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Biomedical subjects

R T Brodell

Publications and source records attributed to R T Brodell.

At least 37 records · Page 2Linked to original sources
PubMed1999

A palpable clue to vasculitis.

A 57-year-old woman presented with a rash on her legs that had recurred several times over the last 2 weeks. Initial treatment had consisted of prednisone, 30 mg/day, for 5 days, but the rash had recurred when therapy was discontinued. Laboratory findings at that time revealed an elevated antistreptolysin O titer, but a complete blood cell (CBC) count, electrolyte levels, erythrocyte sedimentation rate (ESR), and complement fixation test all were normal. The patient was subsequently given amoxicillin, which she discontinued after a few days when the rash worsened. Findings on physical examination were normal except for a palpable purpuric rash on the lower legs (figure 1). A 4-mm punch biopsy was performed, and histopathologic examination confirmed a diagnosis of leukocytoclastic vasculitis. The patient was given prednisone, 60 mg/day orally, tapered over 2 weeks. Erythromycin was also prescribed for the possible persistence of a streptococcal carrier state. The rash cleared within 2 to 3 weeks, with no recurrence during the following year.

Female↗
PubMed1999

Giant cutaneous horn associated with verruca vulgaris.

Cutaneous horn (cornu cutaneum) is the clinical description of a hyperproliferation of compact keratin in response to a wide array of underlying benign and malignant pathologic changes. We report a patient with a giant cutaneous horn associated with a verruca vulgaris. The possible causes of cutaneous horns are reviewed.

Adult↗
PubMed1999

The clinical diagnosis of early malignant melanoma: expansion of the ABCD criteria to improve diagnostic sensitivity.

With the steady increase in incidence of malignant melanomas (MM) in the United States, early diagnosis and complete removal are critical for the containment of the malignancy. [1] The "ABCD" method of identification, originally described by Friedman et al., has been a useful tool in facilitating the diagnosis of MM. [2,3,4] This method analyzes four clinical characteristics to identify a malignant melanoma: Asymmetry, Border irregularity, Color variegation, and a Diameter of 6 mm or more.[4] Clinicians recognize that some melanomas lack all or most of the features defined in the "ABCD" rules. [5] This may be especially true of some early invasive and in situ melanomas. [6,7] In these instances, clinical history documenting morphologic change over time can be an important additional consideration. The following case reports underscore the need to expand the ABCD mnemonic to include an "E" for "Evolutionary change." An additional modification is also needed to emphasize the need for a low threshold for biopsy of unusual lesions which do not show typical benign features, even if they do not meet the ABCDE criteria. To this end we propose an "F" for "Funny looking lesions".

Adult↗
PubMed1998

Treatment of xanthelasma palpebrarum with bichloracetic acid.

BACKGROUND: Although many treatment modalities have been described for xanthelasma palpebrarum, no single technique has emerged as dominant. OBJECTIVES: Our purpose was to review the various therapeutic modalities for xanthelasma and to assess the efficacy of topical bichloracetic acid. METHODS: Thirteen patients with 25 xanthelasma were treated with topical 100% bichloracetic acid. Efficacy was assessed over a follow-up period of 7 months to 10.5 years (average, 64 months). RESULTS: Eighty-five percent of patients experienced initial complete clearing, and 72% of their lesions have not required retreatment over an average period of 68 months. Recurrences responded well to repeat treatment. Eighty-three percent of recurrent or poorly responsive lesions were associated with high cholesterol. The most resistant patient had four-lid involvement. Excellent cosmetic results and high patient satisfaction were seen. CONCLUSIONS: Topical bichloracetic acid is a viable alternative to other modalities in the management of xanthelasma. Advantages include simplicity, cost-effectiveness, speed, safety, and efficacy.

Administration, Cutaneous↗
PubMed1997

Oral contraceptive failure rates and oral antibiotics.

BACKGROUND: Despite anecdotal evidence of a possibility of decreased effectiveness of oral contraceptives (OCs) with some antibiotics, it is not known whether antibiotic use in dermatologic practices engenders any increased risk of accidental pregnancy. OBJECTIVE: Our purpose was to examine the effect of commonly prescribed oral antibiotics (tetracyclines, penicillins, cephalosporins) on the failure rate of OCs. METHODS: The records from three dermatology practices were reviewed, and 356 patients with a history of combined oral antibiotic/OC use were surveyed retrospectively. Of these patients, 263 also provided "control" data (during the times they used OCs alone). An additional 162 patients provided control data only. RESULTS: Five pregnancies occurred in 311 woman-years of combined antibiotic/OC exposure (1.6% per year failure rate) compared with 12 pregnancies in 1245 woman-years of exposure (0.96% per year) for the 425 control patients. This difference was not significant (p = 0.4), and the 95% confidence interval on the difference (-0.81, 2.1) ruled out a substantial difference (> 2.1% per year). There was also no significant difference between OC failure rates for the women who provided data under both conditions, nor between the two control groups. All our data groups had failure rates below the 3% or higher per year, which are typically found in the United States. CONCLUSION: The difference in failure rates of OCs when taken concurrently with antibiotics commonly used in dermatology versus OC use alone suggests that these antibiotics do not increase the risk of pregnancy. Physicians and patients need to recognize that the expected OC failure rate, regardless of antibiotic use, is at least 1% per year and it is not yet possible to predict in whom OCs may fail.

Administration, Oral↗