Search PubMed⌕ Search

Biomedical subjects

S L Greene

Publications and source records attributed to S L Greene.

At least 19 recordsLinked to original sources
PubMed2006

Paracetamol availability and recent changes in paracetamol poisoning: is the 1998 legislation limiting availability of paracetamol being followed?

OBJECTIVE: To determine the degree of adherence to legislation introduced in 1998 restricting the availability of over the counter paracetamol. DESIGN: A prospective observational study. SETTING: An emergency department in an inner city London teaching hospital. Pharmacy and non-pharmacy outlets in south London. MAIN OUTCOME MEASURES: (1) The source of paracetamol ingested by 107 patients presenting with an acute paracetamol overdose (2001-2003) and (2) the ability to purchase paracetamol from pharmacy and non-pharmacy outlets in a manner contravening paracetamol pack size legislation (2004). RESULTS: Potentially toxic amounts of paracetamol in excess of pack size restrictions were purchased in 70% (17 of 24) of outlets. Forty six per cent of patients who had ingested a potentially toxic dose of paracetamol obtained the tablets in a manner contravening the 1998 legislation. CONCLUSION: Legislation limiting the availability of over the counter paracetamol is not being adhered to in south London. A significant number of patients ingesting a potentially toxic dose of paracetamol report purchasing the tablets in a manner contravening the legislation. Studies that attempt to assess the impact of the legislation need to be interpreted in the context of these results. Measures to enforce current legislation may help to reduce the severity of paracetamol poisoning in the UK.

Acetaminophen↗
PubMed2005

Prehospital activated charcoal: the way forward.

OBJECTIVES: Single dose activated charcoal (SDAC) may be an effective method of gastric decontamination when administered to patients within an hour of drug overdose. However, few patients who may benefit from this treatment attend an emergency department within this timeframe. The authors sought to determine the current attitudes of ambulance NHS trusts to recent recommendations that the administration of SDAC should be considered as a prehospital therapy. METHODS: A postal questionnaire was used to determine the current level of use of prehospital activated charcoal by ambulance NHS trusts, the incidence of associated complications, and barriers preventing the routine use of prehospital SDAC. RESULTS: A completed questionnaire was returned by 36 of the 39 ambulance NHS trusts in the UK (response rate 92%). Currently none of the trusts that responded to the questionnaire provides prehospital SDAC as an intervention. The most common barriers to the provision of prehospital SDAC are the current lack of evidence in the medical literature proving it is effective in improving patient outcome and the lack of a recognised protocol for its administration. Other issues included concerns regarding potential complications, ambulance turnaround times, lack of availability of SDAC, and lack of funding. CONCLUSIONS: A lack of published evidence proving efficacy remains the most important factor in preventing the routine administration of SDAC to appropriate patients in the prehospital environment. Further research in this setting is required to determine the usefulness of this therapy.

Attitude of Health Personnel↗
PubMed2005

Acute poisoning: understanding 90% of cases in a nutshell.

The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

Acetaminophen↗
PubMed1991

An observational study of isotretinoin recipients treated for acne in a health maintenance organization.

From September 1982 to June 1987, all members (N = 513) of the Group Health Cooperative of Puget Sound, Seattle, Wash, who were prescribed isotretinoin for acne were observed throughout the first 4- to 5-month course of therapy for effectiveness and adverse effects. The highest rates of use were among male subjects aged 15 to 24 years. Excluding 47 subjects whose prescriptions were stopped because of noncompliance or who left the care of Group Health Cooperative physicians, 39 (8.4%) of the remaining 466 discontinued taking the drug because of the following adverse effects: mucous/skin/musculoskeletal effects (17); elevated triglyceride levels (eight); headaches (five); increased liver enzyme levels (three); amenorrhea (two); and other (four). One subject, excluded from the 466 because of noncompliance, became pregnant while using medication from a previous prescription and had a therapeutic abortion; she was not under the care of a physician at the time of pregnancy. Most subjects (97%) developed a mucocutaneous symptom, and 42% developed musculoskeletal symptoms. Moderate elevations in liver enzyme levels developed in six (1.8%) of 341 subjects with normal baseline values. Of 389 subjects with normal baseline triglyceride values (less than 2.25 mmol/L), nine (2.3%) developed moderate elevations (4.5 to 9.0 mmol/L), and one (0.3%) developed a severe elevation (greater than or equal to 9.0 mmol/L). Of 24 subjects with elevated baseline triglyceride levels, three (12.5%) developed moderate elevations. Of an additional 53 subjects whose baseline serum triglyceride levels were not determined, two developed elevations during therapy, one up to 13.4 mmol/L. Subjects who were overweight or had elevated baseline serum triglyceride values had an increased risk of developing elevations in triglyceride levels during therapy (odds ratio, 6.0; 95% confidence interval, 1.6 to 22.0; and odds ratio, 4.35; 95% confidence interval, 0.9 to 20.2, respectively). Acne was improved for at least 94.0% of subjects.

Acne Vulgaris↗
PubMed1987

Variable expression in ankyloblepharon-ectodermal defects-cleft lip and palate syndrome.

The ankyloblepharon-ectodermal defects-cleft lip and palate (Hay-Wells) syndrome is a rare autosomal dominant form of congenital ectodermal dysplasia. It is characterized by coarse, wiry, sparse hair; dystrophic nails; slight hypohidrosis; scalp infections; ankyloblepharon filiforme adnatum; hypodontia; maxillary hypoplasia; and cleft lip and palate. To date, 12 patients have been reported; however, the diagnosis has been questioned in 3 of these patients. We report 2 additional patients, one of whom has nasal speech but not cleft palate, in contrast to all other reported patients. This entity must be distinguished from numerous other forms of ectodermal dysplasia, especially those forms that can be associated with oral clefts and/or ankyloblepharon.

Child↗
PubMed1987

Effect of stimulus configuration on spatial judgments in search tasks.

Although children over one year of age are able to code spatial information with respect to objects other than the self, there are many instances in which the self is inappropriately used as a spatial referent by children between 2 and 4 years of age. L. G. Braine and R. A. Eder (1983, Developmental Psychology, 19, 45-55) found that, in a search task, the nature of the array influenced the spatial referent used by 2-year-old children. The present work investigated the effect of varying the number, size, and arrangement of boxes in the array. It was found that only the number of boxes defining the left and right sides of the array influenced performance; that is, multiple boxes were associated with the use of external objects as spatial referents. These results were interpreted as stemming from the tendency of young children to code the location of an object with respect to nearby objects. This tendency would lead to the use of adjacent boxes and environmental objects as spatial referents for the multiple-box side, and the use of the self as a spatial referent for the single-box side.

Child, Preschool↗
PubMed1986

Bullous morphea profunda.

A deep sclerotic process developed on the shins of a 58-year-old man, and eosinophilic fasciitis or morphea profunda was suspected clinically. Bullae later arose on the plaques, and histologic examination of a skin biopsy specimen revealed sclerosis and inflammation of the deep dermis, panniculus, and fascia, with subepidermal edema causing formation of bullae. No lymphatic obstruction or vasculitis was seen. Two plaques of typical morphea on the penis were noticed 10 months later. The patient had no peripheral or tissue eosinophilia, hypergammaglobulinemia, hematologic abnormality, or history of exertion before the onset of the disease. The sclerotic process involved more than the fascia. In describing this deeper variant of morphea, the term "morphea profunda" appears to be more appropriate than "eosinophilic fasciitis."

Foot Dermatoses↗
PubMed1985

Double-blind crossover study comparing doxepin with diphenhydramine for the treatment of chronic urticaria.

Fifty patients with chronic idiopathic urticaria were studied to compare responses to treatment with doxepin (10 mg three times a day) and with diphenhydramine (25 mg three times a day). All patients had an evaluation that failed to disclose a cause for their disease. Therapeutic response was assessed according to the suppression of symptoms and symptom diary scores of daily itching and frequency, number, size, and duration of hives. Total clearing of the pruritus and urticarial lesions occurred in 43% of the patients while receiving doxepin and in only 5% while receiving diphenhydramine (p less than 0.001). Partial or total control of the pruritus and hives was noted in 74% of the patients receiving doxepin and in only 10% of those receiving diphenhydramine (p less than 0.001). Doxepin induced markedly less sedation (22%) than diphenhydramine (46%) (p less than 0.05). Dermatopathologic categories included (1) urticaria simplex, (2) lymphocytic urticaria, and (3) leukocytoclastic urticaria. Patients with urticaria simplex had a more favorable response to doxepin than the two other groups.

Adolescent↗
PubMed1985

Netherton's syndrome. Report of a case and review of the literature.

A patient with Netherton's syndrome who was followed since birth had previously been diagnosed as having Leiner's disease and acrodermatitis enteropathica; the disorder was recognized clinically when the patient was 20 years of age. Therapy with 13-cis-retinoic acid significantly aggravated the ichthyosis and induced increased fragility of the skin. This patient also had an intermittent aminoaciduria with clinical investigations that showed normal renal function. Furthermore, the aminoaciduria resolved spontaneously after the discontinuance of topically applied corticosteroids. The normal results of clinical studies and a review of the literature suggest that the aminoaciduria may have been artifactual because excess absorption of topically applied corticosteroids directly affects the renal tubules and impairs renal reabsorption or enhances the free excretion of amino acids. We review forty-two other cases of Netherton's syndrome in the literature and reaffirm the significance of associated ichthyosis, atopy, trichorrhexis invaginata, and other findings in this unique syndrome.

Adult↗
PubMed1984

Ecthyma gangrenosum: report of clinical, histopathologic, and bacteriologic aspects of eight cases.

The records of eight patients with ecthyma gangrenosum who were treated at the Mayo Clinic between 1970 and 1982 were reviewed. All patients had hematologic disease and had received immunosuppressive drugs. Patients with neutropenia that did not resolve by the end of a course of appropriate antibiotic treatment usually died. Solitary lesions of ecthyma gangrenosum were associated with a better prognosis than were multiple lesions. The typical skin findings of ecthyma gangrenosum usually occurred early and were often incorrectly diagnosed, resulting in time lost during which antibiotic therapy could have been instituted. For patients with ecthyma gangrenosum, a systematic procedure is important to establish the diagnosis early, so that appropriate systemic antibiotic therapy can be initiated.

Adult↗
PubMed1984

Cowden's disease with associated malignant melanoma.

Cowden's disease (multiple hamartoma syndrome), a rare genodermatosis, is inherited in an autosomal-dominant genetic pattern. It is characterized by mesodermal and epithelial hamartomas appearing as verrucous papules occurring predominantly over the central portion of the face, with perioral and acral papular lesions and papillomatosis of the lips, gingiva, and tongue extending through the entire length of the gastrointestinal tract. These skin lesions have been found to be associated with a number of benign and malignant tumors involving the breast, thyroid, skin, ovaries, adipose tissue, and gastrointestinal tract. The authors report the second case of Cowden's disease associated with malignant melanoma and emphasize the need for a high index of suspicion for related benign or malignant tumors in these cases.

Female↗
PubMed1984

Epidermolytic palmo-plantar keratoderma.

An 11-year-old girl who at 9 1/2 months was diagnosed as having keratoderma of the palms and soles, present since birth, developed typical granuloma annulare at the age of 11 years. To the authors' knowledge, this is the first report of epidermolytic palmo-plantar keratoderma associated with granuloma annulare. There was no known family history of keratoderma. A review of the literature revealed three other patients without family history, although most of the patients have had multiple family members with the same problem. Many skin conditions can be associated with epidermolytic hyperkeratosis. The authors believe that epidermolytic palmo-planter keratoderma is a distinct form of palmo-plantar keratoderma rather than a type of ichthyosis.

Child↗
PubMed1984

Production of verrucarol.

Verrucarol was obtained from a simple procedure that involved the hydrolysis of a crude extract of a culture of Myrothecium verrucaria ATCC 24571.

Journal Article↗
PubMed1984

Pseudomonas aeruginosa infections of the skin.

Otitis externa, green nail syndrome, toe web infections, hot tub folliculitis, superinfections in chronic antibiotic-treated acne and infectious eczematoid dermatitis are examples of mild cutaneous infections due to Pseudomonas aeruginosa. These may occur in otherwise healthy persons. In persons with lowered resistance, more severe infections such as malignant otitis externa, blastomycosis-like pyoderma and necrotizing fasciitis are observed. Ecthyma gangrenosum, the pathognomonic skin sign of Pseudomonas septicemia, occurs in debilitated or terminally ill patients and must be treated immediately.

Acne Vulgaris↗
PubMed1984

Activated coagulation time test: a convenient monitor of heparinization for dogs used in cardiovascular research.

The usefulness of the activated coagulation time test to monitor heparin effect was studied by administering varying intravenous doses of heparin to six mongrel dogs. Using the activated coagulation time test, a dose response relationship and half-life for heparin action were determined in each dog. It was observed that a heparin dose of 200 units/kg provided less than the generally accepted minimal anticoagulant effect of an activated coagulation time of 180 seconds, while a dose of 500 units/kg produced adequate anticoagulation. Even then, the half-life of heparin activity was less than 50 minutes. These findings suggest that even when large doses of heparin are utilized to provide adequate initial anticoagulation, the short half-life in dogs makes frequent assessment of the heparin response essential. The activated coagulation time test provided a rapid and simple determination of heparin activity within each individual and was used to insure adequate anticoagulation.

Animals↗