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Biomedical subjects

G J Goodman

Publications and source records attributed to G J Goodman.

13 recordsLinked to original sources
PubMed2001

Post-acne scarring: a short review of its pathophysiology.

The onset of acne is an expected phenomenon in adolescence. However, its arrival produces long-term psychological and physical sequelae for the individual. A review of available data illustrates the pathophysiological sequence of the advent of post-acne scarring from its humble beginnings as a microscopic comedone to its eventual devastating end point of indented or exophytic scars. Acne scarring shows many different forms and is explainable by the depth and severity of the antecedent inflammation and the ability of the individual to heal these lesions. Post-acne scarring is debilitating and socially disabling for many and is the avoidable outcome of untreated or inadequately treated acne. Treatment will depend on the resultant scar topography.

Acne Vulgaris↗
PubMed2001

Therapeutic undermining of scars (Subcision).

Two patients are described with depressed atrophic scars. The first patient had undergone skeletal traction around the knee and the second patient developed an apparent anetoderma of the left side of the nose. Dermal undermining was performed as the only treatment with successful resolution of their contour abnormalities. Only a single treatment session was required in each case. A brief review of this technique is presented.

Adolescent↗
PubMed2001

Blood transfer: the use of autologous blood as a chromophore and tissue augmentation agent.

BACKGROUND: Atrophic scars, whether traumatic, postsurgical, or postacne, are distressing and difficult to treat. A freely available autologous agent that provides medium- to long-term correction of this problem would be welcome. There are very few endogenous chromophores in the skin for laser or light energy to target. A benign exogenous pigment implanted in superficial scars may be useful in presenting such a target for light energy, allowing selective injury to these scars and the possibility of new collagen formation. OBJECTIVE: To report five representative case reports that describe elements of two new techniques that may be useful in the management of atrophic acne scarring. METHODS: After drawing blood from the patient, this was immediately reinjected into premarked areas of atrophic scars. If there was substantial tissue deficit, this was either followed by repeated injections of whole blood at monthly intervals on three occasions or until adequate correction was attained and oral antifibrinolysis medication dispensed in addition to the blood transfer (hematogenous augmentation of tissue or the HAT technique). In the other circumstance, where the deficit was superficial, blood was implanted high in the tissue and used as a target for vascular laser or intense pulsed light in a technique termed the blood augmentation (with or without) stimulation of tissues by irradiation with light or laser energy or the Bastille technique. This is again repeated as required. RESULTS: Reasonable short- to medium-term correction has been attained in all five cases and there seemed to be a progressive improvement with each injection session. With the Bastille technique case there seemed to be progressive improvement with time, with the result at 4 weeks being substantially better than that at 2 weeks or at baseline. CONCLUSION: These case reports suggest that blood may be a worthwhile augmentation agent and chromophore. Both these techniques deserve further investigation to determine the optimum parameters. They are so simple in their concept and technique that should they help to provide a medium- to long-term correction for atrophic scars and other depressions, such as expression lines and wrinkles, they would be worthwhile additions to existing dermatologic techniques.

Acne Vulgaris↗
PubMed2000

Postacne scarring: a review of its pathophysiology and treatment.

BACKGROUND: There has been a largely unheralded revolution in the number of techniques that can now be used in the treatment of atrophic postacne scarring. Atrophic scarring is the more common type of scarring encountered after acne. OBJECTIVE: To illustrate the range of techniques useful in the therapy of postacne scarring, their relative advantages and disadvantages, and their place in treatment. METHOD: A review of available techniques is used to illustrate the treatment of indented or atrophic acne scars. RESULTS: The individual architecture of the indented scar must be assessed so that treatment may be designed to maximize its improvement. A variety of new methods now exist, including newer resurfacing tools such as infrared lasers, dermasanding, and others in their infancy such as nonablative resurfacing and radiofrequency methods. A true explosion in autologous and nonautologous tissue augmentation and the advent of tissue undermining and the use of punch replacement techniques has added more precision and efficacy to the treatment of these scars. CONCLUSION: Atrophic postacne scars may be satisfactorily treated in many patients, but multiple methods are often required to ensure the best results.

Acne Vulgaris↗
PubMed1998

Combining laser resurfacing and ancillary procedures.

OBJECTIVE: To investigate the timing of ancillary procedures with carbon dioxide laser resurfacing. METHODS: Two case reports will be used to illustrate some of the principles of laser resurfacing in association with ancillary techniques. RESULTS AND CONCLUSIONS: Recommendations regarding timing of laser resurfacing and ancillary procedures is given in the treatment of upper, middle, and lower facial disease.

Chemexfoliation↗
PubMed1998

Carbon dioxide laser resurfacing: preliminary observations on short-term follow-up. A subjective study of 100 patients' attitudes and outcomes.

BACKGROUND: Carbon dioxide (CO2) laser resurfacing is enjoying broad medical acclaim. It is useful to assess patient morbidity and satisfaction with this procedure. OBJECTIVE: Review the procedure from the patients' perspective with particular focus on the immediate and medium term postoperative period, the patient's progress after the initial 6-8-week period, the postoperative morbidity and complication rate, and the results and patient satisfaction with the procedure. METHOD: One hundred resurfacing patients, who were treated after the advent of the computer pattern generator on a high-energy short-pulse CO2 laser, were studied. Patients were at least 3 months into their postoperative phase. RESULTS: Outcomes of patients' problems were classed as good to excellent 78.8% of the time. Patient outcomes met the patients' preoperative expectations 68.9% of the time. Patients would have the procedure again if needed 78% of the time, and 84% would recommend the procedure to others. Patients reported continuing improvement after the initial 6-8-week healing period 72% of the time. Short-term morbidity was high (49%). Long-term complications were registered in 7% of patients but were mostly minor in nature. CONCLUSIONS: Major indications for laser resurfacing such as wrinkles, sun damage, and acne scarring all appeared to do well with CO2 laser resurfacing.

Adolescent↗
PubMed1996

5. Update on lasers in dermatology.

A range of lasers with acceptably low rates of side effects is now available. Improved laser therapy has been made possible by combining wavelengths that are selectively absorbed by the target and pulses short enough to prevent heat transfer to surrounding tissue. Carbon dioxide (CO2) lasers are useful for treating disorders of skin surface texture and topography (wrinkles, scars, sun damage, benign skin appendages and rhinophyma). Vascular lasers, such as the flashlamp-pumped dye laser, are particularly effective for treating port-wine stains, haemangiomas, telangiectasia, rosacea and spider naevi. Q-switched lasers, which allow ultrashort high intensity pulses, are effective for treating most tattoos and some benign pigmented lesions.

Dermatologic Surgical Procedures↗
PubMed1996

Facial resurfacing using a high-energy, short-pulse carbon dioxide laser.

Facial skin resurfacing is now possible using short-pulse, high-energy carbon dioxide (CO2) lasers. The laser utilized in this particular paper is the Ultra-pulse CO2 laser. The Ultra-pulse laser represents the first CO2 laser able to vaporize tissue in a single pulse with the use of a large spot size. This laser utilizes the principles of selective photothermolysis. The high-power pulses are completed in less than the thermal relaxation time of skin, estimated to be less than 1 millisecond. This translates into rapid vaporization of tissue with little heat conduction to surrounding tissues. It also should allow a reproducibility of results between practitioners with set parameters not possible with previous CO2 lasers. Clinically, this laser is useful for the removal of skin lesions, and the resurfacing of areas of sun damage, wrinkles and scars. The immediate haemostasis and excellent visibility allows for precise vaporization of abnormal tissue. Rapid and pain-free wound healing is usual. The complication rate would appear to compare very favourably with dermabrasion and chemical peeling techniques.

Adult↗
PubMed1983

Post partum nephrotic syndrome in mixed essential cryoglobulinemia.

The clinical and histological findings of a patient with mixed essential cryoglobulinemia (MECG) who developed post partum renal failure and the nephrotic syndrome are described. The renal insufficiency responded dramatically to intensive plasma exchange and longer term immunosuppression with associated resolution of the renal histological changes. To our knowledge deterioration of renal function in the post partum period has not been previously described in the syndrome of MECG.

Adult↗
PubMedDate not supplied

Management of post-acne scarring. What are the options for treatment?

Post-acne scarring is a very distressing and difficult problem for physician and patient alike. Recently, newer techniques and modifications to older ones may make this hitherto refractory problem more manageable. Options for dealing with post-acne scarring are explored. The patient, his or her overall appearance and the morphology of each scar must be assessed and treatment designed accordingly. To adequately address the patient with scarring, a thorough knowledge of the pathophysiology and anatomy of the different types of scars should be sought. Once an understanding of what the pathology is and where it is occurring is attained, the most pertinent treatment for that scar may be devised. A variety of post-acne scars is produced including superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new treatment methods for post-acne scarring includes newer resurfacing tools such as CO2 and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous and nonautologous tissue augmentation and the advent of tissue undermining have greatly improved treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser, and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Acne Vulgaris↗