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Biomedical subjects

M B Duffill

Publications and source records attributed to M B Duffill.

16 recordsLinked to original sources
PubMed1998

Practising dermatology via telemedicine.

AIM: An interactive telemedicine service has been established between Taumarunui Hospital and the Department of Dermatology at Waikato Hospital. The first one hundred dermatological consultations were reviewed to see if the consultations were satisfactory for medical staff and patients. METHODS: A proprietary video conferencing system communicating via the Integrated Systems Digital Network was used to conduct dermatological consultations. Data were collected regarding waiting time, diagnosis and follow-up arrangements. Each patient was asked to complete a questionnaire after the consultation. RESULTS: Of these consultations, 83 were newly referred patients and the rest were follow-ups. The median waiting time for a new patient was 63 days. A variety of skin lesions (in 40 patients), inflammatory eruptions (31) and infections (13) were diagnosed and managed. Sixteen patients had to be seen at the base hospital for surgical treatment (7), face-to-face diagnosis (3), patch testing (3), a second opinion (2), or for personal reasons (1). The others were followed up locally. Savings in time and cost to patients were noted particularly. CONCLUSION: Only about 20% of consultations with new patients resulted in a further face-to-face appointment. The majority of patients found the telelink acceptable. The data supported the continuation and possible expansion of the dermatology telemedicine service. However, improved image quality is desirable.

Dermatology↗
PubMed1997

Diagnostic accuracy of teledermatology: results of a preliminary study in New Zealand.

AIM: To determine the accuracy of a video conferencing system (telemedicine) in diagnosis of dermatological disorders. METHODS: New patients referred to a dermatology clinic were initially examined by telemedicine and then by a standard face to face consultation. The diagnoses made by each type of consultation were compared and accuracy of telemedicine determined. RESULTS: One hundred and four patients with 135 dermatological conditions were analysed. Seventy five percent of conditions were correctly diagnosed by telemedicine. In a further 7% a differential diagnosis was made, which included the final diagnosis made face to face. In 12%, the diagnosis was incorrect using the telemedicine system, and in 3% no diagnosis was made. Four per cent of diagnoses were only made when the patient was seen face to face. CONCLUSION: This preliminary study suggests that video conferencing equipment can be used with a reasonable degree of accuracy for the diagnosis of dermatological disease.

Adolescent↗
PubMed1995

Cutaneous adverse drug reactions in a hospital setting.

AIMS: A prospective survey of the number and nature of cutaneous adverse drug reactions in a hospital setting. METHOD: Six month survey of cutaneous adverse drug reactions in hospital inpatients (April to October 1992). All patients were reviewed by a specialist dermatologist who assessed the adverse drug reaction as being: (1) type A adverse reaction (ie, expected, eg, acne vulgaris from systemic steroids; (2) type B adverse reaction (ie, unexpected, eg, allergic reaction; (3) not drug related; and (4) other/do not know. RESULTS: Sixty patients were reviewed; 38/60 patients (63%) had a cutaneous reaction related to their drug therapy or in-patient care. Of these, 7 had a nonallergic adverse drug reaction (type A). A further 31 had a type B adverse reaction: 27 had an allergic reaction to a systemic drug and 4 had an allergic contact dermatitis to a topical agent. 17 patients had cutaneous signs unrelated to their drug therapy, mostly a primary skin disorder (eg, eczema, psoriasis, etc). Of the remaining 5 patients it was not possible to determine the cause of the cutaneous reaction. The most common drugs associated with adverse drug reactions were the penicillin group of antibiotics, followed by frusemide, prednisone, allopurinol and carbamazepine. CONCLUSIONS: Adverse drug reactions are common and may result in additional morbidity to patients. However, only half of the cutaneous adverse reactions seen were secondary to allergy. As the diagnosis of an allergic reaction to drugs may have important therapeutic implications, review by a specialist dermatologist may be indicated.

Adolescent↗
PubMed1995

Allergic contact dermatitis to Toxicodendron succedaneum (rhus tree): an autumn epidemic.

AIMS: To document all cases of allergic contact dermatitis (phytodermatitis) due to contact with Toxicodendron succedaneum (rhus tree) presenting to a dermatology clinic during 1993. METHOD: Case-note review of all cases of phytodermatitis attributed to exposure to rhus tree seen during 1993 in a dermatology clinic. RESULTS: Twenty cases of phytodermatitis to T succedaneum were reviewed. Eight patients were females and 12 males with a bimodal age distribution (ten children under age of 15 yr, five adults between 35-45 yr of age). Younger patients presented with facial dermatitis reflecting facial contact whilst playing under rhus trees. Older patients presented largely with a dermatitis affecting the upper limbs reflecting contact whilst gardening (usually pruning). Fifteen out of twenty presented during the months of March through May (ie. autumn), with the remainder presenting in summer (Dec-Feb). The majority of patients required systemic steroids to settle the intense dermatitis. CONCLUSIONS: Phytodermatitis to T succedaneum is not uncommon in New Zealand, particularly during the autumn months. The clinical presentation varies according to the patient's activity.

Adolescent↗
PubMed1994

Chloracne, palmoplantar keratoderma and localized scleroderma in a weed sprayer.

The case of a 53-year-old man who developed chloracne, palmoplantar keratoderma and scleroderma after many years of exposure to a variety of chloracnegens is reported. Chloracne is a rare but important acneiform eruption associated with exposure to halogenated aromatic compounds used primarily in agriculture. However, to our knowledge, the association of palmoplantar keratoderma and scleroderma with exposure to chloracnegens has not been previously reported.

Acne Vulgaris↗
PubMed1994

Cyclosporine, azathioprine and local therapy for pyoderma gangrenosum.

A markedly obese 54 year old woman with seropositive rheumatoid arthritis, anaemia, dyspepsia, controlled hypothyroidism and depression presented with a seven month history of large pyoderma gangrenosum ulcers on the shins. Routine dressings for the ulcers had been ineffective. Her arthritis was being treated with azathioprine and NSAID's. Initial treatment with clobestasol propionate and disodium cromoglycate under occlusion produced only partial healing. Introduction of Cyclosporin A and continuation of topical therapy, with the addition of triamcinolone acetonide injections, led to progressive healing which was complete after seven months. There has been no relapse to date. Cyclosporine can be combined with azathioprine and local therapy for successful treatment of pyoderma gangrenosum.

Administration, Topical↗
PubMed1993

Milkers' chilblains.

AIM: To report on the clinical features, causative factors, management and preventive measures for chilblains of the hands occurring in milkers in the Waikato area of New Zealand. METHODS: A review was made of the case notes of all patients with milkers' chilblains seen in dermatological practice in Hamilton over a ten year period ending in 1991 and follow up interviews were made. RESULTS: Eleven milkers were seen with distinctive, at times disabling, seasonally-recurring chilblains of the hands. In most patients the chilblains had developed early in their milking careers. Difficulty was experienced by both the patients and their doctors in recognising the nature of their skin condition. Sunlight aggravation of the lesions was a feature. In most patients treatment of the presenting episode required time off work and in several patients significant scarring resulted. Three patients left dairying because of the chilblains. Those who continued received preventive advice but four patients had further lesions in subsequent years although these were mild. CONCLUSIONS: Milkers' chilblains are uncommon but some cases are misdiagnosed and milder cases may not present for medical attention. Morbidity can be significant. Preventive measures are helpful but their effect may be limited by the difficulty of wearing gloves for milking. The vasodilator nifedipine is suggested as a prophylactic therapy for these patients.

Adolescent↗
PubMed1993

Cutaneous phaeohyphomycosis due to Alternaria alternata responding to itraconazole.

An 81-year-old man presented with a spreading, eczematous-appearing rash on the dorsum of the right hand and forearm, originating from three small, probably post-traumatic, ulcers over the knuckles. He had the nephrotic syndrome for which he was on 60 mg prednisone daily. Histology of a biopsy of lesional skin was consistent with phaeohyphomycosis and Alternaria alternata was cultured. The rash cleared following treatment with 100 mg itraconazole daily and tapering of his prednisone dose.

Aged↗
PubMed1988

Recurrent pseudo-scarlatina and allergy to pseudoephedrine hydrochloride.

A case of recurrent pseudo-scarlatina is described. Challenge with pseudoephedrine hydrochloride reproduced a typical attack but pseudoephedrine ingestion could not be related definitely to all episodes. Allergy to pseudoephedrine or codeine should be considered as a cause for recurrent scarlet fever-like eruptions.

Adult↗
PubMed1987

Pyoderma gangrenosum: a Waikato experience.

Ten cases of pyoderma gangrenosum were seen over a period of nine years at the Waikato Hospital dermatology clinic. Several associated conditions were found. Four cases were associated with inflammatory bowel disease, three cases with arthritis, one case was found in association with myelofibrosis. Four patients were diabetic, an incidence higher than in previous studies. Most patients were treated with oral steroids but additional therapies were used to achieve disease control and for their steroid-sparing effect.

Adult↗
PubMed1987

Pseudoporphyria from nonsteroidal antiinflammatory drugs.

Pseudoporphyria is a condition in which skin fragility and blistering typical of cutaneous porphyria are associated with normal porphyrin metabolism. Naproxen has recently been described as a cause for drug-induced pseudoporphyria and eight examples of this are reported. We also report instances from ketoprofen and diflunisal.

Adult↗
PubMed1977

The measurement of the cell cycle time in squamous epithelium using the metaphase arrest technique with vincristine.

In squamous epithelia with a single layer of germinative cells, the age distribution of cells in the cell cycle is shown to depend on the direction of the mitotic axis (i.e. a line joining the nuclei of daughter cells) relative to the plane of the basal layer. When axes are in the plane of the basal layer the age distribution is exponential; when cells divide at right angles to the plane of the basal layer, the age distribution is rectangular. When there is a ratio of vertical to horizontal axes, the age distribution is intermediate but can be calculated from knowledge of the proportion of axes in the plane of the layer. Squamous epithelia can be classified according to this arrangement of axes. When there are multiple layers of germinative cells, as in psoriasis, the age distribution is shown to be exponential to a good approximation, whatever the direction of the mitotic axes in the several layers. The importance of these observations is demonstrated by analysing metaphase arrest experiments with vincristine in the single layer of germinative cells in the mouse oesophagus, and in the several layers found in psoriatic epidermis. Choice of the wrong age distribution leads to an error of 6 h in the oesophagus and 23 h in psoriatic epidermis, when the mean cell cycle time is calculated. It is concluded that, in squamous epithelium, it is most important to know the age distribution before calculating the cell cycle time by methods involving measurement of the rate of entry of cells into mitosis or DNA synthesis.

Animals↗