Biomedical subjects
Publications and source records attributed to D L Karp.
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PURPOSE: A nurse-managed/physician-supervised treatment program for venous ulceration was evaluated to determine the influence of venous hemodynamics, comorbidities, patient behavior, and ulcer characteristics on time to healing and time to recurrence. METHODS: The clinical course and long-term follow-up of 71 patients with 99 venous ulcers diagnosed between November 1981 and August 1994 were analyzed by a retrospective review of clinic records. Demographic data, severity of venous insufficiency, ulcer characteristics, and patient compliance were studied. Outcome variables were time to complete ulcer healing and time to first recurrence. RESULTS: Ninety-one percent of the ulcers healed completely at a median 3.4 months. There were 52 (57%) recurrences at a median 10.4 months. Ulcers on limbs with a venous refill time of 10 seconds or less demonstrated a significantly longer time to complete healing (p < or = 0.03); however, no effect on time to recurrence was observed. Patients who were in strict compliance with the treatment regimen (n = 32) had significantly faster healing (p < or = 0.02) and fewer recurrences (p < or = 0.004) compared with patients who were less compliant (n = 67). CONCLUSIONS: Most venous ulcers can be expected to heal when patients are enrolled in a nurse-managed/physician-supervised ambulatory ulcer clinic. Photoplethysmography-derived venous refill time of 10 seconds or less predicted delayed healing. Strict compliance with the treatment protocol significantly decreased the time to healing and prolonged the time to recurrence.
An atypical oral presentation of herpes simplex virus infection in a 49-year-old woman after orthotopic liver transplantation is reported. Clinically, the differential diagnosis included chronic hyperplastic candidiasis, nodular leukoplakia of undetermined etiology, and malignant neoplasm. An excisional biopsy revealed herpesvirus infection, and immunoperoxidase staining confirmed herpes simplex virus infection. This report describes the clinical and histologic appearance of these lesions and the course and treatment of the patient.
Lymphomatoid papulosis is a chronic disease of cutaneous lymphoid infiltration characterized clinically by involuting and recurring papules, plaques, and nodules. The intriguing combination of a usually benign clinical course, a cytologically malignant lymphoid infiltrate on histologic examination, and a clear, but sporadic association with extracutaneous lymphomas has stimulated significant investigation. Application of recent technical advances to research in lymphomatoid papulosis prompts this review.
Lichen striatus is a common childhood eruption, but only rare reports link cutaneous manifestations and onychodystrophy. We report a case of lichen striatus and onychodystrophy in a 12-year-old girl, only the eighth such patient in the dermatologic literature. Nail changes may precede the rash of lichen striatus and should be considered in the differential diagnosis of isolated nail dystrophy in children.
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Intraoperative velocity waveform analysis following in situ saphenous vein bypass grafting can identify abnormal hemodynamic conditions that correlate with the presence of a technical error or likelihood of perioperative thrombosis. Pulsed Doppler spectral analysis was used at operation to measure peak systolic blood flow velocity in the distal graft segment of 83 in situ saphenous vein bypasses to the popliteal (n = 35) or tibial (n = 48) arteries. Blood flow velocities were measured in the smallest diameter graft segment below the knee. Peak systolic blood flow velocity was greater than 40 cm/sec in 77 (93%) of grafts, and no early graft failures occurred. Low blood flow velocity (peak systolic blood flow velocity less than 40 cm/sec) was measured in six bypasses (7%) and was attributed to large (greater than 5 mm) vein diameter, residual hemodynamically significant lesions (intact valve leaflet, proximal arteriovenous fistula), or sclerosed vein segments. With the correction of these abnormalities, the 30 day patency for the entire series was 100%. The measurement of low blood flow velocity in the distal segment of an in situ saphenous vein bypass is an uncommon occurrence and mandates a thorough evaluation of the arterial reconstruction for correctable lesions.