Biomedical subjects
B M Coldiron
Publications and source records attributed to B M Coldiron.
Thinning of the ozone layer: facts and consequences.
The ozone layer is showing small but definite signs of depletion. Despite this, significantly increased UV radiation transmission at ground level has been found only in the Antarctic and Arctic regions. The potential for increased transmission of UV radiation will exist for the next several hundred years. Although little damage from increased UV radiation has occurred so far, the potential for long-term problems is great. The natural history of ozone and the causes and consequences of, and possible solutions to ozone depletion are examined in this article.
Foreign-body granuloma due to an unsuspected wooden thorn.
Foreign bodies occasionally cause a chronic granulomatous reaction that may be mistaken for a plantar wart or even a skin malignancy. This possibility should be considered when lesions on the foot become progressively larger and more tender. Diagnosis may require surgical excision.
Surgical treatment of extramammary Paget's disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision.
Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy, usually on the genitalia, that almost always extends beyond clinically apparent margins. Recurrences after standard methods of surgical excision are notoriously frequent; effective treatment with Mohs micrographic surgery was first reported in 1979. It has since been suggested this malignancy may be multifocal, and reports of recurrences after resection with micrographic surgery have appeared. The authors report six cases treated with Mohs surgery, two of which recurred. They also present data on 42 additional cases obtained from a written survey of members of the American College of Mohs Micrographic Surgery and comparison cases selected from the literature. The recurrence rate after micrographic surgery appears to be at least as low as that after conventional surgical excision with vertical frozen section or paraffin section margin control. Mohs micrographic surgery allows for maximal tissue sparing of critical anatomic structures and is performed under local anesthesia as an outpatient; because of this, it may be superior to conventional surgical excision. A scheme for management of this malignancy is presented. Surgeons should be aware radical excision is not needed for most cases of extramammary Paget's disease and very long-term patient follow-up is required.
The surgical management of chondrodermatitis nodularis chronica helicis.
Surgical management of chondrodermatitis nodularis chronica helicis by curettage is described. The curet directs the dissection. The necrotic cartilage is soft and is removed easily. The endpoint is reached when the curet is repelled by firm, elastic cartilage. Contours remain normal because the skin is tented over the defect supported by the remaining cartilage.
Persistent Candida intertrigo treated with fluconazole.
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Cutaneous phaeohyphomycosis caused by a rare fungal pathogen, Hormonema dematioides: successful treatment with ketoconazole.
Annular, fungating, ulcerated lesions developed on both hands of a 64-year-old immunocompetent man 2 months after he was cut with barbed wire. A dematiaceous mold, Hormonema dematioides, heretofore not definitively associated with human disease, was grown from two separate tissue specimens during a period of 9 days. Histopathologic examination demonstrated rare small, periodic acid-Schiff-positive, hyaline, yeastlike organisms in tissue. Twelve weeks of empiric therapy with ketoconazole, 400 mg/day, was curative.
Peripheral in-continuity tissue examination.
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Prevalence and clinical spectrum of skin disease in patients infected with human immunodeficiency virus.
We examined 100 serial patients who were receiving care in a county outpatient immunodeficiency clinic and whose serum was positive by Western blot test for the human immunodeficiency virus (HIV). Skin disorders were found in 92% of these HIV-infected patients, with little difference in prevalence or severity in three clinical categories: patients with the acquired immunodeficiency syndrome, patients with acquired immunodeficiency syndrome-related complex, and those who were asymptomatic. Patients positive for HIV antibodies had significantly more skin disease, with the exception of dermatophytosis, than did a historical control population. A strong association was observed between the use of zidovudine and the absence of infection with Candida albicans. We conclude that there is a high prevalence of skin disease in HIV-positive patients who seek medical care, and that specialists in skin disease should be included in these patients' initial evaluation and continuing care.
Low-dose alternate-day prednisone for persistent Wells' syndrome.
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Closure of wounds under tension. The horizontal mattress suture.
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Resolution of resistant chronic herpetic lesions with zidovudine in a patient with the acquired immunodeficiency syndrome.
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Benign non-X histiocytosis: a unique case bridging several of the non-X histiocytic syndromes.
We present a patient with a papular eruption of 4 years' duration that clinically resembled xanthoma disseminatum or the indeterminate cell disorder. On light microscopy his disorder resembled generalized eruptive histiocytoma or the indeterminate cell disorder. Special stains, cultures, and electron microscopy were noncontributory. Indirect immunofluorescence studies with monoclonal antibodies to cell surface markers demonstrated infiltrating cells of monocyte/macrophage lineage (OKM1, MAC-1, HLA-DR, and HLA-DQ positive) rather than Langerhans or indeterminate cell lineage (OKT6 negative). This case may overlap two or more of the previously reported non-X histiocytic syndromes, suggesting that perhaps these syndromes should be viewed as a spectrum of disease rather than as discrete entities. We recommend performing cell phenotyping on all new cases of non-X histiocytosis because clinical, microscopic, and ultramicroscopic findings often prove inadequate for classification.
Isolation of adenovirus from a granuloma annulare-like lesion in the acquired immunodeficiency syndrome-related complex.
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Common penile lesions.
We have briefly summarized some of the most common and confusing penile lesions likely to be seen by the urologist. We have discussed the clinical features, differential diagnosis, and treatment from the dermatologist's point of view. We have included the latest possible references, as many disorders discussed here are rapidly becoming better understood.
Concurrent features of cutaneous lupus erythematosus and pemphigus erythematosus following myasthenia gravis and thymoma.
A case that exhibits the pathologic features of cutaneous lupus erythematosus and the immunopathologic characteristics of pemphigus erythematosus following myasthenia gravis and thymoma is presented, and the literature pertaining to these disease associations is reviewed. The findings in this case were analyzed with respect to the accepted diagnostic criteria for lupus erythematosus, pemphigus, and pemphigus erythematosus. The pathogenic mechanisms that lead to acantholysis in pemphigus are examined in an attempt to explain why acantholysis did not occur in this case.
Epithelioma cuniculatum (carcinoma cuniculatum) of the thumb: a case report and literature review.
Epithelioma cuniculatum is a rare, slow growing, but locally destructive, low-grade epithelioma of squamous cell origin. The first case of this tumor occurring on the thumb is reported. Treatment of this case is discussed, the literature reviewed, and controversy surrounding the naming of this tumor is examined.
Mycobacterium avium-Mycobacterium intracellulare infection limited to the skin and lymph nodes in patients with AIDS.
Three patients with AIDS who were taking 3'-azido-3'-deoxythymidine (AZT) developed cutaneous abscesses from which Mycobacterium avium-Mycobacterium intracellulare was isolated. Culture of multiple blood samples and bone marrow aspirate from all three patients revealed that the infection was not disseminated. This is a rare form of presentation for this infection in AIDS patients. We speculate that the antiviral drug AZT was responsible for the localization of disease.