Topical application of bichloroacetic acid.
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Biomedical subjects
Publications and source records attributed to S P Stone.
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An overall measure of the recovery of visual neglect in patients with an acute stroke is described: The "Visual Neglect Recovery Inde" (VNRI) expresses the amount of visual neglect on a battery of visual neglect tests as a percentage of complete recovery from the maximal visual neglect measurable. The principles underlying the development of the index are similar to those involved in the development of the Motricity Index for hemiplegia. A population of 68 survivors of stroke who presented with visual neglect at two to three days were followed for up to six months. The VNRI showed that neglect was greater in those with right hemisphere stroke than in those with left hemisphere stroke and that recovery was most rapid over the first 10 days and reached a plateau at three months. Most patients, including many with severe initial visual neglect, showed little visual neglect at three months. Stepwise regression analysis showed that the severity of visual neglect at three months and at six months post-stroke could be predicted by the severity of visual neglect and the presence of anosognosia at two to three days. A regression equation was produced which may enable clinicians to select patients for intensive treatment of visual neglect.
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A patient with basal nervus syndrome was found to have an adenocarcinoma of the colon. This association, probably fortuitous, made it possible to study the effect of intravenous 5-fluorouracil on the cutaneous basal cell tumors. There was no reaction to this treatment. Subsequently, all visible basal cell tumors were satisfactorily eradicated with topical 5-fluorouracil.
Electrosurgery--electrodesiccation, fulguration, and electrocoagulation--is a simple and relatively inexpensive modality for treatment of small skin lesions, whether benign or malignant. The technique is easily mastered, and the results, with proper selection of patients, compare favorably with the results of scalpel-and-suture surgery. Electrosurgery does not mean "burning off" lesions and biopsy of the lesion is an integral part of the technique.
Enthusiasm in the use of dapsome for acne conglobata and other severe acne has created an increase in the use of this drug by dermatologists. We describe three patients in whom jaundice developed during dapsome therapy of 3 to 36 weeks' duration. Jaundice was due to cholestasis in two cases and to hemolysis in the third. These significant side effects call for careful observation by the physician if dapsone is to be used with safety.
At the Mayo Clinic, atopic dermatitis was evaluated in a series of 28 patients to determine whether, during the course of the disease, serum IgE levels fluctuated with changes in the severity of dermatitis. The study covered a 1- to 11/2-year follow-up period. Previously, it had been shown that, at initial examination, serum IgE levels were positively related to the extent of disease. Although notable fluctuations in serum IgE levels and in extent of dermatitis were seen in more than half of the cases, no relationship was found between the two factors during the period of study.
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Urticaria is a problem often as vexing to the physician as to the patient. The approach to the patient with hives first demands a search for the etiology, whether endogenous and triggered by emotions or occult systemic disease, exogenous and triggered by allergy to inhaled or ingested antigens, or physical and due to abnormal sensitivity to heat, cold, light, or pressure. Often a fruitless search, the diagnostic evaluation must be accompanied by appropriate symptomatic therapy requiring familiarity with the antihistamines and their relative advantages in the various forms of urticaria. Elimination diets are of diagnostic as well as therapeutic value: pencillin-free, yeast-free, and salicylate-free diets are particularly useful. Therapeutic trials of tetracycline, nystatin and griseofulvin may be helpful, while corticosteroids and specific desensitization are rarely of value.
To evaluate the significance of the association of systemic malignant disease with bullous pemphigoid, we reviewed the records of patients with bullous pemphigold seen at the Mayo Clinic between 1960 and 1972. Data from 73 patients with bullous pemphigoid were compared with data from 146 controls (73 with contact dermatitis and 73 with psoriasis) matched for age, sex, and calendar year of diagnosis. In the three groups, eight patients with bullous pemphigoid, 11 with contact dermatitis, and ten with psoriasis were found to have malignant disease within the period covering the five years before and five years after the diagnosis of the skin disease. These data indicate that pemphigoid does not seem to be significantly associated with malignant disease.