Biomedical subjects

Marius Rademaker

Publications and source records attributed to Marius Rademaker.

12 recordsLinked to original sources

PubMed2007

Retrospective review of primary melanomas excised at Waikato Hospital, New Zealand, 2002-2003.

The aim of this study was to review and compare melanomas referred by general practitioners and melanomas identified at specialist clinics. The medical records relating to 113 primary melanomas excised at Waikato Hospital (a specialist regional base hospital) during 2002 and 2003 were reviewed retrospectively. Forty-seven melanomas (41%) were detected when patients attended specialist clinics (mainly plastic surgery and dermatology), and 66 melanomas (59%) were specifically referred by general practitioners. The melanomas detected at specialist clinics had a lower mean Breslow thickness than those referred by general practitioners (0.57 mm compared with 1.45 mm). Patients referred by general practitioners waited a mean of 26.5 days (range 0-94 days) for first specialist assessment. Following specialist assessment, patients waited a mean of 24.2 days (0-81 days) before excision biopsy.

Adult↗

PubMed2007

Contact dermatitis to a canine anti-dandruff shampoo.

A 40-year-old teacher presented after her third episode of acute facial oedema within 4 months. Each episode occurred 1-2 days after visiting her mother's house. Patch testing showed positive reactions to miconazole and econazole nitrate. The patient denied use of any antifungal creams, but it transpired that her mother's dog was being shampooed weekly with an antifungal shampoo containing miconazole. No further episodes were recorded after discontinuing the antifungal shampoo.

Adult↗

PubMed2006

Cavitary pyoderma gangrenosum treated with local infusion of corticosteroid.

BACKGROUND: Pyoderma gangrenosum (PG) is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration, often representing a pathergy response. OBSERVATIONS: We report a case of spontaneous retrosternal PG that developed on the background of previous PG of the skin of the back. The patient had underlying ulcerative colitis. After failure of prednisone, minocycline, and dapsone, a novel method was instituted. Local flushing with dexamethasone, by a radiologically inserted retrosternal catheter with precordial suction, induced a rapid and sustained response. Subsequently maxillary sinus PG developed after the patient's tooth extraction. This responded to local corticosteroid injections in combination with systemic corticosteroid. LIMITATIONS: Further reports of this technique are required to consolidate its use and infusion variables. CONCLUSIONS: Two unusual sites of PG have been described, with successful treatment by a novel local steroid infusion. The profound sensitivity to trauma is demonstrated, which suggests that prophylactic corticosteroid may be useful for essential surgical intervention.

Biopsy, Needle↗

PubMed2004

Audit of acute referrals to the Department of Dermatology at Waikato Hospital: comparison with national access criteria for first specialist appointment.

AIM: This audit was designed to compare current referral practice with the Ministry of Health elective services National Access Criteria for first Specialist Assessment (ACA) guidelines, to identify specific problems, and (if possible) to improve the use of acute dermatology services. METHOD: Information regarding referral source, information provided, urgency and diagnostic accuracy, time interval between referral and consultation date, and follow-up arrangements was collected via data sheet on each referral received. We confined the audit to acute referrals--ie, 'immediate and urgent cases' from general practitioners (GPs) that had been discussed with the dermatologist by phone, and internal referrals when an urgent consultation had been requested. RESULTS: More acute referrals came from other hospital departments (74%) than from general practitioners (26%). Acute referrers, especially hospital teams, tended to overestimate the urgency with which a dermatological condition needed to be seen. Information about inpatients was often considered inadequate for triage. GP referrals contained more useful information. GP referral diagnostic accuracy is in keeping with other studies (approximately 50%) but the diagnostic accuracy of hospital doctors is well below this level. All acute referrals were seen within the recommended timeframe. Follow-up patterns were similar (whether referrals came from general practitioners or hospital teams) but for both groups there was a relatively high failure to attend rate. CONCLUSIONS: Inappropriate referrals are time-consuming and reduce our capacity for seeing community patients on the waiting list. To improve referral triage, we recommend that a referral letter that clearly specifies the information that should be provided. The majority of acute referrals did not comply with the ACA guidelines. We recommend applying the ACA guidelines to internal acute dermatology referrals (as well as those from GPs) to reduce unnecessary inpatient reviews, and to provide a better urgent service for those persons who truly require it.

Acute Disease↗

PubMed2004

Cutaneous B-cell lymphoma of nails, pinna and nose treated with chlorambucil.

An 83-year-old woman presented with primary multifocal cutaneous B-cell lymphoma, presenting as discrete nodules on the right pinna and nail-bed of the left middle finger, diffuse swelling and erythema of several other nail-beds of the fingers and toes, with associated pincer nail deformity and rhinophyma. Because of the involvement of several sites not amenable to radiotherapy, she was treated with oral cyclical chlorambucil with good result.

Aged↗

PubMed2004

Healing of severe ulcerative necrobiosis lipoidica with cyclosporin.

A 55-year-old woman with severe, chronic, treatment-resistant ulcerating necrobiosis lipoidica of the shins was commenced on oral cyclosporin at a dose of 2.5 mg/kg/day. Improvement started within 1 week of commencing treatment, and the lesions healed completely over 8 months. Further ulceration occurred 3 months after discontinuing cyclosporin, with improvement on reintroduction of cyclosporin. There have been four previous case reports of healing of treatment-resistant ulcerating necrobiosis lipoidica with cyclosporin.

Cyclosporine↗

PubMed2004

Allergic contact dermatitis to a sanitary pad.

A 13-year-old girl presented with a recurring vulval dermatitis that started several days after first using a sanitary pad. The rash settled but recurred with subsequent use of the same sanitary pads. Patch testing revealed a marked sensitivity (3+) to colophony (rosin). She denied previous reactions to adhesive tape/sticking plaster. During patch testing she also developed reactions to a black permanent waterproof marking pen used to mark the site of patch tests. The ink of this pen also contained colophony.

Adolescent↗

PubMed2003

Occupational contact dermatitis to hydrangea.

Two female commercial hydrangea growers, from separate nurseries, presented with similar hand and facial dermatitis. Both had a hand dermatitis affecting particularly the first three fingers and backs of both hands and complained of a recurrent facial dermatitis affecting the forehead, around both the eyes and bridge of nose. They related their dermatitis to their work. Patch tests confirmed allergy to all components of hydrangeas including petal, leaf and stem. Avoidance resulted in resolution of their dermatoses. Allergy to hydrangeas has been reported previously although infrequently.

Adult↗

PubMed2003

Online consumer health education in dermatology.

Comprehensive and accurate health information for the consumer has the potential to improve patient care and health outcomes. NZDermNet, the web site of the New Zealand Dermatological Society, was established in 1996. Its consumer health information section includes more than 250 pages of information about skin diseases and their treatment. It has proven popular with health professionals and patients. In 2002 an average of more than 5000 visitors used the site daily.

Dermatology↗

PubMed2002

Allergic contact dermatitis following exposure to essential oils.

Allergic contact dermatitis from the topical use of essential oils is not widely recognized as an occupational hazard. Four cases of allergic contact dermatitis to essential oils occurring in three aromatherapists and one chemist with a particular interest in aromatherapy are described. All presented with predominantly hand dermatitis and demonstrated sensitization to multiple essential oils. One patient developed a recurrence of cutaneous symptoms following ingestion of lemongrass tea. Workers within this industry should be aware of the sensitization potential of these products and the risk of limiting their ability to continue employment.

Adult↗

PubMed2002

Contact dermatitis to phenol-formaldehyde resin in two plywood factory workers.

Two cases of occupational allergic contact dermatitis in plywood mill workers are presented. Although both patients thought they were allergic to sawdust, they were in fact allergic to a phenol-formaldehyde resin used to bond the plywood sheets together. Both patients only developed their dermatitis when they came into contact with uncured glue.

Adult↗

PubMed2002

Pharmacoeconomics of drug therapy for atopic dermatitis.

Atopic dermatitis is an increasingly prevalent common childhood disease. While the majority of patients have mild disease, atopic dermatitis can cause considerable distress to patients and their caregivers, with significant social and financial cost to families. With a prevalence of 15 - 20% in Western countries, atopic dermatitis also has a considerable health and societal cost to the community. Many new treatments have been shown to be therapeutically effective, particularly in severe disease, including cyclosporin A (Neoral, Novartis AG), interferon, tacrolimus (Fujisawa Pharmaceutical Co. Ltd.) and iv. immunoglobulin. These are expensive when compared to standard treatments like emollients and topical corticosteroids and have significant adverse effects that limit their use. Additional costs related to monitoring are incurred and the long-term safety of these treatments is yet to be determined. However, an advantage over more traditional therapies is their ability to produce benefits even after treatment ceases. Treatments that produce long-term remissions have a greater likelihood of being cost-effective. With monetary constraints on healthcare and the importance governments place on reducing drug costs, economic evaluations are becoming an increasingly important factor for drug acceptance. Those evaluating cost-effectiveness should pay particular attention to the potential reduction in indirect and intangible costs. Unfortunately, there is a dearth of cost-effectiveness studies in atopic eczema and this needs to be addressed with some urgency.

Cost of Illness↗