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Biomedical subjects

R Marks

Publications and source records attributed to R Marks.

At least 127 records · Page 7Linked to original sources
PubMed1996

Further evidence of impaired position sense in knee osteoarthritis.

The knee joint position sense of a control group of healthy women was compared with that of women diagnosed as having severe osteoarthritis (OA) of the knee. Movements monitored were multi-joint when weightbearing on one leg. All subjects completed two angle rematching tests on two separate test occasions, and the criterion and reproduction angles which lay in the range of 15-45 degrees knee flexion were recorded photographically on each occasion. The results showed that the OA group performed the rematching tests with less accuracy than the controls (p < 0.05). Additionally, the OA group displayed significantly higher average flexion error magnitudes than the controls. These results suggest that joint position sense is less accurate and may be systematically distorted during multi-joint movements of the affected legs of a high proportion of women with severe knee OA. They further suggest that to improve their functional performance, patients with knee OA probably require a carefully constructed sensorimotor rehabilitation programme in which pain, effusion and fatigue are minimised.

Adolescent↗
PubMed1996

A study of white dermographism in atopic dermatitis.

Vascular responses of 15 adults with atopic dermatitis (AD), 15 with psoriasis and 15 with normal skin were studied using an automated dermographometer we have designed. The type of colour change, time to onset and the duration of responses were recorded after a constant stroking force was applied to the skin of each subject. Of the 15 patients with atopic dermatitis, 11 had white dermographism (WD) with abnormal looking skin and four had red dermographism (RD) with normal looking skin. All the control subjects had RD. WD in AD had a significantly longer time to onset and shorter duration of response than RD in controls (P < 0.01), whereas RD in AD had a significantly shorter duration of response than RD in controls (P < 0.01). WD in AD changed to RD after topical corticosteroid treatment and this post-treatment RD was quantitatively similar to the RD in AD. We have quantified, for the first time, a subnormal form of RD in clinically normal skin of patients with AD, which is different from that of the RD in normal subjects. We have also shown that WD in AD is altered to this subnormal form of RD after treatment with topical coricosteroids.

Adolescent↗
PubMed1996

Non-melanoma skin cancer and solar keratoses. I. Methods and descriptive results of the South Wales Skin Cancer Study.

This study aimed to describe the prevalence and incidence of solar keratoses and skin cancers and the natural history of solar keratoses in a random population sample. It was a cross-sectional study, with follow-up, conducted in South Wales, and involved 1034 subjects aged 60 years and over drawn from the Family Health Services Authority register. The main outcome measures were detection of the presence of solar keratoses and skin cancers on sun-exposed skin and photographic validation of solar keratoses and biopsy confirmation of cancers wherever possible. We found that solar keratosis prevalence was 23% (95% confidence interval 19.5-26.5) and that of skin cancer (all types) 2% (95% confidence interval 1.0-3.5). The incidence rate of solar keratoses was 149 lesions per 1000 person-years and of non-melanoma skin cancer 9 per 1000 person-years. In all 21% (95% CL 16-26) of solar keratoses regressed spontaneously during follow-up. None underwent malignant change. We believe that the failure of individuals to seek medical advice and the variable under-registration of non-melanoma skin cancer makes population-based study important. The high prevalence and incidence of malignant and pre-malignant skin lesions in this random sample raise major public health concerns. The high rate of spontaneous regression of solar keratoses and the low rate of malignant change challenges conventional views about the need for routine treatment of these lesions.

Adult↗
PubMed1996

Non-melanoma skin cancer and solar keratoses II analytical results of the South Wales Skin Cancer Study.

This study aimed to identify risk markers for prevalent solar keratoses (SKs) and squamous cell carcinomata (SCC) combined, for incident SKs and for spontaneous remission of SKs and to evaluate primary preventative measures. It was a cross-sectional study, with follow-up, conducted in South Wales, and involved 1034 subjects aged 60 years and over. The main outcome measures were the presence of and changes in SKs, and presence of skin cancers, on sun-exposed skin, and risk factors for prevalent SKs/SCCs and for incidence and remission of SKs. We found that variables independently associated with prevalent SKs/SCCs were: age [80 + years vs 60-64 years, odds ratio (OR) 3.7]; sex (male vs female OR 2.2); cumulative sun exposure (top quintile vs bottom quintile OR 3.3) and skin type (skin type 1 vs 4 OR 12.4). Use of sunscreen or protective clothing was not protective after controlling for confounders. Males and those who sunbathe infrequently showed greater remission of SKs. Older subjects and those spending most time in the sun in the preceeding 2 years were most likely to develop new SKs. We conclude that the risk factors identified are consistent with results from sunnier countries. The failure of sunscreen or clothing to emerge as protective raises doubts as to whether these measures are as effective in routine use in the general population as theoretical considerations and the limited trial evidence would predict. Recently reported sun exposure appears to influence the risk of developing new SKs.

Aged↗
PubMed1996

Comparison of the steady state pharmacokinetics of two formulations of cyclosporin in patients with atopic dermatitis.

A comparison was made of the efficacy, tolerability, safety and steady state pharmacokinetics of Sandimmun and Neoral in 11 stable atopic dermatitis patients already on Sandimmun. The study was of an open, crossover design. At entry into the trial, patients were switched to Neoral for 28 days. Treatment was switched back to Sandimmun for Days 28 to 42. The morning dose was given fasting, the evening dose after a standard meal. All measures of eczema severity improved during the Neoral treatment period. Neoral was markedly better tolerated with fewer side-effects. Switching from Sandimmun to Neoral at the same dose resulted in less variable pharmacokinetic profiles in both fasted and fed states. There was an increase in bioavailability with better, less variable and faster absorption, with a slightly reduced tmax, a higher mean Cmax (+43%) and a higher mean AUC (+30%) in fasted, but not fed patients. Higher trough levels (Cmin) occurred throughout for Neoral. These differences between the two formulations were not associated with any changes in safety parameters. Overall, Neoral was equivalent or superior to Sandimmun in tolerability and efficacy when given on a 1:1 dose basis.

Adult↗
PubMed1996

Early clinical development of tazarotene.

Initial clinical investigations on tazarotene, a new acetylenic retinoid, have suggested potential usefulness in the treatment of mild-to-moderate plaque psoriasis. Tazarotene promotes healing of psoriatic lesions by modulating the key pathogenetic factors in this disease. It is not sensitizing, phototoxic, or photoallergenic, but causes moderate dose-related skin irritation. Systemic absorption is minimal and elimination is rapid, providing a low potential for systemic adverse effects. Tazarotene effectively treats mild-to-moderate plaque-type psoriasis, the benefits seem to be sustained after the cessation of therapy, and once-daily treatment is equally effective as more frequent application.

Clinical Trials as Topic↗
PubMed1996

The kinetics of skin thinning induced by topical fluticasone propionate 0.05% cream in volunteer subjects.

Fluticasone propionate (FP) 0.05% (CutivateTM) cream is a novel corticosteroid used for the treatment of corticosteroid-responsive dermatoses. To date there are no published data concerning its effect on cutaneous atrophy. This randomized, double-blind study of 40 volunteer subjects was performed to investigate the kinetics of skin thinning induced by topical 0.05% FP cream vs. placebo after once-daily application for 2-8 weeks. The results of this study showed no significant effect on the skin thickness of subjects after 8 weeks' treatment with 0.05% FP cream compared with placebo.

Administration, Cutaneous↗
PubMed1996

Deaths due to squamous cell carcinoma in Australia: is there a case for a public health intervention?

The death certificates of all people who died from cancer in Victoria for the years 1988-1990 were examined looking for deaths due primarily to squamous cell carcinoma (SCC) of the skin. The findings were compared with the Australian Bureau of Statistics (ABS) published data on the number of deaths due to non melanoma skin cancer (NMSC) for the same period. One hundred and fifteen deaths due to SCC were identified. The mean age of death for the 74 males (64%) was 74.2 (s.d. 11.7) years and the 41 females (36%) was 81.3 (s.d. 10.3) years. Seventy (80%) of the 91 people where satisfactory information was able to be extracted had one or more major illnesses which were likely to have contributed substantially to the death. Only 3.5% of the total tumours were on the trunk in the covered areas, the remainder were on exposed areas of the body easily seen during a consultation. Seventeen cases of AIDS (Kaposi's Sarcoma) were incorrectly classified by the ABS as primary NMSC deaths. Seventeen other misclassifications included seven deaths from melanoma, eight deaths from cancers which were not skin tumours and two non-cancer deaths. Thirty-one deaths due to SCC were identified from death certificates and careful medical follow up which were not recorded in ABS data. The results suggest that there is likely to be little, if any, reduction in the number of deaths due to SCC as a result of an early detection programme directed at those people currently developing lethal tumours. A professional education programme directed at doctors who are seeing these elderly people with tumours on easily examined sites is more likely to be fruitful. The results also suggest the need for further education about the correct filling out of death certificates by medical practitioners and the careful supervision of those who extract data from these records at the ABS.

Adult↗
PubMed1996

The descriptive epidemiology of warts in the community.

Warts are common skin infections caused by human papillomavirus (HPV) and affect most people sometime in their life. A number of epidemiological studies on the prevalence of warts have been completed in schools, various occupational groups, general practices and hospitals. All studies have relied on a subjective measure for the diagnosis of warts. Cross-sectional studies completed in schools have shown the prevalence in children to vary from 2 to 20%. Occupational handlers of meat, poultry and fish have a higher prevalence than other workers. Children and young adults are the groups most affected. Future studies are needed to investigate the true frequency of warts in the community and the likelihood of an individual developing these lesions during his/her lifetime.

Adolescent↗
PubMed1996

The descriptive epidemiology of tinea pedis in the community.

Tinea pedis is a common inflammatory skin condition due to infection by dermatophyte fungi. A number of epidemiological studies have been completed on the frequency of tinea pedis in the community, particularly sporting and occupational groups and schools. Most studies have focused on small, high-risk populations. These include occupational groups involving manual labour, sporting groups such as swimmers, and those working or living in confined conditions with shared washing facilities, which favour the opportunity for cross-infection. Most studies show that the frequency of tinea pedis is higher in males than females. Tinea pedis infections appear to be least common among children, but do occur, and are commonly misdiagnosed. The difference between clinical disease and confirmed diagnosis by culture is not always clear when statistics of disease frequency have been presented. Clear diagnosis criteria indicating the level of mycologically confirmed diagnosis should be reported in future studies that include statistics on disease frequency. Future epidemiological studies should also aim to be population-based in order to obtain a more complete picture of disease frequency.

Adolescent↗
PubMed1996

Advice about management of skin conditions in the community: who are the providers?

A survey was undertaken in the central Victorian city of Maryborough to investigate the use of pharmacies and general practitioners as sources of advice about skin problems. In a 2 week period consumers purchasing either prescription or over the counter (OTC) products for skin, hair and nails in pharmacies were approached for interview. Simultaneously, each of the city's general practitioners (GP) completed questionnaires on all patients presenting with conditions of skin, hair and nails. Seventy per cent of the 315 consumers interviewed were purchasing OTC products and 50% prescription items. Of the OTC products, 42% were originally recommended by pharmacy staff and 18% by doctors. Over one-third of consumers buying OTC products described symptoms to pharmacy staff and in about half of the cases it was to the pharmacy assistant. One-third of people describing symptoms had already seen a doctor. Problems most frequently reported were dermatitis, skin dryness, acne and tinea. General practitioners recorded 265 conditions (of which 54% were new) in patients. The most common condition treated was solar keratosis, and GP wrote a prescription for 45% and recommended OTC products for 7% of conditions. People in Maryborough are seeking advice for their skin conditions from a variety of sources including GP, pharmacies and others.

Australia↗
PubMed1996

The frequency and nature of skin conditions seen in a private dermatology practice in central Victoria, 1991-95.

A dermatology diagnostic database was established in order to determine the frequency and nature of skin conditions in a private dermatological practice in Central Victoria, Australia. Between August 1991 and June 1995, a total of 3346 dermatological diagnoses were recorded for 3000 new patient presentations. More women (58.9%) were seen than men (41.1%). Dermatitis and tumours of the skin accounted for 50% of new consultation(s), the highest attendance being for solar keratoses (11.9%). The frequency of patients seen was comparable to the previous 1970s survey of private dermatological practice in Australia, with the exception of melanocytic naevi, which was seen with twice the frequency compared to previously. The proportion of patients presenting with dermatitis was higher in the colder seasons of the year (winter and spring compared with summer and autumn). The proportion of people seen with melanocytic naevi was higher in summer and autumn compared with winter and spring. These results illustrate the usefulness of recording clinical patient data in practice as a way of recording patterns of referral as well as having a role in determining causation of disease.

Data Collection↗
PubMed1996

Clinical features in 27 patients with Angelman syndrome resulting from DNA deletion.

We report the clinical features in 27 Australasian patients with Angelman syndrome (AS), all with a DNA deletion involving chromosome 15(q11-13), spanning markers from D15S9 to D15S12, about 3 center dot 5 Mb of DNA. There were nine males and 18 females. All cases were sporadic. The mean age at last review (end of 1994) was 11 center dot 2 years (range 3 to 34 years). All patients were ataxic, severely retarded, and lacking recognisable speech. In all patients, head circumference (HC) at birth was normal but skewed in distribution, with 62 center dot 5% at the 10th centile. At last review HC was around the 50th centile in three patients (12 center dot 5%) while 15 had poor postnatal head growth. Short stature was not invariable, 5/26 (19%) were on or above the 50th centile. Hypotonia at birth was recorded in 15/24 (63%) and neonatal feeding difficulties were recorded in 20/26 (77%). Epilepsy was present in 26/27 (96%) with onset by the third year of life in 20 patients (83%). Improvement in epilepsy was reported in 11/16 patients (69%) with age. An abnormal EEG was reported in 25/25 patients. Hypopigmentation was present in 19/26 (73%). One patient had oculocutaneous albinism. Five patients could not walk independently. Of the remaining 22 who could walk, age of onset of walking ranged from 2 to 8 years. Disrupted sleep patterns were present in 18/21 patients (86%), with improvement in 9/12 patients (75%) over 10 years of age. The clinical features in this group of deletional AS patients were similar to previous reports, but these have not separated patients into subgroups based on DNA studies. In our group of deletional cases, 100% showed severe mental retardation, ataxic movements, absent language, abnormal EEG, happy disposition (noted in infancy in 95%), normal birth weight and head circumference at birth, and a large, wide mouth. These features occurred with a higher frequency than in AS patients as a whole. Our study also provided information on the evolution of the phenotype. The data can act as a benchmark for comparisons of AS resulting from other genetic mechanisms.

Adolescent↗
PubMed1996

Lesion size following Gamma Knife treatment for functional disorders.

In this study we investigated the reproducibility and consistency of the size of radiosurgical lesions produced for functional disorders. The T1 gadolinium-enhanced magnetic resonance (MR) images of 56 patients treated for parkinsonism, pain, or other functional diseases were used to measure 140 lesion sizes at various times after radiosurgical treatment (1-26 months, mean: 11.3 months). Only the 4-mm collimator was used to create the lesions. The maximum dose ranged from 110 to 180 Gy (mean: 145 Gy). In 42 cases (78%), one isocenter was used to create the lesion. Thirteen lesions (20%) were created with two isocenters and in 1 case, three isocenters were used. Lesions were detectable on MR images as early as 30 days after treatment. The maximum lesion volume was reached after 6-12 months and ranged from nondetectable to more than 4,000 mm3. Larger lesion volumes were strongly associated with the use of more than one isocenter. In addition, maximum doses of 160 Gy or more increased the likelihood of producing lesions larger than expected. It is therefore concluded that the use of the Gamma Knife for the treatment of functional disorders is safest when single-isocenter shots with the 4-mm collimator and a maximum dose of less than 160 Gy are used.

Adult↗
PubMed1996

Length of inpatient stay and recidivism among patients with schizophrenia.

OBJECTIVE: The study examined whether length of hospital stay is related to recidivism among psychiatric patients. A quasi-experimental approach was used to address limitations of controlled and epidemiological research. METHODS: Three matched groups, each consisting of 55 inpatients with schizophrenia, were selected from public psychiatric units with different mean lengths of stay. Regression models were used to compare the groups on three variables: time to first readmission (survival analysis), number of readmissions (ordinal logit regression), and total time in the community in the postdischarge year (multiple linear regression). RESULTS: An analysis based on the units with different lengths of stay, which was similar to that typically used in controlled studies, found no differences in the three outcome measures. However, a second analysis that examined data for all patients irrespective of their unit assignment found that inpatients treated for 30 days or less relapsed sooner than those with stays longer than 30 days. The disparity in results was largely due to overlapping quasi-experimental conditions: many patients on the short-stay units had a long lengths of stay, and vice versa. The first analysis supports an administrative policy of short stays. The second reinforces previous findings that a group of patients, primarily young males with onset of illness at an early age and multiple previous hospitalizations, is at greater risk of relapse with short-term treatment. CONCLUSIONS: The apparent contradiction between a unit- or patient-based analysis suggests that unit-based results should be interpreted with caution when used to make clinical or utilization review decisions.

Adult↗
PubMed1996

Ipsilateral and contralateral skill acquisition following random practice of unilateral mirror-drawing.

The present mirror-drawing experiment was conducted over four months on one healthy female (R.H.) to elucidate the nature of the ipsilateral and contralateral learning curves for 12 sessions of unimanual training of the nonpreferred hand using a random practice schedule. Analysis indicated greater initial improvement for the practising nonpreferred hand with further improvements for both hands in number of errors and time to complete a single transfer test trial. A 4-mo, retention test showed the improvements were greater for the preferred (untrained) hand. Star-tracing records completed for both hands were quite similar to those recorded using the mirror after practice. This may reflect central processing and long-term potentiation influential even after practice ceased.

Adult↗