total of 430 respondents were interviewed, of whom 407 completed the HMQ. Altogether 210 also completed the GHQ, and a further 207 completed the NHP. Failure in the interview protocol meant that 12 respondents did not complete either the GHQ or the NHP; these respondents did complete their HMQ. MEASUREMENTS AND MAIN RESULTS--At the descriptive level, Rosser distress categories derived from the HMQ seem to correlate well with the GHQ. There is a strong association between weighted Rosser disability/distress states and scores produced using the NHP. All three measures discriminated between "healthy" and "not healthy" subgroups of respondents. CONCLUSIONS--The results indicate strong evidence for convergent validity. There are significant levels of physical and psychological morbidity within the community. The results of this study reinforce the case for the continued measurement of health status within the general population. Low cost techniques such as the HMQ offer the prospect of such measurement.

Adolescent↗
PubMed1994

Papular elastorrhexis: a variant of dermatofibrosis lenticularis disseminata (Buschke-Ollendorff syndrome)?

BACKGROUND: Buschke-Ollendorff syndrome is an autosomal dominant disorder clinically characterized by the appearance of disseminated white papules and osteopoikilosis. Histologically most cases show normal collagen and increased elastic tissue. Abortive forms of Buschke-Ollendorff syndrome are described, which show characteristic skin involvement, absence of skeletal changes and decreased elastic tissue. Papular elastorrhexis is characterized by nonfollicular, white papules, decreased elastic tissue, no genetic inheritance and no osteopoikilosis. OBJECTIVE: Is papular elastorrhexis a new entity or an abortive form of Buschke-Ollendorff syndrome? METHODS: We examined three members of one family (brother, sister and mother) presenting with nonfollicular, distributed, white papules on the trunk and extremities. Skin biopsies were examined by histological and electron-microscopic methods. RESULTS: The histological and electron-microscopic examinations of skin biopsies showed decreased, fragmented elastic fibers and normal collagen. By X-ray examination, no osteopoikilosis was found. The family presented here supports a genetic background of the disease. CONCLUSION: The clinical appearance with the absence of osteopoikilosis and the histological findings of our cases suggest the diagnosis of papular elastorrhexis. Papular elastorrhexis however was reported to be nonfamilial. Because of the genetic background found here we believe that papular elastorrhexis is an abortive form of Buschke-Ollendorff syndrome. Summarizing our data and reviewing the literature, we suggest that connective tissue nevi with the most prominent alterations in the elastic tissue should be classified under the term elastic tissue nevi.

Adolescent↗
PubMed1994

CD30+ anaplastic large cell lymphomas.

Within the spectrum of CD30+ lymphoproliferative diseases of the skin primary cutaneous CD30+ large cell lymphomas are now recognized as a distinct clinicopathologic entity. Once terminologic confusions are clarified the pertinent clinical, histomorphological, and immunophenotypical features essential for the diagnosis can be delineated. Clinical studies indicate a better prognosis of primary cutaneous CD30+ large cell lymphomas as compared with their nodal counterparts and with other cutaneous large cell lymphomas. Therapeutic strategies should be planned accordingly.

Adolescent↗
PubMed1994

Detection of photoreactivity demonstrated in a modified local lymph node assay in mice.

Photoallergic and phototoxic reactions are an increasing problem in dermatologic practice. Currently available test models are heterogeneous and do not allow differentiation between photoallergic and phototoxic reactions. We have modified the local lymph node assay to screen for photoreactive compounds. We found an ultraviolet A (UVA) irradiation-dependent increase in the weights and cell counts of the auricular lymph nodes after application of 8-methoxypsoralen, tribromosalicylanilide, trichlorosalicylanilide, chlorpromazine and promethazine. In contrast to these photoreactive compounds, contact sensitizers did not produce any reaction to UVA irradiation in the local lymph node assay. This assay system has the advantage of being less expensive and less time-consuming and might even be able to differentiate between phototoxic, photoallergic and contact allergic reactions.

Allergens↗
PubMed1993

Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire.

There is an interest in the consequences of deriving a single index measure of health for validity and sensitivity. This paper presents the results of testing a recent example of a general health measure designed to derive a single index, the Euroqol (EQ), and presents a comparison with a new, influential profile measure, the Short Form 36 (SF-36) Health Survey Instrument. The EQ and an anglicised version of the SF-36 health survey, both designed for self-completion, were included in a postal survey of a random sample of 1980 patients from two practice lists in Sheffield, UK. The response rate for the EQ questionnaire was 83%, and the rate of completion over 95%. Evidence was found for the construct validity of the EQ dimension responses and the derived total EQ health score in terms of distinguishing between groups with expected health differences. Considerable agreement was found between EQ responses and the total EQ score, and the UK SF-36 profile scores. There was substantial evidence of EQ being less sensitive at the ceiling (i.e. low levels of perceived ill-health) and throughout the range of health states. A recent restructuring of the EQ, may help overcome some of the problems with the physical dimensions by reducing their skewness.

Activities of Daily Living↗
PubMed1993

The costs of depression.

Depression is one of the commonest conditions seen by general practitioners. Conventional treatments are typically drug based, and usually involve one of the tricyclic preparations. The evaluation of new treatments requires an understanding of the costs and benefits of existing alternatives, to provide a comparative framework for general practitioners and others concerned with the treatment and management of depressed patients. This paper presents estimates of the direct costs associated with the treatment of patients in England and Wales. These amount to some 420 million pounds annually. Pharmaceutical costs represent a relatively small proportion of this total. Substantial indirect costs are generated through lost productivity, and these may exceed 3 billion pounds.

Adolescent↗
PubMed1993

Phototesting in lupus erythematosus.

Ultraviolet (UV) irradiation is a major factor in the pathogenesis of certain variants of cutaneous lupus erythematosus. Photosensitivity constitutes one of the criteria of the American Rheumatism Association for the diagnosis of systemic lupus erythematosus, which further emphasizes its importance. The pathomechanism of UV-induced lupus erythematosus remains unknown. The characterization of photosensitive subacute cutaneous lupus erythematosus (SCLE) by Gilliam and Sontheimer has led to a new approach. Through the development of standardized test methods it has became possible to reproduce cutaneous lesions in the UV-A and UV-B spectrum. These standardized test methods allow a better definition of photosensitivity than clinical history does. Recent clinical data show that besides SCLE another variant, lupus erythematosus tumidus, also reveals pronounced photosensitivity. In this review article phototest procedures, phototest results, and clinical correlations in different subgroups are discussed.

Fluorescent Antibody Technique↗