Search PubMed⌕ Search

Biomedical subjects

R Marks

Publications and source records attributed to R Marks.

At least 19 recordsLinked to original sources
PubMed2006

Steroid refractory episcleritis as early manifestation of neurosyphilis.

Since the incidence of syphilis is constantly rising in western countries during the last few years the awareness of atypical presentations of this treatable disease is warranted. Especially since early treatment results in complete elimination of Treponema pallidum, thus preventing disabilities and neurological deterioration as a consequence of late stage infection. We describe a case in which a patient with asymptomatic neurosyphilis presented with a history of longstanding episcleritis. The patient was first seen in an outpatient setting, where the resistance of ocular inflammation to steroid treatment led to the uncommon diagnosis. Prolonged antibiotic treatment resulted in a complete solution of all clinical findings and a decrease of specific treponemal antibody titers. This case might serve as an example that with the recent increase in sexual transmitted diseases practitioners might be more often confronted with uncommon presentations of syphilis.

Anti-Bacterial Agents↗
PubMed2006

[The impact of stem cell therapy in hematology and oncology].

The transplantation of hematopoietic stem cells (HSCT) is an established part of the therapy of hematologic neoplasia and certain solid tumors. In the allogeneic approach hematopoietic stem cells are harvested from healthy donors, while in the autologous setting preparations originating from the patient himself are being used. Both therapies use high dose cytotoxic medication for the induction of higher remission rates in malignant diseases. While autologous HSCT rescues hematopoiesis after high dose chemotherapy, in allogeneic HSCT donor immune cells exert an additional allo-reactivity towards recipient tissue and residual malignant cells. Autologous HSCT is mainly used in relapsed malignant high-grade lymphoma. Allogeneic HSCT results in cure from acute leukemia with unfavorable prognosis in a high percentage of patients. Recent developments target the expansion of the donor pool for allogeneic stem cells and want to reduce chemotherapeutic toxicity of allogeneic transplantation with sustained anti-leukemia efficacy.

Antineoplastic Agents↗
PubMed2005

The role of menthol in skin penetration from topical formulations of ibuprofen 5% in vivo.

In vivo plasma profiles from formulations containing 5% ibuprofen were compared after a single topical application in a randomised, double-blind, cross-over trial. Ibuleve gel (Dermal Laboratories, UK) contained only ibuprofen whilst Deep Relief gel (Mentholatum, UK) also contained 3% menthol. In contrast to results obtained when these products were compared under in vitro conditions, there was no statistically significant difference in vivo between delivery of ibuprofen. Estimated relative bioavailability fraction (Deep Relief gel/Ibuleve gel) from log-transformed AUC((0-24h)) was 0.99 (95% CI: 0.94-1.04), estimated C(max )ratio was 0.96 (95% CI: 0.91-1.00) and estimated t(max) ratio was 1.01 (95% CI: 0.81-1.20). Menthol produces local vasodilation, which reduces skin barrier function, and these data demonstrate that it is inappropriate to extrapolate from in vitro data where formulation components produce biologically-mediated enhancement of permeation which cannot be modelled ex vivo. In clinical use, these products deliver comparable amounts of ibuprofen, but only Deep Reliefgel provides the secondary immediate benefit of the direct analgesic action of menthol.

Administration, Cutaneous↗
PubMed2005

Preservation of static and dynamic cerebral autoregulation after mild hypothermic cardiopulmonary bypass.

BACKGROUND: Dysfunction of cerebral autoregulation might contribute to neurological morbidity after cardiac surgery. In this study, our aim was to assess the preservation of cerebral autoregulation after cardiac surgery involving cardiopulmonary bypass (CPB). METHODS: Dynamic and static components of cerebral autoregulation were evaluated in 12 patients undergoing coronary artery bypass graft surgery, anaesthetized with midazolam, fentanyl, and propofol, and using mild hypothermic CPB (31-33 degrees C). Arterial pressure (ABP), central venous pressure (CVP), and blood flow velocity in the middle cerebral artery (CBFV) were recorded. The cerebral perfusion pressure (CPP) was calculated as a difference between mean ABP and CVP. Rapid decrease of CPP was caused by a sudden change of patients' position from Trendelenburg to reverse Trendelenburg. Cerebral vascular resistance (CVR) was calculated by dividing CPP by CBFV. Index of static cerebral autoregulation (CAstat) was calculated as the change of CVR related to change of CPP during the manoeuvre. Dynamic rate of autoregulation (RoRdyn) was determined as the change in CVR per second during the first 4 s immediately after a decrease in CPP, related to the change of CPP. Measurements were obtained after induction of anaesthesia, and 15, 30, and 45 min after termination of CPB. RESULTS: No significant changes were found in CAstat or RoRdyn after CPB. Significant changes in CVR could be explained by concomitant changes in body temperature and haematocrit. CONCLUSION: Autoregulation of cerebral blood flow remains preserved after mild hypothermic CPB.

Aged↗
PubMed2005

Treatment of photoaged skin with a cream containing 0.05% isotretinoin and sunscreens.

AIMS: To determine the safety and efficacy of a cream formulation of 0.05% isotretinoin with sunscreens (SPF 15) (I+S) in the treatment of photoaged skin. DESIGN AND SUBJECTS: A 6-month, multicentre, randomized, double-blind, parallel-group, vehicle-controlled study of 346 subjects with photoaged skin, as defined by the presence of fine lines in the periorbital region. The main outcome measure was profilometry measurements of replicas of the periorbital region, taken at 0 and 6 months. Subsidiary outcome measures were clinical scoring of wrinkles/fine lines at 0, 1, 3, 6 and 9 months and histopathology at 0 and 6 months. METHODS AND RESULTS: A total of 172 subjects were randomized to 0.05% I+S and 174 subjects to vehicle. Subjects used the study medication topically, once-daily for 6 months, followed by a 3-month washout period. Profilometry measurements of the distance between the highest peak and lowest valley (Rz) and the distance between all valleys and peaks from mid-line (Ra) showed that subjects using I+S had statistically significant improvement (p<0.05) compared with the vehicle group. Additionally, at all visits, VAS clinical scoring of wrinkles/fine lines showed a statistically significant difference between the groups in favour of I+S. Tolerance assessments showed that more subjects in the I+S group experienced local side effects at the start of the study; however, reports of side effects decreased over time in both groups. CONCLUSION: This study confirms that I+S improves the appearance of fine wrinkles associated with photoaged skin.

Administration, Topical↗
PubMed2005

Fungiform papillary glossitis: atopic disease in the mouth?

BACKGROUND: Asthma, eczema and hay fever are the classical manifestations of atopic disease. Geographic tongue (benign migratory glossitis) has also been reported to be a manifestation. Anecdotally, atopic people frequently report irritation of the tongue by heat and certain foods, which may be more common than realized. OBJECTIVES: To determine whether atopic people have an increased likelihood of a sensitive tongue manifest as inflamed fungiform papillae and a history of irritation by certain foods. PATIENTS/METHODS: A descriptive classification of inflammation of the fungiform papillae on the tongue was developed using a 9-point analogue scale where 1 was considered normal and 9 was considered to be severely inflamed. An opportunistic sample of participants were classified as atopic or not on the basis of a personal history of asthma, eczema or hay fever. An examination of the tongue was performed using the classification and then a questionnaire was administered on whether they burnt their tongue easily with hot food and whether they were irritated by certain foods. RESULTS: There were 200 participants aged 20 years and over of whom 104 (52%) were classified as atopic on the basis of the personal history. There was a significant positive association between increasingly inflamed fungiform papillae and the likelihood of being atopic. There was also a positive association between increasing inflammation of the fungiform papillae and a history of both burning the tongue easily and irritation of the tongue by food. There was an increased likelihood of a history of irritation of the tongue with certain foods amongst atopic participants and they were also more likely to burn their tongue with hot food than those who were nonatopic. CONCLUSION: Atopic people are more likely than the normal community to have inflammation of the fungiform papillae of their tongue which correlates with a history of a sensitive tongue manifest as irritation by heat and certain foods. These data suggest that atopic disease may occur in the mouth as a common inflammatory change on the tongue-fungiform papillary glossitis.

Adult↗
PubMed2004

The International Foundation for Dermatology: an exemplar of the increasingly diverse activities of the International League of Dermatological Societies.

The International Foundation of Dermatology (IFD) was established by the International League of Dermatology Societies to promote the care of skin disease in the developing world. Starting from an initial base of the Regional Dermatology Training Centre in Tanzania it has successfully trained a cadre of clinical officers and dermatology residents from different African countries. It has now broadened this approach to an assessment of the effectiveness of focused training in Mali. The IFD is also completing a global assessment of dermatological needs in developing countries with a view to establishing guidelines and programmes for the control of common skin diseases. An ongoing strategy has been to work with other agencies to help ease the burden of other endemic tropical diseases that affect the skin; preventing the development of elephantiasis in filarial lymphoedema has been one such project implemented through a programme of skin hygiene.

Dermatology↗
PubMed2004

The stratum corneum barrier: the final frontier.

The stratum corneum (SC) is the differentiated end product of the mammalian epidermis. It is vital to constancy of the milieu interieur (the environment within) because it prevents water loss and the penetration by potentially toxic xenobiotics, damaging radiation, and pathogenic microbes. The intercorneocyte space contains complex nonpolar lipids that constitute the water barrier. The formation of the SC in the process of keratinization is complex providing multiple opportunities for disorders to arise. The final act of keratinization is desquamation and for this to occur the controlled release of single corneocytes is required in which proteases play an important role. Tests and techniques are described that measure the structure and function of the SC.

Animals↗
PubMed2004

A mutation (N177S) in the structurally conserved helix initiation peptide motif of keratin 5 causes a mild EBS phenotype.

Epidermolysis bullosa simplex (EBS) is a group of predominantly autosomal dominant hereditary disorders of the skin, which manifest as superficial skin blisters after minimal mechanical trauma. Three subtypes have been defined, based on clinical severity. Mutations affecting the genes encoding the epidermal keratins 5 (K5) and 14 (K14) have been linked to the disease, and generally those affecting the helix initiation and termination peptide motifs have been linked to severe EBS phenotypes. We report here a novel mutation in the helix initiation peptide of K5, N177S, that causes only a mild EBS-Weber Cockayne phenotype (EBS-WC). The mutation was identified by direct sequencing of polymerase chain reaction (PCR)-amplified genomic DNA encoding the exons of the KRT5 and KRT14 genes, and confirmed by mismatch allele-specific PCR, followed by restriction enzyme digestion with Tsp509 I. The patient is heterozygous for a mutation affecting codon 177, changing a conserved asparagine residue (N) to serine (S). Asparagine 177 is a highly conserved residue among all type II keratins. This is also the first report of a mutation at position 9 of 1A helix (1A:N9S) in a type II keratin. Unlike mutations affecting residues 4, 5, 7, 8, 10, and 11 of the 1A helix of K5 and K14, which were all previously linked to more severe (EBS) phenotypes, K5 1A:N9S produces only a mild EBS-WC phenotype.

Adult↗
PubMed2004

Are foot orthotics efficacious for treating painful medial compartment knee osteoarthritis? A review of the literature.

This work examined the evidence base concerning the efficacy of laterally wedged foot orthotics for improving the symptomatology associated with painful disabling osteoarthritis of the knee medial compartment. To this end, all relevant peer-reviewed publications on this topic published in the English language were retrieved and analysed. In addition, related biomechanical publications were analysed. These data indicate a strong scientific basis for applying wedged insoles in attempts to reduce osteoarthritic pain of biomechanical origin. Further research to substantiate their efficacy in well-designed clinical trials seems warranted.

Biomechanical Phenomena↗
PubMed2004

Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial.

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.

Attitude of Health Personnel↗
PubMed2003

A study of differences in surface roughness between sun-exposed and unexposed skin with age.

BACKGROUND: To understand and separate the roles of age and solar ultraviolet exposure (sun damage) on the surface roughness of skin. OBJECTIVES: To determine the effects of age and site (sun exposed vs. unexposed) on skin roughness in normal healthy subjects. SUBJECTS/METHODS: Using a stylus profilometer and silicone skin surface replicas, we have measured skin surface roughness parameters on habitually exposed (back of hand) and habitually unexposed (upper buttock) skin sites from the same individual in a sample of 73 subjects from the normal population. We compared the two sites in order to determine any differences in roughness caused, we postulate, by the effect of solar ultraviolet exposure on the exposed site. RESULTS: We found that the two sites are indistinguishable in roughness until after 30 years of age. For the over 30 years group, the difference between exposed and unexposed skin roughness correlated strongly with age. For all ages, skin roughness showed a positive correlation with age on the unexposed, but not the exposed, site. On the hand site subjects aged 40 years and older had significantly smoother skin than those aged less than 40 years, as measured by one roughness parameter. On the back, the older group had significantly rougher skin than the younger group measured by two roughness parameters. CONCLUSIONS: We propose that on the back of the hands, solar damage reverses or reduces the increase in roughness which would otherwise be caused by intrinsic ageing.

Adult↗
PubMed2002

Laser treatment of erythema and telangiectasia associated with rosacea.

The response of rosacea-associated erythema and telangiectasia to treatment with the pulsed tunable dye laser (PDL) was evaluated in 12 patients. Improvements in erythema, telangiectasia, flushing, the physician's and the patient's perception of overall severity, treatment tolerability, and the adverse side effects were examined. With the sole exception of the patient's assessment of overall severity we have found highly significant improvements in all other parameters evaluated, with excellent tolerance of treatment. We therefore conclude that the PDL is a safe and effective treatment for the erythemato-telangiectatic component of rosacea.

Adult↗
PubMed2002

Long-term efficacy and safety of tacalcitol ointment in patients with chronic plaque psoriasis.

BACKGROUND: As psoriasis patients often require continuous treatment optimal therapy has to provide efficacy and a good safety profile over the long term. OBJECTIVES: The aim of this multicentre study was to assess the efficacy, safety and tolerability of tacalcitol (4 microg g(-1)) ointment (Curatoderm, Hermal, Reinbek, Germany) applied once daily over a treatment period of 18 months. PATIENTS AND METHODS: Efficacy parameters were Psoriasis Area Severity Index (PASI), based on summed scores of erythema, infiltration and scaling and total body surface involvement (TBI). Safety assessment included serum levels of calcium, parathyroid hormone, calcitonin, 1,25-dihydroxy vitamin D3 (calcitriol); urinary calcium, creatinine, calcium/creatinine ratio in spot and 24-h urine and urinary alpha(1)-microglobulin. A group of 304 patients with chronic plaque psoriasis, covering between 7% and 20% of the body surface area was included for the initial treatment phase of 3 months. Of the 257 patients who completed the initial 3 months, 197 patients continued in a second treatment phase of 15 months. RESULTS: Tacalcitol treatment proved to be effective in reducing the severity of psoriasis and maintained therapeutic response over the study period. The median PASI fell from 9.5 to 4 .6 at month 3 and to 3.25 at month 18 (P < 0.0001). The median improvement in TBI was 30% at month 3 and 50% at month 18. In no patient was there any relevant disturbance of calcium homeostasis. There were no significant changes in mean values of serum calcium, parathyroid hormone and calcitriol. Additionally no significant changes in 24-h urinary excretion evaluation were observed. There was no correlation between levels of serum calcium or urinary calcium and amount of tacalcitol ointment used, even in the patients requiring the largest amounts of ointment (up to 13 g day(-1) and up to 20% of body area affected). Treatment was generally well tolerated and there were no serious or unexpected adverse events reported. However, discontinuation of treatment as a result of skin irritation was seen in 5.9% of patients. The greatest frequency of cutaneous side-effects occurred during initial treatment and the incidence decreased markedly as the treatment was well-tolerated with continued use. CONCLUSIONS: Tacalcitol ointment once daily was demonstrated to be efficacious, safe and well tolerated in the long-term control of plaque psoriasis in patients with up to 20% body surface involvement.

Adolescent↗