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Biomedical subjects

B Berman

Publications and source records attributed to B Berman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Efficacy of pentoxifylline in the treatment of pruritic papular eruption of HIV-infected persons.

BACKGROUND: Pruritic papular eruption (PPE) of HIV/AIDS is a common manifestation of HIV infection. Unfortunately, treatments for the unremitting pruritus have yielded only partial relief. OBJECTIVE: Our purpose was to assess the clinical efficacy of pentoxifylline in the treatment of pruritus in HIV-infected patients with PPE while measuring its effects on HIV viral load and levels of serum triglycerides, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-4. METHODS: Eleven of the 12 patients with PPE and HIV infection placed on a regimen of oral pentoxifylline completed the 8-week study. The degree of pruritus both before and after therapy was measured by means of a patient-reported visual analog scale (0 = none and 10 = worst experienced). A global assessment of the number and size of PPE lesions was performed by the investigator, and serum TNF-alpha, IL-4, and triglyceride levels, as well as HIV viral load, were measured. RESULTS: The average degree of pruritus was significantly reduced (p = 0.0009) from 6.5 at baseline examination to 3.6 at the end of the study. Ten of 11 patients experienced a reduction in their pruritus, ranging from 22.6% to 87.3%. The global assessment of PPE lesions decreased from baseline in most patients and increased slightly in one patient. Serum TNF-alpha was detectable in one patient at baseline, but was undetectable at the end of the study period. Similarly, the two patients who had detectable serum IL-4 at baseline had undetectable serum IL-4 levels at the end of the study. Triglyceride levels in six patients decreased an average of 23.9% by week 8. Although when compared with baseline values, HIV viral loads in seven patients decreased, one patient had no change, and three patients had an increase in their viral load at the end of the study, the magnitude of the changes were of little clinical importance. CONCLUSION: Pentoxifylline is a safe and efficacious treatment of pruritus in HIV-infected patients with PPE. Future controlled studies are needed to confirm the effectiveness of this treatment.

Adult↗
PubMed1998

Multicentric reticulohistiocytosis associated with recurrent breast carcinoma.

Multicentric reticulohistiocytosis (MRH) is a rare systemic disorder that most often affects women in the fourth to fifth decades of life and is characterized by widespread cutaneous papules and nodules, often associated with a destructive arthritis. The characteristic histologic feature of the skin lesions, and of other affected organs, is the presence of histiocytes and multinucleated giant cells containing abundant eosinophilic cytoplasm with a "ground glass appearance." Approximately 30% of the patients have an underlying malignancy suggesting MRH may be a paraneoplastic phenomenon. We describe a case of MRH associated with recurrent, metastatic breast carcinoma.

Adult↗
PubMed1998

Stroke prevention trial in sickle cell anemia.

Stroke occurs in 7-8% of children with Sickle Cell Disease (Hb SS) and is a major cause of morbidity. Rates of recurrence have been reduced from 46-90% to less than 10% through chronic blood transfusions. Prevention of first stroke, however, would be preferable because even one stroke can cause irreversible brain injury. Transcranial Doppler (TCD) ultrasound can detect arterial blood flow rates associated with subsequent stroke risk. By combining TCD screening and a potentially effective treatment, first stroke may be prevented. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) is the first stroke prevention trial in Hb SS and the first randomized, controlled use of transfusion in Hb SS. This multi-center trial is designed to test whether reducing sickle hemoglobin to 30% or less with periodic blood transfusions will reduce first-time stroke by at least 70% compared to standard care. Primary endpoints will be clinically evident symptoms of cerebral infarction with consistent findings on Magnetic Resonance Imaging and Angiography (MRI/MRA) or symptomatic intracranial hemorrhage. Secondary endpoints will be asymptomatic brain lesions detected by MRI in brain areas not involved in primary endpoints. The design calls for a 6-month start-up interval, 18 months of TCD screening and randomization, and observation for stroke from entry through month 54. Key features of the trial are standardized TCD and MRI/MRA protocols interpreted blindly, and blinded adjudication of endpoints. The sample size (60 per treatment group) is based on prospective data relating TCD velocity to risk of stroke. A time-averaged mean velocity of > or = 200 cm/sec is associated with a 46% risk of cerebral infarction over 39 months. The sample size is sufficient to detect 70% reduction in the primary endpoint at 90% power. This trial will determine if transfusion is effective in the primary prevention of stroke. Secondary aims may further the understanding of the effects of transfusion on the brain and guide future research into cerebrovascular disease in Hb SS.

Adolescent↗
PubMed1998

Is the incidence of appendicitis reduced in patients with sickle cell disease?

BACKGROUND: Patients with sickle cell disease (SCD) often present with abdominal pain, usually attributable to vasoocclusion. Experience at a single institution suggested that appendicitis was a rare cause of abdominal symptoms in this population. OBJECTIVE: We sought to determine whether the incidence of appendicitis was significantly lower in patients with SCD than in the population at large. METHODS: A 17-year retrospective chart review was performed at Rainbow Babies and Children's Hospital, Cleveland, OH, to determine the approximate incidence of acute appendicitis (AA) in patients with SCD. In addition, we performed a statistical analysis comparing the incidence of AA among SCD patients enrolled in the Cooperative Study of Sickle Cell Disease with that in the general population. RESULTS: Only two patients with SCD with pathologically confirmed AA were identified among approximately 200 patients followed at our institution during a 17-year period ( approximately 3500 patient-years), yielding an incidence rate of 5.7 cases per 10 000 patient-years. Among 3765 patients with SCD enrolled in the Cooperative Study of Sickle Cell Disease followed for a mean of 5.3 years (19 886 patient-years), a maximum of 9 cases of AA were identified, yielding an incidence rate of 4.5 cases per 10 000 patient-years. Based on data from the National Hospital Discharge Survey of 1978 to 1981, the incidence rate of AA in the general population (0 to 44 years of age) is approximately 16 per 10 000 patient-years. Paired t test analysis demonstrated a highly significant difference (P < .001) when comparing the incidence of AA among patients enrolled in the Cooperative Study of Sickle Cell Disease and the population at large. CONCLUSION: AA is an unusual event in patients with SCD. The likelihood of developing appendicitis in SCD patients is less than one third of that for the population at large. Conservative therapy is warranted in the large majority of patients with SCD who present with acute abdominal pain. Surgical exploration is best limited to patients with clear evidence of potential surgical pathology or progressive findings during a period of observation. The biologic basis of our findings remains unknown.

Acute Disease↗
PubMed1998

The treatment of hypertrophic scars and keloids.

Keloid and hypertrophic scarring develop as a result of a proliferation of dermal tissue following skin injury. It is generally thought that tension plays a major pathophysiologic role. These proliferative scars are characterized by increased collagen and glycosaminoglycan content, as well as increase collagen turnover. The therapeutic management of hypertrophic scars and keloids includes occlusive dressings, compression therapy, intralesional corticosteroid injections, cryosurgery, excision, radiation therapy, laser therapy, interferon therapy and other promising, lesser known therapies directed at collagen synthesis. Although the most commonly used occlusive dressings include silicone based materials, the anti-keloidal effect is the result of the occlusion and hydration effected rather than the silicone itself. Pressure devices, through local tissue hypoxia, have proven effective in reducing scar height. Intralesional steroids decrease the connective tissue components and scar volume. Post-operative steroid injections reduce keloid recurrence to less than 50%. Cryosurgery is most effective when combined with intralesional corticosteroids. Excision only of hypertrophic scars and keloids results in 45-100% recurrence. Radiation therapy, using various protocols, has been a safe and efficacious modality in reducing recurrence. The CO2, Nd:YAG, and Argon lasers have been used as destructive modalities for the treatment of proliferative scarring. The pulsed-dye laser offers symptomatic improvement and reduces the erythema associated with these scars. Intralesional interferon -gamma and -alpha 2b have been used successfully to decrease scar height and reduce the number of post-operative recurrences.

Adrenal Cortex Hormones↗
PubMed1997

Initial and steady-state effects of diphenhydramine and loratadine on sedation, cognition, mood, and psychomotor performance.

BACKGROUND: The classic, first-generation histamine1-receptor antagonists used to treat allergic disorders frequently cause sedation. In contrast, sedation is reduced or absent after administration of recommended doses of second-generation histamine1-receptor antagonists. We measured the initial and steady-state effects of diphenhydramine, a first-generation antihistamine, and loratadine, a second-generation antihistamine, by means of a comprehensive battery of psychometric tests that mirror real-world tasks. METHODS: Healthy volunteers (N = 98) were randomly assigned in a double-blind fashion to receive loratadine (n = 33), diphenhydramine (n = 32), or placebo (n = 33). A computerized test battery was administered at baseline, on day 1 after administration of the initial dose, and on days 3 and 5. RESULTS: After the initial dose, subjects taking diphenhydramine demonstrated poorer cognitive performance than subjects taking loratadine or placebo on tasks of divided attention, working memory, speed, and vigilance. Subjects taking diphenhydramine also reported greater fatigue and sleepiness and lower levels of motivation, and rated the quality of their performance as lower than subjects taking loratadine or placebo. On day 3, subjects taking diphenhydramine continued to show more fatigue and lower motivation, and rated the quality of their test performance as poorer than subjects taking loratadine or placebo. There were no differences between loratadine and placebo after the initial dose or steady-state (day 5) dosing for any measure of cognitive or psychomotor test performance, mood, or sedation. CONCLUSIONS: Patients taking diphenhydramine may be at risk of lapses and significant errors that may lead to potential hazards and decreased work productivity.

Adult↗
PubMed1997

Identification of glypican as a dual modulator of the biological activity of fibroblast growth factors.

Heparan sulfate moieties of cell-surface proteoglycans modulate the biological responses to fibroblast growth factors (FGFs). We have reported previously that cell-associated heparan sulfates inhibit the binding of the keratinocyte growth factor (KGF), but enhance the binding of acidic FGF to the KGF receptor, both in keratinocytes, which naturally express this receptor, and in rat myoblasts, which ectopically express it (Reich-Slotky, R., Bonneh-Barkay, D., Shaoul, E., Berman, B., Svahn, C. M., and Ron, D. (1994) J. Biol. Chem. 269, 32279-32285). The proteoglycan bearing these modulatory heparan sulfates was purified to homogeneity from salt extracts of rat myoblasts by anion-exchange and FGF affinity chromatography and was identified as rat glypican. Affinity-purified glypican augmented the binding of acidic FGF and basic FGF to human FGF receptor-1 in a cell-free system. This effect was abolished following digestion of glypican by heparinase. Addition of purified soluble glypican effectively replaced heparin in supporting basic FGF-induced cellular proliferation of heparan sulfate-negative cells expressing recombinant FGF receptor-1. In keratinocytes, glypican strongly inhibited the mitogenic response to KGF while enhancing the response to acidic FGF. Taken together, these findings demonstrate that glypican plays an important role in regulating the biological activity of fibroblast growth factors and that, for different growth factors, glypican can either enhance or suppress cellular responsiveness.

Animals↗
PubMed1997

Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections.

BACKGROUND: Keloids that are surgically removed commonly recur within the excision sites. OBJECTIVE: Our purpose was to determine whether postsurgical adjunctive therapy reduces such recurrences. METHODS: We determined the rate of recurrence after excision alone (n = 43) and postoperative injection with triamcinolone acetonide (TAC; n = 65) or interferon alfa-2b (IFN-alpha 2b; n = 16). RESULTS: Of lesions excised without postoperative injections, 51.1% (22 of 43) recurred; 58.4% of TAC-treated lesions (38 of 65) recurred and 18.7% of IFN-alpha 2b-treated lesions (3 of 16) recurred (p = 0.025). CONCLUSION: Postoperative TAC injections do not reduce the number of keloid recurrences. However, injection of keloid excision sites with IFN-alpha 2b offers a therapeutic advantage over keloid excision.

Adolescent↗
PubMed1997

Cutaneous disseminated histoplasmosis in AIDS patients in south Florida.

BACKGROUND: Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions. METHODS: Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded. RESULTS: We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques. CONCLUSIONS: Even in non-endemic regions, HIV-positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections.

AIDS-Related Opportunistic Infections↗
PubMed1997

Dermatopathology via a still-image telemedicine system: diagnostic concordance with direct microscopy.

OBJECTIVE: To determine the concordance of dermatopathology diagnosis by still-image telemedicine technology and direct microscopy. MATERIALS AND METHODS: Skin specimens (N = 79) were examined by a dermatopathologist using a still-image phone system, and the diagnoses were compared with those made by the same dermatopathologist 1 year earlier by direct microscopy. The telemedical diagnoses were reached first without, and then with, patient histories. RESULTS: When the patient history was available, identical diagnoses were made in 66 of the 79 cases (84% concordance rate). Without patient history, the concordance rate was 80%. The diagnostic concordance rate for the diagnosis of benign nevocytic nevi, inflammatory diseases, and benign and malignant non-squamous cell carcinoma neoplasms was statistically significantly greater than the concordance rate for the diagnosis of squamous cell carcinoma and squamous cell carcinoma in situ (P = 0.005). CONCLUSIONS: The diagnostic concordance rate achieved by teledermatopathology using a still-image phone system fell short of the 99% intraobserver diagnostic concordance rate using direct microscopy.

Humans↗
PubMed1997

Teledermatology.

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Confidentiality↗