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Biomedical subjects

R S Kirsner

Publications and source records attributed to R S Kirsner.

At least 55 records · Page 3Linked to original sources
PubMed1998

Analysis of antibiotic susceptibilities of skin wound flora in hospitalized dermatology patients. The crisis of antibiotic resistance has come to the surface.

BACKGROUND: Results of an ongoing surveillance of antibiotic resistance in hospitalized dermatology patients are presented. Bacterial isolates cultured from patients with skin wounds admitted to a tertiary care dermatology inpatient unit from May 1995 through May 1996 were evaluated for resistance to commonly used antibiotics. Comparison was made with a previous survey of the same inpatient service from 1992. Our results show an alarming trend toward antibiotic resistance. OBSERVATION: In superficial skin wounds, Staphylococcus aureus constituted 77% of isolates. In leg ulcers, the frequencies of S aureus and Pseudomonas aeruginosa were approximately equal, constituting 43% and 42% of cultures, respectively. Fifty percent of S aureus isolates from leg ulcers were resistant to oxacillin, with 36% of pseudomonad isolates resistant to ciprofloxacin. In superficial wounds, oxacillin resistance in S aureus approached 25%. A comparison of antibiotic resistance profiles using data collected in 1992 for patients admitted to the same inpatient service revealed a marked increase in oxacillin and ciprofloxacin resistance in S aureus and P aeruginosa in leg ulcers, respectively (from 24% to 50% oxacillin resistance in S aureus and from 9% to 24% ciprofloxacin resistance in P aeruginosa), and superficial wounds (24% to 36% ciprofloxacin resistance in P aeruginosa). CONCLUSION: This study demonstrates the rapid emergence of antibiotic-resistant bacteria as a problem of growing significance in hospital dermatology and highlights the importance of local surveillance programs to aid in selecting antibiotic treatments.

Anti-Bacterial Agents↗
PubMed1998

The development of bioengineered skin.

Driven by the need for donor tissue for patients suffering from extensive burns, alternatives to autologous and cadaver-derived tissue have been under development for the past 20 years. Unilayered and bilayered models representing the skin's epidermal and/or dermal components have been developed using both cells and matrix materials. In addition to their use in patients with extensive burns, trials using these products on refractory and challenging patients with both acute and chronic wounds have led to the commercial availability of some of these products.

Cell Transplantation↗
PubMed1998

Diagnosis and treatment of a case of cutaneous cytomegalovirus infection with a dramatic clinical presentation.

A patient receiving long-term immunosuppressive treatment of systemic lupus erythematosus developed multiple large painful ulcers on her upper body. Histologic analysis showed cytopathic changes typical of cytomegalovirus infection that was confirmed by immunoperoxidase staining and polymerase chain reaction analyses. Treatment with ganciclovir and foscarnet resulted in clinical resolution. No recurrence was evident 6 months later.

Adult↗
PubMed1998

Video display terminals: risk of electromagnetic radiation.

BACKGROUND: Technologic advances have led to increased use of computers at home and in the workplace. It is estimated that more than 100 million workers in the United States and Canada will be using computers daily by the year 2000. Anecdotal reports have suggested a link between video display terminals (VDTs) and disease. This has generated much concern about whether electromagnetic radiation (EMR) emitted by VDTs cause illness among users. METHODS: We reviewed pertinent articles in the literature. RESULTS: Several studies have addressed the role of VDTs in disease causation, specifically whether EMR causes skin or ocular disease or obstetric complications. The data reviewed were inconsistent or methodically flawed. Therefore, a definitive conclusion cannot be drawn to support the hypothesis that EMR produced by VDTs causes disease. CONCLUSIONS: We believe continued research should be done to further define and elucidate the risk of EMR produced by VDTs.

Computer Terminals↗
PubMed1998

The rationale for skin cancer screening and prevention.

Skin cancer, the most common malignancy in the United States, accounts for considerable morbidity and mortality. Efforts at lessening the burden of this disease are possible through both primary and secondary prevention, although some barriers may detract from the ability of primary care physicians to perform skin cancer screening. Public education combined with increased vigilance by physicians and other health professionals may significantly alter the morbidity and mortality associated with this disease entity.

Europe↗
PubMed1998

The ethical dilemma of population-based medical decision making.

Over the past several years, there has been a growing interest in population-based medicine. Some elements in healthcare have used population-based medicine as a technique to decrease healthcare expenditures. However, in their daily practice of medicine, physicians must grapple with the question of whether they incorporate population-based medicine when making decisions for an individual patient. They therefore may encounter an ethical dilemma. Physicians must remember that the physician-patient relationship is of paramount importance and that even well-conducted research may not be applicable to an individual patient.

Community Health Planning↗
PubMed1998

Routine histologic examination for the diagnosis of onychomycosis: an evaluation of sensitivity and specificity.

Clinical differentiation of dermatophyte infection from dystrophic changes due to psoriasis may be challenging. Typically, potassium hydroxide (KOH) preparations, fungal culture, and occasionally, nail unit biopsy specimens are utilized to help differentiate between the two. These tests are often time-consuming and may yield false-negative results. Increasing regulation of the office laboratory has caused some physicians to forgo this testing, which was previously routine. We investigated the utility of routine histologic examination of nail clippings in differentiating onychomycosis from psoriatic onychodystrophy. Twenty-three distal nail clipping specimens (twelve specimens from patients with onychodystrophy of unknown cause and eleven control specimens from nails with known cause) were evaluated by routine histology and periodic acid-Schiff (PAS) staining. Of the dystrophic cases, four were demonstrated to be onychomycosis by the presence of hyphae on histologic evaluation and by culture, whereas only three of these cases yielded positive results on KOH examination. Eight cases of onychodystrophy were due to psoriasis. Yeast forms were detected on one case of psoriatic onychodystrophy that demonstrated yeast growth on culture. In our study, routine histologic examination with PAS staining was equal to culture and superior to KOH preparation in leading to the correct diagnosis of dermatophyte infection. In addition, the diagnosis of psoriasis of the nail plate was detected accurately by routine histologic examination. Routine histologic examination with PAS staining is a rapid, simple, and reliable test in the evaluation of onychodystrophy.

Diagnosis, Differential↗
PubMed1998

Squamous cell carcinoma arising from a nonhealing wound and osteomyelitis treated with Mohs micrographic surgery: a case study.

The treatment of choice for squamous cell carcinoma arising from chronic ulcer at the lower extremity has traditionally been amputation. Recently, Mohs micrographic surgery has been used as a limb-saving option in selected patients. One of these patients, a 69 year-old white male, presented with a two-year history of a progressive non-healing would and osteomyelitis. A four-month history of an enlarging mass within the ulcer suggested squamous cell carcinoma, which was confirmed by biopsies. The patient was treated with Mohs micrographic surgery for local eradication of the tumor, intravenous antibiotics, and skin grafting.

Aged↗
PubMed1998

Soaps and detergents: understanding their composition and effect.

Soaps have been used for thousands of years as part of religious ceremonies and daily life. Derived from fatty acids or triglycerides (fats or oils) into their alkali derivatives through a process called saponification, soaps are important for healthcare professionals in preventing the spread of disease. Partly due to their alkaline nature, soaps are limited by their irritancy to the skin and their tendency to form insoluble and inactive salts when combined with either hard water or sea water. Therefore, soap alternatives or synthetic detergents have been developed. Detergents are classified into four groups: anionic, cationic, amphoteric, and non-ionic. These four groups are based on the hydrophilic qualities and surfactants they possess. Each group has characteristics that pertain to its main uses, irritancy, and toxicity. Understanding soaps and detergents may assist clinicians in making intelligent choices when using these agents on their patients as either skin cleansers or wound cleansers. Understanding the characteristics of soaps and detergents is especially important when dealing with at-risk patients such as the elderly.

Bacterial Infections↗
PubMed1998

Microbiologic evaluation of cutaneous wounds in hospitalized dermatology patients.

The purpose of this study is to identify predictability of wound flora which may be helpful in the selection of empiric antibiotic therapy of wound infections while awaiting the results of bacterial cultures. Toward this end, results of an ongoing microbiologic surveillance of skin wound flora in hospitalized dermatology patients are presented. Bacterial isolates cultured from patients with skin wounds admitted to a tertiary care dermatology inpatient unit were evaluated and comparison was made to a previous survey of the same inpatient service done in 1992. Microbiologic evaluation of superficial skin wounds, leg ulcers, and pressure ulcers showed that Staphylococcus aureus was the principal isolate in superficial wounds (77%) compared to the equal prevalence of S. aureus (43%) and Pseudomonas aeruginosa (42%) cultured from leg ulcers. Cultures from pressure ulcers grew Proteus mirabilis as the dominant isolate. These data agree with previous surveillance data from the same inpatient base performed in 1992 and support the relatively predictable wound flora cultured from skin wounds in our hospital inpatient unit over the 4 years surveillance period. This predictability can enhance empiric antibiotic selection for wound infections while awaiting the results of bacterial culture, and supports the value of local microbiologic surveillance programs in the management of wound infections.

Bacterial Infections↗
PubMed1998

Epidemiology of peripheral vascular disease: a predictor of systemic vascular disease.

It is estimated that peripheral vascular disease (PVD) affects 30 percent of the adult population, and two-thirds of all cases are asymptomatic. Detecting PVD can be relatively easy and inexpensive, and based either on subjectively supplied historical information (claudication) or upon physical examination findings [ankle-brachial index (ABI)]. The ABI may serve as a marker for increased risk for systemic vascular disease as an abnormally low ABI has been shown to be associated with systemic vascular disease. Epidemiology of and risk factors for PVD are in similar to coronary heart disease. PVD is uncommon until middle age and then increases dramatically. Prevalence of PVD is slightly higher in men than women, yet this tends to diminish with age. Cigarette smoking is probably the most important risk factor for PVD. Hypertension, hypercholesterolemia, and diabetes are also risk factors for the development of symptomatic PVD. Conversely, the presence of a high degree of physical activity and higher levels of HDL-cholesterol as well as a lower body mass index (BMI) are protective. Patients who have vascular disease in one organ system often exhibit evidence of vascular disease elsewhere. Presence of coronary artery disease among patients with symptomatic PVD is between two and four times higher than those without PVD, and PVD is also associated with cerebrovascular disease.

Adult↗
PubMed1998

Tissue engineered skin: Apligraf, a bi-layered living skin equivalent.

Driven by the need for a readily available, non-immunological tissue that possesses many of the characteristics of normal human skin, tissue-engineered skin has been developed. For over a decade, laboratory grown or processed skin has been under investigation and, in some cases, available as an alternative to autologous grafts. Apligraf, derived from neonatal foreskin and bovine type I collagen, is the first bi-layered living skin equivalent approved in the US and other countries for use in venous ulcers. Apligraf is effective both in the treatment of refractory venous ulcers and for acute wounds such as surgical excision sites and split thickness donor sites. Apligraf is safe and is not clinically rejected. Its ultimate fate is not known, so it may well work to aid healing in a variety of ways including graft 'take' and as a stimulus for healing.

Animals↗
PubMed1998

The use of Apligraf in acute wounds.

Advances in the development of tissue engineered skin have led to several new products aimed at improving wound healing. Designed as a skin substitute, both epidermal and dermal equivalents have been under investigation and used clinically for over a decade. A novel bi-layered living skin equivalent, Apligraf, has been approved in several countries and is approval in the US FDA for the treatment of venous ulcers. Derived from foreskin, cultured neonatal fibroblasts are combined with bovine type I collagen to form a neodermis over which cultured neonatal keratinocytes are placed, proliferate and differentiate. In addition to use in venous ulcers, Apligraf use has also been reported in acute wounds such as surgical excision sites and partial thickness donor sites. Apligraf's use in acute wounds has lent insight into its biologic behavior, safety and efficacy. Through these experiences, it has been learned that Apligraf behaves similar to a partial thickness autograft, and is safe and effective. In addition, Apligraf appears to 'take', in many cases persists, is not clinically rejected but its ultimate fate is not known.

Acute Disease↗