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R D Baughman

Publications and source records attributed to R D Baughman.

At least 19 recordsLinked to original sources
PubMed1998

Consensus workshop on the toxic effects of long-term PUVA therapy.

The possibility that there is an increased risk of melanoma in patients with psoriasis treated with psoralen-UV-A (PUVA) therapy has raised concern on the part of physicians and patients about the long-term safety of this treatment. In response to this concern, the National Psoriasis Foundation sponsored a workshop at which invited participants with expertise in PUVA therapy, psoriasis treatment, melanoma and nonmelanoma skin cancer, and epidemiological and clinical trials were asked to develop a consensus on the following 3 issues: the risk of long-term adverse effects of PUVA therapy with emphasis on nonmelanoma and melanoma skin cancer; the guidelines for physicians and patients for selection and use of PUVA therapy with consideration of the risk-benefit ratio of this treatment compared with the risk-benefit ratios of alternative treatments; and the directions for further evaluation of the long-term effects Of PUVA therapy.

Humans↗
PubMed1998

Cowden's syndrome, Lhermitte-Duclos disease, and sclerotic fibroma.

The authors report a case of Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma, in which a cutaneous sclerotic fibroma was found incidentally during the second resection of a recurrent cerebellar hamartoma. The association of Lhermitte-Duclos disease and sclerotic fibroma with Cowden's syndrome led to a dermatologic examination and confirmation of the diagnosis of Cowden's syndrome. The combination of both Lhermitte-Duclos disease and sclerotic fibroma with Cowden's syndrome has not previously been reported. A review of the 15 cases of Lhermitte-Duclos disease associated with Cowden's syndrome shows no significant gender predilection. Sclerotic fibromas, once thought to be specific for Cowden's syndrome, also are reviewed.

Adult↗
PubMed1995

The safety of etretinate as long-term therapy for psoriasis: results of the etretinate follow-up study.

BACKGROUND: Etretinate is an aromatic retinoid given orally to treat severe psoriasis, a chronic disease that often requires long-term therapy. OBJECTIVE: We assessed the safety of long-term therapy with etretinate for psoriasis. METHODS: This 5-year prospective study of a cohort of 956 patients with psoriasis treated with etretinate assessed the frequency of adverse events in relation to total use and in relation to the frequency of these events in control populations. RESULTS: Our data do not provide evidence for an increased risk of cardiovascular disease, cancer, diabetes, or inflammatory bowel disease in association with long-term etretinate use. Although some patients reported that joint problems improved with the use of etretinate, a greater number associated the use of etretinate with joint problems. CONCLUSION: With proper patient selection and monitoring, long-term etretinate therapy (up to 4 years) does not appear to be accompanied by a substantial increased risk of major adverse effects.

Adult↗
PubMed1995

Assessing the preferences of patients with psoriasis. A quantitative, utility approach.

BACKGROUND AND DESIGN: Patient preferences for health outcomes can be explicitly assessed and expressed in quantitative terms known as utilities. Three standard methods for utility assessment have been used to quantify patient preferences, but these methods have not previously been applied to skin disease. Eighty-seven patients with psoriasis from a tertiary medical center were interviewed, using an interactive, computer-based utility assessment questionnaire, U-Titer. Utilities for three categories of psoriasis severity and potential adverse outcomes of methotrexate therapy were assessed by the vertical rating scale, time trade-off, and standard gamble. RESULTS: Patients assigned a broad range of utilities for each of the health states. Utilities obtained by the vertical rating scale did not correlate well with utilities obtained by standard gamble or time trade-off methods. However, utilities assessed by standard gamble and time trade-off were not significantly different. Patient characteristics such as age, gender, and education were not correlated with utility and did not explain the variation. Indicators of the patients' disease severity were not predictive of utilities for the assessed health states. The relatively high utility for liver biopsy suggests that there is less patient aversion to the procedure than suspected. CONCLUSIONS: Utilities, or quantitative measures of patient preferences for health states, are measurable and vary widely for mild, moderate, and severe psoriasis and possible adverse outcomes of methotrexate treatment. The process of elucidating individual patient utilities for various health outcomes can be used to incorporate patient preferences into the process of clinical decision making. Guidelines that are based solely on severity of symptoms, without input from patients on how they value such symptoms, must be questioned.

Adult↗
PubMed1989

Detection of hepatotoxicity associated with methotrexate therapy for psoriasis.

To determine whether liver function tests and clinical and demographic information would predict methotrexate-associated hepatotoxicity, we identified 78 patients who had undergone 147 liver biopsies associated with methotrexate therapy for psoriasis. The joint sensitivity of aspartate aminotransferase, alkaline phosphatase, and total bilirubin values in detecting abnormal results from a biopsy specimen obtained after treatment was .86; the predictive value of negative test results was .93. A logistic regression model significantly predicted the presence of abnormal (grade III or higher) liver biopsy specimen results. The concordance index was .92 (perfect, 1.0). Regression coefficients may be used along with information from a specific patient to calculate the predicted probability of an abnormal result from a liver biopsy specimen after treatment. We conclude that this multivariate risk estimation model significantly predicts the likelihood of positive findings from liver biopsy specimens in this patient population. The clinical use of this model awaits further validation.

Biopsy↗
PubMed1987

Psoriasis practices.

Explore the source record for details and available documents.

Adrenal Cortex Hormones↗
PubMed1986

Cowden's disease: a further indication for prophylactic mastectomy.

Cowden's disease (multiple hamartoma syndrome) is a syndrome involving abnormalities of multiple organ systems. Transmitted in an autosomal dominant pattern, it carries a high frequency of mammary carcinoma in early middle age in affected women. The hyperkeratotic cutaneous and gingival markers of the disease are its principal overt manifestations. Prophylactic bilateral total mastectomy with optional immediate reconstruction is recommended for women Cowden's disease. An illustrative family with the disease is presented in which one affected young woman was found to have invasive mammary carcinoma with regional metastasis at the time of prophylactic mastectomy.

Adult↗
PubMed1983

Comparative results of prolonged hypothermic storage of canine kidneys preserved with hyperosmolar colloid (TP-II) or crystalloid (Euro-Collins) solution.

The function of kidneys stored for 48 to 72 hours in hypertonic crystalloid, intracellular solution, Euro-Collins (360 mOsm./l.), was compared with those stored in a new hyperosmolar (520 mOsm./l.) colloid solution designated as TP-II. The TP-II solution contained less K2HPO4 (1.05 gm./l.) and KH2PO4 (317 gm./l.) and more glucose (40 gm./l.) than the Euro-Collins, and also had an albumin concentration of 4.3 gm./dl. Kidneys obtained from beagle dogs were flushed with either Euro-Collins or TP-II solution (4C). Hypothermic storage followed for either 48 or 72 hours, prior to autotransplantation into the iliac fossa and contralateral nephrectomy. Four experimental groups were transplanted as follows: group 1 (n = 8) and group 2 (n = 7) received kidneys that were flushed with 250 ml. of Euro-Collins or TP-II solution, respectively, prior to 48 hours hypothermic storage. Group 3 (n = 5) and group 4 (n = 5) received kidneys that were flushed in the same way as those in groups 1 and 2, respectively, but were stored for a 72-hour period. TP-II appears to be superior to Euro-Collins for hypothermic storage of kidneys for periods as long as 48 hours. When hypothermic storage times are extended to 72 hours, the number of kidneys with normal function after transplantation is reduced for both solutions, however, TP-II solution has a slight advantage over Euro-Collins solution. Further studies will hopefully clarify this issue and lead to the application of TP-II in the clinical setting.

Animals↗
PubMed1981

Hereditary epidermolytic palmoplantar keratoderma.

We describe herein a patient in whose family 11 of 20 members have a palmoplantar keratoderma. The pathologic findings in the proband were those of epidermolytic hyperkeratosis. As in the other families described, the disease was found to be inherited as an autosomal dominant trait. All involved family members had hyperkeratosis of the palms and soles as infants. Light microscopy showed hyperkeratosis, hypergranulosis with large irregular keratohyalin granules, and large clear spaces in the cells of the granular and upper spinous layers. Our electron microscopic findings showed that the clear spaces were areas of cytoplasm filled with a fibrillar material and cellular organelles; abnormal clumps of tonofilaments and keratohyalin were also present. We consider this disorder to be a form of keratoderma rather than a localized ichthyosis.

Adult↗
PubMed1980

Methotrexate hepatotoxicity in psoriasis. Consideration of liver biopsies at regular intervals.

Fibrosis of the liver developed to a degree that contraindicated further treatment with methotrexate in 11 of 43 patients who had been receiving maintenance therapy with methotrexate for psoriasis. Liver biopsy had been performed prior to initiation of methotrexate therapy and was repeated at 12- to 18-month intervals. In this retrospective study, age of the patient and duration of therapy have been found to be significant factors in those patients receiving only the weekly oral dosage schedule. Yearly biopsies of the liver are recommended for patients who receive methotrexate throughout their courses of therapy.

Adult↗
PubMed1980

Recurrent erysipelas caused by group B streptococcus organisms.

Group B beta-hemolytic streptococcus (GBS) has emerged as a major cause of neonatal infections. Serious GBS infections in adults occur most frequently when predisposing illness is present. Recurrent erysipelas caused by GBS is reported in a woman who had chronic lymphedema after a radical hysterectomy and radiation therapy. Type III GBS was identified from cultures of vulvar vesicles, vaginal mucosa, and blood. Prophylactic penicillin V potassium therapy prevented further episodes of erysipelas. Group B beta-hemolytic streptococcus should be considered a possible cause of erysipelas or cellulitis.

Abdomen↗