PubMed Health⌕ Search

Biomedical subjects

J E Bernstein

Publications and source records attributed to J E Bernstein.

At least 19 recordsLinked to original sources
PubMed1991

Percutaneous cholecystostomy: does transhepatic puncture preclude a transperitoneal catheter route?

Percutaneous cholecystostomy is now commonly performed for the diagnosis and treatment of gallbladder and biliary disorders. The optimal method and route of percutaneous cholecystostomy catheter placement, however, remain controversial and may depend on the indication for the procedure. The ability to predict traversal of the extraperitoneal plane of fixation ("bare area") between the liver and gallbladder with a transhepatic approach was investigated. With sonographic guidance, 21 transhepatic catheterizations were attempted: 19 in cadavers and two in patients who subsequently underwent cholecystectomy. In all cases, 8-F or 5-F self-retaining catheters were used. At autopsy or surgery, the catheter course and gallbladder puncture site were evaluated. Of 21 punctures, 19 (90%) were transhepatic and two (10%) were transperitoneal. Among the 19 transhepatic punctures, eight catheters (42%) traversed the bare area, while 11 (58%) entered the free gallbladder wall adjacent to the serosal attachment. There were four instances of guide-wire dislodgment during catheter placement; all occurred following puncture of the free wall of the gallbladder. No guide-wire dislodgment occurred when the bare area was transversed. Transhepatic gallbladder puncture does not prevent puncture of the free gallbladder surface. However, the liver and bare area do seem to provide guide-wire stability during catheter placement.

Adult↗
PubMed1989

Topical capsaicin treatment of chronic postherpetic neuralgia.

Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia. In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period. Response to treatment was evaluated by visual analogue scales of pain and of pain relief, together with changes in a categoric pain scale and in a physician's global evaluation. Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables. After 6 weeks almost 80% of capsaicin-treated patients experienced some relief from their pain. Because capsaicin avoids problems with drug interactions and systemic toxicity, we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia.

Administration, Topical↗
PubMed1989

Clinical evaluation of an after-pediculicide nit removal system.

A significant problem in the management of pediculosis is the removal of nits from the hair after pediculicide treatment. This study describes use of a nit removal system incorporating a cream rinse containing formic acid that loosens the bond between the nit and hair. Twenty-four children with pediculosis capitis, age 4 to 12 years, were evaluated. Sections of hair with equivalent numbers of nits were identified as control or test sites. Combining for 5 minutes after use of the formic acid rinse removed 93.5% of nits compared with a 27.6% reduction in the control section (p less than 0.0001). These results demonstrate that use of this nit removal system greatly facilitates nit removal.

Animals↗
PubMed1987

Treatment of chronic postherpetic neuralgia with topical capsaicin. A preliminary study.

Continuing pain following herpes zoster is common in patients 60 years of age or older. Current treatments are generally unsatisfactory. The endogenous neuropeptide substance P is an important chemomediator of nociceptive impulses from the periphery to the central nervous system and has been demonstrated in high levels in sensory nerves supplying sites of chronic inflammation. In an attempt to alleviate the pain of 14 patients with postherpetic neuralgia, capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), known to deplete substance P, was applied topically to painful areas of skin for 4 weeks. Of the 12 patients completing this preliminary study, 9 (75%) experienced substantial relief of their pain. The only adverse reaction was an intermittent, localized burning sensation experienced by one patient with application of capsaicin. Although these results are preliminary, they suggest that topical application of capsaicin may provide a useful approach for alleviating postherpetic neuralgia and other syndromes characterized by severe localized pain.

Administration, Topical↗
PubMed1987

Capsaicin in the treatment of dermatologic disease.

Capsaicin cream is the first of a class of neuropeptide active agents to be introduced into dermatologic therapy. Capsaicin's effects appear primarily related to its ability to deplete the neuropeptide substance P from local sensory terminals in the skin. The use of capsaicin cream in the treatment of postherpetic neuralgia and psoriasis is discussed. I believe that capsaicin and other neuropeptide active agents may become important therapeutic modalities for the dermatologist in the near future.

Capsaicin↗
PubMed1986

Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris.

Alterations in the cutaneous vascular system are prominent in psoriasis and may play an important role in the pathogenesis of this disorder. We evaluated the effects of topically applied capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), a known inhibitor of cutaneous vasodilatation, on moderate and severe psoriasis. Under a double-blind paradigm, forty-four patients with symmetrically distributed psoriatic lesions applied topical capsaicin to one side of their body and identical-appearing vehicle to the other side for 6 weeks. After 3 and 6 weeks of treatment, we performed ratings on changes in scaling and erythema, as well as overall improvement of the psoriasis. Over the course of the study, significantly greater overall improvement was observed on sides treated with capsaicin compared to sides treated with vehicle. Similarly, significantly greater reductions in scaling and erythema accompanied capsaicin application. Burning, stinging, itching, and redness of the skin were noted by nearly half of the patients on initial applications of study medication but diminished or vanished upon continued application. These results suggest that topical application of capsaicin may be a useful new approach in the treatment of psoriasis.

Administration, Topical↗
PubMed1984

Cutaneous immunofluorescence studies in adult rheumatoid arthritis in sun-exposed and non-sun-exposed areas.

The incidence and significance of positive cutaneous immunofluorescence findings were assessed in biopsy specimens of both sun-exposed and non-sun-exposed skin of 34 adult patients with rheumatoid arthritis (RA) who were not receiving systemic corticosteroids. The incidence of lupus erythematosus (LE)-band was low (8.6%) in both groups. Twenty-eight percent of the patients had perivascular IgM and/or C3 deposits, and 74% had cytoid bodies in the papillary dermis. These studies indicate that the incidence of LE band is low in RA and that the detection of such a band in normal skin warrants close follow-up of RA patients for possible development of LE.

Adult↗
PubMed1983

Reduced threshold to suction-induced blister formation in insulin-dependent diabetics.

Diabetics may have an increased susceptibility to cutaneous blister formation clinically manifest as the bullous eruption of diabetes. We evaluated the mechanical force necessary to induce suction blisters in fifteen insulin-dependent diabetics and twenty age-matched normal controls. The mean suction blister threshold for the diabetics was 31.9 minutes versus 68.0 minutes for the controls, a highly significant difference (p less than 0.01). Histologic appearance of suction blisters was similar in diabetic and normal skin, under both light and electron microscopic examination, with a noninflammatory subepidermal separation in the lamina lucida between the cell membrane and the basal lamina. These results demonstrate that insulin-dependent diabetics have a marked reduction in suction blister threshold as compared to age-matched controls.

Adult↗
PubMed1983

Neuropeptides in the pathogenesis of obesity-associated benign acanthosis nigricans.

The association of acanthosis nigricans with pituitary tumors and insulin-resistant diabetes suggests that a pituitary peptide may promote papillomatosis and acanthosis characteristic of acanthosis nigricans. Although such a peptide has not been isolated, it may derive by sequential cleavage from the 31,000-dalton precursor peptide to ACTH and beta-lipotropin (beta-LPH). In order to evaluate the role of pituitary peptides in the pathogenesis of acanthosis nigricans, we compared plasma levels of beta-endorphin (beta-EP) and ACTH in plasma of 8 fasting patients with obesity-associated benign acanthosis nigricans and 7 fasting normal controls utilizing sensitive radioimmunoassay procedures. Mean plasma beta-EP levels for the acanthosis nigricans and control subjects were not significantly different (90 pg/ml vs. 140 pg/ml), nor was any significant difference observed between plasma ACTH levels of the 2 groups (42.3 and 31.2 pg/ml, respectively.) Our data indicate that plasma levels of the pituitary-derived peptides ACTH and beta-EP are not increased in obesity-associated benign acanthosis nigricans, and suggest that its proposed hormonal mediator might originate independently from the large peptide precursor of ACTH, beta-LPH and their fragments.

Acanthosis Nigricans↗
PubMed1983

Heparin-induced cutaneous necrosis unrelated to injection sites. A sign of potentially lethal complications.

Skin necrosis is a rare complication of heparin administration that is usually localized to injection sites. A 32-year-old insulin-dependent diabetic patient, receiving intravenous (IV) and low-dose heparin sodium therapy, had cutaneous necrosis in areas distant to the sites of injection. Prior to the onset of cutaneous lesions, thrombocytopenia develop]ed in the patient that may have been heparin induced. Heparin may induce the production of platelet aggregating immunoglobulins that predispose persons who are sensitive to the drug to thrombocytopenia, skin necrosis, and thrombotic events. Obesity, diabetes, and treatment with broad-spectrum antibiotics seem to increase the risk of such complications. Cutaneous necrosis secondary to heparin administration may serve as a warning of the potentially lethal complications of IV use. In patients in whom skin necrosis or thrombocytopenia develops, heparin therapy should be discontinued and anticoagulation with an oral agent should be considered.

Adult↗
PubMed1982

Antipruritic effect of an opiate antagonist, naloxone hydrochloride.

Central elicitation of itch by morphine may result from binding to opiate receptors, mimicking the physiological binding of endorphins and enkephalins to these receptors. Pretreatment of normal subjects with naloxone hydrochloride resulted in diminution or abolition of histamine-provoked itch. These results suggest an important role for central opioid peptides as mediators of the itch sensation.

Adult↗
PubMed1982

Alcohol-induced rosacea flushing blocked by naloxone.

We evaluated the roles of endogenous opioid peptides and histamine in the pathophysiology of alcohol-induced facial flushing in rosacea. Non-diabetic patients with rosacea ingested 360 ml of 6% ethanol after receiving either subcutaneous naloxone hydrochloride or oral chloropheniramine maleate. Only pretreatment with naloxone blocked the alcohol-induced rosacea flushing (AIRF), suggesting an active role of endogenous enkephalin and/or endorphin in this vascular reactivity. In this respect, AIRF is similar to chlorpropamide alcohol flushing and menopausal flushing.

Adult↗
PubMed1982

Coexisting childhood pemphigus foliaceus and Graves' disease.

We report herein the concurrent appearance of childhood pemphigus foliaceus and Graves' disease in a 14-year-old girl who was initially seen with crusted and hyperpigmented plaques on her chest, back, abdomen, and legs. The diagnosis of pemphigus foliaceus was confirmed by biopsy and immunofluorescent microscopic studies while the diagnosis of Graves' disease was based on clinical and laboratory findings. The coexistence of these two immune-mediated diseases in a single patient suggest that some persons may bear a unique predisposition to the development of two or more autoimmune-type disorders that may affect diverse organ systems.

Adolescent↗
PubMed1981

Unilateral linear nevoidal syringoma.

We here report the unusual occurrence of syringoma in a unilateral linear nevoid distribution in a 32-year-old woman. The papules were located on the right side of the chest and right arm. These lesions need to be distinguished from other linear papular eruptions.

Adenoma↗