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A C Halpern

Publications and source records attributed to A C Halpern.

43 records · Page 3Linked to original sources
PubMed1991

A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures.

To determine the incidence of Stevens-Johnson syndrome, a descriptive epidemiology study was performed using computerized Medicaid billing data from 1980 to 1984 from the states of Michigan, Minnesota, and Florida. The ratio of persons hospitalized with a discharge diagnosis of erythema multiforme (ICD-9-CM code 695.1) to persons with any claim for medical service was first used as an estimate of the incidence rate of the disease. Then, since the ICD-9-CM code for erythema multiforme includes other illnesses in addition to Stevens-Johnson syndrome and because these illnesses are frequently misdiagnosed, the information provided by a review of medical records for a subset of cases of erythema multiforme was used to determine the proportion of patients with true Stevens-Johnson syndrome. The incidence rates of Stevens-Johnson syndrome were 7.1 (6.1 to 8.2), 2.6 (1.6 to 4.0), and 6.8 (4.3 to 10.3) per million per year in each state, respectively. Penicillins, especially aminopenicillins, were frequently used in the 19 patients judged to be true cases of Stevens-Johnson syndrome. In conclusion, Stevens-Johnson syndrome is a uncommon condition. The excess risk of Stevens-Johnson syndrome due to any drug must, therefore, be very low.

Adolescent↗
PubMed1991

Dysplastic nevi as risk markers of sporadic (nonfamilial) melanoma. A case-control study.

The melanoma risk associated with dysplastic nevi outside the context of familial melanoma was studied by the case-control method. One hundred five newly diagnosed incident melanoma cases with negative family histories for familial melanoma and 181 controls (frequency matched for race, age, and sex) were studied by personal interview and cutaneous examination. The prevalence of dysplastic nevi was 41 (39%) of 105 in the cases and 13 (7%) of 181 in the controls. The odds ratio for dysplastic nevi by multiple logistic regression analysis simultaneously correcting for age, sex, eye color, hair color, actinic damage, freckles, and total number of nondysplastic nevi was 6.8 (95% confidence interval, 2.7, 16.9). This study supports the significance of dysplastic nevi as markers of increased risk for nonfamilial melanoma.

Case-Control Studies↗
PubMed1989

Model predicting survival in stage I melanoma based on tumor progression.

We used the lesional steps in tumor progression and multivariable logistic regression to develop a prognostic model for primary, clinical stage I cutaneous melanoma. This model is 89% accurate in predicting survival. Using histologic criteria, we assigned melanomas to tumor progression steps by ascertaining their particular growth phase. These phases were the in situ and invasive radial growth phase and the vertical growth phase (the focal formation of a dermal tumor nodule or dermal tumor plaque within the radial growth phase or such dermal growth without an evident radial growth phase). After a minimum follow-up of 100.6 months and a median follow-up of 150.2 months, 122 invasive radial-growth-phase tumors were found to be without metastases. Eight-year survival among the 264 patients whose tumors had entered the vertical growth phase was 71.2%. Survival prediction in these patients was enhanced by the use of a multivariable logistic regression model. Twenty-three attributes were tested for entry into this model. Six had independently predictive prognostic information: (a) mitotic rate per square millimeter, (b) tumor-infiltrating lymphocytes, (c) tumor thickness, (d) anatomic site of primary melanoma, (e) sex of the patient, and (f) histologic regression. When mitotic rate per square millimeter, tumor-infiltrating lymphocytes, primary site, sex, and histologic regression are added to a logistic regression model containing tumor thickness alone, they are independent predictors of 8-year survival (P less than .0005).

Female↗
PubMed1988

The incidence of bacteremia in skin surgery of the head and neck.

The normal microflora of skin vary significantly between sebaceous rich, wet, and dry areas. This would be expected to influence the likelihood of developing transient bacteremia while undergoing skin surgery on these different areas, thereby affecting the risk of infective endocarditis from such procedures. We evaluated the incidence of transient bacteremia in 45 patients undergoing skin surgery on the sebaceous rich areas of the head and neck. After surveillance skin cultures, aerobic and anaerobic blood culture samples were taken at 0, 1, 5, and 15 minutes after the start of the procedure. All baseline blood culture results were negative. Three of the 45 patients developed transient bacteremia within the first 15 minutes after the start of the procedures. Samples from two patients grew pure cultures of Propionibacterium acnes and that from one patient grew a pure culture of Staphylococcus hominis, yielding a 7% incidence of bacteremia in the 45 patients studied. These data support the use of perioperative prophylactic antibiotics for surgery involving clinically uninfected skin of the head and neck only in patients with prosthetic heart valves. This is in keeping with the current recommendations of the American Heart Association against the need for antibiotic prophylaxis for nonprosthetic valve endocarditis in patients undergoing cutaneous surgery on clinically uninfected skin.

Adult↗
PubMed1988

Comparison of preoperative skin preparations for the face.

Antiseptic preparation of the skin before dermatologic surgical procedures should provide maximal reduction of cutaneous microflora for the duration of the operation. No data currently exist concerning the efficacy of topical antimicrobials on the most common site of cutaneous surgery, the face. In this study the potency and temporal characteristics of three antimicrobials were tested on the faces of 14 volunteers. A 10-second wipe of 70% isopropyl alcohol was as effective in reducing aerobic microflora at the 5-minute postoperative period as a 60-second alcohol wipe or a 60-second povidone-iodine or chlorhexidine tincture application. At 60 minutes after the application, aerobic bacterial reduction possibly was better maintained by the povidone than by the 10- or 60-second alcohol preparation. None of the antiseptics tested were capable of a profound reduction of the anaerobic flora present on the sebaceous facial regions.

1-Propanol↗
PubMedDate not supplied

A survey of skin cancer screening in the primary care setting: a comparison with other cancer screenings.

OBJECTIVE: To determine primary care physicians' perceived importance and frequency of performance of skin cancer screening in comparison with other cancer screening examinations. DESIGN: Descriptive survey study. PARTICIPANTS: Five thousand US family physicians and internal medicine specialists randomly selected from the Official American Board of Medical Specialists Directory of Board-Certified Medical Specialists. MAIN OUTCOME MEASURES: Self-reported importance and performance of cancer screening examinations. RESULTS: Eligible physicians (1363 total: 814 family physicians and 549 internists) completed the survey with a response rate of 30%. Overall, 52% of respondents rated skin cancer screening as "extremely" important, compared with 79% for digital rectal examination, 88% for clinical breast examination, and 87% for Papanicolaou testing. Thirty-seven percent of physicians reported performing complete body skin examinations on 81% to 100% of patients, compared with digital rectal examination, for which 78% of physicians reported performing the examination on 81% to 100% of patients, or the clinical breast examination, for which 82% of physicians reported performing the examination on 81% to 100% of patients. A higher percentage of physicians in practice for more than 30 years ranked skin cancer screening as extremely important and reported a higher frequency of screening examinations. Physicians in a suburban practice setting reported performing skin examinations more often than those in urban or rural settings. Overall, the self-reported frequency of skin examination was strongly correlated with the physician's importance rating of skin cancer screening. CONCLUSIONS: A majority of primary care physicians rate skin cancer screening as extremely important. The reported importance of skin cancer screening and frequency of skin cancer examination among primary care physicians is significantly less than for other cancer examinations. This likely represents a multitude of factors, including logistic constraints and lack of consensus on the efficacy of skin cancer screening. Arch Fam Med. 2000;9:1022-1027

Breast Neoplasms↗