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Biomedical subjects

R A Silverman

Publications and source records attributed to R A Silverman.

35 records · Page 2Linked to original sources
PubMed1988

Screening for the developmental toxicity of retinoids: use of the sea urchin model.

Retinoids are being used increasingly in dermatologic practice. Fetal malformation is a major form of toxicity associated with certain retinoids. In this study, the developmental toxicity of isotretinoin, its metabolites, and a structurally related analog, tretinoin, were evaluated using the sea urchin model. The American sea urchin, Arbacia punctulata, completes its major developmental stages within 24 hr and has been previously utilized for screening human teratogens. The parent compound, isotretinoin, induced dose-dependent delayed rather than dysmorphic development of the sea urchin embryo. In contrast, its metabolites, 4-oxo-isotretinoin and 4-oxo-tretinoin, and the analog tretinoin induced strikingly dysmorphic development. This may indicate that the metabolites of isotretinoin, rather than the parent compound, may be responsible for the fetal abnormalities observed in the "isotretinoin teratogen syndrome." Therefore, the sea urchin model might serve as a discriminating and rapid screening test for identifying other potential developmentally toxic retinoids.

Animals↗
PubMed1988

Poststeroid panniculitis: a case report.

Firm, red, subcutaneous plaques developed on the cheeks of a 19-month-old girl during a one-month period of rapid steroid withdrawal. The clinical features were most consistent with poststeroid panniculitis. This rare complication of steroid therapy should be differentiated from other causes of red cheeks in children.

Diagnosis, Differential↗
PubMed1988

Steatocystoma multiplex treated with isotretinoin: a delayed response.

A patient with steatocystoma multiplex was treated with 0.75 mg per kg per day of oral isotretinoin. After one month of minimal improvement the patient discontinued therapy. Over the next two months he noted some shrinkage of his pre-existing lesions, which persisted for a follow-up period of six months. Isotretinoin may show a beneficial response in some cases of steatocystoma multiplex even after use of the drug is discontinued. Isotretinoin is known to have effects beyond its treatment period that are related to its long serum half-life. A small number of patients with steatocystoma multiplex have been treated with isotretinoin, with varied responses. This is the first case of a patient who discontinued therapy before a response occurred and then showed a response later.

Adolescent↗
PubMed1988

Systemic candidiasis: cutaneous manifestations in low birth weight infants.

The cutaneous manifestations of 18 infants treated for systemic candidiasis during a 3 3/4-year period were examined. Eight infants, with a mean birth weight of 712 +/- 161 g, had a diffuse burn-like dermatitis, usually within the first three days of life. Candida pseudohyphae were identifiable on skin scrapings. A history of a maternal cerclage or intrauterine device complicated by chorioamnionitis was common. A delay in diagnosis or therapy resulted in mortality, whereas promptly treated infants survived. Nine additional infants had monilial diaper rashes, which spread to the trunk and extremities in four infants. These infants were older at the onset of the dermatitis, and all survived the systemic infection. Systemic candidiasis without any cutaneous involvement developed in only one infant. Candidiasis should be more frequently considered, and prompt systemic therapy should be instituted when cutaneous candidiasis occurs within the first few days of life in infants who weigh less than 1,500 g.

Amphotericin B↗
PubMed1987

Cutaneous manifestations of neurologic infections in children.

Neurologic infections in children are frequently accompanied by cutaneous findings that may direct the physician toward the correct diagnosis. In some instances, the appearance of an eruption (such as erythema chronicum migrans and Lyme disease) is specific or a rapid bedside diagnostic test (Tzanck preparation for herpes simplex) is extremely helpful in sorting out the differential diagnosis of a child's illness. In this article, cutaneous clues to some of the more important childhood infections will be reviewed.

Child↗
PubMed1986

Disseminated intravascular coagulation and purpura fulminans in a patient with Candida sepsis. Biopsy of purpura fulminans as an aid to diagnosis of systemic Candida infection.

Disseminated intravascular coagulation and purpura fulminans developed in association with septicemia and meningitis due to Candida tropicalis in an 18-year-old female immunosuppressed renal allograft recipient. Although systemic Candida infection was initially suspected, blood cultures showed no growth of this organism until after its identification in the dermis of a skin biopsy specimen obtained from the site of purpura fulminans. This case illustrates the association between Candida sepsis and purpura fulminans, and demonstrates the usefulness of skin biopsy of purpura fulminans in the early diagnosis of Candida sepsis.

Adolescent↗
PubMed1985

Eosinophils in the cellular infiltrate of granuloma annulare.

Eosinophils have been described in the infiltrates of granuloma annulare, but their frequency, distribution and extent are not well documented. We found eosinophils in 18/45 (40%) cases of granuloma annulare, without significant variation relating to histologic sub-pattern. Eosinophils were seen in over half the cases of deep granuloma annulare and in over one-third of the cases of superficial granuloma annulare. This study demonstrates the lack of specificity of eosinophils in differentiating superficial granuloma annulare from deep granuloma annulare, granuloma annulare from necrobiosis lipoidica, and granuloma annulare from occasional clinical simulants which histologically show eosinophils, such as arthropod bite reactions.

Diagnosis, Differential↗
PubMed1985

A histologic comparison of congenital and acquired nevomelanocytic nevi.

A reliable microscopic differentiation of nevomelanocytic nevi (NMNs) as congenital or acquired would be useful in defining a histogenic relationship between cutaneous melanoma and congenital NMN. In order to delineate histologic differences between congenital NMN and acquired NMN, a standardized assessment was conducted blindly, using a sample of consecutive surgical specimens of NMN submitted to a children's hospital pathology file. Despite significant histologic differences between congenital NMN and acquired NMN, the lack of a reliable prevalence rate for the proportion of congenital NMNs among all NMN specimens submitted for pathologic examination precludes a precise estimate of predictive value for diagnosing a given NMN as congenital or acquired based on histologic features alone. The results of this study can be used neither to support nor to refute a histologic association between cutaneous melanoma and congenital NMN.

Adolescent↗
PubMed1984

Mucocutaneous lentigines, cardiomucocutaneous myxomas, and multiple blue nevi: the "LAMB" syndrome.

We describe a 13-year-old girl with a cardiocutaneous syndrome characterized by an atrial myxoma, pigmented lesions of the skin and genital mucosa, and opalescent papules and dermal nodules of the skin and tongue. Her pigmented lesions included black macules of the face and vulva, brown macules of the lips and perioral skin, multiple blue nevi, and a congenital nevomelanocytic nevus. The black and brown macules of the face and vulva consisted of lentiginous proliferations of large, intensely dopa-reactive melanocytes. The opalescent papules and dermal nodules had histologic, ultrastructural, and histochemical characteristics of myxomas. During follow-up, the patient developed thyroid nodules, which were composed of mixed papillary and follicular hyperplasia. This case emphasizes the necessity of a cardiac evaluation for a potentially fatal (and surgically treatable) atrial myxoma in individuals with multiple melanocytic and myxomatous tumors of the skin and mucosa.

Adolescent↗
PubMed1984

Twenty-nail dystrophy of childhood: a sign of localized lichen planus.

A 9 1/2-year-old girl was seen with 20-nail dystrophy. Lichen planus was suspected and further examination revealed other lesions localized to the oral mucosa. The diagnosis was confirmed as lichen planus by biopsy of tissue from the oral lesions. Careful examination of all mucocutaneous surfaces is recommended before accepting the diagnosis of so-called isolated 20-nail dystrophy of childhood.

Child↗
PubMedDate not supplied

Circadian variation in the frequency of myocardial infarction and death associated with acute pulmonary edema.

The records of 103 patients hospitalized for acute pulmonary edema were reviewed to determine the relationship between short-term outcome and time of presentation to the emergency department. Although only 17% of the patients arrived in the emergency department during the early afternoon hours, half of the deaths in the study occurred in this group. Patients presenting between noon and four PM had a significantly higher incidence of acute myocardial infarction (76% v. 28%, p = 0.03) and death (47% v. 9% p = 0.03) compared with patients presenting at other times. Differences in the pathophysiology of daytime versus nocturnal acute pulmonary edema may account for some of the variation in outcome.

Adult↗
PubMedDate not supplied

Tinea capitis: fluconazole in Trichophyton tonsurans infection.

Tinea capitis is the most common dermatophyte infection in children. Trichophyton tonsurans is the most common etiologic agent in the United States, and for more than four decades the standard therapy has been griseofulvin. The availability of newer, and often more effective, antifungal drugs creates the opportunity for choice and the ability to optimally tailor treatment for a particular patient. Fluconazole is an azole antifungal drug available in a pleasant, well-tolerated, liquid formulation ideal for the pediatric population. It has a good safety profile and is approved in the United States for use in children, although not for tinea capitis. We present five patients with tinea capitis successfully treated with fluconazole.

Adolescent↗
PubMedDate not supplied

Significant others and fear of crime among the elderly.

The authors examine demographic, environmental, behavioral, and social psychological factors that affect fear of crime among the elderly. Using a structural equation model, relevant variables are examined. Confirming earlier studies, elderly women are found to be more fearful than other groups. Further, social isolation, type of housing, length of residence, and area of the city are all related to fear of crime in a predicted direction. The fearful individual expressed low satisfaction with the job being done by the police in providing protection from crime. Social interaction with neighbors and friends reduces the fear of crime among the elderly. Surprisingly, the more they socialize with their relatives, the more fear they express.

Aged↗