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Biomedical subjects

G W Cole

Publications and source records attributed to G W Cole.

At least 19 recordsLinked to original sources
PubMed2001

Reliability of counting actinic keratoses before and after brief consensus discussion: the VA topical tretinoin chemoprevention (VATTC) trial.

OBJECTIVE: To assess the reliability of counts of actinic keratoses (AKs) and the effect of a brief joint discussion of discrepancies on that reliability. DESIGN AND INTERVENTION: Seven dermatologists independently counted AKs on the face and ears before and after a brief joint discussion of discrepancies. SETTING AND PATIENTS: A volunteer sample of 9 patients from the ongoing VA (Department of Veterans Affairs) Topical Tretinoin Chemoprevention (VATTC) Trial. All participating individuals are veterans and have had 2 or more keratinocyte carcinomas (basal or squamous cell carcinoma) in the 5 years before enrollment in the study. MAIN OUTCOME MEASURE: Standard deviation of estimates of the Poisson regression parameter for the dermatologists. RESULTS: Substantial variation was found among the dermatologists in their AK counts. The SD of the parameter estimates for the dermatologists decreased from 0.45 to 0.24 after the brief joint discussion, a 47% decrease (P =.076). The variation attributable to the dermatologists also decreased substantially (chi(2)(6) decrease, 94 to 12). CONCLUSIONS: Actinic keratoses are common, and there is a continuous spectrum of lesions that ranges from sun-damaged skin to squamous cell carcinoma in situ. Clinical distinguishing features may be difficult to delineate precisely. Counts of AK are commonly performed, but appear to be unreliable, even when performed by experienced dermatologists. Joint discussion of discrepancies may enhance the reliability of these counts, although substantial variation remains. Research that relied on these counts must be reevaluated in light of the marked variation among expert observers. Future studies should consider measures to assess and enhance reliability.

Aged↗
PubMed1999

The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.

BACKGROUND: Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia. OBJECTIVE: We attempted to determine the effect of finasteride on scalp skin and serum androgens. METHODS: Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively. CONCLUSION: In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

5-alpha Reductase Inhibitors↗
PubMed1996

Reversal of erythema multiforme major with cyclophosphamide and prednisone.

OBJECTIVE: To report a case of erythema multiforme (EM) major treated with cyclophosphamide and prednisone. SETTING: General medicine and dermatology consult services, Department of Veterans Affairs Medical Center. CASE SUMMARY: A 44-year-old man with C4-C5 quadriplegia developed a skin reaction characterized by a painful, generalized maculopapular rash, bullae, ulceronecrotic lesions, and mucosal and epidermal sloughing after taking trimethoprim/sulfamethoxazole. The patient was treated with intravenous cyclophosphamide 150 mg infused over 1 hour every 24 hours and oral prednisone 15 mg every 6 hours. After two doses of cyclophosphamide, formation of bullae and epidermal sloughing had ceased, and the erythema was markedly diminished. Cyclophosphamide was discontinued before the third dose because of evolving leukopenia. Prednisone therapy was continued until the patient was discharged on hospital day 5, at which time the dosage was tapered. DISCUSSION: Cyclophosphamide has been used extensively for other dermatologic reactions. Relief of pain and regression of the lesions in our patient occurred more quickly than anticipated. CONCLUSIONS: Treatment of EM major with cyclophosphamide combined with prednisone appeared to be highly successful in this patient. Cyclophosphamide may be an effective, empiric initial treatment in reversing EM major.

Adult↗
PubMed1995

Iatrogenic transplantation of osteosarcoma.

We report a case in which a patient having curettage and resection of a presumed benign lesion of the tibia (later recognized as osteosarcoma) had probable iatrogenic transplantation of tumor to the contralateral iliac crest, which had served as a donor site for bone chips used to pack the tibial lesion. The patient later had above-knee amputation for the primary tumor and eventually required contralateral hemipelvectomy when tumor developed in the iliac crest donor site. We discuss the literature of tumor transplantation and seeding in operative settings and stress the clinical importance of avoiding possible tumor contamination of operative fields by meticulous instrument changes and by isolation of multiple surgical fields.

Amputation, Surgical↗
PubMed1994

Look out for latex.

Explore the source record for details and available documents.

Dermatitis, Contact↗
PubMed1991

Clinical comparison of cefuroxime axetil, cephalexin and cefadroxil in the treatment of patients with primary infections of the skin or skin structures.

This study was designed to compare the clinical and bacteriological efficacy of three oral cephalosporins, cefuroxime axetil, cephalexin and cefadroxil, in the treatment of patients with mild to moderate infections of the skin or skin structures. A total of 330 patients were enrolled at 10 centers and were randomly assigned to receive cefuroxime axetil 250 mg (n = 107), cephalexin 500 mg (n = 111) or cefadroxil 500 mg (n = 112), twice daily for 10 days. Patients were assessed for their clinical and bacteriological responses once during treatment (3-5 days) and twice after treatment (1-3 and 10-14 days). A total of 353 bacterial isolates were obtained: Staphylococcus aureus (41%), Staphylococcus epidermidis (33%) and Streptococcus pyogenes (5%). A satisfactory clinical outcome (cure or improvement) was achieved in 97% (89/92), 89% (80/90) and 94% (82/87) of the clinically evaluable patients treated with cefuroxime axetil, cephalexin or cefadroxil, respectively (p = 0.047, cefuroxime axetil vs. cephalexin). With respect to the eradication of the bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 96% (69/72), 85% (60/71) and 93% (63/68) of bacteriologically evaluable patients treated with cefuroxime axetil, cephalexin and cefadroxil, respectively (p = 0.026, cefuroxime axetil vs. cephalexin). All three study drugs were well tolerated, with adverse events affecting the gastrointestinal system most commonly reported. There were no significant differences between treatment groups in the incidence of drug-related adverse events.

Adolescent↗
PubMed1990

Neutralized lidocaine with epinephrine for local anesthesia--II.

The pain usually associated with intradermal injection of lidocaine and epinephrine is significantly attenuated by the addition of either sodium bicarbonate or sodium hydroxide to 1% lidocaine with epinephrine. This suggests that sodium bicarbonate attenuates pain by increasing the pH of the anesthetic solution. The clinical effects of a solution of lidocaine (1%) with epinephrine (1:100,000) and sodium bicarbonate (80 meq/L) were assessed after infiltration in skin. Anesthetic stored for 1 week caused nearly equal areas of anesthesia and vasoconstriction as an identical solution prepared on the day of use.

Anesthesia, Local↗
PubMed1990

An argument for circumcision. Prevention of balanitis in the adult.

A cross-sectional study and a retrospective study were performed to determine the frequency of balanitis in a randomly selected group of dermatology patients. A total of 398 subjects were included in the cross-sectional study, 213 (53.5%) of whom had been circumcised. Balanitis was diagnosed in 2.3% of circumcised men and in 12.5% of uncircumcised men. In patients with diabetes mellitus, balanitis occurred with a prevalence of 34.8% in the uncircumcised population, compared with 0% in the circumcised population. Balanitis did occur with increased frequency in the diabetic population (16%), regardless of circumcision status, compared with the nondiabetic population (5.8%). Of 63 circumcisions performed at our institution between 1987 and 1989, 28.6% were for the treatment of balanitis; 44.4%, for phimosis (which was probably induced by chronic balanitis); 19% in preparation for placement of penile prostheses; and 8% for miscellaneous reasons. No complications of circumcision were reported. In this group of patients, balanitis was more frequent in diabetic than in nondiabetic uncircumcised men (50% vs 15.4%).

Adult↗
PubMed1989

Neutralized lidocaine with epinephrine for local anesthesia.

The pain of infiltrating lidocaine with epinephrine into skin is reduced by the addition of sodium bicarbonate. The effect of varied concentrations of sodium bicarbonate on pain of infiltration of 1% lidocaine with epinephrine 1:100,000 was measured. Sodium bicarbonate at 40 and 100 meq/L of anesthetic solution caused significantly less pain than did 0 or 10 meq/L. The stability of epinephrine in a solution at pH 7.3 was also determined. Epinephrine concentration declined approximately 25% per week in anesthetic solution containing 100 meq/L sodium bicarbonate.

Adult↗
PubMed1989

A comparison of a new oral antifungal, terbinafine, with griseofulvin as therapy for tinea corporis.

Fifty patients with tinea corporis were treated with either 500 mg of griseofulvin (microsize) or 500 mg of terbinfine daily for 6 weeks. Thirty-three patients completed the study. Thirteen (87%) of 15 patients who took terbinafine were considered successfully treated, while 13 (73%) of 18 patients in the griseofulvin group noted resolution of their disease. Five patients taking griseofulvin were forced to discontinue the therapy because of side effects, compared with two patients taking terbinafine. This preliminary study indicates that a new oral antifungal agent of the allylamine class, terbinafine, may possess a safety and efficacy profile similar to that of griseofulvin.

Administration, Oral↗
PubMed1988

The measurement of the volume of leg ulcers.

A method designed to measure the volume of cutaneous ulcers is described that utilizes a silicon rubber dental impression material. This technique is compared to the more popularly used computerized image analysis method in the determination of the size of cutaneous ulcers.

Adult↗
PubMed1988

The effect of topical cyclosporin A on the elicitation phase of allergic contact dermatitis.

The effect of cyclosporin A (CSA) on the elicitation phase of allergic contact dermatitis was investigated. Initially, the ability of CSA to penetrate normal human cadaver skin was determined using 3 different vehicles. 10% CSA in Labrafil was found to be the most effective combination at achieving skin penetration (0.33%). Patients with known contact sensitivities to a variety of allergens were selected. After a 48-h pretreatment with 10% CSA in Labrafil, skin sites were exposed to the appropriate contact allergen. 72 h later, the development of an eczematous patch test reaction was evaluated. Only 1 of 10 patients showed unequivocal signs of suppression of allergic contact dermatitis.

Administration, Cutaneous↗
PubMed1988

Mometasone furoate ointment and cream 0.1 percent in treatment of psoriasis: comparison with ointment and cream formulations of fluocinolone acetonide 0.025 percent and triamcinolone acetonide 0.1 percent.

Mometasone furoate (Elocon) is a newly formulated and unique medium-potency synthetic 17-heterocyclic corticosteroid. The efficacy and safety of the ointment and cream formulations (0.1 percent) of the corticosteroid, administered once daily, were compared with those of the ointment and cream formulations of fluocinolone acetonide 0.025 percent administered three times daily and triamcinolone acetonide 0.1 percent administered twice daily in four multicenter clinical studies. They were conducted involving psoriasis patients with chronic and moderate to severe disease. Evaluation of change in disease sign scores indicated that mometasone ointment, applied once daily, was significantly more effective (P less than 0.01) than fluocinolone ointment, applied three times daily, and triamcinolone ointment, applied twice daily. The cream formulation of mometasone was significantly more effective (p less than 0.001) than fluocinolone cream, applied three times daily, and equivalent to triamcinolone cream, applied twice daily. The incidence of local adverse experiences following treatment with the ointment or cream formulations of mometasone was minimal. Mometasone ointment and cream provide a highly effective once-a-day treatment for moderate to severe psoriasis with minimal risk of side effects.

Administration, Topical↗
PubMed1987

Hypomelanosis associated with a colonic abnormality. A possible result of defective development of the neural crest.

A neonate born of black parents displayed a congenital, dramatic deficiency of most of his normal pigmentation. This was accompanied by a markedly dilated colon and various other defects. Light- and electron-microscopic examination revealed a deficiency in melanin content in the hypopigmented skin as compared to the normally pigmented areas. No other defects were noted. The possibility exists that a single aberration in neural crest development, a neurocristopathy, might be responsible for our patient's multiple congenital defects. Similar conditions in veterinary medicine and human disease are reviewed and compared to this case.

Abnormalities, Multiple↗
PubMed1986

Chloracne from pentachlorophenol-preserved wood.

A patient is presented who developed chloracne after exposure to lumber which was pressure-treated with pentachlorophenol (PCP). It was presumed that his disease arose via percutaneous absorption of polychlorinated aromatic compounds (dioxins and furans) which are known to contaminate technical grade PCP. The patient's condition improved after treatment with oral isotretinoin.

Acne Vulgaris↗
PubMed1986

The adherence of Staphylococcus aureus to human corneocytes.

Staphylococcus aureus has a peculiar ability to colonize the skin of patients with atopic dermatitis. We examined the possibility that this might be due to a specific ability of this pathogenic staphylococcus to adhere to atopic stratum corneum. We used an in vitro model to show that S aureus does have an unusual ability to adhere to atopic corneocytes when compared with corneocytes obtained from patients with other cutaneous diseases, including psoriasis. Protein A--a component of the staphylococcal cell wall--may be responsible in part for this adherence phenomenon. This trait did not extend to the other gram-positive bacteria tested.

Cell Division↗