Biomedical subjects
Publications and source records attributed to P H Jacobs.
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The administration, effectiveness, action, adverse reactions, and commentary are presented in Table I for a selected number of systemic antifungal agents.
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Age of the patient, climate, season, and local environmental factors influence the onset and course of tinea versicolor (pityriasis versicolor). A number of effective topical therapies are available. In addition, a single dose of 400 mg of oral ketoconazole eliminates the disease and can be used prophylactically in some cases to prevent recurrence.
The number of cases of mycotic infections are increasing, presenting physicians today with an unprecedented challenge in handling the treatment and prophylactic control of these disorders. The increase in mycotic disorders is due to many factors, such as longer life span, organ transplantation, and the acquired immunodeficiency syndrome. The pharmaceutical industry is providing physicians with newer, more potent drugs to manage mycoses. An overview of current practice in the use of topical and oral agents, especially ketoconazole, are given in the following specific mycoses: tinea capitis, pityriasis versicolor, seborrheic dermatitis, Trichophyton rubrum infections, vaginal candidiasis, and moist intertriginous tineas. The efficacy of ketoconazole in various vehicles and dosage schedules and of traditional agents such as griseofulvin are discussed with relation to each of the mycoses.
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A great number of human diseases can be attributed in some way to the effects of fungi, and consequently have long been recognized as important to the dermatologist and mycologist. However, not in all spheres of medicine are fungi significant in the diagnosis and treatment of disease. Fungi are biochemically similar to the host since they are eukaryotic. Thus, it is difficult to synthesize agents that will destroy the pathogenic organism and not harm the patient. Ketoconazole, an imidazole, was the first broad-spectrum, oral antifungal drug to be used in clinical medicine. Selected publications on the pharmacology, comparative efficacy in treatment, toxicity and safety of ketoconazole are briefly reviewed. In addition, new areas of research being undertaken for the azole derivatives are surveyed.
There are many occupations that expose people to dermatophytes. Infections from dermatophytes may be transmitted from animal to animal, animal to human, human to human, and human to animal in a cyclic fashion. The most common species of dermatophytes that infect animals and humans, Microsporum and Trichophyton, are discussed here.
Endometrial cups in horses are outgrowths appearing in the uterine wall of the pregnant horn between approximately 38 days and 150 of gestation. The cups are structures which vary in shape from oval to irregular and have distinct raised edges, showing an ulcer-like form. The maximum measurements are approximately 5 X 2.5 X 2.5 cm. Microscopic examination shows that they consist of large epithelioid decidual-like cells having large nucleoli. Pregnant Mare Endometrium Gonadotrophin (PMEG) is produced in the endometrial cups. PMEG may be regarded as a precursor of Pregnant Mare Serum Gonadotrophin (PMSG), which can be detected in the blood of mares. The exact function of PMSG is still obscure; some possible functions are suggested in the present paper. After approximately 70 days of gestation, regression starts. The regression of the cups is an immunological process in which the cellular branch of the immunological system plays an important role. Humoral immunity plays a more protective role in the process of regression, probably as a result of the production of 'blocking' antibodies.
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A large volume of evidence suggests that topical steroids intensify fungal infections. To verify this observation further, we inoculated Trichophyton rubrum into human epidermal keratinocyte cultures in the presence of hydrocortisone. Our results reveal that hydrocortisone does stimulate mycelium growth. However, it only occurs in the cultures containing human epidermal cells, and the stimulation is greater at a higher concentration of the drug (20 micrograms/ml) than a lower one (2 micrograms/ml).
Bile duct cysts as a consequence of liver infarcts have exceptionally been described in polyarteritis nodosa. A case is reported in which necrotic changes due to arterial occlusion, as well as the resulting hepatic bile duct cysts, were clearly demonstrated by diethyl IDA cholescintigraphy.
Twenty-two patients with tinea versicolor (pityriasis versicolor) were treated with a single 400 mg dose of ketoconazole and evaluated one month later. All patients were found to be clinically cured when examined with Wood's light and microscopic techniques approximately one month after the initial dose. Hypopigmented macules persisted for several months in most patients. Prophylaxis with single monthly doses of 400 mg of ketoconazole has resulted in one recurrence to date, with follow-up for four to fifteen months (mean of 8.2 months) in twenty patients. No side effects from ketoconazole were reported by any of the patients.
Five cases of cutaneous sporotrichosis were seen at the Stanford University Department of Dermatology from 1966 to 1977, where the disease was previously unreported. The possibility of sporotrichosis should be considered when suppurative cutaneous lesions do not respond to antibacterial agents. Skin biopsy of sporotrichotic lesion is often nonspecific, while culture is the best method of diagnosis.