Toward optimal health: the experts discuss herpes. Interview by Jodi Godfrey Meisler.
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Biomedical subjects
H E Baldwin
Publications and source records attributed to H E Baldwin.
Medical hazards of the tear gas CS. A case of persistent, multisystem, hypersensitivity reaction and review of the literature.
A 30-year-old incarcerated man was sprayed with the "tear gas" ortho-chlorobenzylidene malononitrile (CS). He was hospitalized 8 days later with erythroderma, wheezing, pneumonitis with hypoxemia, hepatitis with jaundice, and hypereosinophilia. During the subsequent months he continued to suffer from generalized dermatitis, recurrent cough and wheezing consistent with reactive airways dysfunction syndrome, and eosinophilia. These abnormalities responded to brief courses of systemic corticosteroid but recurred off therapy. The dermatitis resolved gradually over 6-7 months, but the patient still had asthma-like symptoms a year following exposure. Patch testing confirmed sensitization to CS. The mechanism of the patient's prolonged reaction is unknown but may involve cell-mediated hypersensitivity, perhaps to adducts of CS (or a metabolite) and tissue proteins. This is the first documented case in which CS apparently caused a severe, multisystem illness by hypersensitivity rather than direct tissue toxicity. Both the ethics and safety of CS use remain controversial, in part because of the difficulty documenting sporadic injuries received in the field, and also because the charged circumstances surrounding CS use may lead to both underreporting and exaggerated claims of medical harm. The medical literature on CS focuses mainly on its immediate irritant effects and on transient dermal and ocular injuries, with only 2 prior case reports of acute lung injury related to CS exposure. Given the paucity of documented lasting effects despite its widespread use for more than 3 decades, CS appears to be safe when deployed (outdoors) in a controlled manner, but it can cause important injuries if misused or if applied to a sensitized individual.
Adult↗
Lasting immunity to varicella in doctors study (L.I.V.I.D. study).
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Chi-Square Distribution↗
Botryomycosis in a patient with acquired immunodeficiency syndrome.
Botryomycosis is a bacterial infection of either the skin alone or in combination with visceral organs. It resembles a deep fungal infection. A histologic evaluation of cutaneous lesions reveals the characteristic Splendore-Hoepple phenomena and assists with management. Patients with acquired immunodeficiency syndrome (AIDS) tend to have uncharacteristic lesions resembling common conditions such as prurigo nodularis and lichen simplex chronicus. Diagnosis in these cases can be challenging. We report the case of a patient with AIDS who was successfully treated with Augmentin (amoxicillin, clavulanate potassium). Complete resolution of the lesion occurred after the causative agent, Staphylococcus aureus, was identified.
AIDS-Related Opportunistic Infections↗
Treatment of porokeratosis of Mibelli with CO2 laser vaporization versus surgical excision with split-thickness skin graft. A comparison.
BACKGROUND: Porokeratosis of Mibelli has been treated with many topical surgical modalities in the past, including cold steel surgical excision and CO2 laser excision. We report a patient with an 8 x 10 cm2 plaque of porokeratosis on the dorsum of his hand, fingers, and web spaces. OBJECTIVE: To compare the treatment results of CO2 laser vaporization versus cold steel surgical excision with split-thickness skin graft placement. METHOD: The portions of the lesion overlying the metacarpophalangeal joints, fingers, and web spaces were treated with CO2 laser vaporization. The remainder of the lesion covering the dorsum of the hand was excised with cold steel, followed by placement of a split-thickness skin graft over that area. RESULTS: The portion of the porokeratosis lesion treated with CO2 vaporization healed with results cosmetically and functionally superior to the grafted area. CONCLUSION: Carbon dioxide laser vaporization, a more superficial treatment modality than CO2 laser excision, should be the preferred treatment modality for porokeratosis lesions.
Aged↗
Subcutaneous nodules of the scalp: preoperative management.
The differential diagnosis of subcutaneous lesions of the scalp is extensive and includes many tumors with intracranial and intraosseous extension. The vast majority of lesions seen by the dermatologist will be benign. However, certain lesional characteristics increase the likelihood of a serious disorder and these must be evaluated preoperatively. We review the important features of subcutaneous scalp lesions and suggest a systematic approach to diagnosis based on patient age, lesion morphology, location, and radiographic findings.
Adult↗
The treatment of Zoon's balanitis with the carbon dioxide laser.
Zoon's balanitis, or plasma cell balanitis, is a chronic erosive process of the uncircumcised penis. The lesions are often refractory to conservative topical and surgical therapy and frequently require circumcision as a curative measure. This case report describes the first reported successful use of the carbon dioxide laser in the defocused mode to vaporize the chronic penile erosions of Zoon's balanitis.
Balanitis↗
STD update: screening and therapeutic options.
Sexually transmitted diseases (STDs) are some of the most common causes of illness worldwide. Prevention and educational programs have helped to curb the rise of syphilis, gonorrhea, non-gonococcal urethritis, chancroid, granuloma inguinale and lymphogranuloma venereum within most of the United States. However, there are still "hot spots" in the southern U.S. and in non-Caucasian and urban populations, and these diseases continue to be prevalent in underdeveloped countries. Molluscum contagiosum and condyloma acuminata are increasing throughout the world. Herpes simplex is in the midst of an epidemic, having increased in the United States by 30% in the last 15 years. The failure of preventive programs to halt or reverse these epidemics stems from a combination of factors involving both patients and the medical profession. Patient and sexual partner ignorance, denial and deliberate deception play an important role. However, healthcare professional ignorance and failure to keep a high index of suspicion are also crucial. These issues are compounded by the quick-visit concept propagated by managed care, which dilutes most educational efforts. Teens particularly suffer from the lack of an unhurried discussion of sexual practices, and the sharp rise in STDs in this population reflects failure in the medical system. This paper will review the classical presentations of the various STDs, and will detail in what ways the coexistence of HIV disease alters clinical appearance and disease progress. Subtle variations in presentations that often lead to misdiagnosis are discussed. Diagnosis and treatment of STDs change rapidly as new developments occur, and the latest recommendations are examined. The ways in which these therapies differ in special need groups such as HIV and pregnancy are specifically detailed. The goal of this review is to arm the clinician with all of the necessary ingredients for timely and accurate diagnosis and treatment, as well as ways to assist the patient in dealing with these difficult topics. Patient education is highlighted, as it, along with practitioner expertise, is the key to disease eradication. We are the missing link in STD eradication.
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