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Biomedical subjects

R S Kirsner

Publications and source records attributed to R S Kirsner.

At least 91 records · Page 5Linked to original sources
PubMed1995

Treatment of psoriasis: role of calcipotriene.

Psoriasis, a common skin disorder, affects over 1 percent of the population of the United States. The majority of these patients have limited disease that can be managed with topical therapy. Topical treatment includes corticosteroids, tar, anthralin and keratolytic agents. Calcipotriene, a new topical treatment for psoriasis of mild to moderate severity, is a vitamin D derivative that inhibits epidermal cell proliferation in vitro. Treatment with calcipotriene results in decreased redness, scaling and thickness of the plaque. Calcipotriene is comparable to mid-potency topical corticosteroids in efficacy, but it does not cause skin atrophy and apparently does not lead to tachyphylaxis. Irritant dermatitis is a common side effect of calcipotriene, especially when it is applied to the face. Careful patient monitoring is recommended because alterations in calcium metabolism have been reported to occur with use of calcipotriene.

Calcitriol↗
PubMed1994

Syphilis presenting as the 'blue toe syndrome'.

The abrupt development of cyanotic and painful toes, "the blue toe syndrome," has been attributed to a number of medical conditions. We describe a patient in which the workup for this condition failed to elucidate a typical cause. Skin biopsy, serologic findings, and response to treatment led to the diagnosis of secondary syphilis. Our experience indicates that secondary syphilis should be included in the differential diagnosis of patients presenting with the blue toe syndrome.

Cyanosis↗
PubMed1994

Squamous cell carcinoma arising from chronic osteomyelitis treated by Mohs micrographic surgery.

Squamous cell carcinoma is a rare, but well documented complication of chronic osteomyelitis. Many authors have recommended amputation as the treatment of choice for locally invasive disease. Presented is a patient with squamous cell carcinoma arising in the draining sinus tract of chronic osteomyelitis of the lower extremity that was treated successfully with Mohs micrographic surgery (MMS). After ten year follow-up he remains tumor free and continues to enjoy use of his leg. We propose MMS as a therapeutic option to amputation for control of locally invasive disease.

Adult↗
PubMed1993

Low oxygen stimulates proliferation of fibroblasts seeded as single cells.

In standard tissue culture conditions (20% oxygen), single human dermal fibroblasts (one cell per well) do not proliferate. We now report that low oxygen tension is a potent stimulus for the proliferation and expansion of human adult and neonatal dermal fibroblasts seeded as single cells. This preferential single-cell proliferation in low oxygen is shown to be also a feature of human lung and dermal rodent fibroblasts, but not of human fibrosarcoma and immortalized 3T3 cells, which proliferate without difficulty in standard oxygen conditions. It is suggested that single-cell proliferation and its dramatic stimulation in low oxygen may represent a fundamental biologic process with an opportunity to better understand mammalian cell growth regulation.

3T3 Cells↗
PubMed1993

Low oxygen tension increases mRNA levels of alpha 1 (I) procollagen in human dermal fibroblasts.

Dermal fibroblasts exposed to low oxygen tension show upregulated synthesis of transforming growth factor-beta 1 (TGF-beta 1), an established stimulatory peptide in the formation of extracellular matrix proteins. In this report, procollagen synthesis was measured in cultures of confluent adult human dermal fibroblasts exposed to either standard (20%) or low (2%) oxygen tension. By Northern blot analysis the steady state levels of alpha 1 (I) procollagen mRNA were increased by 75 to 150% of control (standard oxygen) as early as 12 hours and more than 200% 96 hours after exposure of cells to low oxygen. Similar increases in procollagen mRNA levels were obtained in hypoxic fibroblast cultures in a collagen lattice. The stimulatory effect of hypoxia on procollagen mRNA levels in fibroblast monolayers was diminished by antibodies to TGF-beta, and could not be augmented further by the addition of TGF-beta 1, evidence that hypoxic fibroblasts may already be maximally stimulated by TGF-beta 1. We conclude that low oxygen tension enhances steady state mRNA levels of alpha 1 (I) procollagen, and that this effect is mediated at least in part by TGF-beta 1.

Antibodies↗
PubMed1993

Stanozolol causes rapid pain relief and healing of cutaneous ulcers caused by cryofibrinogenemia.

BACKGROUND: Cutaneous manifestations of cryofibrinogenemia include purpura, ecchymosis, and ulcerations. The histology of these lesions is characterized by intravascular thrombi. OBJECTIVE: Our purpose was to test the efficacy of stanozolol, a drug capable of fibrinolytic enhancement, in treating cutaneous ulcers caused by cryofibrinogenemia. METHODS: Eight patients with cutaneous ulcerations from cryofibrinogenemia were treated with stanozolol. Plasma cryofibrinogen was measured before and during treatment with stanozolol. Histologic evaluation was also performed before treatment and in selected patients during treatment. RESULTS: After treatment, seven of the eight patients had healing of their ulcers, prompt reduction in their pain, and improvement in livedo reticularis and purpura. Four of the eight patients had no detectable plasma cryofibrinogen after treatment. In addition, dermal intravascular thrombi resolved. Stanozolol was well tolerated and had minimal side effects. CONCLUSION: We conclude that stanozolol is a safe and effective treatment of the cutaneous manifestations of cryofibrinogenemia.

Adult↗
PubMed1993

The clinical spectrum of lipodermatosclerosis.

Lipodermatosclerosis refers to the skin induration and hyperpigmentation of the legs that often occurs in patients who have venous insufficiency. Lipodermatosclerosis has also been termed hypodermitis sclerodermiformis and appears to be similar if not-identical to the recently described sclerosing panniculitis of the leg. There has been much confusion about the nature, clinical course, and treatment of lipodermatosclerosis. We believe that lipodermatosclerosis has an acute, inflammatory phase and a chronic, fibrotic stage, although a spectrum exists. Direct immunofluorescence studies of early and late lesions are helpful in that they show dermal pericapillary fibrin deposits without other immunoreactants. Treatment of lipodermatosclerosis consists of compression therapy with either graded stockings or elastic bandages. We and others have found that the anabolic steroid stanozolol improves this condition rapidly and consistently.

Humans↗
PubMed1993

Solitary fibrosing paraspinal plaque: solitary morphoea profunda?

Solitary morphoea profunda is a recently described morphological variant of localized scleroderma. Two of the five reported patients had a solitary fibrotic plaque in the paraspinal region. We report a 16-year-old boy with a solitary fibrotic paraspinal plaque which, on histological examination, showed dermal and subcutaneous sclerosis, with a polymorphous infiltrate including plasma cells and eosinophils. Laboratory tests were either negative or normal, except for mild peripheral blood eosinophilia. Antinuclear antibodies were not detected, and the patient had no evidence of Borrelia infection. Magnetic resonance imaging (MRI) showed that the process involved the subcutaneous tissue, but did not extend to the underlying bone. As half of the patients with this entity (three of six) now described have had a solitary fibrotic plaque in a paraspinal location, we suggest that it may be premature to classify all these cases as being a variant of morphoea. We propose the use of the descriptive term solitary fibrosing paraspinal plaque, until the aetiology or aetiologies of this condition are better understood.

Adolescent↗
PubMed1993

Margin assessment of selected basal cell carcinomas utilizing laser Doppler velocimetry.

BACKGROUND: Basal cell carcinomas (BCC) have increased vasculature, therefore, blood flow within the tumor may be greater than normal surrounding skin. We attempted to detect the difference in blood flow between the tumor and uninvolved surrounding skin utilizing laser doppler velocimetry (LDV). METHODS: Ten patients with 14 BCC were studied. Using LDV, we calculated the size of the tumor based on margin assessment as predicted by the measured difference in blood flow and compared this size with the clinically predicted size and the size of the defect after Mohs micrographic surgery (MMS). RESULTS: Clinical evaluation of tumor size prior to MMS did not correlate with the size of the surgical defect after MMS; however, correlation was found between the predicted size of the tumor as determined by LDV and the defect after MMS. CONCLUSIONS: Tumor size of BCC as predicted by measured differences in blood flow using LDV correlated with the size of the surgical defect after MMS. This suggests that LDV was able to detect the difference in blood flow between the tumor and uninvolved surrounding skin.

Blood Flow Velocity↗
PubMed1993

Techniques of split-thickness skin grafting for lower extremity ulcerations.

OBJECTIVE: To discuss the role of skin grafts in the functional repair of lower extremity ulcerations. METHODS: The indications, types of skin grafts, and the methods of harvesting grafts are described. RESULTS: Detailed description of our method of bedside split-thickness skin grafting with both pinch and mesh grafts in hospitalized patients is given. We also discuss post-operative care and complications seen with skin grafting. CONCLUSION: Split-thickness skin grafting offers an important therapeutic option in the treatment of lower extremity ulcerations.

Humans↗
PubMed1993

The wound healing process.

The field of wound repair continues to grow at an astounding pace. In this review we have discussed both the basic science and the clinical aspects of wound healing. The basic science section details the three phases of wound healing. The inflammatory phase is marked by platelet accumulation, coagulation, and leukocyte migration. The proliferative phase is characterized by re-epithelialization, angiogenesis, fibroplasia, and wound contraction. Finally, the remodeling phase takes place over a period of months, during which the dermis responds to injury with the production of collagen and matrix proteins and then returns to its preinjury phenotype. The second part of this review outlines selected practical clinical aspects of wound repair. That section is subdivided into acute and chronic wounds. We describe the difference between primary and secondary intention healing and discuss factors that affect healing in both. We also describe our systemic approach to dealing with patients with chronic wounds and present our problem-oriented treatment program based on the cause of the chronic wound.

Cell Division↗
PubMed1993

The biology of skin grafts. Skin grafts as pharmacologic agents.

BACKGROUND: Skin grafting is commonly used to treat nonhealing wounds. However, how skin grafts help to heal wounds is not entirely known. Why epithelium from grafted skin is able to migrate and cover these wounds, while epithelium at the edge of nonhealing wounds is unable to, is a long unanswered biologic question. OBSERVATIONS: The recent use of cultured epithelial allografts has rekindled interest in the biology of skin grafts. Replaced, even in chronic wounds, by recipient epithelium, cultured epithelial allografts appear to work by providing a potent stimulus to healing imparted by the graft itself. Based on this, we have reassessed how skin autografts help to heal wounds and hypothesize that, in a similar fashion, autografts may work not only by replacing tissue but also by providing a stimulus for healing. CONCLUSIONS: We suggest that skin grafts may work not only as tissue replacement but as pharmacologic agents that provide a stimulus for healing. We believe that, someday, it may be possible to augment the stimulatory properties of donor skin to speed healing of the recipient wound.

Culture Techniques↗
PubMed1992

The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma.

BACKGROUND: The presence of tumor involving surgical margins after excision of basal cell carcinoma (BCC) presents a therapeutic dilemma. Some authors advocate a conservative policy whereas others recommend immediate reexcision. OBJECTIVE: Our purpose was to evaluate residual tumor utilizing Mohs micrographic surgery (MMS) of those BCCs with margin involvement after primary excision. METHODS: We retrospectively reviewed 77 patients with 78 tumors who underwent MMS because of margin involvement after primary excision of BCC to detect the presence or absence of residual tumor. RESULTS: Residual tumor was found in 55% of the cases as defined by the need for two or more stages of MMS to achieve a tumor-free plane. CONCLUSION: We suggest reexcision of all BCCs that are found to have marginal involvement after primary excision because of the large percentage of cases found to have residual tumor.

Age Factors↗
PubMed1992

Features of an autoimmune process in mid-dermal elastolysis.

Mid-dermal elastolysis is a rare disorder that is manifested clinically by wrinkling and histologically by the selective absence of elastic fibers in the mid dermis. We describe a young woman who developed abnormal wrinkling after augmentation mammoplasty with silicone implants. Histologic examination confirmed the diagnosis of mid-dermal elastolysis. In addition, a positive antinuclear antibody titer and a false-positive Lyme titer were subsequently detected. In a previously reported case a patient who had mid-dermal elastolysis also had an unusual false-positive pattern for Lyme disease. Silicone mammoplasty has been associated with connective tissue diseases. This report adds mid-dermal elastolysis to the list of diseases associated with augmentation mammoplasty and, along with the presence of autoantibodies, supports autoimmune involvement in mid-dermal elastolysis.

Adult↗
PubMed1991

Stanozolol in treatment of leg ulcers due to cryofibrinogenaemia.

Five consecutive patients with cryofibrinogenaemia in association with painful leg ulcers and intravascular dermal thrombi were treated with stanozolol, an androgenic steroid with fibrinolytic properties. In all patients treatment was followed by rapid and striking pain relief and healing of the ulcers. Cryofibrinogenaemia was not detected on subsequent laboratory evaluation, and dermal intravascular thrombi had resolved on repeat histological examination.

Adult↗
PubMed1991

Human wound fluid from acute wounds stimulates fibroblast and endothelial cell growth.

One proposed mechanism for the beneficial effect of occlusive dressings on healing is the maintenance of contact between the wound bed and accumulated wound fluid, which is thought to contain growth stimulatory substances. We have examined the effect of human wound fluid on the in vitro growth of human dermal fibroblasts and umbilical vein endothelial cells. Acute wound fluid was collected from six patients undergoing split-thickness skin grafting. The acute wound fluid was sterilely collected daily from underneath a vapor-permeable membrane applied to the donor site and changed every 24 hours for 3 days postoperatively. After seeding in optimal growth media (control) on day 0, cultures of human dermal fibroblasts and umbilical vein endothelial cells were supplemented with or without acute wound fluid on the next day (day 1) and on day 3. As determined by cell counts, 2% acute wound fluid stimulated the growth of human dermal fibroblasts (p less than 0.05) and umbilical vein endothelial cells (p less than 0.01) when these cells were cultured in 2% fetal bovine serum and endothelial growth medium, respectively. Wound fluid from postoperative days 1 or 3 caused the same level of stimulation. The addition of an anti-platelet-derived growth factor antibody to wound fluid resulted in a 45% mean reduction in its stimulatory effect on fibroblast growth (p less than 0.02), suggesting that platelet-derived growth factor contributes to the observed effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Count↗