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Biomedical subjects

R Baran

Publications and source records attributed to R Baran.

At least 73 records · Page 4Linked to original sources
PubMed1998

A new classification of onychomycosis.

This new classification of onychomycosis is a development of previous schemes and depends on the recognition of different clinical patterns of nail plate involvement associated with fungal infection as well as histopathology. The main types are distal and lateral subungual onychomycosis, superficial onychomycosis, proximal subungual onychomycosis, endonyx onychomycosis and total dystrophic onychomycosis. In addition, patients may show different combinations of these patterns. The identification of clinical patterns of disease may be useful in defining differences in clinical behaviour, treatment response and associated disease.

Acremonium↗
PubMed1998

Itraconazole for the treatment of onychomycosis.

BACKGROUND: The broad spectrum of activity of itraconazole in vitro manifests itself clinically with the drug being effective for the treatment of onychomycosis caused by dermatophytes, Candida and some non-dermatophyte molds. The pharmacokinetics of itraconazole in the nail results in drug remaining at therapeutic levels for 6-9 months after completion of therapy. METHODS: An overview of studies where continuous or pulse itraconazole therapy has been used in the treatment of fingernail and toenail onychomycosis. RESULTS: Following continuous therapy at 200 mg/day for 3 months for toenail onychomycosis (n = 1741), the rates of clinical cure, clinical response and mycologic cure were: (meta-average +/- 95% standard error (SE)), 52 +/- 9%, 86 +/- 2%, and 74 +/- 3%, respectively, at follow-up 12 months following start of therapy. In fingernail onychomycosis (n = 211), the duration of therapy was 6 weeks and the corresponding efficacy rates at follow-up, 9 months after start of therapy, were meta-average (+/- S.E.) 82 +/- 5%, 90 +/- 2%, and 86 +/- 3%, respectively. In toenail onychomycosis treated with 3 pulses of therapy (n = 1389), the clinical response, clinical cure and mycologic cure were observed in meta-average (+/- S.E.) 58 +/- 10%, 82 +/- 3%, and 77 +/- 5% patients, respectively, at follow-up 12 months after the start of therapy. In fingernail onychomycosis treated with 2 pulses of therapy (n = 210), at follow-up 9 months after the start of therapy, the corresponding efficacy rates were meta-average (+/- S.E.) 78 +/- 10%, 89 +/- 6%, and 87 +/- 8%, respectively. CONCLUSIONS: Both the continuous and pulse therapy regimens are safe with few adverse effects. Compared to continuous therapy, the pulse regimen has an improved adverse-effects profile, is more cost-effective, and is preferred by many patients.

Antifungal Agents↗
PubMed1998

Acquired malalignment: a complication of lateral longitudinal nail biopsy.

We report the development of malalignment of the nail following lateral longitudinal biopsy of the nail unit in seven subjects. The lateral biopsies were in excess of the routine 3 mm diagnostic biopsy performed for investigation of a nail dystrophy, being indicated for excision of focal pathology. Deviation of the distal nail towards the side of excision might be accounted for by one or both of two mechanisms. First, the matrix might become skewed by the unilateral loss of a ligamentous structure extending from the lateral ligament of the distal interphalangeal joint. Second, there may be a reduction of embedding of nail in the lateral nail fold on the operative side in spite of a thorough lateral nail fold reconstruction. This reduction may result in an unopposed inward force from the remaining nail fold.

Adult↗
PubMed1998

Etiology and treatment of nail malalignment.

BACKGROUND: There are three main types of nail malalignment. These are: congenital nail malalignment of the big toenail, traumatic nail malalignment, and iatrogenic malalignment of the nail plate. OBJECTIVE: Treatment is only of benefit in the first two conditions, and specific surgical approach to each condition is outlined. The probable mechanism of iatrogenic malalignment is discussed. RESULTS: Nail rotation for congenital malalignment produces its best results in early childhood. CONCLUSION: Surgery is of benefit in congenital malalignment and traumatic malalignment and is worthwhile in selected cases. Iatrogenic malalignment that is the consequence of wide lateral nail biopsies or similar excisions does not respond to treatment.

Biopsy↗
PubMed1997

Proximal subungual Candida onychomycosis. An unusual manifestation of chronic mucocutaneous candidosis.

Instead of presenting the classical appearance of granulomatous dystrophic nails due to Candida, a patient with chronic mucocutaneous candidosis showed, at each recurrence, transverse cloudy leuconychia which appeared beneath the normal cuticle of several fingernails. This pattern of infection was that of proximal subungual onychomycosis. This has been demonstrated histologically and the observation widens the range of organisms known to cause this type of fungal infection.

Candidiasis, Chronic Mucocutaneous↗
PubMed1997

The onychomatricoma: an electron microscopic study.

The electron microscopic findings in the onychomatricoma are described. In the proximal zone of the onychomatricoma, basal cells have various aspects, some being lacunar while others have only a limited cytoplasmic rim containing mitochondria and tonofilaments. In the parakeratotic cell columns the cells elongate and homogenized tonofilaments appear. Around the lacunae the cells are poorly differentiated and their cytoplasm is granular. It can be concluded that in an onychomatricoma the basal cells have a decreased amount of tonofilaments and desmosomes and that their evolution is not uniform. The tumour can be considered as being the result of a disturbed differentiation of nail matrix cells.

Female↗
PubMed1997

Focal subungual warty dyskeratoma.

Warty dyskeratoma is described in an unusual location. Clinically it appeared as a longitudinal reddish ridge bordered on each side by brown splinter haemorrhages forming a nearly continuous line. The free margin of the nail plate was slightly fissured distal to the red band. In the distal groove, histology showed deep epithelial digitations which lined a crater-like area. Numerous multinucleate giant cells, marked dyskeratosis and acantholytic suprabasal clefts were visible inside this tumour resembling Darier's nail disease.

Aged↗
PubMed1997

Genes that guide growth cones along the C. elegans ventral nerve cord.

During nervous system development, growth cone pioneering and fasciculation contribute to nerve bundle structure. Pioneer growth cones initially navigate along neuroglia to establish an axon scaffold that guides later extending growth cones. In C. elegans, the growth cone of the PVPR neuron pioneers the left ventral nerve cord bundle, providing a path for the embryonic extensions of the PVQL and AVKR growth cones. Later during larval development, the HSNL growth cone follows cues in the left ventral nerve cord bundle provided by the PVPR and PVQL axons. Here we show that mutations in the genes enu-1, fax-1, unc-3, unc-30, unc-42 and unc-115 disrupt pathfinding of growth cones along the left ventral nerve cord bundle. Our results indicate that unc-3 and unc-30 function in ventral nerve cord pioneering and that enu-1, fax-1, unc-42 and unc-115 function in recognition of the PVPR and PVQL axons by the AVKR and HSNL growth cones.

Animals↗
PubMed1997

Uncommon clinical patterns of Fusarium nail infection: report of three cases.

Three cases of proximal subungual onychomycosis due to Fusarium oxysporum, including a patient with a fingernail infection, are described. All patients were immunocompetent and presented with acute paronychia associated with proximal or total leukonychia of the affected nails. Nail avulsion followed by topical treatment produced clinical and mycological cure. The literature on Fusarium onychomycosis is discussed. The combination of proximal subungual onychomycosis with subacute or acute paronychia involving fingernails or toenails is highly suggestive of Fusarium sp.

Aged↗
PubMed1997

[Subungueal exostosis of fingers in hereditary multiple exostosis. 3 cases].

INTRODUCTION: The multiple exostosis syndrome is a rare disease transmitted by autosomal dominant inheritance. Bone growth projecting outward from the long bones is observed in multiple localizations during growth. Prognosis of this benign disease is worsened by the possibility of chondrosarcoma. We report three cases of subungueal exostoses observed in children revealing hereditary exostosis. CASE REPORTS: Clinical examination evidenced progressive deformation of several fingers. In all three patients. There was subungueal tumefaction raising a fissured nail with longitudinal crests. In two cases there were also skeletal deformations. Radiograms showed multiple exostoses of the long bones in all three cases and in one a tumefaction of the scapula in addition to visualizing the subungueal exostoses. There was a family history of such manifestations in all cases. DISCUSSION: Subungueal exostosis is frequent in young adults, usually located in the large toe. These three observations were particularly interesting due to the subungueal localization during the first decade of life. Such localization are rare and usually concern several fingers.

Adolescent↗
PubMed1996

Scimitar syndrome: confirmation of diagnosis by a noninvasive technique (MRI).

Scimitar syndrome is a rare congenital pulmonary anomaly that is characterized by hypoplasia of the right lung and the right pulmonary artery with anomalous pulmonary venous drainage to the inferior vena cava or the right atrium. Very few reports are available that analyze the value of magnetic resonance imaging (MRI) in establishing the diagnosis. We present a case with Scimitar syndrome in which anomalous pulmonary venous return was confirmed by cine MRI.

Bronchoscopy↗
PubMed1996

Nail matrix nevi: a clinical and histopathologic study of twenty-two patients.

BACKGROUND: Because most dermatologists do not regularly perform biopsies of longitudinal melanonychia, even when the pigmentation presents as a single band, the true prevalence of nail matrix nevi is unknown. OBJECTIVE: Our purpose was to determine the prevalence of nail matrix nevi in white patients with longitudinal melanonychia involving a single digit and to determine whether longitudinal melanonychia caused by a nail matrix nevus can be clinically distinguished from longitudinal melanonychia from other causes. METHODS: From January 1989 to December 1994 we performed a nail biopsy on 100 of 128 consecutive white patients who had a single band of "idiopathic" longitudinal melanonychia. RESULTS: A nail matrix nevus was detected in 22 patients. A junctional nevus was found in 19 specimens and a compound nevus in three specimens. CONCLUSION: Nail matrix nevi in Caucasian patients are uncommon but not exceptional. The number of nevi presenting with longitudinal melanonychia exceeded that of melanoma. The diagnosis of nail matrix nevi is impossible clinically and always requires histopathologic study. The pathologic features of nail matrix nevi are similar to those of skin nevi except for their architectural pattern, which reflects the peculiar anatomy of the nail unit.

Adolescent↗
PubMed1996

Epidermal hamartoma presenting as longitudinal pachyleukonychia: a new nail genodermatosis.

BACKGROUND: Epidermal hamartomas involving the nail apparatus are uncommon. OBJECTIVE: Our purpose was to define the clinical, genetic, and histologic features of a unique nail abnormality. METHODS: We examined eight members of three generations who presented with an unusual nail abnormality, longitudinal pachyleukonychia, as a sole characteristic that appeared between the ages of 9 and 30 years. One nail was examined histologically. RESULTS: Histologic examination showed pronounced hyperplasia of the nail bed with papillomatosis. Cell nests of a sebaceous type were included in the epithelial digitations. This dysplasia was not accompanied by abnormalities affecting skin, hair, teeth, or sweat glands. CONCLUSION: This unique epidermal hamartoma appears to be inherited as an autosomal dominant condition.

Adult↗