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Biomedical subjects

S E Whitmore

Publications and source records attributed to S E Whitmore.

At least 37 records · Page 2Linked to original sources
PubMed1997

Serum CA-125 screening for ovarian cancer in patients with dermatomyositis.

Ovarian cancer is the most overrepresented malignancy diagnosed in women with dermatomyositis. Unfortunately, screening with pelvic examination rarely detects this cancer prior to the development of metastatic disease. Our objective was to examine the use of serum CA-125 antigen levels in screening patients with dermatomyositis for ovarian cancer. A single blinded, case-control study was conducted in our institution of CA-125 levels in 14 women diagnosed with dermatomyositis between 1986 and 1993, 4 of whom subsequently developed ovarian cancer. In the 4 patients who developed ovarian cancer ("cases"), CA-125 determinations were performed on serum stored 5 to 19 months prior to the diagnosis of ovarian cancer. In the remaining 10 patients ("controls"), serum was drawn for CA-125 level determination at the time of the study, and simultaneous gynecologic and endovaginal ultrasound examinations were performed to exclude clinical evidence of ovarian cancer. All CA-125 serum measurements were performed simultaneously by a technician blinded to disease status using one diagnostic kit. CA-125 was found to be elevated in 2 patients with ovarian cancer (on serum obtained 5 and 13 months prior to the date of diagnosis of ovarian cancer) and in none of the control patients without clinical or ultrasound evidence of ovarian cancer (relative risk = 20, 95% confidence interval = [0.64, 666]). In these 14 patients, the sensitivity of CA-125 elevation for detection of ovarian cancer was 50%, and specificity was 100%. Serum CA-125 screening for ovarian cancer in patients having dermatomyositis may be useful; however, prospective studies are needed to confirm this and to determine the effect of screening on cancer stage at diagnosis and long-term survival.

Aged↗
PubMed1996

Aeroallergen patch testing for patients presenting to contact dermatitis clinics.

BACKGROUND: The role of aeroallergens in the production of allergic contact dermatitis or "allergic contact dermatitis-like" atopic dermatitis is controversial. Although techniques and allergens lack standardization, most studies find positive patch test results in 30% to 40% of patients with atopic dermatitis. OBJECTIVE: Our purpose was to determine the prevalence and clinical significance of positive aeroallergen patch tests in patients undergoing standard patch testing for suspected "nonaeroallerge" allergic contact dermatitis. METHODS: One hundred three consecutive patients referred to three university patch test clinics for patch testing were alos patch tested with six common aeroallergens in glycerine-dust, mold, cat epithelium, tree, grass, and weed-as well as with a glycerine control. Patches were removed at 48 hours. Readings were performed at this time and at 3 to 7 days after initial application. RESULTS: As determined by history, these 103 patients included 16 patients with both atopic dermatitis and mucosal atopy, 10 patients with atopic dermatitis only, 22 patients with mucosal atopy only, and 55 patients with neither atopic dermatitis nor mucosal atopy. Allergic reactions were seen to one aeroallergen in five patients (three with atopic dermatitis and mucosal allergy, and two with no history of atopy). The prevalence (3 of 16 [18.8%]) of reactions in patients with both atopic dermatitis and mucosal allergy was significantly greater than the prevalence (2 of 87 [2.3%]) in patients with only one or neither of these two atopic disorders (p = 0.02). None of these aeroallergen contact hypersensitivities were deemed significant in the patients' current dermatitis. However, reactions were of past relevance in two of the three patients with atopic dermatitis and mucosal allergy. CONCLUSION: In this referral group, none of the six common aeroallergens tested was relevant in the origin of suspected "nonaeroallergen" allergic contact dermatitis. This study suggests that aeroallergen patch testing is of little use in the evaluation of patients referred for routine patch testing for suspected "nonaeroallergen" allergic contact dermatitis. Similar but larger studies inclusive of the assessment of relevance, as well as masked controlled clinical trials assessing the effect of aeroallergen exposure and avoidance, are needed to evaluate this issue more fully.

Adult↗
PubMed1996

Dermatomyositis sine myositis: association with malignancy.

OBJECTIVE: To describe dermatomyositis (DM) sine myositis as a distinct diagnostic subclass of DM and the association with malignancy. METHODS: This case series includes all patients presenting to our primary and tertiary care outpatient dermatology department with DM and DM sine myositis between 1986 and 1993. Seven patients were diagnosed with classic DM and 12 with DM sine myositis. We analyzed average age of onset, duration of followup, clinical course, and incidence of associated malignancy in the patients with classic DM and DM sine myositis. RESULTS: No statistically significant differences were found in these 2 groups on examining age at onset and frequency of associated malignancy. Malignancy was diagnosed in 4 of 12 (25%) patients with DM sine myositis followed for a total of 50.8 patient-years (average followup 51 months) and in 2 of 7 (28%) patients with classic DM followed for a total of 20.6 patient-years (average followup 35 months). CONCLUSION: Although these patients with DM are select and few, they demonstrate that DM sine myositis may be quite similar to classic DM. It may be said that like DM, DM sine myositis may represent a paraneoplastic syndrome. DM sine myositis should be added to the currently accepted polymyositis/dermatomyositis classification system, with appropriate emphasis on the potential association with malignancy.

Adult↗
PubMed1995

Delayed systemic allergic reactions to corticosteroids.

From the limited number of reports in the literature, it would appear that various types of delayed reactions from systemically, intralesionally, and intra-articularly administered corticosteroids are rare, particularly given their widespread use. The purpose of this literature review is to summarize in table form the reported cases of generalized delayed systemic corticosteroid reactions with respect to patient presentation, methods of evaluation, and conclusions reached. In total, 24 cases of generalized delayed systemic corticosteroid reactions have been reported in the literature. Clinical presentation (timing and cutaneous manifestations) as well as evaluation of these patients has been variable; reactions reported include eczematous or exanthematous eruptions, with or without bullae or purpura. In 16 cases, the diagnoses have been supported by positive patch or intradermal testing. Overall, it appears that generalized delayed systemic reactions to corticosteroids show considerable variability and are infrequently reported. Patch and intradermal tests with standardized allergens appear to be the most useful tests currently available to support this clinical diagnosis.

Dexamethasone↗
PubMed1995

Ultraviolet-induced suppression of the primary allergic reaction. Four times the minimal erythema dose of ultraviolet B administered 24 hours prior to sensitization.

The effect of localized irradiation with 4 times the minimal erythema dose (MED) of ultraviolet B (UVB) 24 h prior to sensitization with dinitrochlorobenzene (DNCB) was examined. In a placebo-controlled design, 9 of 19 subjects were locally irradiated on the right buttock; 24 h later, DNCB (1000 micrograms) was applied to the right buttock in all 19 subjects, and subjects were examined 7 and 14 days later for the development of a primary allergic response (PAR). In those not developing a PAR, a challenge dose of DNCB (50 micrograms) was applied to the volar forearm and examined 2 days later for an elicitation response. A statistically significant difference was seen in the number of subjects developing a PAR, comparing the group irradiated with UVB versus the group not irradiated (33% vs 80%). There was no statistically significant difference seen in elicitation responses between the 2 groups. We have shown that intense localized UVB irradiation as early as 24 h prior to sensitization with a potent allergen at this site may inhibit the PAR but does not appear to affect the elicitation response at a distant site.

Adolescent↗
PubMed1995

Prevention of UVB-induced immunosuppression in humans by a high sun protection factor sunscreen.

BACKGROUND AND DESIGN: To date, studies of the effectiveness of sunscreens in preventing UVB-induced suppression of contact hypersensitivity in humans have not been published. Several studies in mice of the protection afforded by sunscreens from UVB-induced suppression of contact hypersensitivity and rejection of transplanted skin cancers have yielded dissimilar results, ranging from "no" to "complete" protection. We sought to determine whether the effect of preapplication of a sun protection factor (SPF) 29 sunscreen (containing octyl methoxycinnamate, oxybenzone, and octyl salicylate) could prevent local UVB-induced suppression of contact hypersensitivity to dinitrochlorobenzene (DNCB). Nineteen subjects received either three minimal erythema doses of UVB daily on three consecutive days (UVB group) or sunscreen followed by this same dose of UVB irradiation (sunscreen plus UVB group) to a 16-cm2 area of the buttock. One day after completion of irradiation, DNCB was applied to this buttock site, and 2 weeks later, forearm challenge with four different concentrations of DNCB was performed. A control group of 10 subjects underwent DNCB testing as above, but with no prior exposure to UVB (no-UVB group). RESULTS: The UVB group had a reduced response rate to all challenge doses of DNCB (3.125, 6.25, and 8.8 micrograms), except for the highest dose (12.5 micrograms) compared with the no-UVB control group (Fisher's Exact test, P < or = .008), and compared with the sunscreen plus UVB group (P < or = .02). The no-UVB and sunscreen plus UVB groups showed no significant differences in response rates to any of the doses of DNCB tested (P > or = .53). CONCLUSIONS: These results indicate that application of a sunscreen with over ninefold greater protection than that needed to prevent erythema prior to localized UVB radiation prevents localized UVB-induced suppression of contact hypersensitivity. Further studies are needed to determine whether sunscreens providing less protection, yet still preventing erythema, adequately prevent suppression of contact hypersensitivity, a possible surrogate marker for skin cancer tumor antigen recognition and rejection.

Adult↗