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Biomedical subjects

A G Pandya

Publications and source records attributed to A G Pandya.

17 recordsLinked to original sources
PubMed1999

Pulse intravenous cyclophosphamide therapy in pemphigus.

BACKGROUND: Adjuvant therapy is commonly used in pemphigus to mitigate the high morbidity and mortality associated with the use of corticosteroids and improve disease control. However, these adjuvant agents are not without adverse effects of their own, including an increased risk of malignancy with the use of oral immunosuppressives. Intravenous pulse cyclophosphamide, which may be more efficacious and less toxic than oral immunosuppressives, has been used successfully in the treatment of pemphigus. OBJECTIVE: To review 9 patients with severe or previously recalcitrant pemphigus who were treated with intravenous pulse cyclophosphamide therapy. RESULTS: Six of the 9 patients responded to therapy, with 2 patients achieving remission from skin lesions. Five patients were able to decrease their daily dose of prednisone, and 1 was able to discontinue the use of prednisone completely. Most patients experienced minimal or no adverse effects. CONCLUSIONS: Intravenous pulse cyclophosphamide may be an alternative treatment option in patients with pemphigus recalcitrant to standard therapy. The decreased cumulative dose of cyclophosphamide observed with monthly pulse doses may reduce the incidence of secondary malignancies when compared with continuous oral therapy. Controlled trials are needed to further evaluate the efficacy of this mode of therapy.

Adult↗
PubMed1998

Treatment of pemphigus with gold.

BACKGROUND: Although gold has been reported to be useful in treating pemphigus vulgaris, its use has waned in recent years because of concerns regarding efficacy and toxicity. OBJECTIVE: To review 26 patients with pemphigus who were treated with intramuscular gold over a 10-year period. RESULTS: Gold was effective in 62% of patients as a primary treatment for pemphigus or as a steroid-sparing agent. An average of 3 months of therapy was required before the daily prednisone dosage could be halved. Four patients were free of disease and stopped receiving all therapy at the conclusion of the study. Toxic effects due to gold therapy developed in 42% of patients and all adverse effects resolved with its cessation. CONCLUSIONS: While toxic effects limit the use of gold in many patients with pemphigus, it may be effective in treating a large percentage of patients who otherwise are unable to reduce their steroid requirement. Because of its delayed onset of action, patients treated with gold usually require systemic steroids when therapy is initiated. Controlled, prospective trials are needed to further evaluate the efficacy of gold and its potential steroid-sparing effects.

Adult↗
PubMed1998

Pigmentary diseases.

Abnormalities of pigmentation are common and frequently produce great concern in patients presenting to primary care physicians. Although many pigmentary changes arise as a consequence of inflammatory skin disorders, it is important to differentiate a primary skin disease from postinflammatory changes. Early recognition of a pigmentary disease allows the clinician to begin appropriate therapy at a stage when medical intervention may be more effective. Although many skin disorders are mainly of cosmetic concern, the condition may be devastating psychologically, requiring the clinician to be sensitive to the overall impact of the disorder and treat it accordingly.

Diagnosis, Differential↗
PubMed1998

Fatal scleromyxedema: report of a case and review of the literature.

Scleromyxedema is a rare fibromucinous connective tissue that can be associated with systemic changes, such as myopathy, neurologic defects, esophageal dysmotility, paraproteinemia, and restrictive lung disease. We describe a fatal case of scleromyxedema in which neurologic, cardiac, gastrointestinal, and muscle changes were present. At autopsy, mucin was found in the papillary dermis of skin and in coronary and pulmonary vessels, but was absent from the brain, kidneys, heart, gastrointestinal tract, esophagus, liver, thyroid, lymph nodes, bone marrow, and pancreas. Because the pathogenesis of scleromyxedema may not always be attributable to mucin deposition, the role of circulating factors in the development of systemic manifestations warrants further investigation.

Adult↗
PubMed1998

Combination therapy of resistant warts in a patient with AIDS.

BACKGROUND: An AIDS patient on anti-HIV therapy consisting of two reverse transcriptase inhibitors had a low CD4+ lymphocyte count, a high HIV viral RNA load, and facial warts that were resistant to ablative therapy. OBJECTIVE: To find a regimen to treat resistant warts in an AIDS patient with a depressed CD4 count and high HIV viral load. METHODS: A protease inhibitor was added to his regimen and he was treated with ablative therapy using a 585 nm flashlamp-pumped pulsed dye laser (FPPDL). RESULTS: Observed resolution of the warts one month later, with no recurrence at seven-month follow-up. CONCLUSIONS: Treatment of resistant warts in patients with AIDS may be enhanced by triple-drug therapy which includes a protease inhibitor, used in combination with ablative therapy, such as the FPPDL.

AIDS-Related Opportunistic Infections↗
PubMed1996

Radiation dermatitis after spinal arteriovenous malformation embolization: case report.

Few cases of radiation injury related to lengthy interventional neuroradiologic procedures have been reported, although concern has been heightened, as evidence by a 1994 FDA Public Health Advisory. We report a case of radiation-induced dermatitis in a patient undergoing multiple diagnostic and embolization procedures for treatment of a spinal arteriovenous malformation.

Adult↗
PubMed1995

Papulonodular mucinosis associated with systemic lupus erythematosus: possible mechanisms of increased glycosaminoglycan accumulation.

BACKGROUND: The mechanism for the production of papulonodular mucinosis in patients with lupus erythematosus (LE) is not known. OBJECTIVE: Our purpose was to determine whether fibroblasts in a patient with LE and papulonodular mucinosis produced more mucin than normal fibroblasts and whether this mucin production could be stimulated by the patient's serum. METHODS: Skin fibroblasts from a patient with systemic LE and massive papulonodular mucin deposition, as well as normal fibroblasts, were incubated in the presence of serum from the patient or from a healthy volunteer. The production of glycosaminoglycan by fibroblasts was analyzed. RESULTS: Fibroblasts from the patient produced more glycosaminoglycan than did normal fibroblasts. Glycosaminoglycan production was increased in all cells when incubated in the presence of the patient's serum. CONCLUSION: Cutaneous mucin deposition in patients with papulonodular LE skin lesions is associated with increased glycosaminoglycan production by dermal fibroblasts. Our preliminary observations suggest glycosaminoglycan production by these fibroblasts appears to be stimulated by a factor, (or factors) in the patient's serum that is yet to be identified.

Adult↗
PubMed1995

Treatment of dermatomyositis with methotrexate.

BACKGROUND: No published data exist on the incidence of liver fibrosis in patients with dermatomyositis treated with methotrexate. OBJECTIVE: Our purpose was to examine the efficacy, steroid-sparing potential, and side effects of methotrexate in patients with dermatomyositis and to report liver biopsy results in four patients. METHODS: A retrospective review of all cases of dermatomyositis treated with methotrexate in a dermatology and rheumatology referral practice was conducted. RESULTS: Of the 10 cases reviewed, seven were of dermatomyositis whereas three were of amyopathic dermatomyositis (ADM). Nine patients received oral methotrexate. One patient received intravenous methotrexate. Improvement of cutaneous disease occurred in seven (100%) of the patients with dermatomyositis and in two (66%) of those with ADM; myositis improved in four (57%) of the patients with dermatomyositis. The initial prednisone dose was halved after an average of 18 weeks of methotrexate therapy in the patients with dermatomyositis and 13 weeks in the patients with ADM. Methotrexate-related side effects occurred in six (86%) of the patients with dermatomyositis and in one (33%) of the patients with ADM. Of the four patients who had liver biopsies, two (50%) showed mild hepatic fibrosis, resulting in discontinuation of the drug. Both patients in whom fibrosis developed had preexisting steroid-induced diabetes mellitus. CONCLUSION: Although methotrexate is an effective treatment for dermatomyositis, side effects are common. Patients with diabetes mellitus should be closely monitored for toxic effects on the liver.

Adult↗
PubMed1992

Treatment of pemphigus vulgaris with pulse intravenous cyclophosphamide.

BACKGROUND: Although corticosteroids have dramatically altered the prognosis in pemphigus vulgaris, morbidity and mortality from systemic corticosteroid side effects remains high. While immunosuppressive agents have been successfully used in pemphigus vulgaris, there is a high incidence of side effects with these agents as well. Particularly bothersome are reports of increased risk of malignancy with long-term use of immunosuppressive agents. For these reasons, we used a protocol that includes low-dose oral cyclophosphamide coupled with pulse intravenous cyclophosphamide in two patients with recalcitrant pemphigus vulgaris. OBSERVATIONS: Both patients responded well to monthly doses of intravenous cyclophosphamide with rapid decrease in the frequency and severity of blistering, resulting in resolution of their disease after 7 and 10 months, respectively. CONCLUSIONS: Pulse doses of immunosuppressive agents appear to be successful in the treatment of pemphigus vulgaris. High-dose steroid therapy can be tapered with the use of this treatment. Because monthly intravenous doses of cyclophosphamide lead to a substantially reduced cumulative dose, when compared with standard oral regimens, the risk of developing malignancy may also be reduced. Further studies using larger groups of patients are needed to evaluate the efficacy of pulse intravenous cyclophosphamide in pemphigus vulgaris. Long-term follow up will be necessary to compare the incidence of malignancy in patients receiving pulse doses of immunosuppressive agents with that in patients receiving continuous oral treatment.

Adult↗