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Biomedical subjects

R M Knobler

Publications and source records attributed to R M Knobler.

At least 55 records · Page 3Linked to original sources
PubMed1990

Venous lakes (Bean-Walsh) of the lips--treatment experience with the argon laser and 18 months follow-up.

The intense blue-green light of the argon laser has proven very effective in the treatment of a great variety of vascular skin disorders. Venous lakes (Bean-Walsh) of the lips are blood-filled dome-shaped lesions, their treatment often requiring surgery. Fifty-one patients suffering from this disorder were treated with the argon laser with 1.5-2.0-mm spot size, 0.3-s pulse duration and 1.8-3.0-W power. In most cases treatment was carried out without local anaesthesia. Laser impact was followed immediately by shrinking of the lesions and replacement by a whitish-grey plaque. Excellent cosmetic results were obtained in 90% of the patients. Three patients showed mild scarring. At 18 months follow-up only one patient showed a recurrence. The argon laser appears to be a highly effective non-invasive treatment modality for venous lakes of the lips.

Adult↗
PubMed1990

Argon laser treatment of small keratoacanthomas in difficult locations.

Seventeen patients (mean age, 64.7 years) with solitary keratoacanthomas (KA) located on the face and auricles were treated with the argon laser. All lesions were less than 10 mm in diameter and had been present for 2-10 weeks (mean, 3.8 weeks). The diagnosis was made clinically and was confirmed by histology. The lesions were treated with the argon laser using the continuous exposure technique with a power setting of 4.5 watts (W) and a beam diameter of 1 mm. Complete re-epithelialization occurred within 14-21 days. Excellent treatment results were achieved in 65% of the patients. Thirty-five percent healed with mild scarring. During a follow-up period of 2 years no recurrences were noted. The use of the argon laser for removal of small KAs in difficult locations, which would often require invasive surgery, appears to be an effective additional treatment modality.

Aged↗
PubMed1990

Exacerbation of porokeratosis during etretinate therapy.

Four patients with disseminated superficial porokeratosis (DSP) were treated with the oral aromatic retinoid etretinate. Using the standard dosage of 1 mg/kg/day, 3 patients showed exacerbation of cutaneous lesions 4-6 weeks after initiation of treatment. Because of additional severe generalized itching and discomfort in all patients, treatment had to be discontinued. The clinical exacerbation correlated with a significant increase in the lymphohistiocytic dermal infiltrate beneath the cornoid lamella. In our experience the use of etretinate triggered the exacerbation of porokeratotic lesions with associated side effects showing that their use is not necessarily of benefit as previously reported.

Aged↗
PubMed1989

[Significance of the dose of josamycin in the treatment of chlamydia infected pregnant patients].

Erythromycin and josamycin are the antibiotics of choice in the treatment of pregnant women with Chlamydia infection. On the basis of differing recommendations in the literature regarding treatment period and dosage, two groups of pregnant women were treated with josamycin according to different dosage schedules: Group A: 170 patients treated with 2 x 500 mg daily for 12 days. Group B: 120 patients treated with 3 x 500 mg daily for 8 days. The diagnosis was confirmed by immunofluorescence with monoclonal antibodies. Non-responding patients were treated again with a similar dose. 17% of the patients in group A and 9.1% in group B were still positive for Chlamydia after the first course of treatment. After a second course, 13.6% of group A and none of group B showed positive controls. Failures of therapy after the first treatment course can be attributed to errors in dosage or re-infection, whereas failures after the second course must be due to bad compliance. Our results suggest that pregnant women with Chlamydia infection are most efficiently treated with high dosages of josamycin over a short period of time.

Chlamydia Infections↗
PubMed1989

DNA dot-blot hybridization implicates human papillomavirus type 11-DNA in epithelioma cuniculatum.

Epithelioma cuniculatum is a rare, low-grade squamous cell carcinoma, belonging to the group of verrucous carcinomas. Evidence is presented that suggests that human papilloma virus type-11 may be involved in the pathogenesis of epithelioma cuniculatum. HPV-DNA was detected by dot-blot hybridization with 32P-labelled probe DNA. Plasmids containing HPV-DNA were isolated by the benzoylated naphthoylated DEAE cellulose method (BND-method), an improved procedure for routine detection of HPV-DNA.

Aged↗
PubMed1989

Unusual presentation of porokeratosis palmaris, plantaris et disseminata.

Porokeratosis plantaris, palmaris et disseminata is an autosomal dominant genodermatosis characterized by multiple lesions on the palms and soles, and later on other areas, both sun-exposed and non-sun-exposed. We report a 66-year-old man with porokeratosis plantaris, palmaris et disseminata whose disease had an unusual evolution. To our knowledge this is the first case of the disease in which the lesions first appeared on the trunk and extremities and later involved the palms and soles.

Aged↗
PubMed1989

Disseminated superficial actinic porokeratosis: experimental induction and exacerbation of skin lesions.

A 55-year-old woman with disseminated superficial actinic porokeratosis (DSAP) had lesions on sun-exposed skin areas that were exacerbated during the summer months and involuted in winter. This is the third report in which induction and exacerbation of DSAP lesions were achieved by irradiation with artificial ultraviolet light sources. Our data show that UVB plus UVA is more effective in inducing new or exacerbating preexisting skin lesions than either wavelength alone. We believe that testing with the appropriate ultraviolet light sources is a practical means to differentiate between DSAP and disseminated superficial porokeratosis.

Female↗
PubMed1989

Giant arteriovenous hemangioma (cirsoid aneurysm) of the nose.

We describe a 97-year-old woman who presented to our clinic with an unusually large pendulous asymptomatic soft tumor on the left side of her nose. History revealed a 40-year course, with accelerated growth in the last 9 years. Histology of this 7 x 3-cm large tumor revealed vascular structures composed of densely aggregated thick- and thin-walled vessels, separated by fibrous tissue. These features are characteristic for an arteriovenous hemangioma, also called cirsoid aneurysm. The distal part of the tumor showed nearly total fibrosis and at the proximal end of the tumor signs of incipient basal cell carcinoma were observed. In spite of the accelerated growth, unusual size, and the presence of a basal cell carcinoma at the base of this tumor, giant cirsoid aneurysms appear to be of a benign nature and thus conservative, nonradical surgical treatment can be performed. The tumor was removed by argon laser surgery with excellent results and no sign of recurrence after 1 year.

Aged↗
PubMed1989

Tiaprofenic acid induced photosensitivity.

45 patients (34 patients with PLE, 11 with phototoxic or photoallergic dermatitis) were photopatch tested to tiaprofenic acid. In 23 patients (51%), phototoxic reactions were found. Positive reactions appeared within 0.5 to 48 h of irradiation. Although each patient was irradiated with 2 different UVA light sources, with significantly different energy outputs (10 J/cm2 against 72 J/cm2), the intensity and duration of positive reactions was virtually the same. We found a considerably higher rate of positive reactions than other investigators, independent of the light energy delivered. None of the patients gave a history of previous tiaprofenic acid exposure.

Adolescent↗
PubMed1989

Human immunodeficiency virus infection.

Knowledge of the ever increasing spectrum in cutaneous pathology caused by infection with the human immunodeficiency virus (HIV) is essential for the clinician examining high-risk individuals as well as patients presenting with recent suspicious cutaneous/mucocutaneous lesions. Timely diagnosis of the unique lesions associated with developing immunodeficiency (such as Kaposi's sarcoma and oral hairy leukoplakia)--as well as the often atypical and overlapping infections and neoplastic and allergic manifestations--is critical in order to initiate the appropriate treatment that may prove life saving and help extend the lives of individuals struck by infection with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Preparation and characterization of biotinylated psoralen.

Biotinylated psoralen (BPsor), a psoralen derivative containing a biotin moiety attached via a long-chain, positively charged linker, has been synthesized and its interactions with DNA and avidin have been studied. As do other psoralen derivatives, BPsor photoreacts with DNA to form interstrand crosslinks. The biotin binds to streptavidin after the reaction of BPsor with DNA, and this property has been used to measure low levels of BPsor modified DNA by ELISA with streptavidin and biotinylated alkaline phosphatase. In addition, BPsor retains the biological activity of psoralen, as shown by its ability to inhibit lymphocyte proliferation at a level of 10 ng/ml.

Biotin↗
PubMed1988

The effects of gilvocarcin V and ultraviolet radiation on pBR322 DNA and lymphocytes.

The antitumor antibiotic gilvocarcin (GV) when photoactivated with UV radiation induced single strand breaks in superhelical pBR322 DNA. The optimal wavelengths for nicking DNA correlated with the absorbance maximum of GV near the visible region (398 nm). The response of lymphocytes to stimulation by phytohemagglutinin was reduced to 10% of controls at 0.10 ng/ml GV in combination with 3 J/cm2 of ultraviolet A (UVA) radiation. The potency of gilvocarcin is attributed to two factors: its strong tendency to intercalate with DNA (K = 6.6 X 10(5) M-1) and its intense absorption of UVA radiation (E398 = 11971 M-1 cm-1).

Aminoglycosides↗
PubMed1988

Disseminated superficial porokeratosis and immunosuppression.

We present a patient who developed skin lesions typical of disseminated superficial porokeratosis (DSP) while on immunosuppressive therapy for pemphigus foliaceus. Phototesting with artificial light sources did not have any effect on the DSP lesions. The literature describing occurrence of DSP on immunosuppression is reviewed and possible pathogenetic mechanisms are discussed.

Aged↗
PubMed1987

Photopheresis--extracorporeal irradiation of 8-MOP containing blood--a new therapeutic modality.

In the course of the last four years our group has had experience with the development of an exciting new concept for the treatment of the exfoliative erythrodermic form of cutaneous T cell lymphoma (CTCL), leukemic form, as well as other T cell mediated diseases: extracorporeal photopheresis (EP). In our first experience with this new therapeutic approach, clinical response was observed in 6 of the 7 patients studied. Skin pathology improved significantly so that 5 of 7 patients were able to resume their normal daily activities. Laboratory response was significant in all 7 as measured by a decrease in abnormal T lymphocytes. In spite of an individually adjusted maintenance therapy no significant side effects have been observed. Our initial observations with this new and apparently safe approach for treatment of CTCL and other T cell mediated diseases (e.g. pemphigus vulgaris) suggest that further more extensive clinical trials as well as research into the basic underlying mechanisms involved are warranted.

Combined Modality Therapy↗
PubMed1987

Clinical evolution of cutaneous T cell lymphoma in a patient with antibodies to human T-lymphotropic virus type I.

A woman who emigrated to the United States from the Dominican Republic developed the first signs of cutaneous T cell lymphoma during the last trimester of her pregnancy. This patient, found to have a positive reaction against human T-lymphotropic (leukemia-lymphoma) virus type I (HTLV-I), was followed up prospectively from the appearance of the initial skin lesion to the development of high-count helper T cell leukemia. Antibodies reactive with the core protein of HTLV-I were also identified in her husband and mother but not in her 2-year-old daughter. Examination of the patient's course provides clues about the latency period and transmission of HTLV-I and highlights similarities between HTLV-I-positive and HTLV-I-negative cutaneous T cell lymphoma.

Adult↗
PubMed1987

Polymorphous light eruption: experimental reproduction of skin lesions by whole-body UVA irradiation.

Fifty patients suffering from polymorphous light eruption (PLE), selected by criteria pointing to UVA sensitivity, were phototested with 2 different polychromatic UVA sources for reproduction of skin lesions. To simulate natural conditions, the patients were whole-body irradiated for up to 5 consecutive days. In 64% of the patients successful reproduction of PLE lesions was obtained by 1 to 4 irradiations. The total dosage ranged from 20 to 280 J/cm2, and the total exposure times from 10 to 60 min. Our results suggest that irradiation of the whole body in UVA-sensitive PLE patients does not provide more convincing test results than phototesting of small previously involved skin sites, as has been done by other groups.

Adolescent↗