Health care for the elderly. What can we learn from Great Britain?
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Biomedical subjects
Publications and source records attributed to S Bruce.
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Sarcoidosis is a systemic granulomatous disease of undetermined cause, with cutaneous manifestations occurring in up to 35 percent of patients. We report a case of the rare form of ichthyosiform sarcoidosis occurring in a young black woman.
Chronic urticaria is a problem for both physician and patient. In an effort to avoid the risks associated with corticosteroid treatment, many first-generation H1-receptor antagonists have been tried and found to induce undesirable levels of sedation when given in amounts sufficient to control urticaria. Cetirizine, a pharmacologically active oxidized metabolite of hydroxyzine, was developed to provide selective H1-receptor inhibition without depression of the central nervous system. In a 4-week, multicenter, double-blind, placebo-controlled safety and efficacy study, cetirizine, in a once-a-day dose (5 to 20 mg), was equivalent in efficacy to hydroxyzine in divided doses (25 to 75 mg/day). The incidence of somnolence in the cetirizine group was not significantly different from that of the placebo group. However, in the hydroxyzine group, the incidence of somnolence was significantly higher than that in the placebo group (p = 0.001). The results of this study demonstrate that cetirizine has a greater safety margin over the older parent drug hydroxyzine.
We report a patient with a pustular eruption in an acral distribution that developed abruptly 4 days after a streptococcal pharyngitis. The histology showed an intraepidermal vesicle filled with neutrophils with an underlying lymphocytic vasculitis. Direct immunofluorescence demonstrated heavy deposition of C3 within the vessel walls. In addition, circulating immune complexes were found.
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A psychological assessment (Symptom Checklist-90) was performed on 19 patients with chronic idiopathic urticaria. Compared to the control group, the urticaria patients had significantly higher scores on the scales of somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety. In general, the urticaria patients were quite anxious and experienced significant discomfort in interpersonal relationships. Based on the results of this study and other similar reports in the literature, it is suggested that adjunctive treatment of urticaria patients should focus primarily on stress management training aimed at relieving anxiety and group therapy which focuses on an exploration of interpersonal issues.
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Waldenström's macroglobulinemia is a lymphoproliferative disorder that only rarely exhibits specific cutaneous findings. The authors present a case of Waldenström's macroglobulinemia in which the patient developed cutaneous lesions while his systemic disease seemed to be under control with chlorambucil therapy. A review of the scant literature regarding the response of cutaneous Waldenström's to treatment suggests that the skin lesions do not respond well to systemic therapy. This case was successfully treated with radiotherapy.
A 36-year-old black man with bilateral squamous cell carcinoma in situ of the feet is described. The DNA hybridization analysis performed on the tumor tissue demonstrated the presence of human papillomavirus 16 DNA. Human papillomavirus 16 has been detected repeatedly in genital carcinomas, and evidence is mounting that it may play an important role in the development of malignancy.
The term neurofibromatosis designates a spectrum of disorders, the most common of which is von Recklinghausen's disease. We describe two patients with forms of neurofibromatosis other than von Recklinghausen's neurofibromatosis, characterized by involvement of half of the face and the contralateral lower extremity. Neither patient had a family history of neurofibromatosis, and a thorough evaluation of both patients failed to reveal evidence of von Recklinghausen's disease. The classification of neurofibromatosis is briefly summarized, with special emphasis placed on the need for a specific diagnosis regarding the type of neurofibromatosis for purposes of estimating prognosis and providing genetic counseling. The relationship between pregnancy and neurofibromatosis is also discussed.
The occurrence of cutaneous carcinoma in black patients is an unusual phenomenon, with basal cell carcinoma being particularly uncommon. We present five cases of basal cell epithelioma in black patients collected from the Texas Medical Center to graphically illustrate the varied and often atypical clinical presentations of such tumors. This report supports recent series of basal cell epithelioma in black patients derived from retrospective chart reviews.
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The epidemiology of genital white piedra was investigated in 166 young men with a variety of genital complaints. Trichosporon beigelii was isolated from sixty-six (40%) of the cultured scrotal hairs. Infection was more common among black patients--54% of those examined, compared to 16% of white patients and 30% of "others" (p less than 0.001). There was no relationship between infection and foreign travel. White piedra was also found in young women, but less frequently than in young men (14% vs 40%, respectively). Transmission rarely occurred from person to person. Occasionally multiple body sites were simultaneously infected. A relationship may exist between T. beigelii and Corynebacterium concurrently infecting genital hair shafts. Eradication of infection was extremely difficult, despite in vitro sensitivity to antifungal agents. Spontaneous remissions occurred, however, in some patients.
An 86-year-old woman presented with bluish black macules on each buttock. Skin biopsy revealed ochronotic pigment in the dermis. On the basis of negative results of a urine test for alkaptonuria and a history of having received quinine injections for malaria 70 years ago, the patient was diagnosed as having localized exogenous ochronosis resulting from quinine injections. Exogenous ochronosis has been reported following the topical use of phenol in leg ulcers, the topical use of hydroquinone bleaching creams in black persons, and the oral administration of antimalarials for malaria and connective tissue diseases, but we could find no reports in the literature of exogenous ochronosis following intramuscular injections of antimalarials.