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Biomedical subjects

M McKay

Publications and source records attributed to M McKay.

At least 19 recordsLinked to original sources
PubMed1992

Vulvodynia. Diagnostic patterns.

The symptom of vulvar burning demands special evaluation and management. Possible factors include complications of therapy, inflammatory dermatoses, lichen sclerosus, and infection with organisms such as Candida, human papillomavirus, and herpes simplex virus. Vulvar vestibulitis and dysesthetic vulvodynia or pudendal neuralgia have characteristic patterns of discomfort. Psychological aspects of vulvodynia include the need for supportive therapy.

Candidiasis↗
PubMed1991

Vulvitis and vulvovaginitis: cutaneous considerations.

Vulvar dermatoses (previously dystrophies) include psoriasis, allergic or irritant reactions, lichen sclerosus, lichen simplex chronicus, lichen planus, and tinea. Some of these have bullous or erosive forms, but they differ from the immune-mediated vesiculobullous disease group, which includes vulvar pemphigus, benign familial pemphigus, pemphigoid, linear IgA disease, and dermatitis herpetiformis. Vulvar ulcers can occur in dermatoses resulting from systemic disease (Behçet's syndrome, lupus, pellagra, and Reiter's disease) or malignancies resembling dermatoses (extramammary Paget's disease, squamous cell carcinoma, and vulvar intraepithelial neoplasia). Many vulvar dermatoses itch or burn. Vulvodynia occurs with irritant and allergic dermatitis, vulvar dermatoses, complications of steroid use, candidiasis, papillomatosis, vestibulitis, or essential (dysesthetic) vulvodynia. Diagnostic tests (potassium hydroxide, cultures, and biopsy) should establish the diagnosis and therapy should be specific. Few skin diseases are curable but all are treatable; effective management is defined by whether a medication reliably controls outbreaks or symptoms when it is used. Patience is recommended, because treatment may take weeks or months.

Administration, Topical↗
PubMed1991

A comparison between Ki-67 antibody reactivity and other pathological variables in breast carcinoma.

Methods of assessing tumor proliferation rates include mitosis counting, flow cytometry and thymidine labelling. While the former is inaccurate and poorly reproducible, the latter methods are time consuming and expensive to perform. Ki-67 is a monoclonal mouse antibody which has been shown to react with a nuclear antigen in proliferating cells. Frozen sections from 75 specimens of breast carcinoma were immunostained with this antibody using an immunoperoxidase technique. The percentage of tumor cells stained, the Ki-67 score, was then compared with a number of pathological and clinical variables in the patients concerned. A positive correlation was seen between the Ki-67 score and mitotic rate (r = 0.71); and a negative correlation was seen between Ki-67 score and estrogen receptor status (r = -0.4). Ki-67 immunostaining may represent a cheap and reproducible method of assessing proliferation rates of breast carcinomas which is applicable in routine laboratories. Further prospective studies are being undertaken to assess its contribution to prognosis.

Adult↗
PubMed1991

Vulvar dermatoses.

Benign and malignant vulvar disorders may look alike, making diagnosis difficult for even experienced vulvologists. Understanding basic principles of differential diagnosis and diagnostic testing is necessary for good medical or surgical management. Skin diseases do not respond quickly even when treatment is appropriate. Therefore it is especially important to establish the correct diagnosis as early as possible. This group of dermatoses demands careful distinction of sometimes subtle differences, but the physician and patient will be rewarded by a sure response to correct therapy.

Diagnosis, Differential↗
PubMed1990

Vulvar dermatoses: common problems in dermatological and gynaecological practice.

The most commonly encountered vulvar dermatoses present as cutaneous papules or scaly plaques. The two major categories are the papulosquamous disorders, which include psoriasis, seborrhoea and the 'lichens' (lichen planus, lichen sclerosus, lichen simplex chronicus) and chronic or recurrent infections (tinea, Candida, papillomavirus, herpes simplex). These conditions are morphologically similar, and treatment for one condition may affect the appearance of another. Lichen simplex chronicus (LSC, histologically squamous cell hyperplasia) is a secondary dermatosis, a non-specific cutaneous change indicating the presence of pruritus. Candida, tinea, lichen sclerosus, papillomavirus and topical agents have all been implicated in the development of LSC. Chronic vulvar burning (vulvodynia) is rarely associated with cutaneous change other than erythema, but may occur with vulvar dermatoses, occult Candida or papillomavirus infection, vulvar vestibulitis or cutaneous dysaesthesias. Topical preparations are most commonly used to treat vulvar disorders. Treatment trials typically require several weeks of therapy to determine responses. Allergic reactions to components must be distinguished from irritants, and complications of therapy must be recognised and prevented if possible. Overuse of topical medications, especially steroids, may lead to mycotic superinfection or to rebound dermatoses related to steroid withdrawal. Anxious patients may overclean or overtreat sensitive genital skin in the belief that they are unclean or harbour a sexually transmitted disease. In some situations, systemic medication may offer an appropriate adjunct or alternative to topical therapy.

Female↗
PubMed1989

Bone metastases in hypernephroma. Frequency of scapular involvement.

A consecutive series of 95 patients with hypernephroma was studied retrospectively after it was clinically suspected that there was a propensity for this tumor to metastasize to the scapula. Fifteen patients (15.8%) have developed scapular metastases which account for 36.6% of all bone metastases in this series, the majority of which required radiotherapy for pain relief. The scapula was a solitary site of bone metastasis in the majority of patients, and, even when associated with other bone lesions, was frequently an isolated site of pain. A comparative series of 40 consecutive patients with breast cancer metastatic to bone was retrospectively studied. Twenty-five percent of these showed scapular metastases but these were all in association with multiple (greater than 3) other bone metastases; none was symptomatic or required treatment. There was a suggestion that hypernephromas spread more often to the ipsilateral scapula, but the trend did not reach statistical significance. Scapular metastasis in hypernephroma is a common and clinically significant problem, sometimes giving a clue to the primary site. The cause for this predilection is not known.

Adult↗
PubMed1989

Vulvodynia. A multifactorial clinical problem.

Symptomatic vulvar burning (vulvodynia) in the absence of abnormal physical findings was long thought to be an unusual psychosomatic gynecologic problem. Within the past decade, however, a number of investigators began to study patients with this frustrating problem. Initial physician insistence on a major role for psychological factors has gradually given way to sophisticated searches for evidence of persistent infectious agents, especially human papillomavirus and Candida. Gynecologists searching for causes and surgical relief of vulvodynia have even reevaluated elements of vulvar anatomy. The purpose of this article is to introduce dermatologists to current perspectives on vulvodynia in the context of the clinical experience of the author, who has been actively involved in the multidisciplinary investigation of this problem since its recognition in the early 1980s. To date, the following five sign-symptom complexes have been identified by the author and recognized by other vulvodynia investigators: (1) vulvar dermatoses, (2) cyclic vulvitis, (3) vulvar papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. A given patient's complaint may be primarily associated with one of these factors, but it is not unusual to see others develop simultaneously or sequentially. Remission or exacerbation of symptoms may occur when treatment for one condition affects the onset of another. It is evident that vulvodynia is a complex diagnosis and that recognition of multiple factors is important to appropriate patient evaluation and management.

Female↗
PubMed1989

Seborrhea, psoriasis and the papulosquamous dermatoses.

Knowledge of the papulosquamous disorders is an important part of the diagnosis of skin diseases in general. Recognition of these commonly encountered cutaneous problems depends upon familiarity with the configuration and distribution of lesions on various parts of the body. Diagnostic tests (such as KOH to rule out tinea) should be performed, and when therapy does not seem to be successful, the diagnosis should be reconsidered with a biopsy and/or dermatologic consultation.

Dermatitis, Seborrheic↗
PubMed1989

Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid.

A prospective study was undertaken of fifty-one patients who were randomly assigned to treatment with either a long or a short thumb-spica cast for a non-displaced fracture of the carpal scaphoid. The duration of follow-up was at least until union; the average follow-up was twelve months. Twenty-eight fractures were treated with a long thumb-spica cast and twenty-three, with a short thumb-spica cast. The hands that initially were treated with a long thumb-spica cast were placed in a short thumb-spica cast after six weeks. Fractures that initially were treated with a long thumb-spica cast united at an average of 9.5 weeks and those that were maintained in a short thumb-spica cast, at an average of 12.7 weeks. There were no non-unions and two delayed unions in the fractures that initially were treated with a long thumb-spica cast, compared with two non-unions and six delayed unions in those that had only a short thumb-spica cast. Fractures of the proximal or middle third of the carpal scaphoid had a significantly shorter time to union when they were treated initially in a long thumb-spica cast. Fractures of the distal third did well regardless of the type of immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Epitopes recognized by human T cells map within the conserved part of the GP190 of P. falciparum.

In a study aimed at developing a vaccine against the asexual blood stages of Plasmodium falciparum, two T cell epitopes were identified within a nonpolymorphic region of gp190 of Plasmodium falciparum merozoites. The two epitopes, which were revealed by deletion analysis, stimulated human T cell clones. Peptides containing sequences of the epitopes stimulated the cloned T cells and peripheral blood mononuclear cells (PBMC) from malaria-infected individuals. Moreover, the T cell clones responded to 11 different Plasmodium falciparum isolates in culture, showing that the epitopes are recognized in native parasites.

Amino Acid Sequence↗
PubMed1988

Cutaneous manifestations of candidiasis.

Candida is identified microscopically by the observation of hyphae, linear chains of asexually budding yeast. Since these structures do not grow extensively through the stratum corneum, cutaneous samples may require Gram stain for identification. Since Candida can colonize normal tissue and also be a culture contaminant, clinicians should consider predisposing factors and clinical presentation when making a diagnosis of candidiasis. Predisposing cutaneous factors for candidiasis include occlusion, maceration, and altered barrier function. The hallmarks of Candida infection are bright erythema, fragile papulopustules, and satellite lesions. Cutaneous and mucous membrane candidiasis may differ in appearance, and sexual transmission should be considered. Treatment usually involves a topical or oral anticandidal agent, such as an imidazole. Although implicated as a predisposing factor to candidiasis, mild topical steroids can be used as short-term adjuvant treatment of these infections; when used responsibly, steroids provide antiinflammatory effects that speed relief of patient discomfort.

Anti-Inflammatory Agents↗
PubMed1988

Monitoring for central apnoea in infancy--limitations of single channel recordings.

Apparent central apnoea (absent breathing movements) detected by monitoring movement of the thoracic wall was compared with simultaneous detection by abdominal wall movement. Eighteen infants provided one or more 24 hour recording of heart rate (electrocardiography), thoracic respiration (transthoracic impedance), and abdominal wall movement (pressure sensitive capsule distortion). Detection of true apnoea, recognition of artefact, and measurement of the duration of true apnoea were all improved when two channels of respiratory monitoring were used in combination. We recommend that any study purporting to observe breathing patterns by indirect recording of respiratory movement will be more reliable if more than one channel of respiratory movements is recorded simultaneously. Further, in infants no estimation of duration of central apnoea can be made on the basis of either a transthoracic impedance record alone or an abdominal wall movement sensor alone. Comparison of findings among studies using different single channel recordings are unlikely to be meaningful.

Electrocardiography↗