Cutis laxa.
Two sisters with inherited generalized cutis laxa and a young man with possible acquired cutis laxa are presented.
Adolescent↗
Biomedical subjects
S George
Publications and source records attributed to S George.
Vaccine-induced necrobiotic granuloma.
We report two cases of necrobiotic palisaded granulomas which developed at the site of intradermal hepatitis B vaccination. To the best of our knowledge, this kind of reaction has not been reported previously.
Adolescent↗
Sezary syndrome - unmasked by cyclosporine.
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Adult↗
Neutrophils from AIDS patients treated with granulocyte colony-stimulating factor demonstrate enhanced killing of Mycobacterium avium.
Neutrophils isolated from AIDS patients have demonstrated improved growth inhibition of Mycobacterium avium when incubated with exogenous granulocyte colony-stimulating factor (G-CSF). In this clinical study, 30 AIDS patients without M. avium infection were randomized to receive 5 days of treatment with rifabutin, G-CSF, or both agents. The M. avium killing capacity of neutrophils harvested from each patient before intervention, during (day 4), and after therapy (day 7) was assessed. The mean change in human immunodeficiency virus load in the group receiving G-CSF alone was -0.07 log of viral RNA. There was a 90% reduction in M. avium growth after therapy for patients treated with G-CSF alone (P=.01), 59% for patients treated with both agents (P=.06), and 11% for patients treated with rifabutin alone (P=.84). Thus, neutrophils isolated from AIDS patients treated with G-CSF demonstrated a significant enhancement of killing of M. avium; there was no notable effect on virus load.
AIDS-Related Opportunistic Infections↗
Erythropoietic protoporphyria treated with narrow-band (TL-01) UVB phototherapy.
Erythropoietic protoporphyria is a rare photodermatosis for which treatment options are limited. The present report describes the clinical features of a patient with erythropoietic protoporphyria and liver function test abnormalities associated with treatment with beta-carotene. Subsequent treatment with narrow-band UVB phototherapy resulted in marked subjective improvement in photosensitivity, which was confirmed by abolition of demonstrated abnormalities on monochromator phototesting. The therapeutic options for photosensitivity in erythropoietic protoporphyria are reviewed and discussed.
Antioxidants↗
Randomised double blind controlled trial of 2% ketoconazole cream versus 0.05% clobetasol 17-butyrate cream in seborrhoeic dermatitis.
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Administration, Topical↗
The Griess test: an inexpensive screening test for asymptomatic bacteriuria in pregnancy.
This study was designed to compare urine microscopy and the Griess test as screening tests for asymptomatic bacteriuria (AB) in pregnancy, using urine culture as a gold standard. Urine microscopy, Griess test and urine culture were carried out on urine samples from 483 antenatal women. AB was detected by urine culture in 30 (6.8%) of the patients. The Griess test and urine microscopy were found to have a sensitivity of 63.3% and 60%, specificity of 99.5% and 83.6%; and positive predictive value of 90.5% and 21.1% respectively. Most of the infections missed by the Griess test were either <100,000 colony count on culture or caused by gram positive cocci. The cost of the Griess test was only one tenth of that of urine microscopy. The Griess test is a simple and inexpensive test that when compared to urine microscopy has equal sensitivity, and better specificity and positive predictive value for the detection of AB in pregnancy than urine microscopy.
Bacteriological Techniques↗
Appropriateness of use of emergency ambulances.
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Ambulances↗
Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. Myeloma Aredia Study Group.
PURPOSE: To determine the efficacy and safety of 21 monthly cycles of pamidronate therapy in patients with advanced multiple myeloma. PATIENTS AND METHODS: Patients with stage III myeloma and at least one lytic lesion received either placebo or pamidronate 90 mg intravenously administered as a 4-hour infusion monthly for 21 cycles. At study entry, the patients were stratified according to whether they were to receive first-line (stratum 1) or second-line (stratum 2) antimyeloma chemotherapy. Skeletal events (pathologic fracture, radiation or surgery to bone, and spinal cord compression) and hypercalcemia were assessed monthly. RESULTS: The results of the first nine previously reported cycles are extended to 21 cycles. Of the 392 randomized patients, efficacy could be evaluated in 198 who received pamidronate and 179 who received placebo. After 21 cycles, the proportion of patients who developed any skeletal event was lower in the pamidronate-group (P = .015). The mean number of skeletal events per year was less in the pamidronate-group (1.3) than in placebo-treated patients (2.2; P = .008). Although survival was not different between the pamidronate-treated group and placebo patients overall, stratum 2 patients who received pamidronate lived longer than those who received placebo (14 v 21 months, P = .041). Pamidronate was safe and well tolerated during the 21 cycles of therapy. CONCLUSION: Long-term monthly infusions of pamidronate as an adjunct to chemotherapy are superior to chemotherapy alone in reducing skeletal events in stage III multiple myeloma patients, and may improve the survival of patients on salvage therapy.
Diphosphonates↗
Adjuvant Chemotherapy for Resected Non-Small Cell Carcinoma of the Lung: Why We Still Don't Know.
The role of adjuvant chemotherapy in resected non-small cell carcinoma of the lung (NSCLC) remains controversial. A critical review of the 11 cisplatin-based randomized trials addressing this issue was performed using methodology adapted from the CONSORT statement. The 11 trials were divided into those that included predominantly node-negative patients (n = 5) and those that included predominantly node-positive patients (n = 6). In the node-negative trials, which included 1,084 evaluable patients, no evidence of heterogeneity of treatment effect between the trials was found. The composite five-year survival rate for chemotherapy patients was 61% versus 55% for control patients, which reached marginal significance (p = 0.06). In the node-positive trials, which included 880 evaluable patients, a marginal lack of homogeneity of treatment effect between trials was found (p =.013). The composite two-year survival rate for chemotherapy patients was 48% versus 40% for control patients, which reached marginal significance (p = 0.06). Although not definitive, these trials suggest a benefit to postoperative adjuvant chemotherapy in resected NSCLC. The cumulative experience of the 11 trials is notable for: A) the small number of patients; B) heterogenous patient populations; C) substandard chemotherapy regimens; D) inadequate chemotherapy delivery, and E) less than optimally executed clinical trials. The 11 trials are discussed in detail, and recently completed and ongoing trials of adjuvant chemotherapy in resected NSCLC are reviewed.
Journal Article↗
Transplant associated Kaposis sarcoma.
This case reports the first transplant associated Kaposis sarcoma reported from India.
Adult↗
A 3 year case study of alcohol related psychotic disorders at Hospital Seremban.
This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.
Adult↗
Trichorhinophalangeal syndrome type I.
A 32-year-old short statured woman with alopecia, typical facies, shortened angulated fingers and toes with Trichorhinophalangeal syndrome type I (TRPS I) is reported. The absence of exostosis and mental retardation rule out TRPS II. The absence of generalized shortness of all phalanges, metacarpals and metatarsals distinguish it from TRPS III. Possibly the various types of Trichorhinophalangeal syndrome are genetically identical but have a varied clinical spectrum.
Adult↗
A case-control analysis of risk factors in HIV transmission in South India.
A case-control study was done among patients attending our clinic for sexually transmitted diseases in South India to assess risk factors for human immunodeficiency virus (HIV) infection. Of 5,876 patients tested, 105 (1.79%) were HIV antibody positive (87 men, 18 women) by enzyme-linked immunosorbent assay and Western blot. They were compared with an equal number of age- and sex-matched patients without HIV antibody. Risk factors significant in the crude odds ratio analysis were occupation (truck drivers and truck cleaners), age at first exposure, and sexual contact with commercial sex workers. In the logistic regression analysis, only a history of past genital ulcer was a significant risk factor. Other important findings of this study were that (a) the spread of HIV to women is mostly from their infected husbands and (b) regular condom use was reported by less than 8% of patients and controls. Obviously, the current methods of education of the population are far from adequate.
Adult↗
Pain in multiple leiomyomas alleviated by nifedipine.
We have confirmed the usefulness of nifedipine in the treatment of pain present in lesions of multiple skin leiomyomata. Our patient, a 28-year-old woman, had hundreds of skin lesions, proven histologically to be leiomyomata. Nifedipine (10 mg) three or four times daily was remarkably effective in diminishing pain that was more marked in the winter season.
Adult↗
Sample sizes for randomized trials measuring quality of life in cancer patients.
This paper describes the methods appropriate for calculating sample sizes for clinical trials assessing quality of life (QOL). An example from a randomized trial of patients with small cell lung cancer completing the Hospital Anxiety and Depression Scale (HADS) is used for illustration. Sample size estimates calculated assuming that the data are either of the Normal form or binary are compared to estimates derived using an ordered categorical approach. In our example, since the data are very skewed, the Normal and binary approaches are shown to be unsatisfactory: binary methods may lead to substantial over estimates of sample size and Normal methods take no account of the asymmetric nature of the distribution. When summarizing normative data for QOL scores the frequency distributions should always be given so that one can assess if non-parametric methods should be used for sample size calculations and analysis. Further work is needed to discover what changes in QOL scores represent clinical importance for health technology interventions.
Adult↗
Advanced neonatal nurse practitioners in the United Kingdom: where are they and what do they do?
The former Wessex region was the first in England to institute an advanced neonatal nurse practitioner (ANNP) course within the United Kingdom (UK), and at the time of this survey three cohorts had completed the course. The role has been developed over several years in the North American health care system, where it has been shown that ANNPs have the ability to perform as competently and efficiently as junior doctors. It is a major development both in neonatal care and nursing. Following a review of the literature on ANNPs, this paper details the distribution of ANNPs in the UK, and reports on a survey undertaken by the authors, which examined the function, clinical grading and source of funding of ANNPs, as well as examining the ANNPs' view of their role and challenges they have encountered.
Female↗