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Biomedical subjects

D Goldminz

Publications and source records attributed to D Goldminz.

16 recordsLinked to original sources

Mohs micrographic surgery of the nail unit.

Malignancies of the nail unit are relatively uncommon, with squamous cell carcinoma (SCC) representing most of the reported cases. Squamous cell carcinoma of the nail unit, although commonly considered to be a curable malignancy, can and does kill. Review of the literature as well as a personal series confirm that Mohs micrographic surgery is an ideal treatment for periungual and subungual SCCs without osseous involvement. In addition, the anatomy and histology of nail unit SCC, as well as prognostic factors and perioperative evaluation as they relate to performing Mohs micrographic surgery, are reviewed.

Carcinoma↗

Multiple miliary osteoma cutis.

We describe the clinical, radiographic, histologic, and metabolic features of an unusual case of multiple miliary osteoma cutis in an otherwise healthy 57-year-old woman. Although the pathogenesis of this rarely reported entity is not fully understood, the novel application of a dynamic bone study revealed a high rate of internal bone remodeling within the lesion. This finding prompted a brief therapeutic trial of a diphosphonate, not previously reported in the treatment of this condition.

Bone and Bones↗

A technique to accurately construct a contact dressing.

We describe a technique to rapidly and accurately construct the contact layer of a composite dressing. This technique is simple to perform and is suitable for any open wound. It is especially useful for moderately sized wounds created during extirpation of tumors by Mohs micrographic surgery.

Bandages↗

Cigarette smoking and flap and full-thickness graft necrosis.

The association between cigarette smoking and necrosis of flaps and full-thickness grafts was analyzed in 220 patients. Review of a series of 916 flaps and full-thickness grafts revealed 44 patients in whom some degree of tissue necrosis occurred. These patients with necrosis were age and gender matched with 176 controls randomly selected from the remaining 872 patients. Current high-level smokers, that is those smoking one or more packs per day, had necrosis develop approximately three times more frequently than never smokers, low-level smokers (less than one pack per day), or former smokers (95% confidence interval, 1.2 to 8.2). Former smokers (relative risk, 1.4; 95% confidence interval, 0.6 to 3.2) and low-level smokers (relative risk, 1.1; 95% confidence interval, 0.2 to 6.1) were at a negligible increased risk for necrosis that was not significantly different from never smokers. Once tissue necrosis developed, the median percent of the visible flap or graft tissue that necrosed was approximately threefold greater among current smokers (regardless of the number of packs per day smoked) than never smokers.

Adult↗

Correlation of laser Doppler wave patterns with underlying microvascular anatomy.

Laser Doppler velocimetry (LDV) was performed on the chest, back, and abdomen of four healthy volunteers. As the probe was moved over distances of 2-6 mm, the red-cell flux varied by 100%, but was associated with three distinctive wave patterns. Correlative skin biopsies showed that a high flux, pulsatile pattern superimposed on vasomotor activity was found when the probe was directly over an ascending elastic arteriole with its immediate branches; low flux, pulsatile flow with minimal or no vasomotor activity was found when the probe was off center relative to the ascending arteriole and its branches; and a low flux, non-pulsatile pattern occurred when the probe window was situated between ascending arterioles over an area in the upper horizontal plexus composed primarily of capillaries and post-capillary venules.

Humans↗

Penile basal cell carcinoma. Report of a case and review of the literature.

We describe a 69-year-old man with penile basal cell carcinoma and review the literature on this condition. Basal cell carcinomas of the penis are rare, and there are only 26 other reported cases. There is no documented case of metastatic penile basal cell carcinoma. The one reported case of metastatic penile basal cell carcinoma actually represents urethral transitional cell carcinoma. Therefore conservative therapy with local removal is adequate treatment, and more extensive procedures are unnecessary. Ultraviolet light exposure may be an important etiologic factor for basal cell carcinomas located on sun-exposed areas. The occurrence of basal cell carcinomas on non-sun-exposed areas raises the possibility of other, not yet defined, etiologic agents.

Aged↗

Calcinosis cutis following extravasation of calcium chloride.

A 27-year-old woman with hypoparathyroidism developed multiple firm white-yellow papules along the path of an infiltrated calcium chloride intravenous infusion. A biopsy specimen obtained ten days after the extravasation revealed an urticarial reaction. A subsequent biopsy specimen, obtained 25 days after the extravasation, showed diffuse dermal calcification, confirmed by roentgenographic analysis, with incipient transepidermal elimination. A biopsy specimen obtained 40 days after the extravasation was consistent with an elimination reaction. An increase in mast cells was not noted. Electron microscopy showed mineral deposits along collagen fibrils without significant collagenous degeneration. In this report we describe a complication of intravenous calcium chloride infusion.

Adult↗

Keratinocyte membrane-associated epidermal cell-derived thymocyte-activating factor (ETAF).

This study describes the association between secreted keratinocyte interleukin 1 (IL-1) and its presence on the keratinocyte cell surface. These properties were studied in normal and transformed human keratinocytes as well as in transformed murine keratinocytes. We will present evidence that the secretion of IL-1 by human and murine keratinocytes is associated with the presence of IL-1 on the keratinocyte membrane. In addition, although transformed murine keratinocytes secrete other cytokines, namely keratinocyte T-cell growth factor (KTGF) and IL-3, no KTGF or IL-3 activity can be demonstrated on the cell surface.

Animals↗

Keratinocyte-derived T-cell growth factor: a T-cell growth factor functionally distinct from interleukin 2.

T-cell growth factor, more recently termed interleukin 2 (IL-2), is the product of activated T lymphocytes and is considered the principal trophic factor for T lymphocytes. The activity of IL-2 preparations is assessed by the degree to which they support the growth of various IL-2-dependent cell lines. We report that murine epidermal epithelial cells (keratinocytes) produce and release a factor that supports the growth of the helper-T-cell-derived, IL-2-dependent cell line HT-2. This substance, keratinocyte-derived T-cell growth factor (KTGF), does not support the growth of an IL-2-dependent cell line derived from cytotoxic T cells (line CTLL-2). This differential effect on IL-2-dependent cell lines is unique to KTGF. KTGF has an apparent molecular weight of 25,000-35,000 and has properties similar to those of conventional IL-2 by reversed-phase and gel-filtration HPLC analysis. However, even highly purified KTGF fails to stimulate the proliferation of CTLL-2 cells. The observation that epidermal epithelium produces a trophic factor for T lymphocytes may help explain the basis for preferential proliferation of T cells in the microenvironment of skin in certain dermatologic disorders. Further, it suggests that different IL-2-dependent T-cell lines may have distinct growth requirements and that non-lymphocyte cell types may produce factors capable of maintaining the growth of T cells.

Animals↗

Agranulocytosis associated with antithyroid drugs. Effects of patient age and drug dose.

The records of all patients with antithyroid drug-related agranulocytosis at two Boston hospitals (Group 1, 14 patients), as well as the published case reports of 36 patients with this syndrome (Group 2) were reviewed. The clinical characteristics of these patients were then compared with those of 50 hyperthyroid patients who had taken antithyroid medication without untoward hematologic reactions (Group 3). The mean ages of patients in Group 1 and Group 2 were significantly greater than that of Group 3 (50.6 +/- 16 years versus 35.7 +/- 13.7 years, p less than 0.001; 46.3 +/- 18.7 years versus 35.7 +/-- 13.7 years, p less than 0.02). By chi-square analysis, the relative risk of developing agranulocytosis in patients over age 40 was 6.4 times that among younger patients (p less than 0.001). The mean doses of methimazole in Group 1 and Group 2 were significantly higher than that in Group 3 (43.8 +/- 9.9 mg/d versus 29.5 +/- 10.4 mg/d, p less than 0.001; 40.7 +/- 15.7 mg/d versus 29.5 +/- 10.4 mg/d, p less than 0.02), with and 8.6-fold increased risk of agranulocytosis with doses greater than 40 mg/d (p less than 0.01). In contrast, the mean doses of propylthiouracil did not differ among the three groups. These data suggest that antithyroid drugs should be administered cautiously to patients over age 40. Because no cases of agranulocytosis were seen with methimazole doses less than 30 mg/d, low-dose methimazole therapy may be safer than high-dose therapy or treatment with conventional doses of propylthiouracil.

Adolescent↗

Up-regulation in vascular endothelial cells of binding sites of high density lipoprotein induced by 25-hydroxycholesterol.

Exposure of bovine vascular endothelial cell cultures to 25-hydroxycholesterol (50--100 microgram/ml) result in a 5--10-fold increase in cell surface binding sites of high density lipoprotein (HDL). This increase in HDL-binding sites was dependent on time and temperature. After a 48-h exposure to the oxygenated sterol, a maximal increase in HDL binding could be observed, and newly binding sites disappeared rapidly once 25-hydroxycholesterol was removed from the medium. No increase in HDL-binding sites was observed when cells were maintained at 4 degrees C. In contrast, cultures maintained at 37 degrees C did show an increase in HDL-binding sites when exposed to 25-hydroxycholesterol. Since simultaneous exposure of the cells to 25-hydroxycholesterol and cycloheximide resulted in an inhibition of HDL binding to the cells, it is suggested that de novo synthesis of HDL-binding sites is induced by 25-hydroxycholesterol. When the abilities of HDL2 and HDL3 to bind to newly synthesized HDL-binding sites were compared, HDL3 was found to bind more efficiently than HDL2. It is therefore unlikely that apoprotein E plays a major role in the binding of HDL to newly synthesized HDL-binding sites. When the properties of newly synthesized HDL-binding sites were analyzed, they were found to have a high affinity for HDL, since half-maximal binding was reached at a concentration as low as 5 microgram HDL protein/ml, and were saturable. Such HDL-binding sites had a relaxed specificity, since they were capable of binding low density liprotein (LDL). However, when LDL bound to newly synthesized HDL binding sites, it was no longer internalized, as reflected by a 90% reduction of LDL degradation, and instead of being cytotoxic it became mitogenic.

Animals↗

Molecular aspects of extracorporeal photochemotherapy.

8-methoxypsoralen (8-MOP), activated upon exposure to long-wavelength ultraviolet radiation, is used therapeutically to treat the diseased blood cells of cutaneous T-cell lymphoma patients. The factors responsible for the efficacy of this therapy are reviewed. Primary among these are the plasma level of 8-MOP at the time of irradiation and the effective dose of UVA. 8-MOP plasma levels determined in a series of six patients demonstrated that the drug is absorbed at a highly variable rate (122 ng/ml +/- 67). A new liquid form of 8-MOP is absorbed with a modest increase in plasma levels (170 ng/ml) but with no improvement in the variability (+/- 163). An examination of the dose-response relationship between 8-MOP concentration and UVA dose indicated that properties such as 8-MOP photoadduct formation and PHA response are proportional to the combined doses of these two factors. A new molecular target for 8-MOP photomodification, cell membrane DNA, is described.

Dose-Response Relationship, Drug↗