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Biomedical subjects

N H Cox

Publications and source records attributed to N H Cox.

At least 19 recordsLinked to original sources
PubMed1992

Using clinicopathological analysis of general practitioner skin surgery to determine educational requirements and guidelines.

OBJECTIVE: To study the impact of skin surgery in general practice on the workload of a pathology laboratory and to identify what further training might be helpful. DESIGN: Analysis of skin biopsy specimens from general practitioners before and after their new contract to determine numbers of specimens, changes in diagnoses, adequacy of treatment of malignant tumours, and areas of low diagnostic accuracy. SETTING: District general hospital. SUBJECTS: All 1017 skin biopsy specimens from general practice for 15 months before and 12 months after the new general practitioner contract. RESULTS: The number of pathology specimens received increased from 16 to 65 per month (median = 6 submitted by each general practitioner in the post-contract year). The proportion of the more common pathological diagnoses was unchanged between the two periods, but the proportion of correctly diagnosed naevi, cysts, and seborrhoeic keratoses increased in the second. Although few diagnoses were overtly incorrect, accurate diagnosis of dermatofibromas and malignancies decreased after the contract, and the overall correct diagnosis rate for seborrhoeic keratoses, dermatofibromas, rashes, and malignancies was below 30%. Only nine out of 21 squamous cell carcinomas were adequately excised with tumour free margins, and follow up of malignant tumours may have been inadequate. CONCLUSIONS: Skin surgery in general practice has advantages but matters of concern are the increase in laboratory workload, the excision of some benign lesions, and the inappropriateness of biopsy of rashes. Squamous cell carcinoma and other malignant tumours submitted for pathological examination were often unsuspected and inadequately excised, and heightened suspicion is recommended. Pathology request forms may need redesigning to encourage provision of clinical details.

Biopsy↗
PubMed1992

Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome.

We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.

Aged↗
PubMed1992

The relationship between chronological age and the erythemal response to ultraviolet B radiation.

To investigate whether erythemal responses to ultraviolet radiation alter with age, we have reviewed the results of monochromator phototesting in adults and children, and have measured the dose-response curves for UVB erythema in a further 38 subjects. There was no significant difference between adults and children in minimal erythema dose (MED) at 300 nm; the median MED in 254 adults was 34 mJ/cm2 (range 14-80 mJ/cm2) and in 24 children aged less than 15 years was 30 mJ/cm2 (range 10-80 mJ/cm2). Objective measurements of UVB-induced erythema were performed in 15 subjects aged below 25 years and 23 subjects aged above 60 years. A dose-response curve for UVB erythema was constructed for each subject and the slope of the steepest part of each curve calculated by logit regression; the values in the young subjects were greater than in the older group (P less than 0.02). However, there was no difference between the two groups in either the visually assessed MED or the calculated UVB dose required to produce a constant degree of mild erythema.

Adult↗
PubMed1992

An acantholytic dyskeratotic epidermal naevus with other features of Darier's disease on the same side of the body.

Many epidermal naevi with the histology of Darier's disease have been reported. In the absence of associated features of Darier's disease, they cannot be assumed to have a common pathogenesis with it, and it has been suggested that they are better classified as acantholytic dyskeratotic epidermal naevi rather than naevoid Darier's disease. We describe a patient with such a naevus who had typical nail and palmar changes of Darier's disease on the same side of the body. We suggest that in at least some cases the naevus has the same genetic defect(s) as generalized Darier's disease, and discuss the possibility that a patient with such a naevus could occasionally transmit Darier's disease to an offspring.

Adult↗
PubMed1992

Dermatitis artefacta as the presenting feature of auto-erythrocyte sensitization syndrome and naproxen-induced pseudoporphyria in a single patient.

A female patient presented with two episodes of apparent dermatitis artefacta. Although it was clear that self-induced lesions were present on both occasions, there was also strong evidence in support of auto-erythrocyte sensitization syndrome on the first occasion and of naproxen-induced pseudoporphyria on the second occasion. The occurrence of two such rare disorders in a single patient is extremely unusual, and we discuss a possible pathogenetic link between them. The case emphasizes that patients with apparent artefactual lesions, or with a previous history of dermatitis artefacta, still require careful evaluation to identify organic disease.

Adolescent↗
PubMed1992

Basal cell carcinoma in young adults.

The epidemiology and outcome of basal cell carcinoma (BCC) in adults aged 15-34 years were examined. Northern Region Cancer Registry data from 1979 to 1989 revealed a crude annual incidence of 37/100,000 total population and the incidence was constant in all age-groups during this period; 150 patients (1.2%) were aged 15-34 years. There was a small excess of females in the young age-group. The outcome of BCC in young adults was determined using records of all patients registered over 5 years ago and additional information from family doctors where required. Patients with BCC in naevus sebaceous or with syndromes of which BCCs are a feature were excluded. Median duration of BCC pre-diagnosis was 3 years. Of 39 patients with completed 5-year follow-up data, 21% had either incomplete excision requiring further early treatment (n = 4), a later local recurrence (n = 2), metastatic BCC (n = 1) or a subsequent further primary tumour (n = 1); an additional three patients had two primary tumours at initial presentation. Median hospital follow-up was 12 months but the apparent disease-free interval in patients with recurrent or new BCC was frequently over 2 years. BCC in young adults may not be suspected because it is uncommon. However, the high frequency of local recurrence and of multiple primary tumours indicates that careful follow-up is prudent in young patients with this tumour.

Adolescent↗
PubMed1991

Induction of lesions of dermatitis herpetiformis by autologous serum.

In the present study various factors which contribute to the initiation of lesions in dermatitis herpetiformis (DH) were examined. Thirty-one patients with DH, seven with bullous pemphigoid, two with linear IgA disease and two healthy subjects were studied either before starting treatment or after stopping dapsone for up to 5 days. Intradermal inoculation of freshly prepared autologous serum was followed after 18-24 h by the formation of DH-like lesions in 24/31 DH patients. The lesions were erythematous papules, often with vesicles and microscopically showed papillary tip microabscesses. Serum-induced formation of lesions only occurred in patients with active DH with some spontaneous lesion formation: it did not occur in any of the non-DH controls. The formation of lesions was dose-related, declining proportionately with dilution of the serum down to 1/16. Plasma prepared by various methods of anticoagulation (heparin, citrate, EDTA) caused lesser reactions, while addition of heparin or epsilon-amino caproic acid (EACA), but not citrate, to serum substantially inhibited the formation of lesions. This suggested the responsible factor might be a protease. Other vasoactive agents including histamine (1-4 micrograms) and compound 48/80 (1-5 micrograms) caused normal immediate wealing. DH-like lesions occurred in only one of 13 subjects challenged with histamine and two of nine challenged with 48/80. In all these, autologous serum elicited large vesicular responses. There is a factor(s) in serum in DH which can initiate the formation of lesions. This factor appears to be activated by clotting and can be inhibited by heparin and EACA, suggesting it may be a protease.

Blood↗
PubMed1991

The relationship between plasma psoralen concentration and psoralen-UVA erythema.

The plasma 8-methoxypsoralen (8-MOP) concentration was measured in 60 patients commencing psoralen photochemotherapy (PUVA). At the time of blood sampling each patient was phototested using a series of 10 exposures to UVA. The resulting erythema was measured objectively 72 h after irradiation and dose-response curves for psoralen-UVA erythema were constructed. Although the dose of 8-MOP was calculated according to body weight, patients receiving 30 mg of 8-MOP had a significantly lower mean plasma concentration than those receiving higher doses. There was no significant correlation between plasma 8-MOP concentration and minimal phototoxic dose, either estimated visually or calculated from the dose-response curves. However the slope of the dose-response curve showed significant correlation with plasma 8-MOP concentration. The variation between patients in the rate of increase of the erythemal response, but not the variation in threshold sensitivity, can be explained by difference in plasma psoralen concentration.

Adolescent↗
PubMed1991

Dowling-Degos disease and Kitamura's reticulate acropigmentation: support for the concept of a single disease.

Dowling-Degos disease and Kitamura's reticulate acropigmentation are both rare disorders of pigmentation, which predominantly affect the flexures and the extremities, respectively. A small number of patients with features of both disorders have been described, suggesting that these clinical patterns may be different manifestations of the same disease. We present a further case to support this conclusion.

Axilla↗
PubMed1991

Halo eczema--resolution after excision of the central naevus alone.

We describe a patient with halo eczema around a benign pigmented compound naevus. The eczema resolved after excision of the central naevus alone; this allowed histological assessment of the naevus without the need for a large excision or for additional topical therapy.

Adult↗
PubMed1991

Osteochondroma of humerus in focal dermal hypoplasia (Goltz) syndrome.

Focal dermal hypoplasia (Goltz) syndrome was diagnosed in a 26-year-old female subject and her 5-year-old daughter. The mother had been treated surgically for syndactyly in early childhood, and at the age of 12 years had developed a large osteochondroma of the proximal humerus. This is a further bone tumour which should be added to the skeletal manifestations of this syndrome.

Adult↗