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Biomedical subjects

S E Chiarello

Publications and source records attributed to S E Chiarello.

14 recordsLinked to original sources
PubMed2001

Linear IgA bullous dermatosis in one of two piroxicam-induced eruptions: a distinct direct immunofluorescence trend revealed by the literature.

BACKGROUND: The report focuses first on two patients with piroxicam-induced bullous eruption, one whose disease was diagnosed as linear IgA bullous dermatosis (LABD) and the other with no disease-specific immunologic findings using immunofluorescence methods. A review of the literature points to a distinctive direct immunofluorescence feature of drug-induced LABD cases. OBJECTIVE: Our purposes were to focus on divergent piroxicam reactions and to compare immunofluorescence findings in our and other reported drug-induced LABD cases to randomly occurring LABD cases. METHODS: Direct and indirect immunofluorescence methods were used to study biopsy and serum samples from both cases and biopsy specimens of 40 other LABD cases. RESULTS: Tense blisters developed in two patients medicated with piroxicam. Immunofluorescence studies demonstrated deposits of IgA at the basement membrane zone (BMZ) in case 1 and only non-disease-specific fibrin deposits at the BMZ in case 2. Within 1 month of discontinuation of piroxicam, all lesions were gone in both patients. CONCLUSION: In LABD cases proven by direct immunofluorescence, (1) the index of suspicion of drug induction should be higher in cases with only IgA and no IgG in the BMZ; (2) possibly up to two thirds of all LABD cases may be drug induced; and (3) the negative immunofluorescence findings in case 2 and other cases reported in the literature suggest that LABD is one of several host responses in drug-induced blistering diseases.

Aged↗
PubMed2000

Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses: an update and comparison.

BACKGROUND: The treatment of actinic keratoses is the most common procedure in dermatology and liquid nitrogen freezing is the most used method of destruction. Yet it is criticized for its limitations of treating only small areas and its tendency to leave hypopigmented skin. 5-fluorouracil (5-FU) treatment is also widely utilized. It has the advantage of treating large areas, but the disadvantages of length of treatment, morbidity, and only partial effectiveness in removing deep or hyperkeratotic actinic keratoses. OBJECTIVE: Long-term follow-up results are reported on the use of extensive cryosurgery to treat areas of widespread solar damage. The literature is reviewed comparing the advantages and disadvantages versus 5-FU treatment. METHODS: Three hundred and seventy-three patients were initially treated for extensive actinic keratoses in a private dermatology office in an retirement community in Florida. Individual lesions were counted under good lighting conditions with the aid of a 2.5x stereoscopic lens. The treated areas were predominately on the face and scalp areas, although some arms and hands were treated. A total of 34,604 were initially treated by spraying each individual keratosis with liquid nitrogen as well as the entire surrounding skin area. RESULTS: The data show that cryopeeling was approximately twice as effective as 5-FU when measured at 1-3 years postoperatively. In addition, the ease of application, its availability, the low cost of materials, its versatility in treating all forms of actinic keratoses, the reduced healing times, and its predictably good cosmetic results make this procedure a logical choice for treating widespread actinic keratoses. The number of squamous cell carcinoma recorded over the entire 6. 5-year study was 33 with no metastases, much lower than predicted for patients with actinic keratoses left untreated. CONCLUSION: Extensive cryosurgery (cryopeeling) is a highly effective method for removing actinic keratoses and preventing recurrences. The subsequent incidence of squamous cell carcinoma is also greatly reduced.

Carcinoma, Squamous Cell↗
PubMed1997

Should every day be melanoma monday?

To what extent am I my brothers' keeper? Perhaps this is one of the stickiest ethical questions that modern man, living in this increasingly impersonalized world, faces. For the medical profession, this quandary keeps resurfacing within the context of the present upheaval in the medical care delivery system and the redefinition and trend toward impersonalization of the physician-patient relationship. What responsibilities do I, as a physician, have to my patients?

Dermatology↗
PubMed1996

Tumescent dermasanding with cryospraying. A new wrinkle on the treatment of rhytids.

BACKGROUND: The art of dermasanding has been recently rediscovered, revived, and refined. This renewed interest follows on the wake of intense interest in the new carbon dioxide resurfacing lasers. Tumescent dermasanding with cryospraying is a simple, inexpensive, highly effective, reliable and safe method of wrinkle removal. Personal experience with over 130 patients with ongoing refinement of existing dermasanding techniques plus the addition of tumescent analgesia, cryospraying, and specific postoperative instructions has resulted in outcomes at least equivalent to those obtained with laser resurfacing. METHODS: A detailed description and pictorial display of preparation, treatment, and postoperative care is presented. Its special attributes as well as its shortcomings versus laser resurfacing are briefly described. CONCLUSION: Strict attention to detail should produce excellent, consistent, and reproducible results with minimal complications.

Analgesia↗
PubMed1996

The TCA Masque. A new cream formulation used alone and in combination with Jessner's solution.

BACKGROUND: Traditional trichloroacetic acid (TCA) peel results are often unpredictable. "Hot spots," delayed healing, and scarring are not uncommon. OBJECTIVE: To reveal how the TCA Masque, used alone or in combination with Jessner's solution, helps minimize some of these problems while retaining efficacy. RESULTS: The masque's ease of application and its easily visualized one-time application have produced effective, safe, and predictable outcomes. The skin peels uniformly. CONCLUSIONS: The masque is also versatile since it is available in 11% and 16.9% strengths and can be applied thickly or spread thinly on the face, neck, arms, etc. When used alone, dyschromia and fine wrinkles are eliminated; the skin appears freshened. When used in combination with Jessner's and 16.9% TCA Masque a medium depth peel is achieved.

Chemexfoliation↗
PubMed1992

Full-face cryo- (liquid nitrogen) peel.

Full face liquid nitrogen cryo spraying of actinically damaged skin accomplishes not only depth-controlled destruction of individual actinic keratoses, but also destruction of surrounding, barely perceptible actinic keratoses, removal of unsightly pigmented surfaces, and removal of seborrheic keratoses and large lentigines. Cryo-peeling imparts a healthier, pinker, smoother, tighter skin surface.

Aged↗
PubMed1992

Agar embedding of curetted biopsy specimens for histopathologic examination.

Fragmented, small curettings are embedded in 3% bacterial agar at the time of tissue biopsy. These small tissue specimens are trapped within the agar and tissue loss is minimized. This method eliminates the additional steps of spinning the fragments (that are usually suspended in formaldehyde) or filtering the contents. The agar method concentrates the tissue specimen and keeps the tissue better oriented. The end result is preservation of all fragments submitted with some retention of tissue specimen orientation. Ease of laboratory preparation is another substantial benefit.

Agar↗