Images in clinical medicine. Talc retinopathy.
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Adult↗
Biomedical subjects
Steven Cohen
Publications and source records attributed to Steven Cohen.
Bilateral choroidal ischemia in giant cell arteritis.
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Administration, Oral↗
Bullous pemphigoid after liver transplantation for liver failure.
Coomb's positive autoimmune hemolytic anemia with giant cell hepatitis (GCH) is a rare cause of liver failure and is usually associated with poor prognosis. A child with liver kidney microsomal (LKM) antibody positivity underwent successful liver transplantation for liver failure secondary to GCH with Coomb's positive hemolytic anemia. Autoimmune neutropenia developed ten months after transplant. Four months later, pemphigoid skin lesions developed. The diagnosis of bullous pemphigoid (BP) was made on the basis of skin biopsy, direct and indirect immunofluorescence test results. Treatment was with immunosuppressants - prednisone and azathioprine/rapamycin, with addition of dapsone when lesions persisted. This child is unique in that his liver function and hemolytic anemia appeared to normalize after liver transplant, but neutropenia and BP both thought to be autoimmune in etiology, developed more than a year post-transplant.
Anemia, Hemolytic, Autoimmune↗
Clinical assessment of pain, tolerability, and preference of an autoinjection pen versus a prefilled syringe for patient self-administration of the fully human, monoclonal antibody adalimumab: the TOUCH trial.
BACKGROUND: Adalimumab is a therapeutic monoclonal antibody for SC administration by 2 single-use injection devices providing bioequivalent amounts of adalimumab: a ready-to-use, prefilled syringe and an integrated, disposable delivery system, the autoinjection Pen. Although pens have been shown to be preferred over syringes by patients requiring long-term SC administration of medications, there are no data on preference and pain in the use of biologics in patients with chronic inflammatory diseases. OBJECTIVE: The aim of this study was to assess injection-site pain, tolerability, and patient preference of 2 delivery systems of adalimumab. METHODS: Patients with rheumatoid arthritis were enrolled in a Phase II, multicenter, open-label, single-arm, sequential trial. Patients self-administered a standard dose of adalimumab 40 mg SC every other week at each of 3 monitored clinical visits: visit 1 (syringe), visits 2 and 3 (Pen). At each visit, patients rated their pain on an 11-point scale (0 = none to 10 = pain as bad as it could be) immediately after injection and 15-30 minutes after injection and provided their impressions of and preferences for each delivery system. Safety events were recorded throughout the study and 70 days after final study dose. RESULTS: Fifty-two patients were enrolled in the trial and completed all 3 visits (32 women, 20 men; mean [SD] age, 53.8 [12.1] years). Forty (76.9%) patients reported that the Pen was less painful than the syringe, 4 (7.7%) patients found the syringe to be less painful, and 8 (15.4%) patients had no preference. Patients had statistically significant reductions in injection-pain scores from visit 1 to visit 2 and from visit 1 to visit 3. No new safety signals or apparent differences regarding tolerability between the syringe and Pen were observed. In addition, 46 (88.5%) patients preferred the Pen, 3 (5.8%) preferred the syringe, and 3 (5.8%) had no preference. Overall, patients evaluated the Pen as easier to use (94.2%), more convenient (92.3%), requiring less time to inject (82.7%), and safer (88.5%). CONCLUSIONS: Patients experienced less pain self-administering adalimumab via the Pen and preferred it versus the syringe. Further, patients perceived the Pen to be easier to use and more convenient. Both delivery systems were generally well tolerated.
Adalimumab↗
Hydroxyapatite cement in craniofacial reconstruction: experience in 150 patients.
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Adolescent↗
An extended 16-week course of alefacept in the treatment of chronic plaque psoriasis.
BACKGROUND: The efficacy and safety of one and two courses of alefacept have been demonstrated in phase 2 and 3 clinical trials, with a course of alefacept defined as 12 weeks of once-weekly treatment followed by 12 weeks of observation. METHODS: This randomized, single-center study compared the safety and efficacy of a standard 12-week versus extended 16-week alefacept dosing period in 20 patients with chronic plaque psoriasis. RESULTS: Both dose groups showed marked improvement in mean Psoriasis Area and Severity Index (PASI) score from baseline through week 24 (between-group difference: not significant). In each group, 60% of patients achieved PASI 50 (> or =50% reduction from baseline PASI score) at any time between weeks 12 and 24. For patients who received 16 weeks of alefacept, the mean percentage change from week-12 PASI score was higher and continued to increase through week 24 compared with that for patients who received 12 weeks of alefacept (P < .05). Adverse events were similar between the two groups and comparable with those observed in phase 2 and 3 clinical studies of alefacept. CONCLUSIONS: This was an open-label, single-center study of 20 patients. Further study is warranted to assess the effect of alefacept when administered for more than 12 weeks. Extended dosing with alefacept appeared to have a similar safety profile to 12-week dosing and may offer further benefit to some patients for disease improvement.
Alefacept↗
Cutaneous adiaspiromycosis: a distinct dermatologic entity associated with Chrysosporium species.
Primary cutaneous infection with Chrysosporium, a saprophytic fungus commonly found in soil, is believed to be very rare, with only two previously reported cases. We present a case of localized cutaneous Chrysosporium in an immunocompromised heart transplant patient. Considering that the histology of the skin in this case is superimposable on that seen in pulmonary Chrysosporium known as adiaspiromycosis, we regard the cutaneous variant in the absence of pulmonary disease as a distinct dermatologic entity. The low frequency of reports of primary cutaneous Chrysosporium infection suggests either underreporting of this diagnosis in the literature, or misidentification of this fungus as another more common mycotic species sharing morphologic similarities. By amplifying our understanding of Chrysosporium infection in the skin, this disorder will be easier to identify and treat.
Adult↗
Clinical evaluation of an HP-guar gellable lubricant eye drop for the relief of dryness of the eye.
PURPOSE: To evaluate the efficacy of a new lubricant eye drop containing polyethylene glycol 400 and propylene glycol demulcents with hydroxypropyl-guar as a gelling agent (Test Product) to a system with carboxymethylcellulose (Control Product) for reducing dry eye signs and symptoms. METHODS: Eighty-seven dry eye volunteers were enrolled at seven sites for this six-week, concurrently controlled, double-masked clinical study. RESULTS: The Test Product significantly reduced conjunctival staining (p = 0.025) and temporal corneal staining (p = 0.024) compared to the Control. The Test Product also significantly reduced symptoms of dryness in the morning and evening, compared to the Control (p = 0.015 and p = 0.023, respectively). Subjects in the Test treatment group reported lower frequencies of foreign body sensation and felt their eyes were "refreshed longer" compared to those in the Control group (p = 0.033 and p = 0.037, respectively). CONCLUSIONS: The Test Product was more effective at reducing both the signs and symptoms of dry eye compared to the carboxymethylcellulose containing Control.
Carboxymethylcellulose Sodium↗
Identifying potential regulators of infantile hemangioma progression through large-scale expression analysis: a possible role for the immune system and indoleamine 2,3 dioxygenase (IDO) during involution.
Hemangiomas are benign endothelial tumors. Often referred to as hemangiomas of infancy (HOI), these tumors are the most common tumor of infancy. Most of these lesions proliferate rapidly in the first months of life, and subsequently slowly involute during early childhood without significant complications. However, they often develop on the head or neck, and may pose a significant cosmetic concern for families. In addition, a fraction of these tumors can grow explosively and ulcerate, bleed, or obstruct vision or airway structures. Current treatments for these tumors are associated with significant side effects, and our knowledge of the biology of hemangiomas is limited. The natural evolution of these lesions creates a unique opportunity to study the changes in gene expression that occur as the endothelium of these tumors proliferates and then subsequently regresses. Such information may also increase our understanding of the basic principals of angiogenesis in normal and abnormal tissue. We have performed large-scale genomic analysis of hemangioma gene expression using DNA microarrays. We recently identified insulin-like growth factor 2 as a potentially important regulator of hemangioma growth using this approach. However, little is known about the mechanisms involved in hemangioma involution. Here we explore the idea that hemangioma involution might be an immune-mediated process and present data to support this concept. We also demonstrate that proliferating hemangiomas express indoleamine 2,3 dioxygenase (IDO) and discuss a possible mechanism that accounts for the often slow regression of these lesions.
CD3 Complex↗
The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation.
Sensory experience is influenced by emotional context. Although perception of emotion and unpleasant visceral sensation are associated with activation within the insula and dorsal and ventral anterior cingulate gyri (ACG), regions important for attention to and perception of sensory and emotional information, the neural mechanisms underlying the effect of emotional context upon visceral sensation remain unexplored. Using functional MRI, we examined neural responses to phasic, non-painful oesophageal sensation (OS) in eight healthy subjects (seven male; age range 27-36 years) either during neutral or negative emotional contexts produced, respectively, by presentation of neutral or fearful facial expressions. Activation within right insular and bilateral dorsal ACG was significantly greater (P < 0.01) during OS with fearful than with neutral faces. In a second experiment, we measured anxiety, discomfort and neural responses in eight healthy male subjects (age range 22-41 years) to phasic, non-painful OS during presentation of faces depicting either low, moderate or high intensities of fear. Significantly greater (P < 0.01) discomfort, anxiety and activation predominantly within the left dorsal ACG and bilateral anterior insulae occurred with high-intensity compared with low-intensity expressions. Clusters of voxels were also detected in this region, which exhibited a positive correlation between subjective behaviour and blood oxygenation level-dependent effect (P < 0.05). We report the first evidence for a modulation of neural responses, and perceived discomfort during, non-painful visceral stimulation by the intensity of the negative emotional context in which the stimulation occurs, and suggest a mechanism for the effect of negative context on symptoms in functional pain disorders.
Adult↗
A novel technique for delivery of epidural steroids and diagnosing the level of nerve root pathology.
Transforaminal epidural steroids are a commonly used technique for diagnosis and treatment of nerve root irritation secondary to herniated disc material. The recent reported occurrences of severe complications using the transforaminal technique have led to the search for a novel alternative that is both a safe and accurate method of steroid delivery. The technique described offers improved safety and diagnostic accuracy over traditional transforaminal steroid injections.
Drug Delivery Systems↗
Motion complications after arthroscopic repair of anterior cruciate ligament avulsion fractures in the adult.
PURPOSE: To investigate the risks involved in arthroscopic reduction of anterior cruciate ligament avulsion fractures in adults. TYPE OF STUDY: Retrospective case series. METHODS: We retrospectively reviewed the outcome of 17 adults treated arthroscopically for displaced anterior cruciate ligament avulsion fractures. All patients were treated with primary repair of the avulsion fragment using nonabsorbable sutures passed through the ligament base and pulled down through arthroscopically placed drill holes. Patients were evaluated an average of 5.4 years (range, 2 to 9 years) after surgery. RESULTS: Of the 17 patients in this investigation, 9 (53%) had severe difficulty regaining motion postoperatively. Four patients (24%) required multiple arthroscopic debridements for lysis of arthrofibrotic scar tissue around the anterior aspect of the knee, 4 additional patients (24%) required manipulation under anesthesia to help regain motion, and 1 patient declined manipulation despite significant motion complications. An additional 3 patients (18%) required a second arthroscopy for reasons including removal of loose bodies, anterior scar impingement, and removal of hardware. Only 5 patients (29%) progressed through physical therapy uneventfully. CONCLUSIONS: Arthroscopic reduction of avulsion fractures of the anterior cruciate ligament was frequently associated with motion complications and often required additional surgical procedures. Adult patients who undergo this procedure should be counseled regarding the increased risk of motion complications.
Adult↗
Central pain.
PURPOSE OF REVIEW: As a result of its accompanying co-morbidity, our lack of understanding regarding its mechanisms, and its resistance to conventional treatment, central pain is one of the most formidable challenges pain physicians are faced with. The objective of this review is to summarize recent advances in our understanding of the etiology, clinical presentation, and treatment of central pain, with special emphasis being placed on studies published within the past year. RECENT FINDINGS: Recent evidence suggests that not only injuries commonly associated with central pain, such as strokes and spinal cord lesions, but also disorders such as fibromyalgia, phantom limb pain and tension-type headaches may involve central phenomena. Perhaps because of the lack of clinical trials, treatment is still largely based on traditional prescribing methods and anecdotal evidence. Recent studies have indicated possible roles for tricyclic antidepressants, anti-seizure medications, and motor cortex stimulation in the treatment of central pain. SUMMARY: Injury to the spinothalamocortical pathways is a necessary, but not sufficient factor in the pathogenesis of central pain. Perhaps because of the similarities in mechanisms, there is considerable overlap between effective treatments for central pain and those for peripheral neuropathic pain. Our poor understanding of the etiology of central pain and the relative lack of effective treatments emphasize the need for further research into this elusive disorder.
Journal Article↗
Patch testing: a retrospective analysis of 103 patients with emphasis on practical aspects for the clinician.
BACKGROUND: Allergic contact dermatitis is a common dermatologic disorder caused by small chemical molecules that can penetrate the skin barrier. Thousands of chemicals capable of inducing allergic contact dermatitis have been identified. To cure allergic contact dermatitis, the allergen should be identified and eliminated from the environment of the patient. Patch testing, utilizing a variety of standard panels of the most frequent allergens, is used to identify the allergen in question. Patch testing is still the gold standard tool used to identify one or more substances that may contribute to the etiology of allergic contact dermatitis. OBJECTIVE: To determine the frequency of patch test positivity and to identify the most common allergens in patients with suspected allergic contact dermatitis. METHODS: A retrospective analysis of files of 103 patients who have been clinically diagnosed to have allergic contact dermatitis and have been patch tested using a standard technique with a Northern American Contact Dermatitis Group series. RESULTS: Sixty-two patients (60.2%) showed positive reactions to one or more substance. The most common allergens were nickel sulfate, fragrance mix, and neomycin sulfate. There was an increased frequency of positive reactions to fragrance mix and a significant decrease of frequency of thimerosal positive reactions. CONCLUSIONS: Increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacturing consumer products. This may have contributed to decreased prevalence rates of certain allergens such as thimerosal and paraphenylenediamine.
Adolescent↗