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Biomedical subjects

R L Rietschel

Publications and source records attributed to R L Rietschel.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of systemic sclerosis with extracorporeal photochemotherapy. Results of a multicenter trial.

BACKGROUND AND DESIGN: In a pilot study of extracorporeal photochemotherapy, two patients with systemic sclerosis who received this therapy experienced significant clinical improvement. These results prompted the development of a multicenter trial to examine the benefit of extracorporeal photochemotherapy in the treatment of systemic sclerosis. Seventy-nine patients with systemic sclerosis of recent onset (mean symptom duration, 1.83 years) and progressive skin involvement during the preceding 6 months entered a randomized, parallel-group, single-blinded clinical trial comparing extracorporeal photochemotherapy treatments given on 2 consecutive days monthly with treatment with D-penicillamine at a maximum dose of 750 mg/d. Blinded clinical examiners evaluated skin severity score (thickness), percent surface area involvement, oral aperture, and hand closure. Serial skin biopsies and pulmonary function studies were also performed. RESULTS: Following 6 months of treatment, significant improvement in skin severity score occurred in 21 (68%) of 31 patients receiving photochemotherapy and in eight (32%) of 25 receiving D-penicillamine treatment, while significant worsening occurred in three (10%) of 31 receiving photochemotherapy and in eight (32%) of 25 receiving penicillamine treatment, thus indicating a significantly higher response rate for individuals who received photochemotherapy (P = .02). At both the 6- and 10-month evaluation points, the mean skin severity score, mean percent skin involvement, and mean oral aperture measurements were significantly improved from baseline among those who received photochemotherapy. Mean right and left hand closure measurements had also improved significantly by 10 months of therapy. By comparison, among the patients treated with D-penicillamine, none of the parameters of cutaneous disease had improved significantly after 6 months of therapy, although for those individuals in whom treatment was continued, the mean skin severity score and mean percent skin involvement had improved by 10 months. Skin biopsy studies revealed a correlation between clinical improvement and decreased thickness of the dermal layer. Adverse effects of extracorporeal photochemotherapy were minimal and did not require discontinuation of treatment in any of the patients receiving this therapy; six patients permanently discontinued the use of D-penicillamine treatment due to adverse effects. CONCLUSIONS: For patients with systemic sclerosis of recent onset, extracorporeal photochemotherapy is a well-tolerated treatment that may partially reverse the process that results in cutaneous sclerosis.

Adult↗
PubMed1991

Alpha 1-antitrypsin deficiency-associated panniculitis: case report and review of the literature.

Alpha 1-antitrypsin is the primary serum proteinase inhibitor. Alpha 1-antitrypsin deficiency, especially the ZZ genotype, has been linked mainly to emphysema and cirrhosis; it is also associated with paniculitis. A case of alpha 1-AT-associated panniculitis was documented in a 13-year-old girl in whom a deficiency of the enzyme was known to be present from infancy. This is unusual, since alpha 1-AT panniculitis previously was described in older patients without prior knowledge of the duration of the deficiency. Our patient developed erythematous, subcutaneous nodules subsequent to trauma, which later developed into deep, painless ulcers. We report this case so that the condition may be suspected in patients with panniculitis. The diagnosis may be confirmed by measuring quantitative alpha 1-AT serum levels and by enzyme genotyping. The treatment of choice is dapsone.

Adolescent↗
PubMed1990

Methylchloroisothiazolinone-methylisothiazolinone reactions in patients screened for vehicle and preservative hypersensitivity.

More than 1100 patients were tested with methylchloroisothiazolinone-methylisothiazolinone, 100 ppm, in aqueous and petrolatum-based patch test materials from 1985 to 1987 by members of the North American Contact Dermatitis Group. Thirteen reactions to the aqueous materials and 10 to the petrolatum-based materials were observed. Irritant reactions were infrequent, and about half the reactions were deemed relevant. From 1984 to 1985, patch tests with this substance at a concentration of 250 ppm in petrolatum were conducted. Thirteen persons were identified as allergic, but three others were sensitized by the patch test procedure. Sensitization as not observed in tests with aqueous or petrolatum-based substance at a concentration of 100 ppm, and this concentration appears to be the best compromise between safety and sensitive detection of allergy. Use tests are helpful but not infallible as a guide in establishing relevance with methylchloroisothiazolinone-methylisothiazolinone. Wash-off products are frequently well tolerated by patients with positive reactions to this substance.

Adult↗
PubMed1990

A palmar dermatosis linked to occult carcinoma of the upper thorax, head and neck: Bazex's syndrome and tripe palm.

An unusual, persistent, corregated-to-honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy. This combination of signs and symptoms has been reported under two clinical entities: Bazex's syndrome and tripe palm. This paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor, the site of metastatic disease, and the ability to cure the cutaneous disease by surgical removal of the primary tumor. In our patient, a squamous cell carcinoma of the lung not detectable on chest x-ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails. Recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor. The characteristics of these paraneoplastic syndromes were reviewed in this report.

Aged↗
PubMed1990

Reactions to thimerosal in hepatitis B vaccines.

Hypersensitivity to thimerosal in vaccines has been reported to induce persistent local reactions, urticarial and generalized exanthematic eruptions, and, in the case of the hepatitis B vaccine, urticaria with asthma. The authors describe two cases of extensive reactions, one in a patient who did not form antibodies to the principal vaccine antigen. Although not all thimerosal-sensitive patients develop adverse reactions to vaccines containing this material, there is a potential risk, and the reactions can be very long lasting.

Adult↗
PubMed1989

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985.

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.

Adult↗
PubMed1989

Is patch testing cost-effective?

Costs for dermatitis can be evaluated against the costs and potential benefits of patch testing on the basis of data available from several sources. Consideration of cost for an individual patient suggests that costs become neutral and benefits become positive if the dermatitis is persistent and multiple physician visits are required. The appropriate use of patch testing should yield a positive test result 30% to 65% of the time.

Cost-Benefit Analysis↗
PubMed1988

The case for patch test readings beyond day 2. Notes from the lost and found department.

Additional patch test readings taken after 2 days (48 hours) are valuable in distinguishing false-positive reactions, which may occur up to 22% of the time. Second readings taken on days 3 through 7 may detect an additional 34% positive reactivity. Those reactions, both lost (initially positive, later negative) and found (initially negative, later positive) by delayed readings, require clinical correlation for relevance as do the readings that persist at and beyond day 2 (positive at both readings).

Allergens↗
PubMed1988

Nonatopic eczemas.

Explore the source record for details and available documents.

Bibliographies as Topic↗
PubMed1988

Patch testing in occupational hand dermatitis.

Patch testing is valuable for the management of most forms of hand eczema; it tends to be diagnostically useful, however, only in the nonendogenous forms. Historical and morphologic clues that distinguish hand eczema of endogenous from that of exogenous causes can increase the yield of valuable information from patch testing. Knowledge of the occupations at risk for skin disease and the time required for irritant and allergic contact dermatitis to develop will improve history taking--the key to suspecting an occupational component.

Allergens↗
PubMed1987

Safety and efficacy of topical minoxidil in the management of androgenetic alopecia.

Of 149 subjects with androgenetic alopecia, 102 completed 1 year of a double-blind, randomized study comparing 2% minoxidil and 3% minoxidil solutions for safety and efficacy. One third of the subjects used a vehicle placebo for the first 4 months and then switched to 3% minoxidil. At 12 months the 2% minoxidil group switched to a 3% solution. During months 5 to 12 a steady increase in terminal hair counts occurred to an equal degree within the 2% and 3% minoxidil groups and the 3% treatment group switched from placebo. Total hair counts at 12 months increased from a baseline mean of 63.5 to 180.6 in the 2% treatment group, from 61.0 to 179.9 in the 3% group, and from 65.0 to 191.1 in the placebo to 3% crossover group. Although all 102 subjects completing 12 months of the study thought that visible hair growth had resulted, 89 were considered by the investigators to have visible growth. Dense hair growth, defined as hair long enough to cut or comb, was present in 48 subjects by their own evaluation and in 33 subjects by investigator evaluation. There were no serious side effects. Two instances of allergic contact dermatitis and four of pruritus were attributed to use of the drug. Two individuals complained of impotence, which disappeared within a few days of discontinuation of topical minoxidil. This effect has not been reported during the use of minoxidil in its oral form (Loniten) for the treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1985

Lymphocyte transformation to membrane-conjugated, liposome-conjugated, or unconjugated pentadecylcatechol in the guinea pig.

This study examined the in vitro immunogenicity of haptenated liposomes and compared them with haptenated biological membranes and unconjugated hapten. Peripheral-blood lymphocytes were obtained from guinea pigs topically sensitized with pentadecylcatechol (PDC) and immunologically naive guinea pigs. Lymphocyte transformations were studied by [3H]thymidine uptake. PDC failed to stimulate the lymphocytes from the immunologically naive group. There was significant blastogenesis in the cells of the sensitized group, but the degree of stimulation was dependent upon the manner in which the antigen was presented to them. Unconjugated hapten caused a low-level, dose-dependent mitogenesis in the sensitized T cells, and hapten-conjugated liposomes enhanced this response (P less than 0.05). By far the most effective immunogen was a haptenated biologic membrane. In all cases, the mitogenic response was macrophage dependent. It is possible that the haptenated biologic membranes were more effective than synthetic membranes (liposomes) because of the presence of membrane proteins that can conjugate with hapten and from a more effective immunogen.

Animals↗
PubMed1985

Oxidized sterols inhibit the formation of podophyllin-induced metaphase figures in mouse vaginal epithelia.

The antimitotic activity of oxidized derivatives of cholesterol was investigated using an assay developed by Van Scott and Bonder. In this assay, a drug that has antimitotic activity and is not a metaphase-blocking agent will inhibit the formation of podophyllin-induced metaphase figures, as counted on histologic specimens. Mouse vaginal epithelia were classified as being estrogen or progesterone predominant on the basis of histologic criteria. Podophyllin-injected mice in the estrogenic phase of the estrus cycle demonstrated high metaphase-figure counts, with an average of 284.86 +/- 132.01. In this group, all intravaginally administered compounds, inhibited the formation of metaphase figures, including a propylene-glycol ethanol vehicle (60% suppression); thus, it is concluded that animals in this phase are not a suitable model for assaying antimitotic activity. Mice in the progesterone-predominant phase of the estrus cycle had lower counts of podophyllin-induced metaphase figures, i.e., 142.13 +/- 39.29. In this group, 25-OH-cholesterol was the most effective inhibitor (59% suppression), followed by 7-ketocholesterol (48% suppression) and methotrexate (40% suppression). Cholesterol (5% suppression) and vehicle (20% suppression) did not have any significant effects. Progesterone-predominant epithelium was only susceptible to methotrexate and oxidized sterols. This suggests that oxidized sterols may have antimitotic activity.

Animals↗