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Biomedical subjects

N J Levell

Publications and source records attributed to N J Levell.

At least 19 recordsLinked to original sources
PubMed2005

Cutaneous findings in mummies from the British Museum.

This paper describes pathological abnormalities visible on the skin of mummies in the British Museum, London, and the photographic methods used to record their appearances. Although the mummification process limits the clinical information available, features compatible with eczema were identified for only the second time in mummified remains.

Adolescent↗
PubMed2004

Sulphur and skin: from Satan to Saddam!

Since the dawn of time, Beelzebub has been showering fire and brimstone (sulphur) on tortured souls, but the cutaneous effects of this have been poorly described. Sulphur has also been used for centuries as a treatment for many skin conditions, such as fungal infections, scabies, psoriasis, eczema and acne. It has also been used extensively in cosmetic preparations and by cosmetic dermatologists treating conditions such as seborrhoeic eczema. Many natural bathing spas have high levels of sulphur; such balneology has been advocated by medical and cosmetic dermatologists as an effective treatment for cutaneous disorders for more than 500 years. Sulphur was often the active agent in many of the so-called 'patent medicines' that became popular in the mid-nineteenth century. Time has not withered medical practitioners' enthusiasm for sulphur. There are various reports in the medical literature of its current use. However sulphur treatment is not without its risks; a sulphur spring dermatitis has been described from a spa bath in Taiwan. With the satanic threat of bio-terrorism, some dermatologists may be treating the effects of contact with sulphur mustard all too soon.

Journal Article↗
PubMed2000

Thomas Bateman MD FLS 1778-1821.

Thomas Bateman was a physician to the Carey Street Public Dispensary with Robert Willan in the first decade of the nineteenth century when the latter was developing the classification that would act as a foundation for modern dermatology. Following Willan's death with his work still incomplete, Bateman published a book, as an abstract of Willan's full concept, which was probably the most influential dermatology text of the nineteenth century. This was the first classification of dermatology that precisely defined the terms used and fitted individual diseases into a single class, rather than considering different stages of the same disease as maladies that belonged in different classes. This was the first attempt to link treatment to the disease process rather than to the clinical appearances and thus represents the origin of modern scientific clinical dermatology.

Dermatology↗
PubMed1996

Inhibitors of nitric oxide synthase in human skin.

The aim of this study was to investigate in human skin in vivo the role of nitric oxide in maintaining resting vascular tone, in the vasodilatation caused by local warming and by ultraviolet B light exposure, and in the response to exogenous calcitonin gene-related peptide (CGRP). Cutaneous blood flow was assessed by planimetry of the visible erythema or pallor and by laser Doppler flowmetry. Intradermal injection of the inhibitor of nitric oxide synthase, NG-nitro-L-arginine methyl ester (L-NAME; 25 nmol), into forearm skin produced a visible pallor and a reduction of blood flow at a controlled ambient temperature of 21 degrees C. The control, NG-nitro-D-arginine methyl ester (D-NAME; 25 nmol) or NG-monomethyl-L-arginine (L-NMMA; 25 nmol) did not cause pallor or reduce blood flow. L-NAME and L-NMMA caused dose- and time-dependent increases in pallor, and reductions in cutaneous blood flow in skin that had been locally warmed by immersion in water at 45 degrees C and in skin that had been exposed to ultraviolet B light. D-NAME and D-NMMA at comparable concentrations did not have the effects on skin blood flow observed with the L forms. L-NAME and L-NMMA both inhibited the increased blood flow in human skin caused by the intradermal injection of CGRP (12.5 or 25 pmol). The reduction of CGRP-induced increase of blood flow by L-NAME was reversed by L-arginine. Neither D-NAME nor D-NMMA inhibited the increase in blood flow caused by CGRP. Neither L-NAME nor L-NMMA inhibited the increase in blood flow in human skin caused by the intradermal injection of prostaglandin E2 (63 pmol). The data show that nitric oxide is involved in the maintenance of resting blood flow in human skin and also in the cutaneous vasodilator responses to local warming, ultraviolet B irradiation, or injection of CGRP.

Adolescent↗
PubMed1996

Hypersensitivity in aseptic loosening of total hip replacements. The role of constituents of bone cement.

Aseptic loosening is seen in a significant proportion of cemented total hip replacements (THR). In a small subgroup of patients who suffer early loosening polyethylene debris is unlikely to be responsible. We recently reported one case of allergic contact dermatitis to N,N-dimethylparatoluidine (DMT), an accelerator used in bone cement. We have therefore investigated this using skin-patch tests to a variety of substances including metals, polyethylene and the separated individual components of Simplex cement. We studied 70 patients, 15 with aseptic loosening less than two years after THR, 25 with satisfactory long-term cemented fixation, five with infected loosening of cemented THRs and 25 awaiting hip arthroplasty. We found seven positive reactions to DMT, all of them in patients with the rapid onset of aseptic loosening. Allergy to DMT is recognized in the dental profession in respect of the 'denture sore mouth' syndrome, and could also be an occupational hazard since some industrial glues contain DMT. Our results suggest the need for awareness of possible previous dental or occupational exposure of the constituents of bone cement. We recommend the use of skin-patch testing in high-risk cases.

Aged↗
PubMed1996

Systemic corticosteroids in the phenytoin hypersensitivity syndrome.

A patient is described with the characteristic features of phenytoin hypersensitivity syndrome (PHS) including fever, erythroderma, tibial and facial oedema, pinhead-sized facial pustules and abnormal liver function tests. The use of systemic corticosteroids in this condition is not established. We report the resolution of all the features of PHS with systemic corticosteroids and recurrence on withdrawal, and further remission on reinstitution of systemic corticosteroids.

Anti-Inflammatory Agents↗
PubMed1996

Systemic sclerosis associated with right ventricular cardiomyopathy.

Systemic sclerosis is an uncommon multisystem disorder of unknown aetiology which predominantly affects the skin. Cardiac involvement, which is far more common than was originally realized, may affect any part of the heart but most frequently affects the left ventricular myocardium. Right ventricular dysfunction is usually associated with pulmonary vascular disease. We report a case of systemic sclerosis associated with right ventricular cardiomyopathy in whom pulmonary artery pressures were normal.

Adult↗
PubMed1995

Remission of ordinary psoriasis following a short clearance course of cyclosporin.

We set out to show that the assumption is incorrect that continuous treatment with cyclosporin is necessary in psoriasis, as this tenet forms a basis for current recommended treatment regimens. Sixty patients with mild to moderate plaque psoriasis were allocated at random to treatment with oral cyclosporin 5 mg/kg/day (30 patients) or topical dithranol and ultraviolet B therapy (30 patients) for up to 16 weeks until clear (median time 6 weeks cyclosporin and 8 dithranol), and the times to relapse compared. The patients were seen monthly for up to 8 months, and the severity and the extent of psoriasis were assessed. Relapse, defined as return of psoriasis to 50% of the area at the start of the trial or patient demand for further treatment, was not significantly different between the groups (hazard ratio 1.11, 95% CI 0.55-2.32). No patients suffered a rebound of severe disease and none relapsed in the first 8 weeks after stopping treatment. The relapse rate was higher following cyclosporin from 8 to 28 weeks after treatment and following dithranol from 28 to 34 weeks. The patients with arthritis had a higher median joint severity score at relapse than prior to treatment with cyclosporin. At the end of 8 months, 5 patients treated with dithranol and 8 patients with cyclosporin remained clear, 75% and 67% having relapsed. We conclude that rapid relapse does not occur after clearance of mild to moderate plaque psoriasis with cyclosporin and the relapse rate was no different from dithranol treatment.

Administration, Oral↗
PubMed1994

Maintenance treatment with cyclosporin in atopic eczema.

We have studied two reducing-dose regimens intended to minimize toxicity of cyclosporin A (CyA) while maintaining its capacity to control atopic eczema following induction of remission. Twenty-four patients with severe chronic atopic eczema were first treated in a double-blind randomized placebo-controlled cross-over study of CyA (5 mg/kg/day). All 19 who completed the study showed the expected highly significant improvements, compared with placebo, in area involved, erythema, excoriation, lichenification, itch and requirement for topical steroid. In 17 of the 19 patients, control was re-established with CyA 5 mg/kg/day, and they were then re-randomized to stepwise reduction at 2-week intervals in either (i) the dose of CyA given daily, or (ii) the frequency with which the 5 mg/kg dose was given. Fifteen patients (seven continuous reducing dose, eight intermittent fixed dose) completed the planned reduction to either 1 mg/kg/day or 5 mg/kg every fifth day. In both groups the response was sustained despite dose reduction, although control was less good at a continuous dose of 1 mg/kg. Intermittent treatment was as good as or better than continuous reducing dosage in this study, and in both groups there was further deterioration after the drug was stopped. The findings suggest that the dose of CyA required to control atopic eczema is less than that required to achieve remission, and that the therapeutic index can be further improved by alternative dosing strategies. This offers a new approach to maintenance treatment of eczema and other chronic refractory dermatoses.

Adult↗