PubMed Health⌕ Search

Biomedical subjects

R S Stern

Publications and source records attributed to R S Stern.

At least 145 records · Page 8Linked to original sources
PubMed1985

Ocular findings in patients treated with PUVA.

This 5-year prospective study of ophthalmologic findings in 1299 patients treated with oral 8-methoxypsoralen photochemotherapy (PUVA) for psoriasis failed to demonstrate a significant dose-dependent increase in the risk of developing symptomatic cataracts. These patients were instructed to wear UVA-blocking eyeglasses when exposed to sunlight and during treatment for a 12-h period beginning from the time of 8-methoxypsoralen ingestion. However, we did observe a small increase in the risk for development of nuclear sclerosis and posterior subcapsular opacities among patients who received at least 100 PUVA treatments, compared to patients with fewer than 100 treatments (relative risk = 2.3 and 3.0, respectively; p less than .05 both comparisons). We compared our results to those of a large, population-based study and found, after adjusting for differences in methods, that the prevalence of cataracts in our study patients, aged 52-75 years, was not significantly different. Since the latency period for development of symptomatic ocular abnormalities may be longer than 5 years, continued surveillance of our cohort and continued use of appropriate ocular protection by all patients treated with PUVA is indicated.

Aged↗
PubMed1985

Low-fluence CO2 laser irradiation: selective epidermal damage to human skin.

The interaction of normal human skin with low-fluence CO2 laser irradiation was studied using a three-phase approach. In phase one, freshly excised skin was observed immediately after impact. In phase two, skin irradiated 2 h prior to excision was studied. In phase three, human volunteers were irradiated and biopsied at time zero, 24 h and 48 h. Seventy-five sites were exposed and 60 biopsies were performed. The earliest histologic changes were observed in the 6-10 J/cm2 fluence (radiant exposure) range and these changes included spindle and vacuolar changes in the basal layer of the epidermis. Papillary dermal coagulation was present to a maximum of 0.03 mm. At fluences of 10-25 J/cm2, superficial dermal necrosis (0.06-0.08 mm) was observed. At fluences above 25 J/cm2, transepidermal necrosis was present with increasing papillary dermal necrosis that was in proportion to the energy density delivered. At 2h, basal vacuolar changes were accompanied by diffuse keratinocytic cell death where contact was maintained between the epidermis and dermis, while where separation occurred limited keratinocytic death was observed. The earliest changes occurred at lower threshold fluences (4-6 J/cm2). After 24 h, these doses resulted in extensive epidermal necrosis with focal acute inflammatory infiltrates. At 48 h, the degree of epidermal "slough" was proportional to the energy density delivered and was maximal with a fluence of 5.7 J/cm2 delivered whereas with a fluence of 3.8 J/cm2 thin slough (0.02 mm) was observed. These findings suggest that low-dose CO2 laser irradiation may provide a new approach to selectively damage the epidermis with minimal dermal damage.

Carbon Dioxide↗
PubMed1985

Ibuprofen in the treatment of UV-B-induced inflammation.

Ibuprofen and placebo were compared in a randomized, double-blind, cross-over study of 19 psoriatic patients receiving UV-B phototherapy to evaluate the symptomatic relief of UV-B-induced inflammation. Signs and symptoms of UV-B-induced inflammation (erythema, pruritus, skin pain, general discomfort, and nocturnal restlessness) were assessed for each treatment. An evaluation of 104 treatments disclosed that, although ibuprofen significantly reduced technician-observed erythema, it was not significantly different from placebo for the five other end points studied. Separate evaluations of higher dose UV-B treatments showed a small, but statistically significant, reduction with ibuprofen for four of the six end points evaluated. The data suggest that ibuprofen is more effective than placebo for the relief of symptoms associated with UV-B-induced inflammation after high dose UV-B phototherapy for psoriasis, but the drug has limited usefulness in the treatment of sunburn reaction from these same doses.

Adult↗
PubMed1985

The epidemiology of joint complaints in patients with psoriasis.

Joint complaints of 1285 patients treated for cutaneous psoriasis were analyzed to better define the epidemiology of arthritis among psoriasis patients selected on the basis of cutaneous rather than rheumatologic disease. Nearly 40% of patients suffered from arthralgia, and 20% had been diagnosed as having psoriatic arthritis (PA). Patients with PA had more extensive cutaneous disease and more frequently had a family history of PA. PA patients frequently noted an association between the activity of their arthritis and the activity of their cutaneous disease. Antinuclear antibodies, uric acid, and white blood cell count had little predictive value in PA.

Adolescent↗
PubMed1985

An evaluation of method reporting and use in clinical trials in dermatology.

In a survey of 62 clinical trials published in four dermatology journals, recommended methodology was reported 41% of the time. Of the 62 trials, 31 were open drug trials and 27 were controlled trials. Forty-one percent of 13 recommended methodologic items were reported in these articles. The rate of reporting for these items ranged from 3% for power and method of randomization to 76% for loss to follow-up and the use of a control group. There were no differences among journals in reporting methods used. Investigators and editors are encouraged to improve the reporting and use of recommended methodology in clinical trials published in the dermatologic literature.

Clinical Trials as Topic↗
PubMed1984

An expanded profile of cutaneous reactions to nonsteroidal anti-inflammatory drugs. Reports to a specialty-based system for spontaneous reporting of adverse reactions to drugs.

The nonsteroidal anti-inflammatory drugs are widely used in the United States and are a frequent cause of cutaneous reactions. Since December 1980, dermatologists have reported 135 of these drug reactions to a specialty-based Adverse Drug Reaction Reporting System. Reactions to piroxicam were most frequently reported; the majority of reactions to this drug were vesiculobullous and occurred most often in sun-exposed areas. Other reactions to nonsteroidal anti-inflammatory drugs not previously recognized include serum sickness, exfoliative erythroderma, and photosensitivity associated with sulindac; toxic epidermal necrolysis was reported with tolmetin, zomepirac sodium, and piroxicam. Fixed drug eruptions were noted with ibuprofen and naproxen, and photosensitivity was reported with sulindac and indomethacin. These findings illustrate the usefulness of a specialty-based system for spontaneous reporting of new and serious adverse reactions to drugs.

Aged↗
PubMed1984

Cutaneous squamous-cell carcinoma in patients treated with PUVA.

A 5.7-year prospective study of 1380 patients treated for psoriasis with oral methoxsalen (8-methoxypsoralen) and ultraviolet A photochemotherapy (PUVA) revealed that after adjustment for exposures to ionizing radiation and topical tar preparations, the risk that cutaneous squamous-cell carcinoma would develop at least 22 months after the first exposure to PUVA was 12.8 times higher in patients exposed to a high dose than in those exposed to a low dose (95 per cent confidence interval, 5.8 to 28.5). No substantial dose-related increase was noted for basal-cell carcinoma. The dose-dependent risk of cutaneous squamous-cell carcinoma suggests that PUVA can act as an independent carcinogen. In our study, morbidity associated with these tumors has been limited, but further follow-up is needed. Meanwhile, patients treated with PUVA should be followed closely for the possible development of cutaneous squamous-cell carcinoma.

Adult↗
PubMed1984

Role of ultraviolet A in phototherapy for psoriasis.

Multiple studies have demonstrated that the doses of ultraviolet A (UVA) (320-400 nm) achieved with ultraviolet sources presently used for phototherapy for psoriasis are inadequate to induce coal tar phototoxicity (as manifested by delayed erythema). Some centers still use a phototherapy protocol that combines UVA, ultraviolet B (UVB), and tar for the treatment of generalized psoriasis. We designed a bilateral comparison study to determine whether the addition of UVA to one side, in doses sufficient to induce an immediate burning or smarting sensation in tar-treated skin, would add to the beneficial effects of UVB. The psoriasis of ten of thirteen ambulatory patients cleared in a mean of 26.1 treatments. Despite a mean cumulative UVA dose of 130.8 joules/cm2, none of the thirteen patients showed a better response on the side that received additional UVA. A "nonaggressive" inpatient protocol was designed to maximize the chances of demonstrating a beneficial effect of UVA. The psoriasis of eight of twelve patients cleared in a mean of 21.0 treatments. Despite a mean cumulative UVA dose of 40.3 joules/cm2, the twelve patients showed no difference in clearing between sides. The threshold for smarting increased throughout the treatment and provided a convenient guide to the delivery of increasing doses of UVA. In doses sufficient to induce coal tar phototoxicity manifested by the smarting reaction, UVA does not add to the known benefits of UVB phototherapy.

Administration, Topical↗
PubMed1984

Sun and malignant melanoma.

The incidence and mortality rates of malignant melanoma in Caucasians are increasing rapidly in many countries worldwide. Considerable circumstantial evidence suggests that exposure to solar radiation may play a role in this substantial rise in malignant melanoma. This evidence comes primarily from epidemiologic studies and from the identification of susceptible phenotypes. Despite the increasing data that implicate sunlight as an important factor in the development of certain types of malignant melanomas in humans, the role of solar electromagnetic radiation in the pathogenesis of human malignant melanomas is yet to be determined.

Aged↗
PubMed1984

Isotretinoin and pregnancy.

Approximately 120,000 women of childbearing age used isotretinoin in the first 16 months after its release for the treatment of cystic acne. In September, 1983, the American Academy of Dermatology requested its members to relate the outcome of pregnancies of women inadvertently exposed to isotretinoin ( Accutane ) during pregnancy to its Adverse Drug Reaction Reporting System ( ADRRS ). Of nine pregnancies reported, seven ended in spontaneous abortion or the birth of an infant with birth defects. Of thirty-five pregnancies with isotretinoin exposure reported to the ADRRS or the U.S. Food and Drug Administration, twenty-nine (83%) resulted in spontaneous abortion or infants with birth defects. The most frequently reported severe birth defects involved the central nervous system (microcephaly or hydrocephalus) and the cardiovascular system (anomalies of the great vessels). Microtia or absence of external ears were also noted in a majority of cases. These findings illustrate the usefulness of specialty-based reporting of adverse drug effects and emphasize the teratogenic risk of isotretinoin in humans. Physicians need to fully and carefully inform women of childbearing age of these risks.

Abnormalities, Drug-Induced↗
PubMed1984

Topical v systemic agent treatment for papulopustular acne. A cost-effectiveness analysis.

We used cost-effectiveness analysis to compare the costs, risks, and benefits of two strategies for clearing papulopustular acne; topical therapy alone as initial therapy or a combination of systemic antibiotics and topical agents used at the first visit. Patients treated with combination therapy had fewer weeks of morbidity from acne, and lower dollar costs but have a greater risk of side effects. If the topical therapy alone was chosen to reduce the risk of side effects in a population of patients there would be an additional $764 in costs and 238 weeks of morbidity from acne to avert a single additional instance of side effects. Initial treatment of papulopustular acne with combined oral antibiotics and topical agents thus seems to be cost-effective. After clearing is achieved, maintenance therapy with topical agents should be considered.

Acne Vulgaris↗
PubMed1984

Psoralens and UV-A and UV-B twice weekly for the treatment of psoriasis.

In an effort to determine if combination phototherapy (psoralens and UV-A [PUVA]) [PUVA-UV-B]) administered twice weekly provides a substantial advantage over therapy with PUVA alone, we investigated twice-weekly PUVA-UV-B therapy for the treatment of psoriasis. In a bilateral comparison study of 11 patients, we found that seven cases of psoriasis cleared in the same number of treatments with PUVA-UV-B or PUVA, but in four cases the PUVA-UV-B treated side cleared significantly more rapidly. In a study of these 11 split cases, plus ten additional patients treated with PUVA-UV-B twice weekly, this therapy was effective in clearing psoriasis. A bilateral comparison of "aggressive" and "nonaggressive" PUVA and UV-B increments in ten patients suggested that lower doses of PUVA and UV-B may, in the majority of patients, be equally effective. Further study is necessary to define the maximally effective protocol--maximizing clearance yet minimizing UV exposure, acute side effects, and long-term toxic reactions.

Adult↗
PubMed1984

Carcinogenic risk of psoralen plus ultraviolet radiation therapy: evidence in humans.

Despite differences in study populations, methodologies, and levels of psoralen plus UV irradiation at 320-400 nm (PUVA), results from 4 prospective studies of patients treated with PUVA support the hypothesis that the risk of squamous cell carcinoma is increased with prolonged exposure. Tumors that develop after PUVA exposure behaved like skin tumors associated with sun exposure. In view of the latency for cancer in humans, continued prospective follow-up is required if we are to determine the ultimate carcinogenic risk of this type of therapy.

Humans↗
PubMed1984

Skin typing for assessment of skin cancer risk and acute response to UV-B and oral methoxsalen photochemotherapy.

Skin typing is a clinical classification system based on a patient's historical reporting of the acute skin response to sunlight. It is advocated as a means of determining an individual's relative risk of skin tumors and has been used to determine the initial therapeutic dose of UV radiation for UV-B phototherapy or oral methoxsalen photochemotherapy (PUVA) for psoriasis. Among PUVA-treated patients, the relative risk of cutaneous carcinoma was significantly higher among patients with skin types I and II compared with patients with skin type IV (3.2 and 2.3, respectively). Skin type was a better predictor of this risk than eye or hair color. The minimal erythemal dose ( MErD ) and minimal phototoxic dose (MPD) increased with increasing skin type number, but within a given skin type each varied as much as sixfold. Skin type was a good clinical predictor of skin cancer risk, but lacked specificity as a predictor of an individual's MErD or MPD.

Administration, Oral↗
PubMed1983

Variation in antenatal testing over time and between clinic settings.

Variation in the use of diagnostic procedures may be due to characteristics of patients, physicians, or their environment. Testing rates for 24-hour urinary estriol levels (EST), diagnostic ultrasound, and antepartum fetal heart rate testing (AFHRT) were examined in 8,527 deliveries from 1975 through 1978. Over the period, utilization of EST remained constant at about 7% of deliveries, while ultrasound increased from 20% to 35% and AFHRT, from 7% to 12%. This increase persisted after stratifying patients on a multivariate confounder score using 45 items of clinical information. Those receiving antenatal care in a hospital-based group practice or a resident-staffed community clinic were more likely to be tested than patients seen in private offices or a prepaid group practice.

Adolescent↗