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Biomedical subjects

M Keefe

Publications and source records attributed to M Keefe.

At least 19 recordsLinked to original sources
PubMed1992

Shape analysis for classification of malignant melanoma.

Melanoma is a malignant skin tumour. If detected and surgically removed early whilst residing in the superficial part of the skin the prognosis is excellent. A seven-point check-list of signs and symptoms has been adopted by the Cancer Research Campaign to help non-dermatologists distinguish benign pigmented lesions from melanoma. The presence of irregularity in shape or outline of a mole is one of these important signs. However, it has recently been shown that not only patients, but also clinicians have difficulty in agreeing upon whether a mole exhibits irregularity or not. Computer image analysis methods have been developed to derive quantitative measures of those shape parameters which dermatologists appear to use in their assessment of shape irregularity. The overall shape of the lesion is expressed by the 'bulkiness' measure. Irregularity of the border is expressed by two fractal dimension measures, one for the 'structural' aspect of the shape and the other for the 'textural' aspect. These measures were used in combination to classify melanomas in the study containing silhouettes of 43 melanomas and 45 benign lesions producing correct classification with 91% sensitivity and 69% specificity. This paper describes computer image analysis aspects of the study.

Diagnosis, Computer-Assisted↗
PubMed1992

Successful treatment of steatocystoma multiplex by simple surgery.

Steatocystoma multiplex is usually a minor cosmetic problem but rarely can be extremely disfiguring. Unfortunately, the very patients who would benefit most from treatment are usually regarded as having too may cysts for surgery. We report a case of extensive steatocystoma multiplex which was treated by a simple surgical technique under general anaesthetic.

Arm↗
PubMed1992

Hailey-Hailey disease--exacerbation by herpes simplex virus and patch tests.

Benign familial chronic pemphigus, or Hailey-Hailey disease, is a rare hereditary condition characterized by development of blisters at sites of friction such as the neck, axillae and groin. Contact sensitivity to topical medications is reported to be common and routine patch testing has been strongly advocated. We report a case of Hailey-Hailey disease in a 43-year-old veterinary surgeon who presented with an acute exacerbation of his disease caused by herpes simplex virus type 1 (HSV). Patch testing was carried out to exclude a coexistent contact dermatitis and was complicated by severe local blistering. We are reporting this case to remind clinicians that HSV is a recognized cause of exacerbations of this disease and to warn that patch testing is not without hazard.

Adult↗
PubMed1991

Papuloerythroderma. Another case of a new disease.

We describe a case of papuloerythroderma. This is a distinctive clinical entity characterized by pruritus, red-brown flat-topped papules exhibiting the "deck-chair" sign, eosinophilia, and lymphopenia. We propose that the Langerhans cell may have a central role in the pathogenesis of papuloerthroderma and we describe an excellent response to photochemotherapy.

Aged↗
PubMed1991

The relationship between risk of death from clinical stage 1 cutaneous melanoma and thickness of primary tumour: no evidence for steps in risk. Scottish Melanoma Group.

Previous reports have suggested that the relationship between survival and thickness of primary cutaneous malignant melanoma is not linear, but that there are natural breakpoints at which survival worsens in a step fashion. Nine hundred and ninety-seven cases of primary cutaneous malignant melanoma less than 9.75 mm thick, excised in Scotland between 1979 and 1983 inclusive, were examined to see if this could be confirmed. An adjusted Cox's regression analysis showed that age, sex, site and thickness were all significant predictors of survival. Thickness was grouped either empirically or by the breakpoints reported by other authors. It was then entered into a model either as a regressor or as a factored variable. The ranges 0-9.75 mm and 0-2 mm were studied separately. In the 0-9.75 mm range the factored variable was a statistically significant better fit than the regressor for each set of breakpoints, including an empirical analysis with eight groups. This suggests that there is no single best fit and that a step-effect is unlikely. Across the 0-2 mm range there was no significant improvement in the fit if thickness was entered as a factored variable, again indicating that a step effect is unlikely. We argue that there is no biological or statistical evidence to support the existence of natural breakpoints.

Age Factors↗
PubMed1991

Bowen's disease arising in a scar--a case report and review of the relationship between trauma and malignancy.

A 55-year-old female presented with a 1-year history of Bowen's disease on the leg at the site of a scar from an injury that occurred at 5 years-of-age. The clinical features in this case suggest a causal relationship, although trauma may have been acting as a co-carcinogenic factor to an unknown primary-cause. The relationship between trauma and malignancy is reviewed and proposals for further investigation are discussed.

Bowen's Disease↗
PubMed1990

A study of the value of the seven-point checklist in distinguishing benign pigmented lesions from melanoma.

A seven-point scoring system has been adopted by the Cancer Research Campaign to help non-dermatologists recognize melanoma (MM). Its value is reviewed in the light of increasing referrals of pigmented lesions. One-hundred and ninety-five patients (M:F, 43:152; mean age = 43 years, s.d. = 19) were asked whether their lesions possessed the seven points before diagnosis. The dermatologist assessed the signs. Six patients were unable to comply and some had multiple lesions; thus, 216 lesions were fully assessed by patient and dermatologist, and six by the dermatologist alone. Histology was obtained where appropriate. There were eight MMs, 95 naevi, 80 seborrhoeic warts, three dysplastic naevi, and 36 other lesions. Seven of the eight MMs were diagnosed clinically; the other was biopsied because of suspicious features and was a nodular MM. Four lesions suspected to be MMs proved benign. The predictive value (PV) of a clinical diagnosis of MM was 64% and of non-MM was 99%. Using accepted cutpoints for the seven-point system (refer if score greater than or equal to 3) patients' scores gave a PV for MM of 7% and for non-MM of 99%. Two MMs scored less than three. Dermatologists' scores gave a PV for MM of 8% and for non-MM of 99%. One MM scored less than 3. Univariate analyses showed that enlargement (P less than 0.05), dermatologists' assessments of an irregular margin (P less than 0.001), size (P less than 0.05) and pigmentary irregularity (P less than 0.05), and patients' assessments of size (P less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Cryotherapy of hand warts--a questionnaire survey of 'consumers'.

One-hundred and thirty (82%) of 159 patients who had been treated with cryotherapy for warts on the hands replied to a postal questionnaire. Most patients had wanted treatment for cosmetic reasons, although 35% also wanted treatment because of pain. Only 34% had used a wart paint for more than 6 weeks before referral. The long-term results of cryotherapy were poor, although 83% of patients thought they had been cured in the short-term; only 57% of patients were clear of warts after a median of 19 months' follow-up. Seventy-one per cent had defaulted from follow-up. In some cases this may have been encouraged by the dermatologists, but other reasons were pain, cost and perceived failure of treatment. Nearly 90% tolerated cryotherapy well and for 76% this was the preferred method of treatment. Fifty-nine per cent would have preferred to be treated in their local health centre and 85% would have been willing to be treated by a nurse. The results are discussed and we conclude that cryotherapy should be offered as a treatment for hand warts in most general practices.

Adolescent↗
PubMed1989

Acute pancreatitis: a fatal complication of treatment of bullous pemphigoid with systemic corticosteroids.

Acute pancreatitis may be a rare complication of systemic corticosteroids, although this is disputed. We describe a patient with bullous pemphigoid whose treatment was complicated by fatal acute pancreatitis. The question of a cause and effect relationship is discussed with reference to the literature. We emphasise the way that corticosteroids modified the presentation of acute pancreatitis in this case.

Acute Disease↗
PubMed1989

Routine treatment of cutaneous warts: a questionnaire survey of general practitioners.

A postal questionnaire was sent to 185 general practitioners to assess their approach to cutaneous warts and their views on the future development of the routine wart treatment service; 159 (85.9%) replied. A wide range of treatments were offered and most patients were given some treatment. The main reasons respondents gave for referring patients to hospital were failure of wart paints (73.6%) and lack of availability of liquid nitrogen (70.4%). Most general practitioners (74.2%) believed that dermatologists should spend less than 5% of their time treating warts. Many general practitioners (61.6%) wanted a practice-based wart clinic offering cryotherapy and 30.8% would like to refer directly to a hospital clinic run by a nurse. A practice clinic was more popular with general practitioners who have a treatment room nurse (P less than 0.01). Most seemed to appreciate the need for training to use liquid nitrogen. We conclude that general practitioners are keen to use cryotherapy and we argue that hospital management should provide the necessary resources for running a community-based service.

Adult↗
PubMed1989

An audit of wart treatment in a Scottish dermatology department.

We measured a dermatology department's workload from wart treatment in terms of time and numbers, and we studied the use made of routine treatments according to the site of the warts and the age of the patient. Twenty-one per cent of new referrals were for warts and 19% of clinic time was used for wart treatment, 9% of clinic time was for plantar warts alone and 29.5% of new patients failed to attend. Overall cryotherapy was the commonest treatment, particularly for warts on the hands and face, 73.2% of patients treated for hand warts defaulted from follow-up and 11.3% were referred back for further treatment. The implications of the results are discussed and we argue that hospital budget holders should fund community-based wart treatment facilities.

Dermatology↗
PubMed1988

Death from metastatic, cutaneous, squamous cell carcinoma in autosomal recessive dystrophic epidermolysis bullosa despite permanent inpatient care.

A 36-year-old female patient with severe autosomal recessive dystrophic epidermolysis bullosa, who had spent her entire life from age 2 as an inpatient in the dermatology unit, recently died of metastatic squamous cell carcinoma of the skin. The development of malignancy was not prevented by continuous medical and nursing supervision and, despite early detection, rapidly led to her death. Oral phenytoin and topical mupirocin ointment had not reduced blistering.

Adult↗