Beauty today and youth tomorrow?
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Animals↗
Biomedical subjects
R S Stern
Publications and source records attributed to R S Stern.
The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups.
To determine whether the hospital stays are longer and charges within a given diagnosis-related group (DRG) are higher for poor patients, we examined patterns of care for patients hospitalized at the Brigham and Women's Hospital for connective-tissue disorders (DRGs 240 and 241) from 1981 to 1985. The socioeconomic characteristics of 402 patients were determined through interviews, and the severity of their illness was measured by means of a standard scale of function--the Instrumental Activities of Daily Living (IADL) scale. After excluding outliers and adjusting for DRG, we found that hospital stays were significantly longer for subgroups of patients of lower socioeconomic status, whether this was defined by occupation, education, or income (P less than 0.05 for all three). Patients of low socioeconomic status also had higher total hospital charges, although the differences were not statistically significant. The differences between patients of low socioeconomic status and those of high socioeconomic status were as great as 25 percent for length of stay and 16 percent for charges. These trends persisted after we adjusted for patients' age and sex, the severity of illness, the year of discharge, the doctor's specialty, whether the patient had a regular doctor, and whether the patient lived alone. Our results suggest that for at least some conditions, hospital care for poor patients entails longer stays and probably requires the use of more resources.
Activities of Daily Living↗
Melanosomal alterations in dysplastic melanocytic nevi. A quantitative, ultrastructural investigation.
Abnormal-looking melanosomes are observed commonly in both intraepidermal melanocytes of cutaneous melanoma and dysplastic melanocytic nevi (DMN). This was investigated by using transmission electron microscopic examination to determine the percentage of abnormal melanosomes among 8267 melanosomes assessed in at least five solitary intraepidermal basal unit melanocytes from each of five specimens of DMN, superficial spreading melanoma (SSM), common acquired nevomelanocytic nevi (NMN), and normal skin (NS) adjacent to DMN. The percentage of abnormal melanosomes in DMN (mean + SD, 44 + 23%) was seven times greater than that in NMN (6 + 7%) and 22 times greater than that in NS (2 + 5% [P less than 0.001, both comparisons]), but only 80% that in SSM (57 + 19% [P less than 0.02]). Melanocyte area, nuclear area, and the ratio of nuclear area to cytoplasmic area did not account for the observed differences. Melanosomal alterations may be a useful marker of atypicality in melanocytic tumors.
Adult↗
Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System.
Between October 1982 and June 1985 the Adverse Drug Reaction Reporting System received reports of 104 suspected adverse reactions occurring in 93 patients who took isotretinoin. Adverse reactions involving the skin and mucous membranes (29 reports), central nervous system (23), musculoskeletal system (12), pregnancy (11), and eyes (8) were most commonly reported. Severe headache was the most frequently reported adverse reaction (15 reports). In four cases headaches were attributed to pseudotumor cerebri. Some of the reported reactions, for example, a disulfiram (Antabuse)-like reaction and oculogyric crisis, have not been described previously in the literature. Other reports, such as congenital malformations, serve to emphasize some of the serious reactions that are known to occur. These spontaneous reports of adverse reactions associated with isotretinoin use, together with the literature we review, may help alert physicians to the diverse spectrum of adverse reactions that may develop in patients taking isotretinoin.
Abnormalities, Drug-Induced↗
Cutaneous melanomas in patients treated with psoralens plus ultraviolet A. A case report and the experience of the PUVA Follow-up Study.
Psoralens plus ultraviolet A (PUVA) therapy is widely used in the treatment of psoriasis and other cutaneous conditions. We present the case of a patient who developed a superficial spreading melanoma 3 years after first being treated with PUVA. The development of melanomas in patients receiving PUVA is reviewed. During 13,224 person-years of prospective follow-up of 1380 patients enrolled in the PUVA follow-up study, three melanomas were diagnosed, which does not differ significantly from the expected rate (relative risk = 1.5 with 90% confidence interval 0.3 to 7.3). However, considering the effects of PUVA on melanocytes and that the development of melanomas may have a long latent period, continued follow-up studies are indicated.
Adult↗
Non-melanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment.
Continued prospective study of the 1,380 patients enrolled in the PUVA study for 10 years after first exposure to PUVA demonstrates a strong association between cumulative exposure to PUVA and an increased risk of squamous cell carcinoma of the skin. For tumors occurring at least 58 months after first treatment, after adjustment for age, sex, and area of residence, we observed that patients with more than 260 treatments had an 11-fold increase in risk compared to patients who had received 160 or fewer treatments during the same interval (P less than 0.01). Comparable increases in relative risk were noted in patients of all skin types, irrespective of prior ionizing radiation exposure. We also noted a modest dose-dependent increase in the risk for the development of basal cell carcinoma for patients who received an excess of 200 treatments compared to those who had received fewer than 160 treatments within the same time period (P less than 0.05). Tumors detected in our cohort exhibit biologic behavior similar to non-melanoma skin cancers associated with sun exposure. Careful monitoring and early detection should limit the morbidity associated with these tumors.
Basal Cell Carcinoma↗
Cardiovascular disease, cancer, and cause of death in patients with psoriasis: 10 years prospective experience in a cohort of 1,380 patients.
After 10 years of prospective study of a cohort of 1,380 patients with psoriasis enrolled in the Photochemotherapy (PUVA) Follow-up Study, our data show that the incidence of death and causes of death were comparable to those expected in the general population. We noted no increase in cardiovascular mortality, but observed that cirrhosis caused more deaths among our cohort than in the general population (Standard Mortality Ratio: 4.7, P less than 0.05). The overall incidence of non-cutaneous cancer was slightly but not significantly elevated in our population (Standard Mortality Ratio = 1.2, P greater than 0.05). In an analysis of individual sites, we observed significant increases in the incidence of colonic cancer and primary neoplasms of the central nervous system. We found no significant increase in the incidence of lymphoma, leukemia, or malignant melanoma within our cohort. Because of the possible long latency time and the low incidence of these malignancies only continued follow-up of this cohort can assure us that PUVA therapy does not substantially alter the risk for the development of these conditions.
Adult↗
The benefits, costs and risks of topical tar preparations in the treatment of psoriasis: considerations of cost effectiveness.
Cost-effectiveness analysis provides an analytical framework for comparing the costs, benefits, and risks of treatment. Using these techniques we evaluated topical tar in the treatment of psoriasis. Topical tar has, at most, a small benefit in accelerating the clearing of psoriasis. There is no systematic evidence to suggest that using topical tar during clearing extends the length of a remission. This analysis suggests that using topical tar may increase costs of therapy three-to thirteen-fold without substantial clinical benefits. Adequate data to support tar as a cost-effective agent in the treatment of psoriasis is lacking.
Administration, Topical↗
Low-fluence carbon dioxide laser irradiation of lentigines.
Low-fluence carbon dioxide (CO2) laser irradiation of skin has previously been shown to induce damage limited primarily to the epidermis. To evaluate whether this technique was therapeutically effective for pigmented epidermal lesions, ten lentigines caused by methoxsalen and ultraviolet light therapy were treated in one patient using the CO2 laser at fluences ranging from 3.0 to 7.7 J/cm2 for 0.1-s exposures with 4.5-mm spot size. Based on substantial clearing in seven of ten lesions treated, 146 solar lentigines were treated in five patients at fluences of 3.0, 3.7, or 4.4 J/cm2. Biopsies were performed on a total of 30 lesions immediately and 24 hours, seven days, and six weeks after irradiation. Of 125 lesions followed up clinically for six weeks, 12 cleared completely, 81 lightened substantially, and 28 remained unchanged. Only two demonstrated atrophic change. Hyperpigmentation or hypopigmentation did not occur. All lesions that improved had been treated at 3.7 or 4.4 J/cm2. Immediate histologic injury consisted of vacuolar and spindly change and subsequent vesiculation limited to the basilar epidermis. Twenty-four hours later there was epidermal necrosis with regeneration, 0.1 mm of dermal basophilia and stromal condensation, and a mild inflammatory infiltrate. These alterations were dose-dependent, with near complete epidermal necrosis and superficial dermal involvement at the highest fluence, and only focal epidermal necrosis at the lowest. At seven days, epidermal regeneration was complete with traces of melanin remaining in keratinocytes. Melanophages first appeared at seven days and persisted at six weeks, by which time the inflammatory infiltrate had cleared. No lentiginous proliferation was evident and epidermal pigmentation had become normal. Low-fluence CO2 laser irradiation is an effective means of damaging the epidermis with only minimal dermal change. This mode of therapy is an effective way to lighten the pigmentation of lentigines without substantial scarring.
Adult↗
Micturition and the mind: psychological factors in the aetiology and treatment of urinary symptoms in women.
The mental state of 211 women attending a urodynamic clinic was assessed using questionnaires. Patients with genuine stress incontinence had scores comparable with other patients with longstanding physical complaints. Patients with sensory urgency were more anxious than those with genuine stress incontinence. Patients with detrusor instability were as anxious as patients with sensory urgency and in addition had higher scores on the hysteria scale. A subset of patients (roughly a quarter of the total) was identified, comprising members of all three diagnostic groups, for whom urinary symptoms rendered life intolerable. These patients were as anxious, depressed, and phobic as psychiatric inpatients, emphasising the serious psychological morbidity experienced by patients with urinary symptoms. Fifty patients with detrusor instability or sensory urgency entered a randomised trial comparing psychotherapy, bladder drill, and propantheline. The psychotherapy group significantly improved on measures of urgency, incontinence, and nocturia, though not on frequency. Bladder training was an effective treatment for frequency and patients became less anxious and depressed. There was a modest improvement in frequency of micturition in patients given propantheline. Frequency may be a learnt disorder which responds to the direct symptom oriented approach of bladder training. Patients with urgency and nocturia predominating might derive more benefit from psychotherapy.
Anxiety↗
Topical minoxidil. A survey of use and complications.
To obtain data on clinicians' experiences with topical minoxidil, we performed a mail survey of one in six members of the American Academy of Dermatology. Sixty-one percent of this random sample of dermatologists responded. More than 70% of these reported they had prescribed topical minoxidil for hair loss. The frequency of prescribing varied substantially among dermatologists, with less than 10% of respondents being responsible for over half the reported prescriptions. Only 2% of prescribers reported complications other than local irritation that they associated with topical minoxidil therapy, but underreporting of noncutaneous side effects in this survey of dermatologists cannot be excluded.
Administration, Topical↗
Establishment and characterization of five cell lines derived from human malignant gliomas.
We established and characterized five cell lines derived from human malignant gliomas (four glioblastomas multiforme and one highly anaplastic astrocytoma). All cell lines exhibited tumor cell morphology and growth kinetics, and anchorage-independent growth in soft agar. Cytogenetic analysis revealed significant aneuploidy in all five cases as well as clonal chromosomal alterations unique to each cell line. No cell line was tumorigenic in athymic mice. Two of the cell lines were sensitive to carmustine (BCNU) in monolayer and soft-agar cultures. Electron microscopy showed marked variability between cell lines in the number and structure of intracytoplasmic organelles; SF-126 formed collagen fibers in vitro. Immunohistochemical analysis of the surgical specimens showed variable expression of glial fibrillary acidic protein (GFAP) in malignant astrocytes; positive immunostaining for glycoproteins of the extracellular matrix was found predominantly in perivascular regions. In early-passage cultures, only cell line SF-295 expressed GFAP; at establishment, none of the cell lines expressed GFAF or glutamine synthetase. Fibronectin and laminin were expressed by all cell lines in early-passage culture, but expression of these glycoproteins at establishment was variable. Only SF-126 was positively identified by immunostains for procollagen III; this was also the only cell line in which DEAE-cellulose chromatography and SDS-PAGE demonstrated interstitial collagen synthesis. These well-characterized glioma-derived cell lines may now serve as useful tools with which to study the cell biology of gliomas. The synthesis of interstitial collagen by a glioma-derived cell line may suggest a derivation from vascular mesenchymal elements, either reactive or transformed, in the original heterogeneous malignant glioma, rather than from a glial precursor cell.
Adult↗
Panniculitis in familial Mediterranean fever. Case report with histopathologic findings.
A 79-year-old Armenian-born woman with stable, long-term familial Mediterranean fever had progression of chronic renal failure concurrently with two types of skin lesions. One lesion resembled erysipelas, which is quite common in familial Mediterranean fever, whereas the other was panniculitis, only occasionally described in familial Mediterranean fever. The unique histopathologic features of the latter are presented. The onset of acute cutaneous disease in this patient coincided with worsening renal disease and preceded a flare of disease activity in other sites after a 14-year period of quiescence. The severe and unremitting pain from the skin lesions and their tendency to form nonhealing ulcers were substantial causes of morbidity in this patient with familial Mediterranean fever.
Aged↗
Psoralens and related compounds in the treatment of psoriasis.
PUVA therapy has radically altered the management of severe psoriasis. It is of greatest benefit in those patients with extensive involvement, and in those unresponsive to conventional therapy. The long term side effects of PUVA currently limit its use to patients with disabling disease. The full extent of long term side effects has yet to be defined. In order to reduce the toxicity and improve the efficacy of PUVA, a better understanding of the molecular aspects of psoralen-DNA interaction, DNA repair, and mutagenesis is required. The action spectrum of PUVA in clearing psoriasis has yet to be defined. By limiting the spectrum of UVA exposure it may be possible to reduce some of the toxic effects of PUVA. The recent advances in the formulation of 8-MOP preparations has yielded a drug with more predictable pharmacokinetics and clinical response. Further research with newer psoralens may produce more effective and less toxic compounds. In the last ten years, PUVA has been both a valuable addition to dermatologists' clinical armamentarium and a useful tool in increasing our understanding of cellular biology and the interaction between ultraviolet radiation and biologic systems.
Animals↗
A comparison of the melanocyte response to narrow band UVA and UVB exposure in vivo.
The visible cutaneous pigmentary response to ultraviolet-A (UVA) is immediate and, following sufficient exposure, may persist, whereas ultraviolet-B (UVB)-induced pigmentation appears after a delay of several days. We compared the in vivo response of melanocytes to single and multiple exposures of narrow band UVA and UVB irradiation which produced visibly equal increases in pigmentation. Using a xenon-mercury source matched to a monochromator, human volunteers were exposed to 304 (+/- 5) and 365 (+/- 10) nm radiation. Biopsies were performed 1, 7, and 14 days after irradiation. For each biopsy, the number of melanocytes per square millimeter of epidermis was determined using L-3,4-dihydroxyphenylalanine (dopa)- and tyrosine-incubated split epidermal preparations. Vertical sections were also examined. At days 7 and 14, after both 304 and 365 nm radiation, melanocytes were more intensely dopa-positive than in unirradiated controls, and demonstrated enlarged perikarya and a greater number of enlarged dendrites. Following both 304 and 365 nm radiation the number of dopa-positive melanocytes was increased at days 7 and 14 by 44% and 58%, respectively. Tyrosine positivity, an indicator of enhanced tyrosinase activity and increased melanin formation, was absent in controls and at day 1, and became positive in all but one sample at day 7 and day 14. Therefore, one day after UVA exposure, visible pigmentation but not tyrosinase activity was increased. At day 7, the number of tyrosine-positive melanocytes approximately equaled the number of dopa-positive melanocytes. Although UVA and UVB induce different pigmentary responses, their effects on melanocyte number and function were indistinguishable.
Adult↗
Etretinate follow-up study.
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Etretinate↗
Adverse drug reactions: reporting and evaluating cutaneous reactions.
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Drug Eruptions↗
Complications of cutaneous laser surgery. A survey.
We surveyed a selected group of 139 dermatologists and plastic surgeons about their experience with the complications of cutaneous laser surgery. Reported complication rates varied from 0% to 35%, with means of 3.2% for dermatologists and 6.2% for plastic surgeons using the argon laser, and 4.2% for dermatologists and 2.8% for plastic surgeons using the carbon dioxide laser. Hypertrophic scarring was the complication noted most frequently; 69% of physicians using the argon laser and 64% of physicians using the carbon dioxide laser have seen at least one case of hypertrophic scarring. Complications noted less frequently include infection, pain, atrophic scarring, intraoperative or postoperative hemorrhage, and prolonged wound healing. Environmental accidents were few. No procedure-related deaths, ocular damage, or secondary cutaneous malignant neoplasms were reported. We conclude that cutaneous laser surgery has an acceptable risk profile but that complications are not uncommon.
Argon↗