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Biomedical subjects

M J Rico

Publications and source records attributed to M J Rico.

At least 19 recordsLinked to original sources
PubMed2003

Safe treatment of head/neck AD with tacrolimus ointment.

BACKGROUND: Atopic dermatitis(AD) with head and neck involvement is common and therapeutically challenging. METHODS: Efficacy and safety data specific to treatment of head/neck regions with tacrolimus ointment (Protopic) from three double-blind, randomized, vehicle-controlled studies are reported. A total of 631 adult and 352 pediatric patients with moderate to severe atopic dermatitis applied the vehicle, 0.03% or 0.1% tacrolimus ointment twice daily to affected areas for up to 12 weeks. RESULTS: Significant improvements from baseline to end of treatment for signs of atopic dermatitis (erythema, edema, excoriation, oozing, scaling, and lichenification) were noted for head/neck and non-head/neck areas treated with either 0.03% or 0.1% tacrolimus ointment (p<0.001). Within each treatment group, the overall 12-week adjusted incidence rate of application site adverse events was similar for both head/neck and non-head/neck areas. The incidence of common adverse events such as pruritus, "skin burning", erythema, infection, and skin tingling in head/neck areas was comparable to that observed in non-head/neck areas within each treatment group. The overall prevalence of application site adverse events decreased rapidly during the first few days of treatment. CONCLUSION: Tacrolimus ointment is a safe and effective treatment for atopic dermatitis on the head and neck.

Adolescent↗
PubMed2001

Tacrolimus clinical studies for atopic dermatitis and other conditions.

The first topical immunomodulator approved for human use, tacrolimus ointment (Protopic, Fujisawa, Healthcare, Inc, Deerfield, IL), has been shown to be effective and safe in the treatment of children (aged 2 years and older) and adults with atopic dermatitis (AD). Clinical trials conducted worldwide have involved 12,000 patients, with safety and efficacy data available for up to 3 years of treatment. In addition to its beneficial effects in the management of AD, topical tacrolimus has also been reported to be of benefit in other immunologically mediated skin diseases including: hand dermatitis, contact dermatitis, eyelid dermatitis, erosive lichen planus, steroid-induced rosacea, pyoderma gangrenosum, and graft-versus-host disease. This article reviews the clinical experience of topical tacrolimus in the treatment of AD and other skin conditions.

Administration, Cutaneous↗
PubMed2001

Traveling through skin manifestations of HIV in 2001.

There are currently over 34 million people worldwide infected with human immunodeficiency virus (HIV) with 15,000 new patients infected each day. The acquired immunodefiency syndrome (AIDS) pandemic has particularly affected the third world and currently over 70% of those infected reside in sub-Saharan Africa. The epicenter of the pandemic is shifting to Asia as HIV infection increases in the densely populated countries of India, China, and SE Asia. Patients with HIV infection develop a variety of mucocutaneous diseases and often present to dermatologists.

Adult↗
PubMed2000

Rising drug costs: the impact on dermatology.

In the US prescription drug costs are rising faster than any other component of health care expenditures, and show no signs of slowing. Spending on prescription drugs has been estimated by the Health Care Finance Administration (HCFA) to be rising by approximately 12% per year, more than twice the rate for national health care expenditures (5.1%). Factors driving the rise in prescription drug costs include the introduction of new drugs, and consumer demand.

Cost Control↗
PubMed1999

Treatment of autoimmune blistering diseases.

The treatment of autoimmune blistering diseases remains therapeutically challenging. Significant improvement in the management of autoimmune bullous diseases has occurred as a consequence of improvements in our ability to predict, monitor, and treat the deleterious effects associated with the drugs used to treat these conditions and the introduction of new agents with lower toxicity. Examples include improvements in monitoring and preventing osteoporosis in patients on long-term systemic corticosteroids, the detection of those at risk for azathioprine toxicity bowing to low thiopurine methyltransferase activity, and the addition of agents such as mycophenolate mofetil and IVIG to our therapeutic armamentarium. These advances offer the promise of improved disease control with fewer side-effects and long-term toxicity for our patients.

Anti-Inflammatory Agents↗
PubMed1999

Characterization of skin cytokines in bullous pemphigoid and pemphigus vulgaris.

The purpose of this study was to determine cytokine and cell marker expression in perilesional skin biopsies from patients with the autoimmune blistering diseases bullous pemphigoid (BP, n = 21) and pemphigus vulgaris (PV, n = 7). Immunohistochemistry and in situ hybridization were used to detect T helper (Th)1 [interleukin (IL)-2, interferon (IFN)-gamma] and Th2 (IL-4, IL-5, IL-13) protein and mRNA. Perilesional skin biopsies from patients with BP were characterized by the deposition of IL-4, IL-13 and IL-5. In patients with BP, IL-4 and IL-13 localized to mononuclear cells within the dermal infiltrate while IL-5 was predominately expressed at the dermal-epidermal junction. BP skin sections also expressed vascular cell adhesion molecule 1 on endothelial cells, not seen in patients with PV. PV biopsies were remarkable for a mixed Th1/Th2 pattern of cytokine expression, including the presence of IL-2, IFN-gamma and IL-4 and the absence of IL-5 and IL-13. In situ hybridization detected mRNA for IL-4 and IL-5 in the cellular infiltrate of BP patients, and IL-2 in a patient with PV. In vitro binding assays demonstrated that normal human eosinophils, activated by coculture in IL-5, bound preferentially to BP skin sections that contained detectable in vivo bound IL-5. The predominance of Th2 cytokines in BP, in association with increased binding of eosinophils in vitro, suggests that Th2 cytokines are relevant in the recruitment and adhesion of eosinophils within the dermal infiltrates of patients with BP, and may play a part in the pathogenesis of blister formation.

Biomarkers↗
PubMed1999

Atypical cutaneous lymphoproliferative disorder in patients with HIV infection.

BACKGROUND: An inflammatory pruritic eruption which is characterized histologically by CD8+, atypical lymphocytes has been described in human immunodeficiency virus (HIV)-infected patients. This disorder has been described as "pseudo-Sezary" or a "cutaneous T cell lymphoma (CTCL)-simulant", however, as these patients do not resemble CTCL clinically, and the relationship between this entity and CTCL is unclear, a more descriptive term is "atypical cutaneous lymphoproliferative disorder" (ACLD). The purpose of this study is to categorize the clinical, histologic, and immunophenotypic features of 16 HIV-infected patients with this skin disorder seen at the New York Department of Veterans Affairs Medical Center. METHODS: A retrospective chart review was conducted on 16 HIV-infected patients with a histologic diagnosis of an atypical cutaneous lymphoproliferative infiltrate on skin biopsy. Skin biopsies were reviewed, and histologic features noted. Immunophenotyping was performed on 14 out of 16 samples; electron microscopy was performed on samples from five patients. Clinical manifestations, disease course, medication history, and response to treatment were noted. RESULTS: The patients presented with a pruritic, persistent, generalized, papular eruption. Pigment changes, including hyperpigmentation and hypopigmentation were common. Histologically, lesional biopsies were characterized by a superficial and deep polymorphous infiltrate with atypical lymphocytes which were CD8+ predominant, Ki-1 negative, and occasionally CD7 antigen depleted. Sezary-like cells were present in the infiltrate in four out of five patients by electron microscopy. None of the patients has systemic manifestations of lymphoma; however, one of the 16 patients eventually developed frank CTCL. CONCLUSIONS: HIV-infected patients can present with a pruritic, widespread disorder, often with pigment changes characterized by an atypical cutaneous lymphocytic infiltrate. This clinicopathologic disorder is a rare, reactive inflammatory condition which generally occurs in late stage HIV infection and rarely progresses to frank lymphoma.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Reoperations of myocardial revascularization].

UNLABELLED: Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations. RESULTS: Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients) IN CONCLUSION: a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.

Adult↗
PubMed1996

Comparative epitope mapping of sera from United States (US) and Japanese patients with bullous pemphigoid (BP) to fusion proteins encoded by BPAG1.

Sera from patients with bullous pemphigoid (BP) from the United States (US), Japan, and Britain demonstrate similar reactivity to the major target antigens BPAG1 and BPAG2. The purpose of the present study was to determine if the epitope specificity of circulating autoantibodies in patients with BP from the US and Japan is similar as mapped by binding to fusion proteins encoded by BPAG1. Sera from patients and controls with BP from the US and Japan were assayed for reactivity to intact BPAG1 and BPAG2 by immunoblot, and to fusion proteins encoded by BPAG1 by immunoblot and enzyme-linked immunosorbant assay (ELISA). Significant reactivity to fusion proteins encoded by the carboxyl region (FP 16-8) and coiled-coil region (FP3) was seen in sera from the US and Japanese patients, but not from normal controls from the US or Japan. Sera from US and Japanese patients differed in their response to FP7; namely, the reactivity of sera from US patients but not from Japanese patients to FP7 was significantly different from the reactivity of their respective control sera. The reasons for this difference in reactivity are unknown but may reflect genetic or environmental factors relevant in the generation of an autoantibody response to these target antigens.

Aged↗
PubMed1995

Autoimmune blistering diseases in children.

Autoimmune blistering diseases are relatively rare in children and adolescents. LADC and DH are the most often seen of these conditions and respond well to therapy. Some newly recognized diseases have been reported in children including localized vulvar pemphigoid, intraepidermal neutrophilic IgA dermatosis, and paraneoplastic pemphigus.

Adolescent↗
PubMed1994

Peripheral blood mononuclear cells from patients with bullous pemphigoid have an increased frequency of response to synthetic peptides encoded by BPAG1.

We determined the response of peripheral blood mononuclear cells from patients with bullous pemphigoid and normal subjects to synthetic peptides encoded by BPAG1. Peripheral blood mononuclear cells from patients and normal subjects were cocultured in the presence of 15-22-amino-acid-long amphipathic and hydrophilic peptides selected from the BPAG1 sequence. Seven of 10 patients (70%) with bullous pemphigoid had an increased response of peripheral blood mononuclear cells (> 3.25/10(6) cells) when cultured with amphipathic sequences encoded by BPAG1 compared to 3 of 10 (30%) normal subjects. Peripheral blood mononuclear cells from 3 of 15 (20%) patients and 3 of 15 normal subjects (20%) demonstrated an increased response when cultured with hydrophilic peptides. Peptides associated with an increased peripheral blood mononuclear cell response in patients with bullous pemphigoid were adjacent to regions of BPAG1 recently demonstrated to contain epitopes recognized by circulating autoantibodies in the sera of patients with bullous pemphigoid. Increased peripheral blood mononuclear cell responses were more commonly observed in patients with bullous pemphigoid with generalized disease and those who had their disease for longer than 2 months (p < 0.05). The observation that increased duration and generalized disease was associated with increased peripheral blood mononuclear cell responses to peptides encoded by BPAG1 supports the hypothesis that responses to BPAG1 may occur as a consequence of ongoing inflammation at the basement membrane.

Amino Acid Sequence↗
PubMed1994

Cross-reactive idiotypes in the sera of patients with bullous pemphigoid express anti-basement-membrane-zone activity.

We have previously generated a monoclonal anti-idiotypic antibody (antiId 3-17) specific for a cross-reactive idiotype (CRI) present in sera and bound at the basement membrane zone (BMZ) in some patients with bullous pemphigoid (BP). The purpose of the present study was to determine if CRI isolated from sera of patients with BP expressed anti-BMZ activity. CRI, isolated by affinity chromatography from 5 nonrelated patients with BP, bound to the epidermal side of normal human split skin as detected by indirect immunofluorescence. In patients with BP, the presence of the CRI on circulating IgG is associated with anti-BMZ activity.

Antibodies, Anti-Idiotypic↗