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Biomedical subjects

L Shall

Publications and source records attributed to L Shall.

At least 19 recordsLinked to original sources
PubMed1994

Bacitracin: a significant sensitizer in leg ulcer patients?

We report the results of patch testing 85 patients with either long-standing venous ulceration or eczema complicating their leg ulcers. As previously reported, lanolin and its derivatives and topical antibiotics were the most frequent sensitizers. However, unlike previously published data, we found bacitracin to be the most potent sensitizer of all topical antibiotics tested. There were no positive reactions in a control group of patients, although we were unable to repeat the patch tests in patients with a positive reaction to bacitracin. In the past 10 years, our department has used a proprietary mixture of polymyxin and bacitracin in treating infected leg ulcers and other dermatoses. It is therefore possible that chronic usage of topical bacitracin on leg ulcers carries a significant risk of contact sensitization.

Adult↗
PubMed1993

Carbamazepine-induced anticonvulsant hypersensitivity syndrome--pathogenic and diagnostic considerations.

Two epileptic patients developed an infectious mononucleosis-like illness which subsequently proved to be a carbamazepine-induced anticonvulsant hypersensitivity syndrome. Patch testing to carbamazepine 3 years later was positive in the one patient tested and negative in normal controls. The second patient died a few weeks after the illness, secondary to long-standing cardiac disease without having undergone patch testing. A skin biopsy was, however, consistent with an immune complex mediated drug reaction. Patch testing for systemically administered drugs is generally believed to be of little value in diagnosing drug allergies. However, we reinforce a previous suggestion that this investigation may be helpful in some cases of anticonvulsant hypersensitivity syndrome caused by carbamazepine. The pathogenic role of type 3 and 4 hypersensitivity is also discussed.

Adult↗
PubMed1993

Concentric isokinetic trunk extension/flexion testing of rigid and semirigid lumbar/sacral supports.

Using a Cybex(R) trunk extension/flexion device, we measured the effects of rigid and semirigid lumbar/sacral supports on peak muscular torque, total work, and average power. Ten well-conditioned men, aged 21 to 35, performed three testing sessions each at 7-day intervals (one session with a rigid support, one session with a semirigid support, and one with no support). We selected four isokinetic testing speeds (30 degrees /s, 60 degrees /s, 90 degrees /s, and 120 degrees /s), complying with a standard Cybex trunk extension/flexion protocol. Differences between lumbar/sacral supports were analyzed using an analysis of variance (ANOVA) and Scheffé post hoc tests. Peak torque, total work, and average power were significantly different (p<.05) during trunk flexion at various isokinetic velocities. Trunk extension movements did not appear to be affected by the use of supports, but trunk flexion was significantly greater with the semirigid device and with no device than with the rigid support. We concluded that a rigid lumbar/sacral support decreases strength during movement tasks involving trunk flexion with resistance.

Journal Article↗
PubMed1992

Darier's disease of the external ear.

Darier's disease is a hereditary dermatological condition characterized by crusted papules distributed over the seborrhoeic areas of the trunk and head. A case of Darier's disease presenting to the Otolaryngology department because of severe involvement of the pinna is reported. The typical histological appearances are described and treatment discussed.

Darier Disease↗
PubMed1992

Comparative inhibition profiles of three non-sedating antihistamines assessed by an extended Lewis model.

Antihistaminic drugs are widely prescribed across a multitude of medical specialties such as Allergy and Dermatology. The potentially serious sedative effect of these valuable agents has previously restricted their full use and the choice of drug has been dictated more by individual patient acceptability than by any laboratory demonstrations of comparative efficacy. Unsurprisingly therefore, there is a trend towards prescribing those newer preparations which leave the central nervous system unclouded. We have studied the most frequently prescribed non-sedating antihistamine preparations, terfenadine (Triludan, Triludan Forte), cetirizine (Zirtek) and loratadine (Clarityn) in pharmacodynamic and relative efficacy trials using a quantifiable and reproducible extension of the classic Lewis model. The results indicate that two preparations, terfenadine 120 mg (Triludan Forte) and cetirizine 10 mg (Zirtek) are superior to their immediate rivals in degree of efficacy and/or speed of action. These results should assist clinicians in the positioning of effective, rapidly acting antihistamines for the symptomatic treatment of immediate hypersensitivity reactions such as urticaria and rhinitis.

Adult↗
PubMed1992

Aberrant cutaneous weal and flare responses in chronic urticaria.

This study examined cutaneous mast cell behaviour in 14 patients with chronic urticaria but no dermographism and 11 healthy controls, by measuring cutaneous weal and flare reactions evoked in response to intradermal challenge injections of 0.1 ml isotonic saline, histamine (20 micrograms), codeine phosphate (10 micrograms) and compound 48/80 (10 micrograms). Five minutes after each injection, the area of the resulting weal and flare was calculated by computer-aided planimetry. The process was repeated at 15, 30 and 45 min following the injection. In patients, saline flares were significantly larger than those of the volunteers at 15, 30 and 45 min (p < 0.05). However, histamine and codeine flare areas were significantly smaller in the patients when compared to the controls at 15, 30 and 45 min (p < 0.05). Compound 48/80 produced smaller reactions in the patients without reaching statistical significance.

Adolescent↗
PubMed1991

Dose-response relationship between objective measures of histamine-induced weals and dose of terfenadine.

Terfenadine is a safe non-sedative H1-receptor antagonist. This study aimed to quantify the relative reduction in weal and flare area, thickness and erythema at 4, 8, 12 and 24 h following a single but variable oral dose of terfenadine compared with pre-treatment measurements, in order to compare the dose-effect relationship and time course of the different dosages. In a double-blind randomized cross-over study, 12 healthy volunteers were given 60, 120 or 240 mg of terfenadine or placebo. Twenty micrograms of histamine acid phosphate was then injected intradermally at 4, 8, 12 and 24 h. The weal and flare areas were measured by planimetry, the thickness of the weal by an A-scan pulsed ultrasound device and the redness of both the weal and flare by an erythema-meter. A definite dose-response relationship was demonstrated between the weal and flare areas and the three active treatments. For the weal area, there was a significant difference between 60 mg and 240 mg of terfenadine at 4 h (p less than 0.01), at 8 and 12 h (p less than 0.05). For the flare area there was a similar significant difference at 4 h (p less than 0.01) and at 8 h (p less than 0.05). A dose-response relationship was demonstrated between weal erythema and 120 mg or 240 mg and 60 mg of terfenadine (p less than 0.05). There was a correlation between the plasma levels of the major metabolite and the initial dose of terfenadine, demonstrating their expected proportionality. This metabolite was also demonstrated in tissue fluid.

Adult↗
PubMed1991

Stucco keratoses. A clinico-pathological study.

Stucco keratoses are benign acquired papular warty lesions which usually occur on the distal parts of the lower limbs of elderly men. Their nature and pathogenesis are uncertain. Eight patients with multiple stucco keratoses who presented to the Cardiff Dermatology Department over an 18-month period were studied in an attempt to characterize these lesions. All subjects were male, with ages ranging from 50 to 72 years. Their lesions were most numerous over the fronts of the lower legs, but were also evident over other areas of the limbs. Most patients had a history of prolonged solar exposure, but the relationship of this to the development of the lesions was uncertain. Histologically there were no dysplastic changes and a characteristic regular 'church spire' type retention hyperkeratosis without marked acanthosis was evident. Lack of a marked increase in the epidermal cell population size is reflected in the normal in vitro tritiated thymidine autoradiographic labelling indices (7.81 +/- 1.67%, normal range 5 to 9%). Ultrastructurally no viral particles were evident and a normal pattern of epidermal differentiation with hypergranulosis was present. Two of the patients with myriads of lesions who were treated for 2 months with etretinate showed a dramatic clinical improvement which, however, lasted for 6 months only.

Aged↗
PubMed1988

Painful red hands: a side-effect of leukaemia therapy.

Five cases of 'painful red hands', following chemotherapy for leukaemia, are reported. All the patients were women who had received treatment with cytosine arabinoside, 6-thioguanine and adriamycin. Several days after courses of chemotherapy, painful erythematous swelling of the palms and soles developed. In all cases the reaction was self-limiting and did not adversely affect their prognosis. Physicians should be aware of this reaction in order to reassure their patients. No treatment is required and the chemotherapy need not be stopped or altered.

Adult↗
PubMed1988

Assessment of the duration of action of terfenadine on histamine induced weals.

In this study we aimed to quantify the reduction in area, perimeter and thickness of histamine induced weals 12, 18 and 24 h after a single oral dose of 120 mg terfenadine. Ten healthy volunteers were given 120 mg of terfenadine or placebo in a double-blind randomized two-period cross-over study. Twenty micrograms of histamine were then injected intradermally at 12, 18, and 24 h. The thickness of the resulting weal was measured by an A-scan pulsed ultrasound device. The area and perimeter of the resulting weal and flare were measured by tracing onto acetate sheets and using a digitizing tablet linked to a microcomputer. Just before each dose of histamine was injected, blood was taken to measure the level of the major metabolite of terfenadine. There was a significant difference between terfenadine 120 mg and placebo in the area and perimeter of the weal and the area and perimeter of the weal and flare at 12, 18 and 24 h, but no significant difference in weal thickness. Thus, terfenadine suppresses the wealing response caused by intradermally injected histamine over a 24 h period. It may be possible, therefore, to use a once daily dose of terfenadine.

Adult↗
PubMed1987

Enhanced release of von Willebrand factor by human endothelial cells in culture in the presence of phorbol myristate acetate and interleukin 1.

Human umbilical vein endothelial cells (EC) were cultured in the presence of 4 beta-phorbol 12-myristate 13-acetate (PMA), interleukin 1 (IL-1) and interleukin 2 (IL-2), and secretion of von Willebrand factor activity (vWF, Ristocetin Co-factor) and von Willebrand factor antigen (vWFAg) measured at intervals. The levels of both vWF and vWFAg in cultures containing IL-1 were significantly higher than those in control cultures after longer than 5-6 days growth. Similarly, the levels of vWF and vWFAg were significantly increased in cultures containing PMA, but in these instances the rate of cell growth appeared to be enhanced, and confluence was observed after 6 days compared to 9-10 days in control cultures. vWF and vWFAg also increased significantly in the supernatant of confluent control EC incubated further with IL-1. Moreover, the immuno-fluorescence pattern of vWFAg in these treated cells was markedly less granular than that of control cells. Immuno-fluorescence of PMA-treated cells suggested that vWFAg might be less granular than in control EC but the mean levels of vWF and vWFAg in the supernatant of cells incubated with PMA were not significantly different from control values. The results of all assays in the presence of IL-2 were not significantly different from those of control cells. In all instances no morphological evidence of endothelial injury was observed, and more than 90% of cells remained viable at the termination of cultures. The results indicated that the synthesis and release of vWF were increased in the presence of PMA, and secretion of vWF was stimulated by IL-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens↗
PubMed1987

Non-invasive instrumental techniques to detect terfenadine and temelastine induced suppression of histamine weals in man.

1. The effectiveness of chronic dosing with temelastine (SK&F 93944) 75 mg twice daily and terfenadine 60 mg twice daily compared with placebo in inhibiting the weal and flare response to intradermal histamine was assessed using non-invasive objective assessment techniques. 2. The mean weal thickness, as measured by the A-scan pulsed ultrasound device, was significantly decreased by both temelastine and terfenadine when compared with placebo. 3. There was a significant reduction in both the areas of the weal and the weal and flare, as measured by a digitizing tablet linked to a microcomputer, following treatment with temelastine and terfenadine compared with placebo and also between temelastine and terfenadine. 4. No significant difference was found in blood flow in the weal or flare as measured by the laser doppler flowmeter among any of the groups tested. 5. The ultrasound and digitizer techniques aid objectivity and precision in the investigation of the effects of drugs on histamine induced weals. 6. Temelastine and terfenadine were found to possess antihistaminic effects on histamine induced weal and flare in the skin.

Adolescent↗